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Purpose: To measure the prevalence of speech-language pathologist (SLP) involvement and associated trends for critically ill children in United States (US) paediatric intensive care units (PICU) through secondary analysis of the Prevalence of Acute Rehab for Kids in the PICU (PARK-PICU) study data. Method: A secondary analysis of cross-sectional point prevalence study conducted over 1 day in 82 US PICUs. Data collected included SLP presence, patients' age, length of stay, medical interventions, aetiology, admission data, Glasgow Coma Scale scores, staffing involvement, and family presence. Result: Among 961 patients, 82 were visited by an SLP on the study day for a prevalence of 8.5%. Most visits were for children <3 years old. The odds of SLP involvement were lower for children who were 7–12 years old (vs. age 0–2; adjusted odds ratio [aOR] 0.28; 95% CI 0.1–0.8), were mechanically ventilated via endotracheal tube (vs. room air; aOR 0.02; 95% CI 0.005–0.11), or had mild or severe disability (mild vs. no disability; aOR 0.34; 95% CI 0.16–0.76 and severe vs. no disability; aOR 0.39; 95% CI 0.17–0.90). Concurrent physical and/or occupational therapy involvement was associated with higher odds of SLP involvement (aOR 3.6; 95% CI 2.1–6.4). Conclusion: SLP involvement is infrequent in US PICUs. PICU teams should be educated about the scope of SLP practice, to support communication and oral feeding needs during early recovery from critical illness. [ABSTRACT FROM AUTHOR]

This study on the racial socialization practices and dilemmas of caregivers of 0–8 year-old BIPOC children utilized an open-ended online survey, with a mixed-methods approach to data analysis. The study included 173 caregivers (i.e., 59% white; 41% BIPOC; 94.2% female) in the U.S. who held a variety of roles (e.g., 33.5% parents/relatives; 28.3% early childhood educators; 12.1% mental health/health professionals). Caregivers were prompted with a message about joy and resilience in BIPOC children. Analysis of open-ended data revealed practices such as the use of books, adult education, talking, preparation for bias or acknowledgment of racism, stereotyping, privilege, anti-bias/anti-racist education, art, music, dance, home language, and miscellaneous topics. Caregivers highlighted the following: (a) Nurturing a positive racial identity and pride in children's own heritage; (b) Nurturing love and knowledge about racial diversity; (c) Preparation for bias; and, (d) Racial socialization network: Adult-to-adult practices. Regarding racial socialization dilemmas, caregivers highlighted challenges with nurturing a positive racial identity/pride in children's heritage; nurturing love and knowledge about racial diversity; preparation for bias; and, adult education. Dilemmas were reported about nurturing self-love in a racist world, whiteness, others' biases, relationships, representation, multiracial families, own biases, age appropriateness, and colorism. Chi-square analyses confirmed that there were no statistically significant differences between white and BIPOC, and familial and non-familial, caregivers' racial socialization practices and dilemmas. Descriptive results revealed some differences in racial socialization dilemmas by race and role of caregivers. Highlights: 173 racially diverse familial and non-familial caregivers caring for BIPOC children reported racial socialization practices and dilemmas Examples of racial socialization practices include: use of books, adult education, talking, preparation for bias or acknowledgment of racism, stereotyping, privilege, anti-bias/anti-racist education, art, music, dance, and home language Racial socialization dilemmas were reported around nurturing self-love in a racist world, whiteness, others' biases, relationships, representation, multiracial families, own biases, age appropriateness, and colorism [ABSTRACT FROM AUTHOR]

Background Asymptomatic SARS-CoV-2 infection in children is highly prevalent but its acute and chronic implications have been minimally described. Methods In this controlled case-ascertained household transmission study, we recruited asymptomatic children <18 years with SARS-CoV-2 nucleic acid testing performed at 12 tertiary care pediatric institutions in Canada and the United States. We attempted to recruit all test-positive children and 1 to 3 test-negative, site-matched controls. After 14 days' follow-up we assessed the clinical (ie, symptomatic) and combined (ie, test-positive, or symptomatic) secondary attack rates (SARs) among household contacts. Additionally, post–COVID-19 condition (PCC) was assessed in SARS-CoV-2–positive participating children after 90 days' follow-up. Results A total of 111 test-positive and 256 SARS-CoV-2 test-negative asymptomatic children were enrolled between January 2021 and April 2022. After 14 days, excluding households with co-primary cases, the clinical SAR among household contacts of SARS-CoV-2–positive and –negative index children was 10.6% (19/179; 95% CI: 6.5%–16.1%) and 2.0% (13/663; 95% CI: 1.0%–3.3%), respectively (relative risk = 5.4; 95% CI: 2.7–10.7). In households with a SARS-CoV-2–positive index child, age <5 years, being pre-symptomatic (ie, developed symptoms after test), and testing positive during Omicron and Delta circulation periods (vs earlier) were associated with increased clinical and combined SARs among household contacts. Among 77 asymptomatic SARS-CoV-2–infected children with 90-day follow-up, 6 (7.8%; 95% CI: 2.9%–16.2%) reported PCC. Conclusions Asymptomatic SARS-CoV-2–infected children, especially those <5 years, are important contributors to household transmission, with 1 in 10 exposed household contacts developing symptomatic illness within 14 days. Asymptomatic SARS-CoV-2–infected children may develop PCC. [ABSTRACT FROM AUTHOR]

