Effect of ready‐to‐use foods for preventing child undernutrition in Niger: analysis of a prospective intervention study over 15 months of follow‐up

Strategies for preventing undernutrition comprise a range of interventions, including education, provision of complementary food and cash transfer. Here, we compared monthly distributions of two different lipid‐based nutrient supplements (LNS), large‐quantity LNS (LNS‐LQ) and medium‐quantity LNS (LNS‐MQ) for 15 months on prevention of undernutrition among children 6 to 23 months. Both groups also received cash transfer for the first 5 months of the intervention. We conducted a prospective intervention study in Maradi, Niger, between August 2011 and October 2012. Six and 11 villages were randomly allocated to LNS‐LQ/Cash and LNS‐MQ/Cash, respectively. Children measuring 60–80 cm were enrolled in the respective groups and followed up monthly. Poisson regression was used to assess differences between interventions and adjust for baseline characteristics, intervention periods and child‐feeding practices. The analysis included 2586 children (1081 in the LNS‐LQ/Cash group and 1505 in the LNS‐MQ/Cash group). This study suggests that provision of LNS‐LQ (reference) or LNS‐MQ had, overall, similar effect on incidence of severe acute malnutrition (RR = 0.97; 95% CI: 0.67–1.40; P = 0.88), moderate acute malnutrition (RR = 1.20; 95% CI: 0.97–1.48; P = 0.08), severe stunting (RR = 0.94; 95% CI: 0.70–1.26; P = 0.69), moderate stunting (RR = 0.95; 95% CI: 0.76–1.19; P = 0.67) and mortality (RR = 0.83; 95% CI: 0.41–1.65; P = 0.59). Compared with LNS‐LQ, LNS‐MQ showed a greater protective effect on moderate acute malnutrition among children with good dietary adequacy: RR = 0.72; 95% CI: 0.56–0.94; P = 0.01. These results highlight the need to design context‐specific programmes. Provision of LNS‐LQ might be more appropriate when food insecurity is high, while when food security is better, distribution of LNS‐MQ might be more appropriate.     

Risk Factors and Psychological Outcomes of Bullying Victimization: A Community-based Study

To understand the negative impact of bullying on the psychological well-being of children and adolescents we need to examine the associated context of adverse home life, problem peer relationships and school experience. Standardized retrospective in-depth interviews provide a useful method. A sample of 160 high-risk community-based emerging adults in the UK (age 16–30) were interviewed to rate familial and peer/school relationships, and severity of bullying with or without aggression before age 17. A clinical interview assessed psychiatric disorders in teenage years. Statistical analyses showed a differential model for bullying victims versus aggressive victims and internalizing versus externalizing disorders. Both types of bullying experiences were associated with parental neglect and abuse, parental discord and inadequate supervision; victimization alone related to problem school context and internalizing disorders (anxiety disorders and major depression); in contrast, bullying victimization with aggression was distinctly associated with experiences of violence in family, problem peer group, and externalizing disorders (conduct disorder and substance use disorder). Thus differentiation of context of young people’s experience can inform effective psychosocial, educational and clinical approaches to reduce the risks associated with bullying victimization.     

Bullied by peers in childhood and borderline personality symptoms at 11 years of age: a prospective study

Background: Abuse by adults has been reported as a potent predictor of borderline personality disorder (BPD). Unclear is whether victimisation by peers increases the risk of borderline personality symptoms. Method: The Avon Longitudinal Study of Parents and Children (ALSPAC) prospective, longitudinal observation study of 6050 mothers and their children. Child bullying was measured by self‐report and mother and teacher report between 4 and 10 years. Family adversity was assessed from pregnancy to 4 years; parenting behaviours from 2 to 7 years, sexual abuse from 1.5 to 9 years, and IQ and DSM‐IV axis I diagnoses at 7 to 8 years. Trained psychologists interviewed children at 11.8 years to ascertain DSM‐IV BPD symptoms (five or more). Results: Accounting for known confounders, victims of peer bullying had an increased risk of BPD symptoms according to self‐report (OR, 2.82; 95% CI, 2.13–3.72); mother report (OR, 2.43; 95% CI, 1.86–3.16); and teacher report (OR, 1.95; 95% CI, 1.34–2.83). Children who reported being chronically bullied (OR, 5.44; 95% CI, 3.86–7.66) or experienced combined relational and overt victimisation (OR, 7.10; 95% CI, 4.79–10.51) had highly increased odds of developing BPD symptoms. Children exposed to chronic victimisation according to mother report were also at heightened risk of developing BPD symptoms (OR, 3.24; 95% CI, 2.24–4.68). Conclusions: Intentional harm inflicted by peers is a precursor or marker on the trajectory towards the development of BPD symptoms in childhood. Clinicians should be adequately trained to deal with, and ask users of mental health services routinely about, adverse experiences with peers.     

