Inequalities in the Distribution of Childhood Adversity From Birth to 11 Years

ObjectiveExposure to early adversity carries long term harmful consequences for children's health and development. This study aims to 1) estimate the prevalence of childhood adversity for Australian children from infancy to 10–11 years, and 2) document inequalities in the distribution of adversity according to socioeconomic position (SEP), Indigenous status, and ethnicity.MethodsAdversity was assessed every 2 years from 0–1 to 10–11 years in the nationally representative birth cohort of the Longitudinal Study of Australian Children (N = 5107). Adversity included legal problems; family violence; household mental illness; household substance abuse; harsh parenting; parental separation/divorce; unsafe neighborhood; family member death; and bullying (from 4 to 5 years). Adversities were examined individually and summed for a measure of multiple adversity (2+ adverse experiences).ResultsBy 10–11 years, 52.8% (95% confidence interval [CI] 51.0–54.7) of children had been exposed to 2 or more adversities. When combined with low SEP, children from ethnic minority and from Indigenous backgrounds had 4 to 8 times the odds of exposure to 2 or more adversities than children from higher SEP Anglo-Euro backgrounds, respectively (odds ratio [OR] 4.3, 95% CI 2.8–6.6 and OR 8.1, 95% CI 4.4–14.8). Ethnic minority and Indigenous children from higher SEP backgrounds had increased odds of exposure to multiple adversity than similarly advantaged Anglo-Euro children (OR 1.8, 95% CI 1.4–2.3 and OR 2.3, 95% CI 1.3–4.3, respectively).ConclusionsAddressing early adversity is a significant opportunity to promote health over the life course, and reduce health inequalities experienced by marginalized groups of children.     

Associations of Passive and Mentally Active Screen Time With Perceived School Performance of 197,439 Adolescents Across 38 Countries

ObjectiveTo examine the associations of passive (ie, television) and active (ie, electronic games, computer use) screen time (ST) with perceived school performance of adolescents across gender.MethodsData were from the 2014 Health Behaviour in School-aged Children survey conducted across 38 European countries and Canada. Perceived school performance was assessed using an item and dichotomized as high (good/very good) versus the remainder (average/below-average as reference). Participants reported hours per day of time spent watching television, playing electronic games, and using a computer in their free time. Multilevel logistic regression was used to estimate the associations.ResultsA total of 197,439 adolescents (average age 13.6 [standard deviation 1.63] years; 51% girls) were analyzed. Multivariable modeling showed that engaging in >2 h/d of ST was progressively and adversely associated with high performance in both boys and girls. Adolescents reporting >4 h/d of television time (≤1 h/d as reference) had 32% lower odds in boys (odds ratio [OR] 0.68; 95% confidence interval [CI]: 0.65–0.71) and 39% lower odds in girls (OR 0.61; 95% CI, 0.58–0.65) of reporting high performance. Playing electronic games for >4 h/d was associated with high performance with odds being 38% lower in boys (OR 0.62; 95% CI, 0.59–0.66) and 45% lower in girls (OR 0.55; 95% CI, 0.52–0.57). Sex differences in the estimates were mixed.ConclusionsHigh screen use, whether active or passive, was adversely associated with perceived high school performance, with association estimates being slightly stronger in girls than boys, and for mentally active than passive screen use. Discouraging high levels of screen use of any type could be beneficial to school performance.     

The Effect of Primary Care Interventions on Children's Media Viewing Habits and Exposure to Violence

ObjectiveTo determine if brief primary care interventions can affect children's media viewing habits and exposure to violence.MethodsEnglish- and Spanish-speaking parents of 2- to 12-year-old children presenting to a pediatric primary care clinic participated in a randomized controlled trial. There were 2 intervention groups; one group viewed 5 minutes from the Play Nicely program and another received a handout, "Pulling the Plug on TV Violence." There were 2 control groups; the primary control group received standard primary care, and the alternative control group viewed a program about obesity prevention. The outcome measure was parental report of changes in media viewing habits and changes in exposure to violence.ResultsA total of 312 of 443 parents who were randomized completed a 2-week follow-up survey. Compared with the primary control group, parents in the video intervention group were more likely to report a change in their children's media viewing habits (odds ratio [OR] 3.29; 95% confidence interval [CI] 1.66–6.51) and a change in their children's exposure to violence (OR 4.26; 95% CI 1.95–9.27). Compared with the primary control group, parents in the handout group were more likely to report a change in their children's media viewing habits (OR 4.35; 95% CI 2.20–8.60) and a change in their children's exposure to violence (OR 3.35; 95% CI 1.52–7.35).ConclusionsBrief primary care interventions can affect children's media viewing habits and children's exposure to violence. These results have implications for how to improve primary care services related to decreasing children's media exposure and violence prevention.     

