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Objective: Children's health beliefs are significantly related to their adherence; however, pediatric literature has rarely tested health-related theories as a whole. The goal of the present study was to evaluate the use of the health belief model (HBM) in understanding children's adherence, both globally and to individual treatment components. Method: Thirty-three patient-parent dyads completed questionnaires regarding health beliefs and adherence to medical regimens. Results: Multiple linear regressions found a significant relationship among the HBM variables and reports of global adherence for children and parents. For children, the HBM variables were significantly related to adherence to aerosol medications, aerosol antibiotics, metered dose inhalers, and vitamins. For parents, the HBM variables were significantly related to children's adherence to airway clearance, oral antibiotics, and vitamins. Paired sample "t" tests found children and parents had significantly discrepant heath beliefs. Conclusion: These findings provide further support for the HBM in evaluating pediatric adherence, with evidence that barriers and cues to action may be targets for early intervention. Future research using this model to identify a comprehensive way to assess, understand, and elicit change in the adherence to medical regimens for youth with chronic illness would be beneficial.

Pediatric obesity is a widespread health concern and youth with obesity face teasing and ridicule, which can lead to academic difficulties (e.g., falling behind from missed class time). Teachers have a direct role in how children are treated by peers. We examined how teachers' views of children with obesity differ from their views of children with asthma, a less stigmatized chronic condition. Online questionnaires assessing attitudes toward children with health conditions were completed by 140 first- to fifth-grade teachers. Teachers rated children with asthma as more likely to be accepted by their peers than children with obesity. Additionally, teachers reported children with obesity as more burdensome to have in their classroom. Our findings that teachers reported children with obesity as more burdensome and less accepted may be influenced by societal attitudes related to the stigma associated with obesity. Findings highlight the importance of education for teachers on how to improve attitudes and outcomes for students with obesity.

Children with chronic health conditions need the support of school staff to flourish socially and academically in educational settings. This study explored teacher experiences and knowledge of the following common paediatric conditions: asthma, food allergies, cancer, diabetes, HIV/AIDS, heart disease and seizure disorder. Participants included 140 elementary education teachers. This study also explored teacher perceptions of willingness and burden in implementing a range of classroom accommodations. Findings revealed that teachers were less willing to implement accommodations that were perceived to be burdensome. In addition, teachers perceived HIV/AIDS and seizure disorder to be among the most challenging conditions, and they reported the least amount of exposure to childhood cancer, heart disease, HIV/AIDS and seizure disorder. Suggestions to enhance the educational experiences of students with chronic illness are provided. Specifically, expanded collaborative roles for school-based mental health practitioners are recommended.

Parenting behaviors have received ample support as a mediator of the relationship between maternal affect and child behavior problems. The majority of these research efforts were based on a uni-dimensional conceptualization of maternal mood, even though decades of theory and research suggest that mood is multidimensional. We examined the mediating role of parenting behaviors on positive affect (PA) and negative affect (NA) and reports of child behavior problems. Evidence for mediation was demonstrated for both PA and NA for children in early to middle childhood. Consistent with the positive psychology movement, our results suggest that maternal PA plays an important role in parents' utilization of effective parenting behaviors. Implications for clinical intervention and future research are discussed.

