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Chapter 8: Impact of Head Start on Parenting Practices
Highlights
By the end of the program year, Head Start had positive, albeit modest, average impacts on parenting practices:
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For both age cohorts, Head Start had a consistently positive overall average impact on the amount of time parents reported reading to their child, with parents of Head Start children significantly more likely to read to their child than parents of non-Head Start children. Statistically significant average impacts were also found for 3-year-olds on the extent to which their parents exposed them to a variety of cultural enrichment activities such as taking them to a museum or a zoo.
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For parents of 3-year-olds, there is a small, but statistically significant, reduction in the use of physical discipline, but no impact was found for parents of children in the 4-year-old group. Parents of children in the Head Start group were significantly less likely than non-Head Start parents to report using spanking when their child misbehaved and reported using it less frequently.
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No statistically significant impacts were found on parents’ child safety practices at home, for parents of children in both the 3- and 4-year-old group.
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Significant impacts were also found for specific subgroups of parents and/or children.
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For the 3-year-old group, mothers who had first given birth before age 19 had significant impacts in the area of physical discipline, while significant impacts for mothers who had first given birth after age 19 were found in the area of educational activities.
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Among parents of children in the 3-year-old group, the impact of Head Start on the use of physical discipline (i.e., spanking) decreased with increasing levels of depressive symptoms, but Head Start’s impact on the frequency of physical discipline increased with increasing levels of depressive symptoms.
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Parents of 3-year-olds whose primary language was English were especially likely to benefit from Head Start, with significant impacts on the likelihood of reading to their child, on a reduced use of spanking and the frequency of its use, and on the use of child safety practices.
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For parents of boys in the 3-year-old group, there is a significant reduction in parent’s use of spanking as a disciplinary strategy.
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Introduction
This chapter shifts focus from impacts on children to the potential positive benefits of Head Start for low-income parents. One of the hallmarks of Head Start is its recognition that parents are their child’s first and primary teacher and that the involvement of parents is crucial for fostering children’s school readiness.1 From the beginning, Head Start programs have reached out to families in a variety of ways, by encouraging parent involvement in their child’s classroom, providing parent education to help strengthen parents’ childrearing knowledge and skills, and providing referrals to address family needs so that parents can be more effective in their role as caregiver.
A strong, nurturing parent-child relationship is essential for healthy cognitive and social-emotional growth during early childhood.2 Parent-child interactions that involve talking, reading, teaching, and exposure to new experiences are crucial for promoting language development and early literacy. Parents can also support their young child’s cognitive development by providing a stimulating learning environment at home and in the community. Parental discipline that emphasizes establishing firm but fair expectations for child behavior promotes the development of social understanding and skills necessary for positive relationships with peers and adults. Parental nurturance provides young children with the emotional support needed for developing trusting relationships with adults, learning to regulate their emotional responses, and playing cooperatively with peers. Finally, parents’ preventive efforts to safeguard the child’s environment are crucial for children’s physical health and overall well-being. Head Start’s efforts to support parents on these dimensions of childrearing can go a long way in ensuring that the Head Start services that children receive are complemented and augmented by what their experiences at home.
Organization and Presentation of Findings
The measures used in this report to assess the impact of Head Start on childrearing practices focus on three key parenting constructs—educational activities, discipline strategies, and child safety practices. Selection of these measures was guided by several factors, including relevance for program goals, appropriateness for Head Start families, prior use in national studies and evaluations, and adequate psychometric properties. These skill-based dimensions of childrearing emphasizing cognitive stimulation, child discipline, and child safety are common elements of parent education offered through Head Start and thus are likely to be affected by parents’ access to the program. Prior research with similar populations has shown significant associations between these domains and children’s cognitive and social-emotional development3. Moreover, these domains are likely to be important mediators of the impact of Head Start on children’s health and development. As noted in Chapter 4, the specific measures of childrearing practices4 examined in this report cover three constructs—educational activities, disciplinary practices, and safety practices.
The target sample for these analyses included all caregivers who identified themselves in spring 2003 as the person primarily responsible for the study child’s daily care and overall well-being. For the vast majority of study children (92%), the primary caregiver was the child’s biological or adoptive mother.5 For simplicity of discussion, throughout the chapter we use the term “parent” when referring to the primary caregiver.