Breastfeeding and educational achievement at age 5

Our aim was to investigate whether the duration of breastfeeding, at all or exclusively, is associated with educational achievement at age 5. We used data from a prospective, population‐based UK cohort study, the Millennium Cohort Study (MCS). 5489 children from White ethnic background born at term in 2000–2001, attending school in England in 2006, were included in our analyses. Educational achievement was measured using the Foundation Stage Profile (FSP), a statutory assessment undertaken by teachers at the end of the child's first school year. Breastfeeding duration was ascertained from interviews with the mother when the child was 9 months old. We used modified Poisson's regression to model the association of breastfeeding duration with having reached a good level of achievement overall (≥78 overall points and ≥6 in ‘personal, social and emotional development’ and ‘communication, language and literacy’ points) and in specific areas (≥6 points) of development. Children who had been breastfed for up to 2 months were more likely to have reached a good level of overall achievement [adjusted rate ratio (RR): 1.09, 95% confidence interval (CI): 1.01, 1.19] than never breastfed children. This association was more marked in children breastfed for 2–4 months (adjusted RR: 1.17, 95% CI: 1.07, 1.29) and in those breastfed for longer than 4 months (adjusted RR: 1.16, 95% CI: 1.07, 1.26). The associations of exclusive breastfeeding with the educational achievement were similar. Our findings suggest that longer duration of breastfeeding, at all or exclusively, is associated with better educational achievement at age 5.     

Bullying, psychosocial adjustment, and academic performance in elementary school

BACKGROUND: Over the past decade, concerns about bullying and its role in school violence, depression, and health concerns have grown. However, no large studies in the United States have examined the prevalence of bullying during elementary school or its association with objective measures of school attendance and achievement. OBJECTIVE: To determine the prevalence of bullying during elementary school and its association with school attendance, academic achievement, disciplinary actions, and self-reported feelings of sadness, safety, and belonging. DESIGN: Cross-sectional study using 2001-2002 school data. SETTING: Urban, West Coast public school district. PARTICIPANTS: Three thousand five hundred thirty (91.4%) third, fourth, and fifth grade students. MAIN OUTCOME MEASURE: Self-reported involvement in bullying. RESULTS: Twenty-two percent of children surveyed were involved in bullying either as a victim, bully, or both. Victims and bully-victims were more likely to have low achievement than bystanders (odds ratios [ORs], 0.8 [95% confidence interval (CI), 0.7-0.9] and 0.8 [95% CI, 0.6-1.0], respectively). All 3 bullying-involved groups were significantly more likely than bystanders to feel unsafe at school (victims, OR, 2.1 [95% CI, 1.1-4.2]; bullies, OR, 2.5 [95% CI, 1.5-4.1]; bully-victims, OR, 5.0 [95% CI, 1.9-13.6]). Victims and bully-victims were more likely to report feeling that they don't belong at school (ORs, 4.1 [95% CI, 2.6-6.5] and 3.1 [95% CI, 1.3-7.2], respectively). Bullies and victims were more likely than bystanders to feel sad most days (ORs 1.5 [95% CI, 1.2-1.9] and 1.8 [95% CI, 1.2-2.8], respectively). Bullies and bully-victims were more likely to be male (ORs, 1.5 [95% CI, 1.2-1.9] and 3.0 [95% CI, 1.3-7.0], respectively). CONCLUSIONS: The prevalence of frequent bullying among elementary school children is substantial. Associations between bullying involvement and school problems indicate this is a serious issue for elementary schools. The research presented herein demonstrates the need for evidence-based antibullying curricula in the elementary grades.     

Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomised controlled trials

Aims: To compare the effectiveness of short course (2–4 days) with standard duration oral antibiotic treatment (7–14 days) for urinary tract infection (UTI). Methods: Meta-analysis of randomised controlled trials using a random effects model. Ten trials were eligible, involving 652 children with lower tract UTI recruited from outpatient or emergency departments. Main outcome measures were UTI at the end of treatment, UTI during follow up (recurrent UTI), and urinary pathogens resistant to the treating antibiotic. Results: There was no significant difference in the frequency of positive urine cultures between the short (2–4 days) and standard duration therapy (7–14 days) for UTI in children at 0–7 days after treatment (eight studies: RR 1.06; 95% CI 0.64 to 1.76) and at 10 days to 15 months after treatment (10 studies: RR 1.01; 95% CI 0.77 to 1.33). There was no significant difference between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment (one study: RR 0.57, 95% CI 0.32 to 1.01) or in recurrent UTI (three studies: RR 0.39, 95% CI 0.12 to 1.29). Conclusion: A 2–4 day course of oral antibiotics is as effective as 7–14 days in eradicating lower tract UTI in children.     

Risk factors for obesity in childhood survivors of suprasellar brain tumours: a retrospective study

Aim: To characterize postdiagnosis changes in body mass index (BMI) among childhood survivors of suprasellar brain tumours, and to determine the risk factors associated with obesity. Methods: We conducted a retrospective analysis of 46 children (16 boys and 30 girls) with median (IQR) age of 7.49 (3.47–11.59) years at tumour diagnosis, and followed up for 3.93 (1.68–7.27) years. Survival analyses were used to identify risks of developing obesity. Results: There were no sex differences in age at tumour diagnosis, duration of follow‐up, tumour types, endocrinopathies, treatment modalities or baseline BMI SDS. In the first year after tumour diagnosis, ΔBMI SDS (median; IQR) was greater in girls (1.32; 0.07–2.08) than in boys (0.48; ?0.40 to 0.89) (p = 0.01). At diagnosis, 3/46 children (6%) were obese; this increased to 20/46 (43%) by last follow‐up (p < 0.001) and was more common in girls (17/30; 57%) than in boys (3/16; 19%). Female gender (hazard ratio 5.0, 95% CI 1.2–21.7; p = 0.04) and greater than average baseline BMI (hazard ratio 4.7, 95% CI 1.1–20.8; p = 0.02) were risk factors for subsequent obesity. Conclusion: Accurate prediction of obesity risk is important and would allow early targeted intervention in high‐risk patients.     

Effects of antibullying school program on bullying and health complaints

OBJECTIVE: To evaluate the effects of an antibullying school intervention in elementary schools. DESIGN: Two-year follow-up randomized intervention group-control group. SETTING: Forty-seven elementary schools in the Netherlands. PARTICIPANTS: Three thousand eight hundred sixteen children aged 9 to 12 years. INTERVENTION: During the first study year, an antibullying school program was implemented in the schools in the intervention group. MAIN OUTCOME MEASURES: A questionnaire measuring bullying behavior, depression, psychosomatic complaints, delinquent behavior, and satisfaction with school life and peer relationships was filled out by the students at 3 times to obtain the following data: a baseline measurement, a first-effect measurement at the end of the first year, and a second-effect measurement at the end of the second year. RESULTS: The number of bullied children decreased by 25% in the intervention group compared with the control group (relative risk, 0.75; 95% confidence interval, 0.57-0.98). The intervention group also showed a decline in the scale scores of victimization (-1.06 vs 0.28; P< .01) and active bullying behaviors (-0.47 vs 0.12, P< .05). Self-reported peer relationships also improved in the intervention schools (0.48 vs 0.11; P< .05), and there was a trend for a decrease in reported depression in the intervention schools (-0.33 vs -0.10; P< .10). At follow-up, there were no differences between the intervention and control groups for the outcome measures. Schools had also lowered their antibullying activities during the second study year. CONCLUSIONS: An antibullying school policy can reduce bullying behavior. To keep bullying at a consistently low level, schools must continue antibullying measures every year. Continued counseling may help schools in their efforts to establish a lasting antibullying policy.     