The medical needs of individuals with sickle cell disease (SCD) are complex. Patients with SCD experience complications such as recurrent pain episodes and increased hospitalizations. Over 70% of AYA and their parents seek medical information from the Internet; 83% inquire on sites that have interactive/social features, such as Facebook or Twitter, yet accuracy remains unclear. Our objective was to assess the accuracy of the SCD-information posted on social media. We hypothesized that most of the posted information is inaccurate. We coded one month of threads from two common SCD Facebook groups (Sickle Cell Warriors Unity and Sickle Cell Anemia) to identify the purpose of each post and the accuracy of medical information posted. Amongst both social media sites, there were 487 posts. Most of the posts were directed toward socializations (n = 311, 63.8%), while other posts mainly focused mainly on SCD and its management (n = 173, 35.5%). When looking at the medical posts, 44.9% were accurate, whereas 55.1% of the posts included inaccurate information. We found that less than half of the medical information posted on interactive social media is inaccurate. Our findings raise potentially serious implications for individuals with SCD and/or their caregivers who may rely on social media to gather more information about their or their child's disease. Our data highlight the importance of health care providers encouraging patients and parents to ask any questions they may have about SCD, given they may consult social media and Internet site that provide inaccurate information. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Geographic barriers limit access to clinical care in the United States for transgender and gender-diverse (TGD) youth. Some factors differentiating access to care are variability in state laws/policies, the number of available clinical care programs and mental health providers for TGD youth. METHODS: We aggregated data from the Human Rights Campaign for pediatric clinical care programs for TGD youth, the Movement Advancement Project for state-by-state assessment of gender identity laws and policies, and Psychology Today for mental health providers for TGD youth by state. Current prevalence rates for TGD youth were applied by state with 2020 Census data. Findings were summarized as a whole and per capita by state, region, and country overall. RESULTS: The South has the highest number of TGD youth per clinic (36 465-186 377), and the lowest average equality score in gender identity laws and policies (1.96). The Midwest has the highest number of TGD youth per mental health provider (278-1422). The Northeast has the lowest number of TGD youth per clinic (11 094-56 703), the highest average equality score in laws and policies per state (17.75), and the highest average number of TGD youth per mental health providers (87-444). CONCLUSIONS: Findings support there are barriers to TGD youth care throughout the United States, especially the South and Midwest. Increasing medical and mental health care for TGD youth is likely to improve their health and well-being. Enacting gender identity protective laws/policies would allow for equal treatment and access to care among TGD youth. [ABSTRACT FROM AUTHOR]

Observes the impact of gender and status on the communication of 26 same-sex and 13 mixed-sex dyads of college students. Suggests that differences in the use of certain linguistic features may be more a result of a power differential than of gender. Other characteristics of the speaker, however, must also be considered. (CJS)

Objective: Given the associations between externalizing behaviors and childhood unintentional injuries (CUI), this pilot study evaluated whether an empirically supported behavioral parent training program, Group Triple P, decreased risk for CUI. Methods: Parents of 19 children ages 2-8 referred by their child’s primary care physician for child externalizing behavior problems completed measures of child injury risk pre- and post-Triple P. Results: Child injury risk and disruptive behavior problems decreased significantly. Conclusions: Overall, our findings indicate that teaching behavior management and parenting skills to parents has the potential to decrease injury risk in their children, despite this not being an explicit target of intervention. [ABSTRACT FROM AUTHOR]

A review of the article "Strengths-based, Clinic-integrated Nonrandomized Pilot Intervention to Promote Type 1 Diabetes Adherence and Well-being" by M.E. Hilliard, S.S. Eshtehardi, and others, which appears in the same issue of the journal, is provided.

Approximately 20% of children in the United States meet the criteria for a psychosocial disorder; however, less than 25% of these children receive psychosocial services. A questionnaire assessed primary care pediatricians’ (PCPs) perceptions of effectiveness, availability, and burden of treatment options for children’s psychosocial difficulties and parents’ acceptance and adherence with these treatments. Repeated measures analysis of variance found that PCPs are more likely to refer children with psychosocial problems to a mental health professional than to prescribe medication. PCPs prescribe medications more than counseling parents themselves or watchful waiting. PCPs reported children’s behavior is more likely to improve with mental health services than with medication, though medication is the most available treatment. PCPs believe parent training programs are very effective for treating children’s behavior problems, but believe parents are more accepting and compliant with other treatments. Findings indicate PCPs’ perceptions of availability and acceptability of treatment options drive their treatment recommendations of psychosocial problems. [ABSTRACT FROM PUBLISHER]