As in previous chapters, this discussion of estimated impacts examines statistically significant “intent-to-treat” impact estimates using the complete sample of children who were randomly assigned in 2002, focusing first on overall average impacts for all newly entering children in both the 3- and 4-year-old groups and then examining any notable differences in average impacts by the language used for child assessment. The discussion then moves to an examination of the extent to which impacts occurred for key subgroups of Head Start children, and how different in size impacts may be for various subgroups. Appendix 8.1 presents estimated impacts on program participants.
The statistical results discussed in this chapter are presented in a series of tables, some of which are provided in Appendix 8.2. Exhibits 8.1 (for children in the 3-year-old group) and 8.2 (for the 4-year-old group), present the overall average impact estimates for the combined sample. Exhibits 8.3-A and 8.3-B (for the 3- and 4-year-old groups, respectively) summarize all of the statistically significant average impacts (both for the overall group and for a set of 12 subgroups discussed in Chapter 4) along with their associated effect sizes. Finally, Exhibits 8.4 through 8.23, provided in Appendix 8.2, show the results of the moderator/subgroup analyses, with a separate table for each individual measure of parenting outcomes.
Estimated Impact of Access to Head Start
This first section discusses the estimated impact of Head Start on parenting practices outcomes using the sample of children randomly assigned to either Head Start or to the non-Head Start group, referred to as “intent-to-treat” impact estimates. These measures show the average impact of access to the program.
Educational Activities
As shown in Exhibits 8.1 and 8.2, for children in both age groups, small but statistically significant positive impacts were found for parents’ reading to their child (effect size = 0.18 and 0.13 for children in the 3- and 4-year-old groups, respectively). These results are consistent with program impacts of similar magnitude from the National Evaluation of Early Head Start regarding daily reading among parents of 3-year-olds. They are also encouraging in light of accumulating evidence that the amount of shared reading at home plays a critical role in low-income children’s language development and emergent literacy.6
Statistically significant impacts were also found for children in the 3-year-old group on the extent to which their parents exposed them to a variety of cultural enrichment activities, with Head Start parents providing significantly more enrichment activities for their child than parents of non-Head Start children by the end of the program year (an effect size of 11 percent). Although the impact of Head Start on this aspect of childrearing is small (and not detected for parents of children in the 4-year-old group), it does indicate that, at least for the younger children, Head Start parents are making greater efforts to broaden their child’s world to include learning experiences like trips to the zoo, local museums, and cultural events.
Disciplinary Practices
Small, but statistically significant, impacts were found on the physical disciplinary practices used by parents of children in the 3-year-old group; however, no statistically significant impacts were found on physical disciplinary practices for children in the 4-year-old group. By the end of the first program year, parents of children in the Head Start group were significantly less likely than non-Head Start parents to report the use of spanking in the last week (an effect size of -14 percent) and the frequency with which spanking was used during the past week (an effect size of -10 percent) when their child misbehaved. These results are consistent with findings from the National Evaluation of Early Head Start, which found significantly lower reported use of physical punishment among program parents. They are also promising in light of evidence from experimental studies that interventions to reduce parents’ reliance on physical discipline to gain child compliance can lead to improvements in Head Start children’s social behavior at home and in preschool.7
Safety Practices
No statistically significant impacts were found on parents’ child safety practices at home. Most Head Start and non-Head Start parents of children in both the 3- and 4-year-old groups reported “almost always” or “always” storing medicines and cleaning supplies out of children’s reach, supervising the child during bath time, using a child car seat, and following other safety practices. These results suggest that low-income parents may already have a strong awareness of what is needed to protect their child from harm, coming from other sources such as their pediatrician, family and friends, or media campaigns. Of course, it must be kept in mind that these are reported data and may differ from parent’s actual behavior.
Moderator/Subgroup Differences
As in the previous chapters, the impact of Head Start on childrearing was examined for key subgroups of parents, acknowledging that Head Start may be especially beneficial for certain types of caregivers. These analyses, detailed in Appendix 8.2 and summarized in Exhibits 8.3-A and 8.3-B for those found to be statistically significant, show some variations in impact for particular types of parents. The most notable findings are discussed below in the same way as in previous chapters.