Gender-specific prevalence and associated risk factors of prehypertension among rural children and adolescents in Northeast China: a cross-sectional study

Little is known about the prevalence and risk profile of prehypertension among Chinese children and adolescents. The aim of the present study was to investigate the prehypertensive status and its associated risk factors among rural Chinese children and adolescents. We conducted a cross-sectional study including 5,245 children and adolescents (2,732 boys and 2,513 girls) aged 5–18 years in Northeast China. Main anthropometric data and related information were collected. The overall prevalence of prehypertension and hypertension was 15 % and 20.2 %, respectively. The prevalence of prehypertension among boys was 15.7 %, compared to that of 14.2 % among girls (P?=?0.256). After adjusting for age, race, weight status, waist circumference, triceps skinfold, family income, smoking and drinking status, boys aged 12–14 and 15–18 years had a 2.86- and 5.97-fold risk of prehypertension, respectively, compared to those aged 5–8 years. Overweight and obese boys had an increased risk of prehypertension in comparison to those with normal weight (overweight: odds ratio [OR]?=?1.837, 95 % confidence interval [CI] 1.321–2.556; obese: OR?=?2.941, 95 % CI 1.783–4.851). A larger triceps skinfold (≥90th percentile) was significantly related to increased odds of prehypertension (OR?=?2.32; 95 % CI, 1.516–3.55) among boys. For girls, only older age was found to be a risk factor for prehypertension. Conclusion: Pediatric prehypertension is highly prevalent in rural Northeast China. The risk factors for prehypertension differed among boys and girls. A more comprehensive risk profile of prehypertension among children and adolescents needs to be established for early prevention.     

Sexual maturation in early adolescence and alcohol drinking and cigarette smoking in late adolescence: a prospective study of 2,129 Norwegian girls and boys

Early sexual maturation has been associated with higher involvement in risk behaviour during early and mid-adolescence. In a prospective study of 2,129 girls and boys, we investigated whether the timing of sexual maturation was associated with cigarette smoking and alcohol drinking in late adolescence and whether this relation differed between boys and girls. Nine hundred and eighty boys and 1,149 girls, who participated in a cross-sectional study in middle school, were included in a follow-up study in high school 4 years later. Self-rating of pubertal status, as registered at baseline in middle school, was used to indicate the timing of sexual maturation. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CIs), estimated by logistic regression, were used to assess the association between sexual maturation and alcohol drinking and daily smoking at follow-up. We found that girls who had matured early (OR 1.7, CI 1.2–2.4) or late (OR, 1.5, CI, 1.1–2.2) were both more likely to report more advanced drinking in late adolescence than were girls who were on time. Boys who had matured late were less likely (OR 0.5, CI 0.3–0.8) than boys who were on time to engage in advanced drinking. In general, daily smoking was more common among girls than boys, and more common among girls who had matured early (OR 1.5, CI 1.1–2.2) than among girls who were on time. Adjustment for social factors, e.g. parental education and marital status and parental drinking and smoking habits, did not substantially influence these results. We concluded that, for girls, but not for boys, early sexual maturation was associated with more advanced drinking and higher frequency of smoking in late adolescence. In boys, late sexual maturation was associated with reduced risk of advanced drinking.     