The study objective was to evaluate the impact of the coronavirus disease (COVID-19) pandemic on pediatric blood lead testing in the United States. Clinical laboratory pediatric (ages <6 years) blood lead level (BLL) tests performed by Quest Diagnostics, January 2019–March 2022, were analyzed. Patients were categorized by age, by sex, and, through matching by ZIP code with US Census data, for race, ethnicity, pre-1950 housing, and poverty estimates. Over 2.8 million results from children (<6 years old) from all 50 states and the District of Columbia were included. Compared to March–May 2019, BLL testing was lower by 53.6% in March–May 2020 and lower by 14.6% in March–May 2021. Testing rebounded more for children in predominantly White non-Hispanic communities and among children living in communities, based on ZIP codes, with the least pre-1950 housing stock and lowest poverty rates. The proportion of children with BLL at or above the United States Centers for Disease Control and Prevention reference values of 3.5 and 5.0 µg/dL fell by 19% and 24%, respectively, in 2021 versus 2019. In conclusion, pediatric BLL testing has rebounded from sharp declines during the early pandemic period but unevenly. Declines in the proportion of children with elevated BLL should be interpreted with caution, as testing rebounds were less robust among communities with the highest risk of lead poisoning, notably communities with the oldest housing stock and higher poverty rates. More public health efforts are needed to address lead toxicity throughout the United States, especially in communities that did not experience a full rebound subsequent to the early COVID-19 pandemic period. [ABSTRACT FROM AUTHOR]

This study examined the role of parental aggravation in the pathway from maternal depression to child depression in different family structures. While studies have extensively examined the transmission of maternal depressive symptoms to children, there is still a limited emphasis on potential contributors, such as parental aggravation. Meanwhile, cohabiting and single‐parent families are more vulnerable to multiple risk factors than married families. Using a large national longitudinal dataset, this study examined the indirect effect of parental aggravation on the association between maternal depression and child depression among married, cohabiting and single‐mother families. Secondary data analysis was performed using multigroup mediation analysis on three waves from the Future of Families and Child Wellbeing Studies (n = 3 117). The study results show that only in cohabiting households did maternal depression have a direct association with child depression. Furthermore, in married, cohabiting and single‐mother families, parental aggravation had indirect effects on the association between maternal depression and child depression. Implications for social work professionals to address the mental health of parents and children from non‐traditional families are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have evaluated the health of Middle Eastern and North African (MENA) women and children in the United States. Objectives were to determine the odds of well-visits, preventive behaviors during pregnancy, and low birthweight among foreign-born non-Hispanic MENA women and children compared to their US- and foreign-born non-Hispanic White counterparts after adjusting for covariates (hereafter, reported as MENA and White). Methods: We analyzed 2000–2018 National Health Interview Survey data (411,709 women, 311,961 children). Outcomes included well-woman visits (past 12 months); dentist visits (past 6 months) and current smoking among pregnant women; and low, moderately low, and very low birthweight among children. Covariates included age, family income, and health insurance for children. Education and marital status were also evaluated among women. Results: Over half (53.4%) of foreign-born MENA women were of childbearing age (ages 18–45) compared to 47.7% US-born and 43.2% foreign-born White women. The odds of completing a well-women visit were 0.73 times lower (95% CI = 0.38–0.89) among foreign-born MENA women compared to US-born White women after adjusting for age, education, and marital status. There was no statistically significant difference in dental visits between groups. No foreign-born MENA pregnant women reported current smoking. Foreign-born MENA children had higher odds of low (OR = 1.65; 95% CI = 1.16–2.35) and moderately low birthweight (OR = 1.78; 95% CI = 1.19–2.66) compared to US-born White children in adjusted models. Discussion: MENA women and children are classified as White by the federal government. Our results highlight that the health of foreign-born MENA women and children differ from their White counterparts. Significance: What is already known on this subject?: National studies have evaluated maternal and perinatal health among minoritized groups; however, none have presented results among Middle Eastern and North African (MENA) women and children. The few studies that have evaluated MENA maternal and child health (MCH) outcomes have provided only state and local estimates. What this study adds?: This study provides nationally representative baseline data on the maternal and perinatal health of foreign-born MENA women and children. This is the first study to examine oral health among pregnant MENA women compared to US- and foreign-born pregnant White women. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the impact of a culturally based intervention, the Intertribal Talking Circle program, compared to a standard alcohol and drug abuse education, the Be A Winner program. Community‐based participatory research was used to implement a two‐condition, quasi‐experimental study. The sample included 540 Native American youth ages 10−12 years old from three tribal areas in the United States. Data were collected at baseline, 6 and 12‐months post‐intervention for both the intervention and control groups using demographic, cultural identity, alcohol use, and drug use questionnaires. Regression models evaluated participants' improvement in decreasing alcohol and drug use and increasing cultural identity. Findings revealed that alcohol and drug use decreased more significantly among youth who participated in the Intertribal Talking Circle (ITC) intervention program than youth who participated in a standard alcohol and drug abuse education Be A Winner (BAW) program. Cultural identity also increased more significantly among participants who completed the Talking Circle intervention program. Native American youth ages 10−12 years old respond positively to a culturally based intervention for the reduction of alcohol and drug use. The findings highlight the importance of cultural values and identity and their significance in preventing and reducing alcohol and drug use among Native American youth. [ABSTRACT FROM AUTHOR]

Purpose: This study had two aims. Aim 1 was to query both communication science and disorders (CSD) faculty and school-based speech-language pathologists (SLPs) regarding how written language is/was covered in their graduate programs. Aim 2 was to query school-based SLPs about their written language service provision. Method: CSD faculty (n = 143) and school-based SLPs (n = 610) completed an online survey examining (a) if and how written language was addressed in their graduate program, (b) what content related to written language was covered in graduate school, and (c) provision of written language services in schools (SLPs only). Results: There was a discrepancy in reports of training provision. Faculty reported providing more training than SLPs reported receiving. However, SLPs with fewer years of experience reported slightly higher levels of training compared to those with more years of experience. Additionally, there was variability among SLPs in how often they targeted written language in therapy. Finally, receipt of training in written language was a significant predictor of provision of written language services, as reported by SLPs. Conclusions: SLPs play a key role on literacy teams in schools, but many SLPs did not receive adequate training in written language. In order to ensure SLPs are trained to work with children with reading difficulties, graduate programs should ensure that written language is part of the clinical and academic curricula. [ABSTRACT FROM AUTHOR]