Cyberbullying and Sleep Disturbance Among Early Adolescents in the U.S.

ObjectiveTo determine the association between cyberbullying (victimization and perpetration) and sleep disturbance among a demographically diverse sample of 10–14-year-old early adolescents.MethodsWe analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study (Year 2, 2018–2020) of early adolescents (10–14 years) in the US. Modified Poisson regression analyses examined the association between cyberbullying and self-reported and caregiver-reported sleep disturbance measures.ResultsIn a sample of 9,443 adolescents (mean age 12.0 years, 47.9% female, 47.8% white), 5.1% reported cyberbullying victimization, and 0.5% reported cyberbullying perpetration in the past 12 months. Cyberbullying victimization in the past 12 months was associated with adolescent-reported trouble falling/staying asleep (risk ratio [RR] 1.87, 95% confidence interval [CI] 1.57, 2.21) and caregiver-reported overall sleep disturbance of the adolescent (RR: 1.16 95% CI 1.00, 1.33), in models adjusting for sociodemographic factors and screen time. Cyberbullying perpetration in the past 12 months was associated with trouble falling/staying asleep (RR 1.95, 95% CI 1.21, 3.15) and caregiver-reported overall sleep disturbance of the adolescent (RR: 1.49, 95% CI 1.00, 2.22).ConclusionsCyberbullying victimization and perpetration are associated with sleep disturbance in early adolescence. Digital media education and counseling for adolescents, parents, teachers, and clinicians could focus on guidance to prevent cyberbullying and support healthy sleep behavior for early adolescents.     

Poor performance in physical education - a risk factor for bully victimization. A case-control study

Aim: Poor social skills are a risk factor for becoming bullied, which could explain why this frequently occurs to children with autism spectrum disorders (ASD) and attention‐deficit hyperactivity disorder (ADHD). Poor social skills tend to coexist with clumsiness. According to a pilot study, poor performance in physical education (PE) was correlated with bully victimization. Methods: Sixty‐nine healthy university students reported performance in PE and bully victimization in childhood. In addition, the participants responded to questionnaires for ADHD and ASDs to assess personality traits related to increased risk for bully victimization. Results: Below average performance in PE was a risk factor of being bullied in school with an odds ratio of 3.6 [95% confidence interval: 1.23–10.5; p = 0.017]. Strong correlations between poor performance in PE and long duration of victimization (p = 0.007) and poor performance in PE and high frequency of victimization (p = 0.008) were found. Autistic traits were related to performance below average in PE. Conclusion: Poor motor skills are a strong risk factor for becoming bullied. Prevention programmes that identify, protect and empower the clumsy children could be an important step to avoid bullying of the most vulnerable children.     

The role of maternal education in the 15‐year trajectory of malnutrition in children under 5 years of age in Bangladesh

Malnutrition in children under 5 years of age (U5s) is a serious public health problem in low‐ and middle‐income countries including Bangladesh. Improved maternal education can contribute effectively to reduce child malnutrition. We examined the long‐term impact of maternal education on the risk of malnutrition in U5s and quantified the level of education required for the mothers to reduce the risk. We used pooled data from five nationwide demographic and health surveys conducted in 1996–1997, 1999–2000, 2004, 2007 and 2011 in Bangladesh involving 28 941 U5s. A log‐binomial regression model was used to examine the association between maternal education (no education, primary, secondary or more) and malnutrition in children, measured by stunting, underweight and wasting controlling for survey time, maternal age, maternal body mass index, maternal working status, parity, paternal education and wealth quintile. An overall improvement in maternal educational attainment was observed between 1996 and 2011. The prevalence of malnutrition although decreasing was consistently high among children of mothers with lower education compared with those of mothers with higher education. In adjusted models incorporating time effects, children of mothers with secondary or higher education were at lower risk of childhood stunting [risk ratio (RR): 0.86, 95% confidence interval (CI): 0.81, 0.89], underweight (RR: 0.83, 95% CI: 0.78, 0.88) and wasting (RR: 0.82, 95% CI: 0.74, 0.91) compared with children of mothers with no education. We demonstrated the importance of promoting women's education at least up to the secondary level as a means to tackle malnutrition in Bangladesh.     