Other statistically significant findings in Exhibits 8.3-A and 8.3-B are not discussed because it is possible they are due to chance alone and do not represent true impacts of the intervention (see discussion of subgroup impact analysis in Chapter 4).8
Differences in Impact
A statistically significant relationship was found between the impact of Head Start on childrearing practices and reported parental depression for children in the 3-year-old group. However, the results are mixed. Among parents of children in the 3-year-old group, the impact of Head Start on the use of physical discipline (i.e., spanking) decreased with increasing levels of depressive symptoms, but the frequency of physical discipline increased with increasing levels of depressive symptoms. Taken together, these findings indicate that Head Start parents with elevated depressive symptoms are significantly less likely to use physical discipline when their child misbehaves, but if they use physical discipline, use it more often than other parents.
Parents with chronic depressive symptoms tend to be less sensitive and responsive to their children’s needs, less nurturing, and more erratic and punitive in their discipline practices, all of which have serious consequences for children’s development and well-being. While these parents represent a highly vulnerable group, their greater needs also make them more difficult to engage and serve in intervention programs.9 The mixed pattern of relationships between depression and program impacts may, therefore, reflect the difficulties Head Start staff face in engaging and working with this group of caregivers.
In the 3-year-old group, Head Start had a larger effect on discipline strategies (i.e. decreasing spanking) for mothers who gave birth as teenagers than those who gave birth after age 19.
Impacts on Particular Subgroups
Age of Mother at First Birth. Head Start had positive impacts on the childrearing practices of mothers who first gave birth as a teenager (“teen mothers”)10 and for mothers who had their first baby when they were older (“not teen mothers”), but the impacts are found in different areas of parenting practices for the two groups. Mothers who had first given birth before age 19 had significant impacts in the area of physical discipline, while significant impacts for mothers who had first given birth after age 19 were found in the area of educational activities.
Among parents of children in the 3-year-old group, teen mothers of Head Start children were significantly less likely than non-Head Start teen mothers to use spanking and to use it less frequently when their child misbehaved. The size of the impacts for teen mothers were sizable (subgroup effect sizes of -34 percent for the use of spanking and -23 percent for the frequency of spanking), more than twice as large as the impacts obtained for the sample overall (overall effect sizes of -14 percent and -10 percent, respectively). These results are consistent with findings from the National Evaluation of Early Head Start, which found significant program impacts on the use of physical discipline among mothers who were 19 or younger when their child was born. These findings are also encouraging in light of general consensus that those who become mothers in adolescence are at heightened risk for punitive parenting practices, as well as child abuse and neglect.11 Although Head Start was not designed specifically to serve the needs of teenage mothers, these findings suggest that access to the program can have beneficial effects in reducing children’s risk for punitive discipline practices, although results of studies of efforts to improve the parenting skills of young low-income mothers have had mixed results. 12
Statistically significant impacts of Head Start were also found for the educational activities provided by mothers who had first given birth after age 19. Among these non-teen mothers of children in the 3-year-old group, those in the Head Start group spent significantly more time reading to their child and taking them to a greater variety of cultural enrichment activities than mothers in the non-Head Start group. A similarly positive impact of Head Start on reading to the child at home was found for the non-teen mothers of children in the 4-year-old group. These results are also consistent with findings from the National Evaluation of Early Head Start, which found significant program impacts for older, but not younger, mothers on an array of language and literacy-promoting practices.
Finally, a small, but statistically significant, impact of Head Start was found on parents’ use of “time out” but only for the non-teen mothers of children in the 4-year-old group. Mothers in the Head Start group were less likely than similar non-Head Start mothers to report placing their child in time out when they misbehaved.
Home Language. Parents of 3-year-olds whose primary language was English were especially likely to benefit from Head Start. Among native English speakers, those in the Head Start group were significantly more likely to read to their child and were less likely to use spanking, and to use it less frequently, when their child misbehaved than parents in the non-Head Start group. These impacts were modest in size, but taken together suggest that Head Start may be more effective in working with native English-speaking parents than with parents with limited English language skills.
These findings highlight an important subgroup of families that could benefit from efforts tailored to their unique language and cultural needs. Limited-English-proficient parents and children, and immigrant families with children more generally, are the fastest growing segment of the nation’s low-income population, with children of immigrants currently constituting a quarter of all children under age five.13 While their need for services are as high, or higher, than those of U.S.-born families, some may be ineligible for many Federal and state public assistance benefits, and language and cultural barriers often deter them from seeking out benefits for which they or their children are eligible14.