Objective Both high altitude and trisomy 21 (T21) status can negatively impact respiratory outcomes. The objective of this study was to examine the association between altitude and perinatal respiratory support in neonates with T21 compared with those without T21. Study Design This retrospective cohort study used the United States all-county natality files that included live, singleton, in-hospital births from 2015 to 2019. Descriptive statistics for neonates with and without the primary outcome of sustained assisted ventilation (>6 hours) were compared using t -tests and Chi-squared analyses. Multivariable logistic regression was used to determine the association between respiratory support and the presence of T21, and included an interaction term to determine whether the association between respiratory support and the presence of T21 was modified by elevation at delivery. Results A total of 17,939,006 neonates, 4,059 (0.02%) with T21 and 17,934,947 (99.98%) without, were included in the study. The odds of requiring sustained respiratory support following delivery were 5.95 (95% confidence interval [CI]: 5.31, 6.66), 4.06 (95% CI: 2.39, 6.89), 2.36 (95% CI: 1.64, 3.40), and 5.04 (95% CI: 1.54, 16.54) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevations, respectively. The odds of requiring immediate ventilation support following delivery were 5.01 (95% CI: 4.59, 5.46), 5.90 (95% CI: 4.16, 8.36), 2.86 (95% CI: 2.15, 3.80), and 12.08 (95% CI: 6.78, 21.51) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevation, respectively. Conclusion Neonates with T21 have increased odds of requiring respiratory support following delivery when compared with neonates without T21 at all categories of altitude. However, the odds ratios did not increase monotonically with altitude which indicates additional research is critical in understanding the effects of altitude on neonates with T21. Key Points Neonates with T21 have an increased need for perinatal respiratory support at all altitudes. The odds of needing perinatal respiratory support did not increase monotonically with elevation. Additional research is critical to understanding the effects of altitude on neonates with T21. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the implementation of the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines for the Psychological Care of Children and Adolescents with Type 1 Diabetes. Objective: To collect benchmark data on psychosocial staffing and implementation of the ISPAD guidelines across U.S. pediatric diabetes clinics. Methods: Medical (n = 95; 77 endocrinologists and 18 advance practice providers) and psychosocial (n = 86; 43 social workers and 43 psychologists) providers from 98 of 115 contacted clinics completed an online survey (85% response rate). Providers reported the number of psychosocial staff and rated the adequacy of psychosocial staffing, quality of psychosocial care, and adherence to the ISPAD guidelines in their clinics. χ2 Tests and ANOVA were used to examine differences across clinic size and across medical and psychosocial providers. Results: Clinics averaged a total of ∼4 hours per week of psychosocial provider time per 100 patients with type 1 diabetes. Only 27% of providers agreed that psychosocial staffing was adequate, and 35% described their psychosocial care as comprehensive. Implementation of the ISPAD guidelines varied across clinics, with minimal differences across clinic size. Medical providers reported that evidence-based psychological assessment and interventions were delivered consistently by <55% of clinics. Psychosocial, compared with medical, providers were more likely to report frequent implementation of psychosocial assessment and intervention guidelines. Conclusion: Psychological care in U.S. pediatric type 1 diabetes clinics does not consistently meet the ISPAD guidelines, and many clinics lack adequate psychosocial staff. These benchmark data are a foundational step to improve psychosocial care for pediatric patients with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Background: To evaluate how effective preparatory interventions for paediatric day surgery are at reducing parents' anxiety and stress and children's pain and fear. Methods: A systematic review was conducted according to Joanna Briggs Institute (JBI) guidelines and reported using the PRISMA 2020 checklist. PubMed, CINAHL (EBSCO), Scopus, Medic and Web of Science were screened for original research published up until December 2020, while Mednar and EBSCO Open Dissertations were used to identify any relevant grey literature. The methodological quality and risks of bias were evaluated according to JBI guidelines by two authors. The eligibility criteria were parents of a preschool (2‐ to 6‐year‐old) child going through day surgery with preparatory interventions, outcomes measured anxiety, stress (parent), fear and pain (child), and randomised controlled trial (RCT). Results: Two thousand and three hundred and fourteen RCTs were screened. Fifteen studies (including 1514 participants) were chosen for narrative synthesis of parental anxiety and stress and children's fear and pain. Nine studies underwent a meta‐analysis of parental anxiety (n = 970). The interventions were categorised as functional, informative or a combination of both. Four interventions reduced parents' anxiety while two significantly alleviated children's postoperative pain. The interventions found to be effective combined various ways of providing information. The meta‐analysis did reveal a statistically significant impact on parents' anxiety (SMD =0.22, 95% Cl [0.03, 0.41], z = 2.28, p =.023). None of the studies dealt with parental stress or fear in children. Conclusions: The studied interventions used various preparatory approaches, some of which were effective at reducing parental anxiety. More RCT studies are needed to find the most effective methods for preparing parents and their children for day surgery. Relevance to Clinical Practice: Preparation for day surgery through appropriate interventions can reduce anxiety among parents and postoperative pain in children. [ABSTRACT FROM AUTHOR]

We examined the impact of distance learning-related parental stress due to COVID-19 on parental alcohol consumption using an online survey in May 2020 with a convenience sample of U.S. adults. This article focuses on the 361 parents who had children under the age of 18 living with them. Seventy-eight percent had children who were engaged in distance learning; 59% reported being stressed because they were not sure how to help their children with distance learning. Stressed parents reported consuming significantly more alcohol and binge drinking more often than parents who were not stressed by distance learning. We hope that public health professionals can use our findings to better target alcohol prevention programs aimed at parents to reduce parental stress, and hopefully, parental alcohol consumption. [ABSTRACT FROM AUTHOR]