Parental Psychological Distress and Children's Mental Health: Results of a National Survey

ObjectiveQuestions persist as to which dimensions of child mental health are most associated with parental mental health status and if these associations differ by parental gender. We assessed associations between parental psychological distress and children's mental health.MethodsPooled data from the 2001, 2002, and 2004 National Health Interview Surveys (NHIS), a nationally representative, cross-sectional survey of US children aged 4 to 17 (n = 21,314), were used. Multivariate logistic regression was performed assessing associations between parental psychological distress, measured by the Kessler 6 scale, and the extended-form Strengths and Difficulties Questionnaire (SDQ) scales.ResultsLogistic regression demonstrated associations between parental psychological distress and increased likelihood of child mental health problems. Children aged 4 to 11 were more likely to have mental health problems if they had a psychologically distressed father (odds ratio [OR] 7.5, 95% confidence interval [CI] 2.3–24.3) or mother (OR 6.7, 95% CI 2.7–16.7). Children aged 12 to 17 with a psychologically distressed father (OR 4.53, 95% CI 1.18–17.47) or mother (OR 3.90, 95% CI 1.34–11.37) were also more likely than those without to have mental health problems. In parents of both genders, associations existed between parental psychological distress, and abnormal emotional symptoms in younger children, conduct disorder in older children, and hyperactivity in children of all ages.ConclusionsParental psychological distress appears similarly associated with adverse child mental health outcomes, regardless of parental gender. These findings corroborate limited prior research and demonstrate that associations between child mental health and parental mental illness are similar in magnitude for fathers and mothers.     

The relation between physical activity and mental health among Hispanic and non-Hispanic white adolescents

OBJECTIVE: To assess the relation of physical activity (PA) with feelings of sadness and suicidal thoughts and behaviors among Hispanic and non-Hispanic white adolescent boys and girls. DESIGN: Cross-sectional study using a modified 2001 Youth Risk Behavior Survey. PARTICIPANTS: One thousand eight hundred seventy Hispanic and non-Hispanic white adolescents, aged 14 to 18 years, attending high school in Nueces County, Texas. MAIN OUTCOME MEASURE: Logistic regression analysis was used to assess the relation between PA, including moderate and vigorous PAs, strength and toning, total PA, physical education class, and participation in team sports, and the dependent variables feelings of sadness and considering, planning, and attempting suicide. RESULTS: More boys reported participating in PA than girls (P<.001), and more girls than boys reported feelings of sadness and considering and planning suicide (P<.001). Greater attendance in physical education class was inversely related to feelings of sadness (odds ratio [OR], 0.80 [95% confidence interval (CI), 0.68-0.94]); participation in more total PA sessions per week was associated with a lower risk of considering suicide (OR, 0.72 [95% CI, 0.65-0.79]); and higher levels of vigorous PA (OR, 0.73 [95% CI, 0.57-0.93]), total PA (OR, 0.65 [95% CI, 0.48-0.87]), and strength and toning activity (OR, 0.64 [95% CI, 0.42-0.99]) were associated with a lower risk of planning suicide. CONCLUSIONS: These findings are consistent with a beneficial effect of PA on feelings of sadness and suicidal behaviors in Hispanic and non-Hispanic white boys and girls. Physical activity may be considered as part of an intervention strategy to improve adolescent health as a whole.     

Factors influencing child mental health: A state‐wide survey of Victorian children

Aims: This study aims to estimate the prevalence of mental health problems among Victorian children and to investigate factors associated with poorer mental health. Method: Computer‐assisted telephone interviews were undertaken with the parents of 3370 randomly selected Victorian children aged 4 to 12 years. They reported on their child's mental health and special health‐care needs as well as their own mental health, family functioning and a range of community and socio‐demographic variables. Population estimates and odds ratios (OR) were calculated with 95% confidence intervals (95% CI). Results: Overall, 11.6% (95% CI = 10.3–12.9%) of Victorian children were estimated to be at risk of having mental health problems. Factors independently placing children at increased risk of mental health problems that were ‘of concern’ include a child having special health‐care needs (OR = 7.89, 95% CI 5.16 to 12.08), unhealthy family functioning (OR = 3.84, 95% CI 2.19 to 6.74), parental mental health problems (OR = 7.89, 95% CI 5.16 to 12.08), neighbourhood safety (OR = 2.47, 95% CI 1.20 to 5.07) and area of residence (OR = 2.01, 95% CI 1.33 to 3.02). Conclusions: A significant proportion of Victorian children are at some risk of mental health problems. These limited but important predictors of children's mental health reinforce the need for policy solutions that will extend beyond those offered by traditional mental health service systems.     