The present study examined the relationship between stigma and parental help-seeking after controlling for demographics, child behavior, and barriers to treatment. One hundred fifteen parents of children ages 4 to 8 years were surveyed during well-child visits in a rural pediatric primary care practice. Parental perceptions of stigma toward parents and children were both assessed. Parents believe that children are more likely to be stigmatized by the public and personally impacted by stigma. In linear regression analyses, parents rated themselves as more likely to attend parenting classes with lower levels of self-stigma and greater levels of personal impact of stigma. Stigma toward the child was not associated with help-seeking. Child behavior moderated the relationship between stigma and parental help-seeking. When referring parents to treatment, providers should address potential stigma concerns. Future research should assess both the impact of the stigma of attending treatment and the stigma of having a child with behavior problems. [ABSTRACT FROM AUTHOR]

Caregiver developmental knowledge was tested as a moderator of the association between caregiver-perceived self-efficacy and perceived supervision to prevent childhood unintentional injury. Caregivers (N = 123; 95 mothers and 28 fathers) of children (M = 3.5 ± 1.2 years, 49.6% female, 80.8% Caucasian) were recruited from pediatric primary care offices and local message boards. All caregivers completed self-report questionnaires on perceived self-efficacy, developmental knowledge, and perceived supervision to prevent injury. Separate hierarchical linear regression models were conducted to test moderation for mothers and fathers. The interaction effect of perceived self-efficacy and developmental knowledge significantly predicted maternal-perceived supervision, R2 change = .06, F(1, 86) = 6.76, p < .01. No significant findings were detected for fathers. Models of studying injury prevention that consider complex cognitive-behavioral interactions and their potential modifiable role in the development of injury-prevention practices may elucidate upon the attitude–practice gap currently identified in the literature. [ABSTRACT FROM PUBLISHER]

BACKGROUND. Physician identification and management of psychosocial problems in children is related to parental disclosure. The purpose of this research was to evaluate a method of prompting parental disclosure of such problems and to determine the impact of parental disclosure on family physicians' identification of and intervention for childhood psychosocial problems. METHODS. Participants were parents and physicians of 60 children between the ages of 3 and 10 years attending an ambulatory care clinic of a community-based, university-affiliated family medicine training program. Parents completed the Child Behavior Checklist and also indicated whether psychosocial problems were discussed or managed. Physicians completed a checklist about the psychosocial status of the child and potential interventions for identified problems. One half of the participating parents formed the experimental group and were also asked to note their concerns on a Psychosocial Checklist for Children and to discuss these concerns with their child's physician; the other half of parents received no such checklist and acted as the control group. All interactions between parents and physicians were videotaped. RESULTS. The number of parental psychosocial disclosures, but not the number of parents who disclosed them, was significantly higher for the experimental group. Physicians were three times as likely to identify a psychosocial problem and 10 times as likely to intervene when parents discussed psychosocial concerns. CONCLUSIONS. Parents' disclosure of psychosocial concerns to their child's physician increases the likelihood of physicians identifying and intervening for these problems. The finding that physicians intervened for psychosocial problems even when they failed to record these problems suggests that research needs to focus on measuring both intervention and identification. [ABSTRACT FROM AUTHOR]

BACKGROUND. Between 15% and 25% of children who visit primary care physicians have emotional, behavioral, or psychiatric problems that affect their functioning. The majority of these children are treated by primary care physicians. The purpose of this study was to examine the presentation and treatment of children's psychosocial problems in primary care and to investigate ways in which physician management of a problem is related to parent-physician agreement that the problem exists. METHODS. Twenty-six physicians at an ambulatory care center of a community-based, university-affiliated family medicine training program collected data during outpatient visits of 898 children aged 2 to 16 years. The physicians used a checklist to collect data on children's developmental problems, parents' concerns about the psychosocial functioning of their children, whether physicians and parents were in agreement about these concerns, and the parents' influence on physicians' management of the problems. RESULTS. Family physicians and parents agreed that 10% of the children were experiencing psychosocial problems. For 5% of children, physicians recorded emotional or behavioral concerns when parents did not disclose any such concerns. For only 1.8% of children, parents raised psychosocial concerns while physicians did not. Physicians diagnosed and managed psychosocial concerns during both acute-care and well-child visits. When parents and physicians agreed on the presence of pediatric psychosocial problems, referral to a mental health professional was more likely than when they disagreed (60% vs 16%). CONCLUSIONS. Pediatric psychosocial concerns are raised by parents during acute-care and well-child visits. Family physicians identified and managed these problems at rates consistent with past research. Management strategies appeared to differ as a function of agreement between physicians and parents on whether a problem existed. [ABSTRACT FROM AUTHOR]