孕期及婴幼儿期补充益生菌预防儿童特应性皮炎效果的Meta分析

目的 系统评价孕期及婴幼儿期补充益生菌预防儿童特应性皮炎的效果。方法 运用RevMan5.3软件,对2008年1月至2018年5月国内外发表的有关孕期及婴幼儿期使用益生菌预防儿童特应性皮炎的随机对照试验研究进行Meta分析,并按干预菌株、随访时间、补充益生菌时间、研究地区进行亚组分析。结果 最终纳入22篇文献,干预组和对照组病例分别为3280例和3 281例。合并效应量结果显示,孕期和/或婴幼儿期使用益生菌可减少儿童特应性皮炎的发生（RR=0.81,95% CI：0.70~0.93,P < 0.05）。亚组分析结果显示,使用乳酸杆菌和双歧杆菌混合菌株干预效果显著（RR=0.68,95% CI：0.52~0.90,P < 0.05）;孕期及婴幼儿期均补充益生菌效果显著（RR=0.77,95% CI：0.66~0.90,P < 0.05）;孕期和/或婴幼儿期补充益生菌预防特应性皮炎对≤ 2岁儿童效果较显著（RR=0.74,95% CI：0.61~0.90）,而对2岁以上儿童效果不显著;研究地区为澳洲或欧洲/美国的效果显著（P < 0.05）,合并RR及95% CI分别为0.83（95% CI：0.73~0.96）、0.74（95% CI：0.61~0.91）。异质性主要源于不同随访时间（I²=62.7%）和补充益生菌时间（I²=53.5%）。结论 孕期及婴幼儿期补充益生菌有利于预防儿童特应性皮炎的发生,其中使用乳酸杆菌和双歧杆菌混合菌株干预效果显著。     

Paediatric functional abdominal pain: significance of child and maternal health. A prospective study

Aim: First, to what extent do general paediatric outpatients with functional abdominal pain experience other somatic and mental health symptoms compared with children in a population‐based sample? Second, to what extent are such symptoms in both patients and their mothers associated with persistent child abdominal pain and functional disability? Methods: Ninety‐four referred patients [mean age (SD) 11.1 (1.9) years, 62% girls] were assessed by questionnaires and a paediatric consultation at baseline and at follow‐up after 6–9 months (94% follow‐up participation). At baseline, somatic and mental health symptoms in the patients were compared with a population‐based sample of 14 000 school children. Outcome at follow‐up was patient self‐reported abdominal pain and disability. Prognostic factors explored included patient and maternal somatic and mental health symptoms. Results: The patients experienced significantly more somatic [e.g. headache (OR: 9.2; 95% CI: 5.9–14.6)] and emotional symptoms than the school children. Patient’s older age and peer problems at baseline were significantly associated with more abdominal pain at follow‐up, whereas patient’s older age, emotional symptoms, prosocial behaviour and maternal somatic symptoms were associated with disability. Conclusion: Our results highlight the importance of focusing wider than just the patient’s symptoms of abdominal pain in clinical practice and research.     

Randomised controlled trial adapting US school obesity prevention to England.

OBJECTIVES: To determine whether a school obesity prevention project developed in the United States can be adapted for use in England. METHODS: A pilot cluster randomised controlled trial and interviews with teachers were carried out in 19 primary schools in South West England. Participants included 679 children in year 5 (age 9-10). Baseline and follow-up assessments were completed for 323 children (screen viewing) and 472 children (body mass index). Sixteen lessons on healthy eating, physical activity and reducing TV viewing were taught over 5 months by teachers. Main outcome measures were hours of screen activities, body mass index, mode of transport to school and teachers' views of the intervention. RESULTS: Children from intervention schools spent less time on screen-viewing activities after the intervention but these differences were imprecisely estimated: mean difference in minutes spent on screen viewing at the end of the intervention (intervention schools minus control schools) adjusted for baseline levels and clustering within schools was -11.6 (95% CI -42.7 to 19.4) for a week day and was -15.4 (95% CI -57.5 to 26.8) for a Saturday. There was no difference in mean body mass index or the odds of obesity. CONCLUSIONS: It is feasible to transfer this US school-based intervention to UK schools, and it may be effective in reducing the time children spend on screen-based activities. The study has provided information for a full-scale trial, which would require 50 schools ( approximately 1250 pupils) to detect effects on screen viewing and body mass index over 2 years of follow-up.     