Television, computer use, physical activity, diet and fatness in Australian adolescents.

PURPOSE: To examine sedentary behaviours (including television viewing, playing computer games and computer use), diet, exercise and fitness in relation to overweight/obesity in Australian adolescents. METHODS: Questionnaires elicited food frequency data, time spent in TV-viewing, using computers, other sedentary occupations and physical activity recall. Weight, height and fitness (laps completed in the Leger test) were measured. RESULTS: Among 281 boys and 321 girls, mean age 12 years (SD 0.9), 56 boys (20.0%) and 70 girls (23.3%) were overweight/obese. Greater fitness was associated with decreased risk of overweight/obesity in boys (Odds ratio [OR] 0.74; 95% CI 0.55, 0.99) and girls (OR 0.93; 95% CI 0.91, 0.99). TV-viewing predicted increased risk in boys (OR 1.04; 95% CI 1.01, 1.06) and decreased risk in girls (OR 0.99; 95% CI 0.96, 0.99). Computer use, video games, and other sedentary behaviours were not significantly related to risk of overweight/obesity. Vegetable intake was associated with lower risk in boys (OR 0.98; 95% CI 0.97, 0.99); greater risk was associated with lower fat intake in boys and girls, lower consumption of energy-dense snacks in boys (OR 0.74; 95% CI 0.62, 0.88) and greater intake of vegetables in girls (OR 1.02; 95% CI 1.00, 1.03), suggesting dieting or knowledge of favourable dietary choices in overweight/obese children. CONCLUSIONS: Among these adolescents, fitness was negatively related to risk for overweight/obesity in boys and girls. TV-viewing was a positive predictor in boys and a negative predictor in girls but the effect size was small; other sedentary behaviours did not predict risk.     

Association of maternal characteristics and behaviours with 4‐year‐old children's dietary patterns

This study examined the association of family and maternal characteristics with preschool children's dietary patterns. Trained interviewers evaluated subsample 3422 mothers and children enrolled in the population‐based birth cohort Generation XXI (Porto, Portugal, 2005–2006). Maternal characteristics and behaviours (exercise, smoking habits, diet and child‐feeding practices) and family characteristics were evaluated. Maternal diet was classified by a dietary score, and children's dietary patterns were identified by latent class analysis. Odds ratios (OR) and confidence intervals (95% CI) were estimated by multinomial regression models. The analysis was based on a framework with four conceptual levels: maternal socio‐economic position (SEP) at 12 years, maternal socio‐economic and demographic characteristics at child's delivery, family characteristics and maternal behaviours at child's 4 years. Three dietary patterns were identified in children: high in energy‐dense foods (EDF); low in foods typically consumed at main meals and intermediate in snacks (Snacking); higher in healthy foods; and lower in unhealthy ones (Healthier, reference). Lower maternal SEP had an overall effect on children's diet (low vs. high SEP; EDF, OR = 1.76, 95% CI: 1.42–2.18; Snacking, OR = 1.73, 95% CI: 1.27–2.35), while maternal education was directly associated with it (≤9 vs. >12 schooling years, EDF, OR = 2.19, 95% CI: 1.70–2.81; Snacking, OR = 2.22, 95% CI: 1.82–3.55). Children whose mothers had worse dietary score were significantly more likely to follow unhealthier patterns (first vs. fourth quartile; EDF, OR = 9.94, 95% CI: 7.35–13.44, P‐trend < 0.001; Snacking, OR = 4.21, 95% CI: 2.94–6.05, P‐trend < 0.001). Maternal diet was the key factor associated with children's diet, above and beyond socio‐economic and demographic characteristics, accounting for one‐third of the determination coefficient of the fully adjusted model. At preschool age, interventions should give a particular focus on maternal diet and low SEP groups.     