Background Comparing body fat and the effect of body fat on metabolic abnormalities in Chinese and USA teenagers may provide clues for the early prevention and control of cardiovascular disease (CVD). We aimed to compare the prevalence of glucose and lipid metabolism abnormalities, body fat amount and distribution, and the effect of body fat on glucose and lipid metabolism in Chinese and US teenagers. Methods We included 5424 Chinese teenagers (48.5% male) from the China Child and Adolescent Cardiovascular Health (CCACH) study and 8704 USA teenagers (55.6% male) from the USA National Health and Nutrition Examination Survey (NHANES). Blood lipid, blood glucose, and body fat indicators were obtained using the same standardised measurements. Results The prevalence of dyslipidaemia in Chinese teenagers was of those in the USA (hypercholesterolaemia = 3.5% vs 7.4%; high low-density lipoprotein cholesterol (LDL-C) = 3.6% vs 5.0%; low high-density lipoprotein cholesterol (HDL-C)=9.9% vs 14.3%; hypertriglyceridaemia=3.7% vs 10.1%) (P<0.05). However, with the increase in body mass index (BMI), the prevalence of high LDL-C increased more in Chinese than in US teenagers, even exceeding them in the obese group (2.7% in non-overweight to 9.7% in overweight group in China, P<0.05; 3.5% in non-overweight to 6.5% in the obese group in the USA, P<0.05). The prevalence of impaired fasting glucose was higher in China than in the USA (28.0% vs 17.5%, P<0.05). Besides, Chinese adolescents are more likely to accumulate fat in the abdomen, and the per-unit fat increase would bring a higher risk of dyslipidaemia in Chinese boys than in USA boys. Conclusions Dyslipidaemia was more prevalent in US teenagers than in Chinese teenagers, but with the increase in BMI, the prevalence of high LDL-C increased more in Chinese than in US teenagers. Impaired fasting glucose (IFG) was significantly more prevalent in China than in the USA. The unfavoured body fat and higher risk of body fat on metabolic disorders in Chinese teenagers suggest that Chinese teenagers should pay more attention to the adverse effect of body fat on metabolic abnormalities. [ABSTRACT FROM AUTHOR]

Bullying is a type of youth violence and an adverse childhood experience that can result in trauma and have immediate and long-term consequences for all involved. It can happen at school or elsewhere — including online entertainment and social and learning environments. Some children are at increased risk for bullying victimization, such as those targeted because of their racial/ethnic background or cultural identity. This study assessed U.S. parents and caregivers' self-reported changes in concern about their children's involvement in bullying during Fall 2020 compared to the prior year, which was marked by extraordinary historical circumstances (e.g., COVID-19 pandemic, heightened awareness of racial inequities, schools transitioning to virtual learning). Secondary analyses of data from the 2020 Fall ConsumerStyles and Estilos online panel surveys — designed to be representative of U.S. adults overall and U.S. Hispanic adults, respectively — were conducted. Differences by children's type of school attendance (i.e., physically at school or not) and parents' sociodemographic characteristics were explored. While findings suggest that U.S. parents' concern for their children being bullied during Fall 2020 compared to the prior year did not change, significant differences were found by the children's type of school attendance and the parents' race/ethnicity — with increased concern among parents of children who physically attended school, non-Hispanic Black parents and Hispanic parents. Among parents who reported being less concerned during Fall 2020 about their children being bullied compared to the prior year, not being physically at school is noted as the main reason why. Parents who reported being more concerned frequently noted racism as the reason why. It is imperative to understand what parents think about bullying, to best inform efforts to support their key role in bullying prevention. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) vaccine hesitancy has remained a significant concern among adults worldwide. However, not much is known about parental vaccine hesitancy for getting children vaccinated for COVID-19 in the U.S. Thus, the purpose of this study was to conduct a national assessment of parents' preferences for COVID-19 vaccination of children using the evidence-based Multi-Theory Model (MTM) and explore the predictors of vaccine hesitancy. Methods: To participate in this study, a national random sample of parents (n=263) took a valid and reliable online questionnaire based on the MTM. Independent samples t test, chi-square test, multiple logistic regression was utilized to analyze data. Results: More than two-fifths (42%) of the participating parents were not willing to get their children vaccinated for COVID-19. Parental vaccination status, booster dose acceptance, education, and political affiliation were significant predictors of willingness to get children vaccinated for COVID-19. In the multiple logistic regression analyses, behavioral confidence and participatory dialogue (i.e., perceived advantages versus disadvantages) were statistically significant predictors of COVID-19 vaccination hesitancy for children among the participating parents. Conclusion: Given the multiple factors that were found influential in parental hesitancy for COVID-19 vaccination among children, multimodal and evidence-based interventions are needed to increase the uptake of COVID-19 vaccines among children by influencing the parents' perceptions, increasing their confidence, dispelling misinformation, and reducing constraints for vaccination. Such interventions should emphasize communication and messaging that is truthful, interactive, scientifically correct, and to be delivered in a variety of community-based settings. [ABSTRACT FROM AUTHOR]

Despite a series of high-profile media reports of sexual abuse in sport over the past few years, little research has been done to explore the scope of the problem in the United States. The current article reports on prevalence of child sexual assault in elite athletes in the United States. Using a retrospective web survey, adults answered questions on their experiences in sport. Of the 473 elite athletes surveyed, 3.8% (n = 18) reported being sexual assaulted as a minor in the sporting context. Of those reporting assault, most (61%) reported being abused by an adult authority figure (usually a coach) and 44% reported being assaulted by a peer. Abused athletes were significantly more likely to report having been diagnosed with a mental disorder (Fisher's exact test; p <.001). The findings can be utilized to improve prevention and child protection measures and other safeguarding initiatives in sport. [ABSTRACT FROM AUTHOR]

Few studies have examined children's enrollment in high-deductible health plans (HDHPs) and associations with health service use. We examine trends, health service use, and financial barriers to care for US children with high-deductible private insurance. Trend data on HDHP enrollment were available for 58,910 children ages 0 to 17 with private insurance from the 2007 to 2018 National Health Interview Survey. Health service indicators were examined in a cross-sectional sample of 23,959 children in the 2014-2018 datasets. High deductible was defined as a minimum of $2,700 for a family in 2018. Chi-square tests examined associations of HDHPs with health service indicators. Logistic regression models adjusted for sociodemographics and child health. The percent of privately insured children with HDHPs increased from 18.4% to 48.6% from 2007 to 2018. In adjusted regression, those with HDHPs fared worse than those with traditional plans on 7 of 10 measures and those with HDHPs and no health savings account (HSA) fared worse on eight. While small differences were found for various child-focused measures, the most consistent differences were found for family-focused measures. Parents with HDHPs were more likely than parents with traditional private insurance to report they had delayed or forgone their medical care (10.2% vs 5.7%), had problems paying medical bills (15.7% vs 10.3%), and had family medical debt (34.1% vs 25.8%). Privately insured families have seen substantial growth in high-deductible plans in the last decade. Families with HDHPs, especially those without HSAs, have more financial barriers to care. [ABSTRACT FROM AUTHOR]