Maternal and paternal age and risk of autism spectrum disorders

OBJECTIVE: To explore the association between maternal and paternal age and risk of autism spectrum disorders (ASDs) in offspring. DESIGN: Historical birth cohort study. SETTING: Kaiser Permanente (KP) in Northern California. PARTICIPANTS: All singleton children born at KP from January 1, 1995, to December 31, 1999, were included in the study. We identified 593 children who had ASD diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification, code 299.0 or 299.8) recorded 2 or more times in KP outpatient databases before May 2005. These children were compared with all 132,251 remaining singleton KP births. Main Exposures Maternal and paternal age at birth of offspring. MAIN OUTCOME MEASURES: Relative risks (RRs) estimated from proportional hazards regression models. Risk of ASDs evaluated in relation to maternal and paternal age, adjusted for each other and for the sex, birth date, and birth order of the child, maternal and paternal educational level, and maternal and paternal race/ethnicity. RESULTS: Risk of ASDs increased significantly with each 10-year increase in maternal age (adjusted RR, 1.31; 95% confidence interval [CI], 1.07-1.62) and paternal age (RR, 1.28; 95% CI, 1.09-1.51). Adjusted RRs for both maternal and paternal age were elevated for children with autistic disorder (maternal age: RR, 1.18; 95% CI, 0.87-1.60; paternal age: RR, 1.34; 95% CI, 1.06-1.69) and children with Asperger disorder or pervasive developmental disorder not otherwise specified (maternal age: RR, 1.45; 95% CI, 1.09-1.93; paternal age: RR, 1.24; 95% CI, 0.99-1.55). Associations with parental age were somewhat stronger for girls than for boys, although sex differences were not statistically significant. CONCLUSION: Advanced maternal and paternal ages are independently associated with ASD risk.     

Child stunting is associated with child,maternal, and environmental factors in Vietnam

Child stunting in Vietnam has reduced substantially since the turn of the century but has remained relatively high for several years. We analysed data on children 6–59 months (n = 85,932) from the Vietnam Nutritional Surveillance System, a nationally representative cross‐sectional survey. Multivariable Poisson regression models were used to estimate relative risk (RR) of stunting, stratified by child age and ecological region. Covariates at the child, maternal, household, and environmental levels were included based on available data and the World Health Organization conceptual framework on child stunting. Among children 6–23 months, the strongest associations with child stunting were child age in years (RR: 2.49; 95% CI [2.26, 2.73]), maternal height < 145 cm compared with ≥150 cm (RR: 2.04; 95% CI [1.85, 2.26]), living in the Northeast compared with the Southeast (RR: 2.01; 95% CI [1.69, 2.39]), no maternal education compared with a graduate education (RR: 1.77; 95% CI, [1.44, 2.16]), and birthweight < 2,500 g (RR: 1.75; 95% CI [1.55, 1.98]). For children 24–59 months, the strongest associations with child stunting were no maternal education compared with a graduate education (RR: 2.07; 95% CI [1.79, 2.40]), living in the Northeast compared with the Southeast (RR: 1.94; 95% CI [1.74, 2.16]), and maternal height < 145 cm compared with ≥150 cm (RR: 1.81; 95% CI [1.69, 1.94]). Targeted approaches that address the strongest stunting determinants among vulnerable populations are needed and discussed. Multifaceted approaches outside the health sector are also needed to reduce inequalities in socioeconomic status.     