Factors associated with the decision of a French hospital to report child abuse to judicial rather than administrative authorities

ObjectivesTwo independent sectors manage the child protection system in France: judicial and administrative protection. The choice between judicial or administrative reporting depends on the seriousness of the case. The goal of this study was to determine the characteristics associated with the decision in a French pediatric hospital to report child abuse to judicial instead of administrative authorities.MethodsA retrospective study was conducted. Participants were all the children (n = 83) who were admitted from 2017 to 2018 to the emergency department (ED) and the general ward of a pediatric university hospital in France, and were reported for suspicion of child abuse by the professional teams. The children who were suspected victims of sexual abuse were excluded. Multivariate logistic regressions were used.ResultsA total of 47 children were reported to judicial authorities, and 36 to administrative authorities. Their median age was 7 years. Suspicion of physical abuse (odds ratio [OR]: 21.2; 95% confidence interval [CI]: 4.5–99.1), cases reported by the pediatric ward team (OR: 9.1; 95% CI: 1.9–43.6), adult person different from parents who accompanied the child to the ED (OR: 5.8; 95% CI: 1.2–28.6), and perception of parental behavior as inappropriate and non-cooperative (OR: 6.6; 95% CI: 1.4–29.6) were associated with a higher risk of the case being reported to judicial authorities. Data were often unavailable for parental health issues, history of child abuse, and intimate partner violence.ConclusionSome factors associated with the choice of report type were most likely quite subjective. Better documentation and standardization are needed.     

Family Experience of Caregiver Burden and Health Care Usage in a Statewide Medical Home Program

ObjectiveTo evaluate family-reported caregiver experiences and health care utilization of patients enrolled in the Pennsylvania Medical Home Program (PA-MHP) statewide practice network and compare results to PA-MHP practices’ Medical Home Index (MHI) scores. We hypothesized families enrolled in higher-scoring patient-and-family-centered medical homes (PCMH) on completed MHIs would report decreased caregiver burden and improved health care utilization.MethodsWe analyzed surveys completed by families receiving care coordination services in PA-MHP's network and each practice's mean MHI score. A total of 3221 caregivers completed surveys evaluating hours spent coordinating care/week, missed school/workdays, sick visits, and emergency department (ED) visits. A total of 222 providers from 54 participating PA-MHP practices completed the nationally recognized MHI. Family/practice demographics were collected. We developed multivariate logistic regression models assessing independent associations among family survey outcomes and corresponding practices’ MHI scores.ResultsFamilies enrolled in high-scoring PCMHs had decreased odds of spending >1 h/wk coordinating care (odds ratio [OR] 0.82, adjusted OR [aOR]: 0.70, 95% confidence interval [CI] 0.55–0.90), missing workdays in the past 6 months (OR 0.82, aOR: 0.72, 95% CI 0.69–0.97), and ED visits in the past 12 months (OR 0.83, aOR: 0.81, 95% CI 0.65–0.99) in comparison to families enrolled in lower-scoring PCMHs. Families enrolled in higher-scoring PCMHs did not report fewer sick visits despite fewer ED visits, indicating more appropriate health care utilization. High-scoring PCMHs had lower percentages of publicly insured and low-income children.ConclusionsHigher-scoring PCMHs are associated with decreased caregiver burden and improved health care utilization across diverse PA practices. Future studies should evaluate interventions uniformly improving PCMH quality and equity.     

Detailed family history of diabetes identified children at risk of type 2 diabetes: a population‐based case‐control study