Gender. The most notable finding by child gender is in the area of physical discipline, with parents of boys in the 3-year-old group significantly less likely to use spanking as a disciplinary strategy. In addition, among children in the 4-year-old group, parents are less likely to use spanking for discipline for girls compared to boys. Also, it was found that parents of girls in the 3-year-old Head Start group were more likely to read to them than parents in the non-Head Start group.
| Outcome Measure | Intent-To-Treat Impact Estimates | ||||
|---|---|---|---|---|---|
| Head Start Mean | Non-Head Start Mean | Mean Difference 2 | Regression-Adjusted Impact Estimates (Demographic Covariates Only) | Regression-Adjusted Impact Estimates (With Fall Measure) | |
| (Sample N=2,071): | |||||
| Number of Times Child is Read to On Average 1i | 2.9 | 2.8 | 0.2* | 0.17** (0.18) | 0.13* |
| Family Cultural Enrichment Scale | 3.8 | 3.5 | 0.2** | 0.19* | 0.15* (0.11) |
| Used Time Out in Last Week? 1ii | 0.6 | 0.7 | -0.0 | -0.03 | -0.02 |
| Number of Times Used Time Out in Last Week | 1.6 | 1.9 | -0.3 | -0.23 | -0.21 |
| Spanked Child in Last Week? 1iii | 0.4 | 0.5 | -0.1* | -0.07* (-0.14) | -0.06 |
| Number Times Spanked Child in Last Week 1iv | 0.8 | 1.0 | -0.2* | -0.16* (-0.10) | -0.06 |
| Parental Safety Practices Scale 1v | 3.7 | 3.7 | 0.0 | 0.03 | 0.02 |
Removing Harmful Objects Subscale |
3.9 | 3.9 | 0.0 | 0.03 | 0.02 |
Restricting Child Movement Subscale 1vi |
3.9 | 3.9 | -0.0 | -0.02 | -0.02 |
Safety Devices Subscale |
3.4 | 3.3 | 0.1 | 0.07 | 0.05 |
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* = p≤0.05, ** = p≤0.01, *** = p≤0.001. 1 Fall measure used in regression failed statistical test. (back: 1i, 1ii, 1iii, 1iv, 1v, 1vi) 2 Differences are rounded to the nearest 0.1. (back) Note: Numbers in parentheses in shaded boxes are estimated effect sizes. |
| Outcome Measure | Intent-To-Treat Impact Estimates | ||||
|---|---|---|---|---|---|
| Head Start Mean | Non-Head Start Mean | Mean Difference 2 | Regression-Adjusted Impact Estimates (Demographic Covariates Only) | Regression-Adjusted Impact Estimates (With Fall Measure) | |
| Sample (N=1,638): | |||||
| Number of Times Child is Read to On Average1i | 3.0 | 2.8 | 0.2* | 0.13* (0.13) | 0.11 |
| Family Cultural Enrichment Scale | 4.0 | 3.9 | 0.1 | 0.08 | 0.11 |
| Used Time Out in Last Week? | 0.6 | 0.7 | -0.1* | -0.09* | -0.10** |
| Number of Times Used Time Out in Last Week | 1.7 | 1.7 | 0.1 | 0.03 | 0.04 |
| Spanked Child in Last Week? | 0.4 | 0.4 | 0.0 | -0.01 | -0.01 |
| Number Times Spanked Child in Last Week1ii | 0.7 | 0.7 | 0.0 | 0.02 | -0.04 |
| Parental Safety Practices Scale | 3.7 | 3.7 | 0.0 | 0.03 | 0.04 |
Removing Harmful Objects Subscale |
3.9 | 3.9 | 0.0 | 0.00 | -0.00 |
Restricting Child Movement Subscale |
3.9 | 3.9 | 0.0 | 0.02 | 0.02 |
Safety Devices Subscale |
3.4 | 3.4 | 0.1 | 0.06 | 0.10 |
* = p≤0.05, ** = p≤0.01, *** = p≤0.001. 1 Fall measure used in regression failed statistical test. (back: 1i, 1ii) 2 Differences are rounded to the nearest 0.1. (back) Note: Numbers in parentheses in shaded boxes are estimated effect sizes. |
| Outcome Measure | Estimated Impact of Access to Head Start | Effect Size | |
|---|---|---|---|
| Overall Impact | Number of Times Child is Read To | 0.17** | 0.18 |
| Family Cultural Enrichment Scale | 0.15* | 0.11 | |
| Spanked Child in Last Week | -0.07* | -0.14 | |
| Number Time Spanked Child in Last Week | -0.16* | -0.10 | |
| Difference in Impact 1 | Spanked Child in Last Week (Teen Mom Impact Exceeds Not Teen Mom) | 0.16** | 0.32 |
| Spanked Child in Last Week: Depression | -0.07* | -0.14 | |
| Number of Times Spanked Child: Depression | 0.01* | 0.01 | |
| Parental Safety Practices Scale: Home Language (English Impact Exceeds Not English) | 0.09* | 0.27 | |
| Safety Devices Subscale (English Impact Exceeds Not English) | 0.22* | 0.29 | |
| Impact on Subgroup 2 | Number of Times Child is Read To: Not Teen Mom | 0.16* | 0.17 |
| Number of Times Child is Read To: Female | 0.23* | 0.25 | |
| Number of Times Child is Read To: White | 0.27* | 0.29 | |
