Low-income students are now a majority of schoolchildren attending public schools in the United States. Data collected by the National Center for Education Statistics show that 51% of students across US public schools were from low-income families in 2013.¹ Socioeconomic disparities in school readiness and academic performance are well documented. Children living in poverty have lower scores on standardized tests of academic achievement, poorer grades in school, and lower educational attainment.^2,3 These patterns persist into adulthood, ultimately contributing to low wages and income.^4,5 Moreover, increased exposure to poverty in childhood is tied to greater deficits in these domains.^6,7 Despite numerous studies demonstrating the relationship between family resources and children’s educational outcomes, little is known about mechanisms underlying the influence of poverty on children’s learning and achievement. In the current study, we tested whether atypical structural development in several areas of the brain tied to school readiness skills may have mediated the relationship between childhood poverty and impaired academic performance. Our hypotheses were motivated by the widespread environmental inequities (both physical and psychological) faced by children living in poverty along with increasing evidence that environmental stimulation, parental nurturance, and early life stress affect brain growth and functioning.

Living in poverty places children at very high risk for problems across a variety of domains, including schooling, behavioral regulation, and health. Aspects of cognitive functioning, such as information processing, may underlie these kinds of problems. How might poverty affect the brain functions underlying these cognitive processes? Here, we address this question by observing and analyzing repeated measures of brain development of young children between five months and four years of age from economically diverse backgrounds (n = 77). In doing so, we have the opportunity to observe changes in brain growth as children begin to experience the effects of poverty. These children underwent MRI scanning, with subjects completing between 1 and 7 scans longitudinally. Two hundred and three MRI scans were divided into different tissue types using a novel image processing algorithm specifically designed to analyze brain data from young infants. Total gray, white, and cerebral (summation of total gray and white matter) volumes were examined along with volumes of the frontal, parietal, temporal, and occipital lobes. Infants from low-income families had lower volumes of gray matter, tissue critical for processing of information and execution of actions. These differences were found for both the frontal and parietal lobes. No differences were detected in white matter, temporal lobe volumes, or occipital lobe volumes. In addition, differences in brain growth were found to vary with socioeconomic status (SES), with children from lower-income households having slower trajectories of growth during infancy and early childhood. Volumetric differences were associated with the emergence of disruptive behavioral problems.

Despite ongoing efforts to improve childhood vaccination coverage, including in hard-to-reach and hard-to-vaccinate communities, many children in sub-Saharan Africa (SSA) remain unvaccinated. Considering recent goals set by the Immunization Agenda 2030 (IA2030), including reducing the number of zero-dose children by half, research that goes beyond coverage to identify populations and groups at greater risk of being unvaccinated is urgently needed. This is a pooled cross-sectional study of individual- and country-level data obtained from Demographic and Health Surveys Program and two open data repositories. The sample includes 43,131 children aged 12–59 months sampled between 2010 and 2020 in 33 SSA countries. Associations of zero-dose status with individual and contextual factors were assessed using multilevel logistic regression. 16.5% of children had not received any vaccines. Individual level factors associated lower odds of zero-dose status included mother’s primary school or high school education, employment, use of antenatal care services and household wealth. Compared to children in countries with lower GDP, children in countries with relatively high GDP had nearly four times greater odds of being unvaccinated. Both individual and contextual factors are correlated with zero-dose status in SSA. Our results can inform efforts to identify and reach children who have not received any vaccines.

More than 5.9 million COVID-19–associated hospital admissions have been recorded among US adults.¹ It is estimated that at least 3 million to 5 million US adults are currently living with activity-limiting post–COVID-19 conditions (PCCs) and that approximately 15% of the US adult population (approximately 39 million adults) have, at some point, experienced PCCs.^2,3 Beyond significant personal health effects, there is accumulating evidence that patients with severe COVID-19 and PCCs face considerable economic consequences. Symptoms of PCCs can adversely affect daily functioning and have been associated with a lower likelihood of working full time and a higher likelihood of being unemployed.^4,5 COVID-19–associated hospitalizations have been similarly associated with job loss.⁶ In addition to the direct associations with patients’ work and earnings, household finances may be further stressed by out-of-pocket medical expenses and lost caretaker productivity.^6-9 The consequences may be even more severe for families with low income who have fewer resources available to buffer against COVID-19–related financial shocks but appear to be more likely to experience severe or long-term health effects from COVID-19.^10,11