Wei J‐N, Li H‐Y, Wang Y‐C, Chuang L‐M, Lin M‐S, Lin C‐H, Sung F‐C. Detailed family history of diabetes identified children at risk of type 2 diabetes: a population‐based case‐control study. Objectives: Recently, the incidence of type 2 diabetes (T2D) in children has increased dramatically. Mass screening is suffering and costly. It remains unknown if a detailed family diabetes mellitus history (FDMH) can identify children with different risks of T2D. This study investigated how FDMH was associated with childhood T2D. Methods: From 1992 to 1997, a nationwide survey conducted in Taiwan for all 3 000 000 school children aged between 6 and 18 yr identified 1966 children with diabetes. For comparison, 1780 children were randomly selected as the control group from all students with normal fasting glycemia (NFG). Telephonic Interviews were conducted using questionnaire for detailed FDMH. In the present analysis, 505 children with T2D and 619 children with NFG were enrolled. Results: Children with more family members having diabetes were more likely to have T2D. Children with the parental FDMH had a higher risk for T2D than children with the grandparental FDMH; the odds ratios (ORs) were 2.61 (95% confidence interval (CI) 1.25–5.48, p < 0.05) for boys and 6.47 (95% CI 2.69–15.6, p < 0.05) for girls, adjusting for age, birth weight, gestational age and body mass index (BMI) z‐score. Children with maternal FDMH had a higher risk for T2D than children with paternal FDMH, and much greater in boys (OR = 29.5, 95% CI 3.67–237, p < 0.05) than in girls (OR = 7.63, 95% CI 2.05–28.4, p < 0.05), adjusted for age, birth weight, gestational age, BMI z‐score, and FDMH in grandparents. Conclusions: Children with parental FDMH, especially the maternal FDMH, have an elevated risk for T2D. Detailed FDMH is a convenient alternative to identify children with different risks of T2D.     

A Longitudinal Study of Risk Factors for Sexual Victimization in Puerto Rican Youth

ObjectiveTo determine whether youth, family, and neighborhood factors and minoritized status are associated with youth-reported sexual victimization from childhood through young adulthood.MethodsWe analyzed longitudinal data from 2 population-based samples of Puerto Rican youth living in the South Bronx (as a minoritized group) and Puerto Rico (as a nonminoritized group). Waves 1 to 3 were collected annually beginning in 2000 (youth age 5–13). Wave 4 was collected 2013 to 2017 (youth age 15–29). We estimated multivariable associations between youth, family, and neighborhood factors and minoritized status at Wave 1 (independent variables); and youth-reported sexual victimization at Waves 1 to 4 (dependent variables).ResultsNone of the factors was associated with youth-reported sexual victimization at Wave 1 (N = 1911). Among youth reporting no previous history of sexual victimization at Wave 1 (n = 1823), youth in the South Bronx vs Puerto Rico were more likely to report sexual victimization at Waves 2 or 3 (odds ratio (OR) [95% confidence interval (CI)] = 3.62 [1.46–8.97]). Older youth were less likely to report sexual victimization (OR [95% CI] = 0.77 [0.65–0.91]) (all P < .01). Among youth reporting no history of sexual victimization at Waves 1 to 3 (n = 1782), youth in the South Bronx (OR [95% CI] = 2.53 [1.52–4.22]), female youth (OR [95% CI] = 2.81 [1.83–4.30]), and youth whose parents had more than a high school degree (OR [95% CI] = 2.25 [1.38–3.67]) were more likely to report sexual victimization at Wave 4 than their counterparts (all P ≤ .001).ConclusionsFuture research should investigate how living as a minoritized youth may contribute to an increased risk of sexual victimization.     

The patient-centered medical home, practice patterns, and functional outcomes for children with attention deficit/hyperactivity disorder

ObjectiveTo determine whether children with attention deficit/hyperactivity disorder (ADHD) receive care in a patient-centered medical home (PCMH) and how that relates to their ADHD treatment and functional outcomes.MethodsCross-sectional analysis of the 2007 National Survey for Children’s Health, a nationally representative survey of 91,642 parents. This analysis covers 5169 children with parent-reported ADHD ages 6–17. The independent variable is receiving care in a PCMH. Main outcome measures are receiving ADHD medication, mental health specialist involvement, and functional outcomes (difficulties with participation in activities, attending school, making friends; having problem behaviors; missed school days; and number of times parents contacted by school).ResultsOnly 44% of children with ADHD received care in a PCMH. Children with ADHD receiving care in a PCMH compared with those who did not were more likely to receive medication for ADHD (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1–1.9); less likely to have mental health specialist involvement (OR, 0.6; 95% CI, 0.4–0.7); less likely to have difficulties participating in activities (OR, 0.6; 95% CI 0.4–0.8), making friends (OR, 0.6; 95% CI, 0.5–0.9), and attending school (OR, 0.4; 95% CI, 0.3?06); less likely to have problem behaviors (OR 0.6; 95% CI 0.5–0.9); had fewer missed school days (β = ?1.5, 95% CI ?2.4 to ?0.5); and parents were contacted by school less frequently (β = ?0.2, 95% CI ?0.3 to ?0.1).ConclusionsFor children with ADHD, receiving care in a PCMH is associated with practice pattern change and better outcomes. The PCMH may represent a promising opportunity to improve quality of care and outcomes for children with ADHD.     