| Number of Times Child is Read To: Parent Married | 0.28** | 0.30 | |
| Number of Times Child is Read To: Home Language is English | 0.19** | 0.20 | |
| Family Cultural Enrichment Scale: Not Teen Mom | 0.23** | 0.16 | |
| Family Cultural Enrichment Scale: Male | 0.28* | 0.20 | |
| Family Cultural Enrichment Scale: Black | 0.24* | 0.17 | |
| Number of Time Outs in Last Week: Female | -0.32* | -0.17 | |
| Spanked Child in Last Week: Teen Mom | -0.17*** | -0.34 | |
| Spanked Child in Last Week: Male | -0.11* | -0.22 | |
| Spanked Child in Last Week: Home Language English | -0.10* | -0.20 | |
| Spanked Child in Last Week: Parent Married | -0.11* | -0.22 | |
| Number of Times Spanked Child: Teen Mom | -0.36* | -0.23 | |
| Number of Times Spanked Child: Black | -0.35* | -0.22 | |
| Number of Times Spanked Child: Home Language English | -0.25** | -0.16 | |
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* = p≤0.05, ** = p≤0.01, *** = p≤0.001. 1 A total of 80 differences in impacts between subgroups were examined. The complete set of results, including differences not found to be statistically significant, appears in Appendix 8.2. Findings for baseline factors other than depression indicate the amount by which Head Start’s estimated impact for the first subset of participants listed in the row label exceeds that for the second subset listed. (back) 2 A total of 110 subgroup impacts were examined. The complete set of results, including differences not found to be statistically significant, appears in Appendix 8.2. Findings for depression indicate the change in Head Start’s estimated impact that accompanies a 1-point increase in mother’s baseline depression score. (back) |
| Outcome Measure | Estimated Impact of Access to Head Start | Effect Size | |
|---|---|---|---|
| Overall Impact | Number of Times Child is Read To | 0.13** | 0.13 |
| Difference in Impact 1 | Spanked Child in Last Week: Gender (Female Impact Exceeds Male) | 0.15* | 0.31 |
| Used Time Out in Last Week: Depression | -0.09* | -0.19 | |
| Impact on Subgroup 2 | Number of Times Child is Read To: Not Teen Mom | 0.18* | 0.18 |
| Family Cultural Enrichment Scale: Hispanic | 0.22* | 0.15 | |
| Used Time Out in Last Week: Not Teen Mom | -0.12* | -0.26 | |
| Used Time Out in Last Week: Male | -0.12* | -0.26 | |
| Used Time Out in Last Week: White | -0.11** | -0.23 | |
| Used Time Out in Last Week: Parent Not Married | -0.08* | -0.17 | |
| Used Time Out in Last Week: Home Language English | -0.11** | -0.23 | |
| Safety Devices Subscale: Home Language Not English | 0.22* | 0.29 | |
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* = p≤0.05, ** = p≤0.01, *** = p≤0.001. 1 A total of 80 differences in impacts between subgroups were examined. The complete set of results, including differences not found to be statistically significant, appears in Appendix 8.2. Findings for depression indicate the change in Head Start’s estimated impact that accompanies a 1-point increase in mother’s baseline depression score. Findings for baseline factors other than depression indicate the amount by which Head Start’s estimated impact for the first subset of participants listed in the row label exceeds that for the second subset listed. (back) 2 A total of 110 subgroup impacts were examined. The complete set of results, including differences not found to be statistically significant, appears in Appendix 8.2. (back) |
1 Zigler, E., & S. Muenchow. (1992). Head Start: The Inside Story of America’s Most Successful Educational Experiment. New York: Basic Books. (back)
2 National Research Council. (2000). From Neurons To Neighborhoods: The Science of Early Childhood Development. Washington, DC: National Academy Press. (back)
3 Administration on Children, Youth, and Families. (2003). Head Start FACES 2000: A Whole Child Perspective On Program Performance, Fourth Progress Report. Washington, DC: US Department of Health and Human Services; Administration on Children, Youth, and Families. (2002). Making a Difference in the Lives of Infants and Toddlers and Their Families: The Impacts of Early Head Start. Washington, DC: US Department of Health and Human Services. (back)