This study examines the lifetime prevalence and distribution of family/friend homicide exposure among children and adolescents age 2 to 17 in the United States, and assesses the impact of family/friend homicide on emotional and behavioral outcomes, while controlling for potential co-occurring factors. Data were collected by telephone about the experiences of youth in 2008, 2011, or 2014, as part of the National Surveys of Children's Exposure to Violence (NatSCEV). Analyses are based on a pooled sample (n =11,771) from these three surveys. Approximately 8% of all children and youth ages 2 to 17 were exposed to a family/friend homicide. Older adolescents, Black youth, those living in single parent and nonparent family households, those from lower socioeconomic status households, and youth living in large cities were overrepresented among youth experiencing family or friend homicide. Exposed youth were also substantially more likely to be poly-victims, experience other major adversities, and live in neighborhoods with more community disorder. Exposure to family/friend homicide was significantly related to trauma symptoms. However, when other co-occurring factors were taken into account, only family/friend homicide that occurred within the last 2 years remained significant. With respect to delinquency, only nonfamily homicide exposure remained significant with these other factors controlled. Findings suggest that family/friend homicide represents a powerful marker for a broad level of victimization risk and adversity, demonstrating that family/friend murder is often just one relatively small part of a more complicated life of adversity. Although recent exposure is certainly distressing to youth, it is the wider, co-occurring context of poly-victimization and other types of adversity that appears most impactful in the longer term. [ABSTRACT FROM AUTHOR]

The literature reports that regardless of the high obesity prevalence estimates in young children, parents often do not accurately perceive their child's weight status. The purpose of this analysis was to examine the association between parent/child demographic characteristics including ethnicity, country of birth and years living in the United States and the perception of child's anthropometric phenotype status based on a visual silhouette instrument. Caregiver (n = 456) and child sociodemographic, perception of child anthropometric phenotype status and height/weight measurements were collected in 2015, from 24 childcare centres in Miami, Florida, among children ages 2‐to‐5 years old. Chi‐square analysis determined parent perception accuracy by actual child healthy (

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

Problem: Prenatal substance exposure and neonatal abstinence syndrome (NAS) are risk factors for adverse behavioral outcomes in children at 24 months of age. Methods: The purpose of this study was to examine factors associated with abnormal behavioral development in children with prenatal substance exposure or NAS through 10 years of age. A retrospective, nonexperimental, longitudinal design to examine the effects of prenatal substance exposure and NAS on behavioral development at 1, 5, and 10 years of age, while controlling for intrapersonal, interpersonal, community, organizational, and public policy characteristics. A hierarchical multivariate logistic regression model was used to evaluate the influence of substance exposure and NAS on behavioral outcomes. Findings: Abnormal behavioral development was predicted at 10 years of age with polysubstance exposure to three substances (odds ratio [OR] = 2.711, p < 0.01) and NAS (OR = 2.077, p <.001). Conclusion: Psychiatric nursing care for children with prenatal substance exposure and NAS should include implementation of early and continued behavioral evaluation and childhood trauma and adversity surveillance in children through middle childhood. [ABSTRACT FROM AUTHOR]

Background Motor impairments are pervasive in Autism Spectrum Disorder (ASD); however, children with ASD rarely receive a dual diagnosis of Developmental Coordination Disorder (DCD). The Simons Foundation SPARK study engaged families affected by ASD through an online study. Objectives The DCD parent questionnaire (DCDQ) was used to assess the prevalence of a risk for motor impairment or DCD in children with ASD between 5 and 15 years of age. Design This study utilizes parent reports from a large database of children with ASD. Methods A total of 16,705 parents of children with ASD completed the DCDQ. We obtained our final SPARK dataset (n = 11,814) after filtering out invalid data, using stronger cut-offs to confirm ASD traits, and excluding children with general neuromotor impairments/intellectual delays. We compared DCDQ total and subscale scores from the SPARK dataset with published norms for each age between 5 and 15 years. Results The proportion of children with ASD at risk for a motor impairment was very high at 86.9%. Children with ASD did not outgrow their motor impairments and continued to present with a risk for DCD even into adolescence. Yet, only 31.6% of children were receiving physical therapy services. Limitations Our analysis of a large database of parent-reported outcomes using the DCDQ did not involve follow-up clinical assessments. Conclusions Using a large sample of children with ASD, this study shows that a risk for motor impairment or DCD was present in most children with ASD and persists into adolescence; however, only a small proportion of children with ASD were receiving physical therapist interventions. A diagnosis of ASD must trigger motor screening, evaluations, and appropriate interventions by physical and occupational therapists to address the functional impairments of children with ASD while also positively impacting their social communication, cognition, and behavior. Using valid motor measures, future research must determine if motor impairment is a fundamental feature of ASD. [ABSTRACT FROM AUTHOR]

Research is needed to examine new and innovative web-based intervention delivery methods that are feasible, cost-effective, and acceptable to children and their families to increase access to palliative care services in the home and community. Our previous work included the development of a legacy intervention using face-to-face digital storytelling for children with cancer that showed feasibility and strong promise to improve child outcomes. However, face-to-face intervention delivery techniques limited our recruitment, thus decreasing sample size and potential access to broader populations. Here we present the systematic steps of the development of a web-based legacy intervention for children (7-17 years of age) with relapsed or refractory cancer and their parent caregivers. Counts and frequencies for parent (n = 81) reports on satisfaction surveys are presented and parent suggestions for future work. Results suggest the web-based legacy intervention is feasible and acceptable, with parent-perceived beneficial outcomes for the child, parent, and family. Results provide a foundation for web-based intervention development in palliative care and the implementation of a theoretically grounded intervention to reduce suffering of seriously ill children and their family members, thereby advancing the science of symptom management in vulnerable palliative care populations. [ABSTRACT FROM AUTHOR]