Factors Associated With Self-Reported Family Enrollment in Community Services After Referral by First Born Home Visitors

ObjectiveTo examine factors associated with family enrollment in community services after receiving a referral from First Born home visiting staff in New Mexico.MethodsAnalyses of program administrative data from August 2010 to January 2020 for 1049 families with 5397 referrals were conducted in Stata 15.1 using mixed effects logistic regression; missing data were imputed. We examined the likelihood of a referral outcome being coded as “client enrolled in services” based on family self-report as a function of program, referral type and initiator, and staff and referral recipient characteristics.ResultsAbout one fourth of referrals resulted in enrollment in services, with the highest enrollment rate for early intervention (39%) and lower enrollment rates for behavioral health (18%) and domestic violence (14%) services. Reported enrollment in the referred-to service was significantly higher for older caseholders versus teens (odds ratio [OR]: 1.69, 95% confidence interval [CI] 1.07–2.67) and for children (OR: 1.33, 95% CI 1.06–1.67) and pregnant mothers (OR: 1.45, 95% CI 1.04–2.01) versus non-pregnant mothers and significantly lower for referrals initiated by home visitors (in discussion with family - OR: 0.62, 95% CI 0.49–0.79; based on screening results - OR: 0.52, 95% CI 0.37–0.72) versus family initiated referrals, for fathers versus non-pregnant mothers (OR: 0.49, 95% CI 0.32–0.75) and for Asian, Black, and multi-racial/ethnic group caseholders versus white caseholders (OR: 0.53, 95% CI 0.30–0.97).ConclusionsQuality improvement efforts and home visitor training on making sensitive referrals, anti-racism, and motivational interviewing could potentially improve family engagement with community services via the First Born home visiting model.     

Health self-perception and its association with physical activity and nutritional status in adolescents

ObjectiveTo evaluate the association between total physical activities, physical activity in free time and nutritional status with self-perceived health in adolescents of both genders.MethodsThis is a quantitative study that integrates the school-based, cross-sectional epidemiological survey with statewide coverage, whose sample consisted of 6261 adolescents (14–19 years old) selected by random conglomerate sampling. Data were collected using the Global School-based Student Health Survey. The chi-squared test (χ²) and the Poisson regression model with robust variance were used in the data analyses.ResultsIt was observed that 27.3% of the adolescents had a negative health self-perception, which was higher among girls (33.0% vs. 19.0%, p < 0.001). After adjusting for potential confounding factors, it was observed that boys who did not practice physical activity during free time (PR = 1.44, 95% CI: 1.15–1.81) and were classified as insufficiently active (PR = 1.27, 95% CI: 1.04–1.56), as well as girls who did not practice physical activity during free time (PR = 1.15, 95% CI: 1.02–1.29) and were classified as overweight (PR = 1.27, 95% CI: 1.01–1.29) had a greater chance of negative health self-perception.ConclusionBehavioral issues may have different effects on health self-perception when comparing boys with girls. Negative health self-perception was associated with nutritional status in girls and a lower level of physical activity in boys, and the practice of physical activity in the free time was considered a protective factor against a negative health self-perception for adolescents of both genders.     