4 It is important to note that all of the childrearing measures used in this analysis are based on parent reports of their own, or other family members’, behavior and are therefore susceptible to response biases inherent in self-reported data. In the absence of observations of parent-child interactions, or other reporter data (e.g., interviewer assessments of the home environment), it is difficult to determine the degree of response bias and whether it represents an over- or underestimate of parents’ actual childrearing practices. Therefore, caution should be used when interpreting obtained group means and proportions as reflecting actual levels of childrearing practices. However, the random assignment design of the Head Start Impact Study ensures that the degree and direction of bias should, on average, be equivalent for all families regardless of their assignment to the treatment or control group, i.e., the Head Start—non-Head Start difference is unbiased. (back)
5 Four percent of the caregivers were biological or adoptive fathers, 3 percent were grandparents, and about 1 percent were either other relatives or individuals unrelated to the study child. In 95 percent of study families, the individual identified as the child’s primary caregiver in spring 2003 was also identified as the child’s primary caregiver at baseline in fall 2002. In the remaining 5 percent of cases, the primary caregiver assumed this responsibility at some point between the fall and spring assessments. (back)
6 Bus, A.G., M.H. van IJzendoorn, & A. Pellegrini. (1995). “Joint Book Reading Makes for Success in Learning to Read: A Meta-Analysis on Intergenerational Transmission of Literacy.” Review of Educational Research, 65, 1-21. (back)
7 Webster-Stratton, C. (1998). “Preventing Conduct Problems in Head Start Children: Strengthening Parent Competencies.” Journal of Consulting and Clinical Psychology, 66, 715-730; Webster-Stratton, C., M.J. Reid, & M. Hammond. (2001). “Preventing Conduct Problems and Promoting Social Competence: A Parent and Teacher Training Partnership in Head Start.” Journal of Clinical Child Psychology, 30, 283-302. (back)
8 While each of the remaining subgroup findings taken one at a time is structured to limit the probability of a “false positive” to 1 in 20, as a group it is almost inevitable that some of these results will reach that level by chance alone. Only when a substantial share of all the tests of impact conducted for a given subgroup—or of a difference in impact between two subgroups—is statistically significant across all four of the outcome domains considered (not simply the outcomes reported in this chapter) can we be sure that at least some of those findings represent real impacts. (back)
9 Administration on Children, Youth, and Families. (2002). Making A Difference in the Lives of Infants and Toddlers and Their Families: The Impacts Of Early Head Start. Washington, DC: US Department of Health and Human Services. (back)
10 It is important to keep in mind that this variable refers to whether the mother was ever a teen mother and not whether she gave birth to the target child as a teenager. (back)
11 Maynard, R. (1996). Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. Washington, DC: Urban Institute Press. (back)
12 Kisker, E., A. Rangarajan, & K. Boller. (1998). Moving Into Adulthood: Were the Impacts of Mandatory Programs for Welfare-Dependent Parents Sustained after the Programs Ended? Princeton, NJ: Mathematica Policy Research, Inc.; Qunit, J.C., J.M. Bos, & Polit, D.F. (1997). New Chance: Final Report on a Comprehensive Program for Young Mothers in Poverty and Their Children. New York: Manpower Demonstration Research Corporation. (back)
13 Hernandez, D., & E. Charney. (1998). From Generation to Generation: The Health and Adjustment of Children in Immigrant Families. Washington, DC: National Academy Press. (back)
14 Fix, M., & W. Zimmerman. (1999). All Under One Roof: Mixed-Status Families in an Era of Reform. Washington, DC: The Urban Institute. (back)
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