Improving clinician self-efficacy does not increase asthma guideline use by primary care clinicians

ObjectiveThe purpose of this study was to show the association between changes in clinician self-efficacy and readiness to change and implementation of an asthma management program (Easy Breathing).MethodsA 36 month randomized, controlled trial was conducted involving 24 pediatric practices (88 clinicians). Randomized clinicians received interventions designed to enhance clinician self-efficacy and readiness to change which were measured at baseline and 3 years. Interventions consisted of an educational toolbox, seminars, teleconferences, mini-fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. The primary outcome was program utilization (number of children enrolled in Easy Breathing/year); secondary outcomes included development of a written treatment plan and severity-appropriate therapy.ResultsAt baseline, clinicians enrolled 149 ± 147 (mean ± SD) children/clinician/year; 84% of children had a written treatment plan and 77% of plans used severity-appropriate therapy. At baseline, higher self-efficacy scores were associated with greater program utilization (relative rate [RR], 1.34; 95% confidence interval [CI], 1.04–1.72; P = .04) but not treatment plan development (RR, 0.63; 95% CI, 0.29–1.35; P = .23) or anti-inflammatory use (RR, 1.76; 95% CI, 0.92–3.35; P = .09). Intervention clinicians participated in 17 interventions over 36 months. At study end, self-efficacy scores increased in intervention clinicians compared to control clinicians (P = .01) and more clinicians were in an action stage of change (P = .001) but these changes were not associated with changes in primary or secondary outcomes.ConclusionsSelf-efficacy scores correlated with program use at baseline and increased in the intervention arm, but these increases were not associated with greater program-related activities. Self-efficacy may be necessary but not sufficient for behavior change.     

The impact of peer victimization on later maladjustment: mediating and moderating effects of hostile and self‐blaming attributions

Background: Evidence indicates that being a victim of bullying or peer aggression has negative short‐ and long‐term consequences. In this study, we investigated the mediating and moderating role of two types of attributional mechanisms (hostile and self‐blaming attributions) on children’s maladjustment (externalizing and internalizing problems). Methods: In total, 478 children participated in this longitudinal study from grade 5 to grade 7. Children, parents, and teachers repeatedly completed questionnaires. Peer victimization was assessed through peer reports (T1). Attributions were assessed through self‐reports using hypothetical scenarios (T2). Parents and teachers reported on children’s maladjustment (T1 and T3). Results: Peer victimization predicted increases in externalizing and internalizing problems. Hostile attributions partially mediated the impact of victimization on increases in externalizing problems. Self‐blame was not associated with peer victimization. However, for children with higher levels of self‐blaming attributions, peer victimization was linked more strongly with increases in internalizing problems. Conclusions: Results imply that hostile attributions may operate as a potential mechanism through which negative experiences with peers lead to increases in children’s aggressive and delinquent behavior, whereas self‐blame exacerbates victimization’s effects on internalizing problems.     

A prospective longitudinal study of children's theory of mind and adolescent involvement in bullying

Background: Theory of mind (ToM) allows the understanding and prediction of other people’s behaviours based on their mental states (e.g. beliefs). It is important for healthy social relationships and thus may contribute towards children’s involvement in bullying. The present study investigated whether children involved in bullying during early adolescence had poor ToM in childhood. Method: Participants were members of the Environmental Risk (E‐Risk) Longitudinal Twin Study, a nationally representative sample of 2,232 children and their families. We visited families when children were 5, 7, 10 and 12 years. ToM was assessed when the children were 5 years using eight standardized tasks. Identification of those children who were involved in bullying as victims, bullies and bully‐victims using mothers’, teachers’ and children’s reports was carried out when they were 12 years’ old. Results: Poor ToM predicted becoming a victim (effect size, d = 0.26), bully (d = 0.25) or bully‐victim (d = 0.44) in early adolescence. These associations remained for victims and bully‐victims when child‐specific (e.g. IQ) and family factors (e.g. child maltreatment) were controlled for. Emotional and behavioural problems during middle childhood did not modify the association between poor ToM and adolescent bullying experiences. Conclusion: Identifying and supporting children with poor ToM early in life could help reduce their vulnerability for involvement in bullying and thus limit its adverse effects on mental health.