Objectives: One in five children have a learning and attentional disability (LAD). Parents of children with LAD are vulnerable to distress, but an evidence-based treatment has not been developed. Methods: From June 2016 to November 2017, we conducted a mixed methods study to adapt and assess the virtual delivery of a mind-body group resiliency program, the Stress Management and Resiliency Training-Relaxation Response Resiliency Program (SMART-3RP), to meet the needs of parents of children with LAD; this is an 8-session weekly group intervention. In the first phase, we conducted 4 parent focus group interviews, 2 professional focus group interviews, and 5 professional individual interviews, and 1 pilot group to adapt the SMART-3RP to target the needs of parents of children with LAD. In the second phase, we conducted a pilot wait-list controlled study to assess the feasibility, acceptability, and preliminary efficacy of a videoconferencing delivery of the adapted program. Parents were randomized to an immediate intervention group (IG) or wait-list control group (WC). Surveys were administered at baseline (time 1), end of intervention for the IG or 3 months post-baseline for the WC (time 2), and 3 months post treatment for the IG or end of intervention for the WC (time 3). Results: Qualitative findings illustrated high levels of parental stress, with primary stressors including navigating the educational system, interactions with other parents, familial concerns, and financial and professional sacrifices. We adapted the manual to target these stressors and modified session logistics and delivery. Fifty-three parents (mean age = 46.8; 90.6% female) participated nationally in the pilot trial. 62.5% of participants completed ≥ 6/8 sessions; 81.8% reported continued daily/weekly relaxation response exercise practice. T1–T2 comparisons found that IG versus WC participants showed significant improvements in distress [VAS], ∆M = − 1.95; d =.83 and resilience [CES], ∆M = 6.38; d =.83, as well as stress coping [MOCS-A] ∆M = 8.69; d = 1.39; depression and anxiety [PHQ-4], ∆M = − 1.79; d =.71; social support [MOS-SSS], ∆M = 5.47; d =.71; and empathy [IRI], ∆M = 3.17; d =.77; improvements were sustained at the 3 month post intervention follow-up. Conclusion: Pilot wait-list randomized trial findings showed promising feasibility, acceptability, and preliminary efficacy for the SMART-3RP intervention adapted for parents of children with LAD. This virtually-delivered resiliency intervention improved parents' distress, resiliency, and stress coping, which were sustained. Clinical Trials ID: NCT02772432. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify factors associated with the risk of closed head injury (CHI) in children under age 2 years with suspected minor head injuries based on age‐appropriate, or near age‐appropriate, mental status on an exam. The study was a secondary data analysis of a public‐use dataset from the largest prospective, multicenter pediatric head injury study found in the current literature. An existing, validated clinical decision rule was examined using a sample of 3,329 children under age 2 to determine whether it, or the individual variables within it, could be utilized alone, or in conjunction with other variables to accurately predict the risk of underlying CHI in this sample. Results indicated that the keys to an accurate triage assessment for children under age 2 with suspected minor head injuries include the ability to identify the specific skull region injured, the ability to assess for the presence and size of any scalp hematoma, the ability to identify signs of altered mental status in this age group, and having access to accurate information regarding the child's age and the details of the injury mechanism. The findings from this study add to the body of knowledge regarding what factors are associated with CHI in children under age 2 with suspected minor head injuries and could be used to inform age‐specific recommendations for children under age 2 in triage, educational resources, and national trauma criteria. [ABSTRACT FROM AUTHOR]

Purpose: Music is an important part of life for many people. Furthermore, music training has been shown to improve a variety of cognitive functions among children and adults. However, little research exists on how children who are hard of hearing (HH) perceive or participate in music. In particular, it is unknown whether hearing loss limits participation in music activities among school-aged children with mild-to-severe hearing loss. The purpose of this study was to determine whether hearing loss limits participation among children who are HH compared to children with normal hearing (NH). Method: Participants were parents of 2 cohorts of children finishing 5th grade (approximately 11 years old). Parents were asked to complete a survey (online or paper) regarding the role of music in their child's life. A total of 88 surveys were completed (67 from parents of children who are HH and 21 from parents of children with NH, with an overall response rate of 74%). Results: Hearing loss did not limit music participation among children. Children who are HH listened to recorded music, attended live concerts, and practiced an instrument at the same rates as children with NH. Listening to recorded and live music, practicing an instrument, and playing in an ensemble were equally as important to children who are HH as children with NH. Children who are HH were significantly more likely to regularly play in an ensemble than children with NH. Parent participation in music significantly influenced music participation for children who are HH but not children with NH. Descriptive data about music genres, instruments, and ensembles are also presented. Conclusions: Children who are HH participate in music at the same or greater rates as children with NH. Parent participation in music may be particularly important for children who are HH. In light of this, music listening should be a consideration when fitting children with hearing aids. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the influence of oxidative stress (F2-isoprostanes) and inflammatory (interleukin [IL]-8) biomarkers on symptom trajectories during the first 18 months of childhood leukemia treatment. Method: A repeated-measures design was used to evaluate symptoms experienced by 218 children during treatment. A symptom cluster (fatigue, pain, and nausea) was explored over four time periods: initiation of post-induction therapy, 4 and 8 months into post-induction therapy, and the beginning of maintenance therapy (12 months postinduction). F2-isoprostanes and IL-8 were evaluated in cerebrospinal fluid (CSF) samples collected at baseline (diagnosis) and then at the four time periods. The longitudinal relationships of these biomarkers with the symptom cluster were examined using the longitudinal parallel process. Results: Pain and fatigue levels were highest during the post-induction phases of treatment and decreased slightly during maintenance therapy, while nausea scores were relatively stable. Even in the later phases of treatment, children continued to experience symptoms. CSF levels of the biomarkers increased during the post-induction phases of treatment. Early increases in the biomarkers were associated with more severe symptoms during the same period; patients who had increased biomarkers over time also experienced more severe symptoms over time. Conclusions: Findings reveal that children experienced symptoms throughout the course of leukemia treatment and support hypothesized longitudinal relationships of oxidative stress and inflammatory biomarkers with symptom severity. Activation of the biomarker pathways during treatment may explain underlying mechanisms of symptom experiences and identify which children are at risk for severe symptoms. [ABSTRACT FROM AUTHOR]