Correlates of Complementary and Alternative Medicine Use in a Pediatric Tertiary Pain Center

ObjectiveTo examine correlates of complementary and alternative medicine (CAM) use in a pediatric population with chronic pain, and to determine whether CAM use is positively correlated with adaptive coping skills.MethodsWe examined patient data from 1175 children aged 7 to 18 years with chronic pain who completed the intake assessment at the time of initial evaluation at Boston Children's multidisciplinary Pain Treatment Service between 2003 and 2011. The intake assessment included validated measures of anxiety, depression, pain coping skills, and functional disability. Parents were also asked whether their child had tried CAM modalities in the past. We used a multivariable logistic regression model to determine correlates of CAM use and a multivariable linear regression model to determine the relationship between biobehavioral CAM (relaxation training, hypnosis, and biofeedback) and accommodative coping.ResultsIn our multivariable model, we found that female gender (odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.07–2.02), level of parental education (OR 1.11 per year, 95% CI 1.06–1.16), greater pain intensity (OR 1.06 per point on an 11-point numerical analog scale, 95% CI 1.01–1.11), and more functional disability (OR 1.19 per 10-point increment on the Functional Disability Inventory, 95% CI 1.06–1.34) were independently associated with CAM use. Biobehavioral CAM was found to have a statistically significant correlation with accommodative coping skills (β = 0.2, P = .004).ConclusionsIn a pediatric chronic pain center, CAM users tended to have higher pain intensity and greater functional disability. Exposure to biobehavioral CAM techniques was associated with adaptive coping skills.     

Weight concerns and weight control behaviors of adolescents and their mothers

OBJECTIVE: To assess the association between weight concerns and weight control practices of adolescents and their mothers. DESIGN AND PARTICIPANTS: Cross-sectional study of 5331 adolescent girls and 3881 adolescent boys (age range, 11.8-18.4 years) in an ongoing cohort study and their mothers. Participants were included in the analysis if both the adolescent and his or her mother returned a questionnaire mailed in 1999 and provided information on weight, height, and weight concerns. RESULTS: More adolescent girls (33.0%) than boys (8.1%) thought frequently about wanting to be thinner. Compared with adolescent girls who accurately perceived that their thinness was not important to their mother, girls who misperceived (odds ratio [OR] = 1.9; 95% confidence interval [CI], 1.3-2.8) or accurately perceived (OR = 2.85; 95% CI, 1.0-8.4) that it was important to their mother that they be thin were significantly more likely to think frequently about wanting to be thinner. Among the adolescent boys, only those who accurately perceived that it was important to their mother that they not be fat were more likely than their peers to think frequently about wanting to be thinner (OR = 3.8; 95% CI, 2.3-6.2). Adolescents who accurately perceived that it was important to their mother to be thin or not fat were significantly more likely to be frequent dieters than their peers who accurately perceived that their weight was not important to their mother. CONCLUSION: Among adolescents, an accurate perception that weight status is important to their mother is associated with thinking frequently about wanting to be thinner and about frequent dieting.     

Parental overweight/obesity,social factors,and child overweight/obesity at 7 years of age

Background: This study used gender‐based analyses to examine whether child overweight/obesity is related to parental overweight/obesity and sociodemographic factors, in a representative population‐based cohort of 7‐year‐old children. Methods: Data from the Québec Longitudinal Study of Child Development 1998–2010 was used. Children (n= 1336) were randomly selected from each public health region of Québec. The study was based on face‐to‐face interviews and a set of questionnaires addressed to mothers and fathers. Results: Compared to children with no overweight/obese parent, the adjusted odds ratio (OR) of being overweight/obese with two overweight/obese parents was 5 for boys (95% confidence interval [CI]: 2.31–10.85) and 5.87 for girls (95%CI: 2.63–13.12). Gender differences appeared when one parent was overweight/obese. For girls, having either an overweight/obese mother (OR, 3.10; 95%CI: 1.14–8.38) or father (OR, 3.64; 95%CI: 1.68–7.91) significantly increased the odds of being overweight/obese at 7 years. For boys, however, having only an overweight/obese father (OR, 2.05; 95%CI: 1.01–4.16) was related to overweight/obesity, but having only an overweight/obese mother was not related to overweight/obesity at 7 years for boys. In girls, but not in boys, having an immigrant mother also significantly related to overweight/obesity (OR, 2.71; 95%CI: 1.28–5.75) at 7 years, after controlling for other social factors. Conclusions: Gender differences in socialization may explain why at 7 years of age, girls' bodyweight is influenced by having even one overweight/obese parent (mother or father), while boys' bodyweight appears to be influenced only by father's overweight/obesity when only one parent is overweight/obese.