Research on the perception of assertive behavior has suggested that although assertion may result in compliance with one's requests, assertion alone may be negatively evaluated. Recent research has suggested that an opportunity to observe models in commendatory situations may mitigate the negative impact of assertion. This study evaluated whether an opportunity to observe models in conversational situations could also mitigate the negative impact of assertion. Findings suggested that the addition of conversational comments to an individual's repertoire of social skills mitigated the negative perceptions of assertion alone. When compared with commendatory comments, conversational comments resulted in similar evaluations for females and more favorable evaluations for males. Also, the findings of the present study suggest a cumulative impact of exposure to assertion, implying possible artifactual results in some previous perception of assertiveness research. [ABSTRACT FROM PUBLISHER]

The present study examined the impact of assertion, empathic assertion, and conversational behavior on the perception of likability and sex-role orientation of the asserter. Findings suggested that empathic comments mitigated the negative impact of assertion. Perceptions of sex-role indicated that males viewed assertive models as either androgynous or masculine whereas females tended to classify assertive models as masculine. Both males and females rated empathic assertive models as either androgynous or masculine. Possible clinical implications of sex-role-consistent assertive behavior and explanations for lack of assertiveness are discussed. [ABSTRACT FROM PUBLISHER]

Introduction: Sickle cell disease (SCD) can shorten lives and may result in severe clinical complications. Hydroxyurea (HU) is inexpensive, widely available, and National Institutes of Health (NIH) recommends HU for SCD. Despite these benefits, utilization of HU is low. Barriers to taking HU include inaccurate perceptions of serious side effects such as hair loss, a significant barrier in the African American community. However, at doses for treating SCD, the incidence of side effects is extremely low. Using a retrospective medical record review, the impact of a revised consent procedure for HU that addressed these barriers was evaluated., Methods: SCD patients 2-20yo eligible for HU were examined. Patients prescribed HU versus those not prescribed HU were compared one year before and one year after revising consent procedures., Results: Change in clinic practice (including revised consent procedures) resulted in 158% more patients agreeing to HU therapy (p<.001)., Discussion: The revised consent procedures are not resource intensive and easy to implement. Future research should address treatment acceptability, intimidation, and cultural sensitivity., (Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: Parenting practices and cognitions are associated with child externalizing behavior problems. Parenting programs targeting these areas are effective in improving child behavior but are limited to the extent to which they reach at-risk families. This study compared the parenting practices and cognitions of parents with high and low tolerance for misbehavior to parents of children with clinically significant behavior problems to evaluate the utility of assessing parental tolerance for identifying children at risk for externalizing behavior problems., Methods: Participants were 1014 parents of children between the ages of 2 and 16 years presenting for primary care. Parents completed the Eyberg Child Behavior Inventory, Parenting Scale, and Parenting Sense of Competence Scale., Results: Parents with high and low tolerance resembled the clinically significant problem groups in both parental behaviors and cognitions. Differences regarding parental cognitions were consistent across all age groups assessed., Conclusions: This study demonstrated the clinical utility of interpreting caregiver responses to questions about the intensity of their child's behavior problems and parental tolerance for these problems separately. Results indicated that parents with high or low tolerance for their child's behavior are at risk of having children with clinically significant behavior problems. Parents who are concerned about their child's behavior, even if their child does not currently exhibit clinically significant behavior problems, are likely to profit from early intervention for behavior problems.