Despite increased effort to respond to human trafficking at national and state levels, very little empirical research has been conducted on domestic child sex trafficking. This study retrospectively examines associations between multiple risk factors and domestic child sex trafficking (i.e., entry into the commercial sex industry under the age of 18) in a sample of individuals aged 16 and older currently involved in the commercial sex industry (N = 273). Two primary research questions are addressed: (1) What set of risk factors, prior to entering the commercial sex industry, are associated with domestic child sex trafficking and (2) what group differences, if any, exist in risk factors between current or former domestic child sex–trafficking victims and non-trafficked adults engaged in the commercial sex industry? A cross-sectional survey was administered using Respondent-Driven Sampling (RDS) in five cities in one Midwestern state. Overall, 115 participants (48.3%) were identified as current or former domestic child sex–trafficking victims. Bivariate results suggest that childhood emotional and sexual abuse, rape, ever running away from home, having family members in sex work, and having friends who purchased sex were significantly associated with domestic child sex trafficking. Multivariate results indicate that domestic child sex trafficking victims were significantly more likely to have ever run away and to be a racial/ethnic minority than non-trafficked adults engaged in the commercial sex industry. Findings can inform state-level policies on human trafficking and assist child protection and juvenile justice agencies in developing prevention and intervention responses to commercial sexual exploitation. [ABSTRACT FROM AUTHOR]

Objectives: Population-based recruitment of a cohort of women who are currently pregnant or who may become pregnant in a given timeframe presents challenges unique to identifying pregnancy status or the likelihood of future pregnancy. Little is known about the performance of individual eligibility items on pregnancy screeners although they are critical to participant recruitment. This paper examined the patterns and respondent characteristics of key pregnancy screener items used in a large national study.Methods: Cross-sectional analyses were conducted. Descriptive statistics and multivariable logistic regression models were used to examine nonresponse patterns to three questions (currently pregnant, trying to get pregnant and able to get pregnant). The questions were asked of 50,529 women in 17 locations across the US, as part of eligibility screening for the National Children's Study Vanguard Study household-based recruitment.Results: Most respondents were willing to provide information about current pregnancy, trying, and able to get pregnant: 99.3% of respondents answered all three questions and 97.4% provided meaningful answers. Nonresponse ranged from 0.3 to 2.5% for individual items. Multivariable logistic regression results identified small but statistically significant differences in nonresponse by respondent age, marital status, race/ethnicity-language, and household-based recruitment group.Conclusions for Practice: The high levels of response to pregnancy-related items are impressive considering that the eligibility questions were fairly sensitive, were administered at households, and were not part of a respondent-initiated encounter. [ABSTRACT FROM AUTHOR]

Objectives: Learning to swim is recommended for children to prevent drowning and to promote lifelong physical activity. Dissimilar US youth swimming ability rates by demographics have been reported. Our research purpose was to examine youth swimming ability by selected variables, and to compare with similar research in 2010. Methods: USA Swimming Foundation sponsored a cross-sectional study in 5 US cities during 2017. Trained YMCA personnel administered surveys measuring self-reported swimming ability among youth, ages 4-18 (N = 1373). We compared the 2017 results with findings from the 2010 study (N = 1741). Results: In 2017, fewer respondents reported no/low swimming ability. However, groups were identified with a high percentage (greater than 50%) of no/low swimming ability including the following ones; girls, African-American boys and girls, and boys and girls who participate in free or reduced-cost lunch programs. Multivariate analysis showed that significant predictors for lower swimming ability were parent education (less than college education), qualifying for free or reduced-cost lunch programs, and being African-American. Conclusions: No/low swimming ability groups were identified and continue to need support. Interventions should target children who are African-American, qualify for free or reduced-cost lunch, and have parents with lower levels of education. [ABSTRACT FROM AUTHOR]

Background. The effect of age at first dose on the immunogenicity of a 2-dose pediatric schedule of measles-mumps-rubella (MMR) or measles-mumps-rubella-varicella (MMRV) vaccine was assessed in children born to mostly vaccinated mothers. Methods. Immunogenicity data among children given their first measles vaccine dose between 11 and 22 months of age were pooled from 5 randomized controlled trials conducted in Europe and the United States between 2004 and 2010. Measles antibody titers were measured by enzyme-linked immunosorbent assay before and after each dose; geometric mean concentrations (GMCs) and the proportion seronegative (GMC <150 mIU/mL) were derived by age at first dose. Results. Among 5542 children given a first measles vaccine dose at 11, 12, 13-14, and 15-22 months of age, the proportion seronegative decreased from 8.5% to 3.2%, 2.4%, and 1.5%, respectively (P < .001), whereas GMCs increased with older age measles vaccine initiation (P < .001). MMRV induced higher GMCs than MMR (P < .001). First and second dose GMCs were highly correlated (Spearman coefficient = 0.8). Conclusions. As previously noted among infants born to mothers with history of wild-type measles, antibody responses among children born to vaccinated mothers were reduced based on earlier administration of their first measles vaccine dose at =12 vs =15 months of age. Negative effects of earlier age at first measles vaccine dose persisted after the second dose. The measles elimination goal may require a careful balance between earlier infant protection and the risk of reduced antibody responses and secondary vaccine failure among successive birth cohorts systematically initiated to measles vaccination <15 months of age. [ABSTRACT FROM AUTHOR]

Healthy People 2020 targets high vaccination coverage among children. Although reductions in coverage disparities by race/ethnicity have been described, data by nativity are limited. The National Immunization Survey is a random-digit-dialed telephone survey that estimates vaccination coverage among U.S. children aged 19-35 months. We assessed coverage among 52,441 children from pooled 2010-2012 data for individual vaccines and the combined 4:3:1:3*:3:1:4 series (which includes ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine/diphtheria and tetanus toxoids vaccine/diphtheria, tetanus toxoids, and pertussis vaccine, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, ≥3 or ≥4 doses of Haemophilus influenzae type b vaccine (depending on product type of vaccine; denoted as 3* in the series name), ≥3 doses of hepatitis B vaccine, ≥1 dose of varicella vaccine, and ≥4 doses of pneumococcal conjugate vaccine). Coverage estimates controlling for sociodemographic factors and multivariable logistic regression modeling for 4:3:1:3*:3:1:4 series completion are presented. Significantly lower coverage among foreign-born children was detected for DTaP, hepatitis A, hepatitis B, Hib, pneumococcal conjugate, and rotavirus vaccines, and for the combined series. Series completion disparities persisted after control for demographic, access-to-care, poverty, and language effects. Substantial and potentially widening disparities in vaccination coverage exist among foreign-born children. Improved immunization strategies targeting this population and continued vaccination coverage monitoring by nativity are needed. [ABSTRACT FROM AUTHOR]

Parental feeding behaviors and concern about child weight are associated with obesity among youth who are typically developing. Little is known about this relationship among parents of youth with special needs, despite these children having higher obesity risk. This study used an online survey to explore associations among parental feeding behaviors, parent weight concerns, demographics, and child weight status in a sample of 356 parents of children diagnosed with autism spectrum disorder, spina bifida, and Down syndrome. Specific parental feeding behaviors were significantly related to the child’s weight and intensified when the parent was concerned about the child’s weight. Child’s diagnosis, family income, parent age, and parent gender influenced select feeding behaviors. Obesity has significant health ramifications and negatively affects an individual’s ability to self-manage, which is crucial in individuals with special needs. These findings present an opportunity for the health care community to educate and promote healthy feeding practices in this vulnerable population. [ABSTRACT FROM AUTHOR]

A growing number of studies have examined the “immigrant paradox” with respect to health behaviors in the United States. However, little research attention has been afforded to the study of adverse childhood experiences (ACE; neglect, physical and sexual abuse, and witnessing violence) among immigrants in the United States. The present study, using Waves I and II data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), aims to address these gaps by comparing forms of ACE of first- and second-generation immigrants with native-born American adults in the United States. We also examined the latent structure of ACE among immigrants and conducted analyses to assess the psychiatric correlates of identified latent classes. With the exception of neglect, the prevalence of ACE was markedly higher among native-born Americans and second-generation immigrants compared with first-generation immigrants. Four latent classes were identified—limited adverse experience (n = 3,497), emotional and physical abuse (n = 1,262), family violence (n = 358), and global adversity (n = 246). The latter three classes evinced greater likelihood of being diagnosed with a mood, anxiety, personality, and substance use disorder, and to report violent and non-violent antisocial behavior. Consistent with prior research examining the associations between the immigrant paradox and health outcomes, results suggest that first-generation immigrants to the United States are less likely to have experienced physical and sexual abuse and witness domestic violence. However, likely due to cultural circumstances, first-generation immigrants were more likely to report experiences that are deemed neglectful by Western standards. [ABSTRACT FROM AUTHOR]

Prevalence of self-injurious behavior (SIB) is as high as 50% among children with autism spectrum disorder (ASD). Identification of risk factors for the development of SIB is critical to early intervention and prevention. However, there is little empirical research utilizing a prospective design to identify early risk factors for SIB. The purpose of this study was to evaluate behavioral characteristics predicting SIB at age 2 years among 235 infants at high familial risk for ASD. Logistic regression results indicated that presence of SIB or proto-SIB and lower developmental functioning at age 12 months significantly predicted SIB at 24 months. A pattern of persistent SIB over this period was associated with a diagnosis of autism and poorer cognitive and adaptive outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to describe rates of antipsychotic medication use and the association between their use and demographics, clinical variables, and the use of behavioral/education services among children with ASD. For children with ASD ages 2-11 (n = 4749) and those 12-17 (n = 401), 5.4 and 17.7% were prescribed at least one atypical antipsychotic medication respectively. In the multivariable model of young children, older age, use of multiple psychotropic medications, prior ASD diagnosis, non-white Hispanic race/ethnicity, and oppositional defiant problems were associated with antipsychotic use. Among older children, only older age was associated with antipsychotic use. In at least one age group, antipsychotic medication use was also related to behaviour, family and occupational therapy, public insurance, site region, externalizing problems, body mass index, and sleep and gastrointestinal problems. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine if prenatal, pregnancy, or postpartum-related environmental factors abstract are associated with multiple sclerosis (MS) risk in children. METHODS: This is a case-control study of children with MS or clinically isolated syndrome and healthy controls enrolled at 16 clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire, including the capture of pregnancy and perinatal factors. Case status was confirmed by a panel of 3 pediatric MS specialists. Multivariable logistic regression analyses were used to determine association of these environmental factors with case status, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status. RESULTS: Questionnaire responses were available for 265 eligible cases (median age 15.7 years, 62% girls) and 412 healthy controls (median age 14.6, 54% girls). In the primary multivariable analysis, maternal illness during pregnancy was associated with 2.3-fold increase in odds to have MS (95% confidence interval [CI] 1.20-4.21, P = .01) and cesarean delivery with 60% reduction (95% CI 0.20-0.82, P = .01). In a model adjusted for these variables, maternal age and BMI, tobacco smoke exposure, and breastfeeding were not associated with odds to have MS. In the secondary analyses, after adjustment for age, sex, race, ethnicity, and socioeconomic status, having a father who worked in a gardening- related occupation (odds ratio [OR] 2.18, 95% CI 1.14-4.16, P = .02) or any use in household of pesticide-related products (OR 1.73, 95% CI 1.06-2.81, P = .03) were both associated with increased odds to have pediatric MS. CONCLUSION Cesarean delivery and maternal health during pregnancy may influence risk for pediatric-onset MS. We report a new possible association of pesticide-related environmental exposures with pediatric MS that warrants further investigation and replication. [ABSTRACT FROM AUTHOR]

The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors. [ABSTRACT FROM AUTHOR]

Past research has demonstrated the particularly damaging effects of exposure to multiple forms of victimization, or "poly-victimization," on youth mental health. The primary objective of the present study is to begin to identify the mechanisms that help explain its powerful impact. Analyses are based on two waves of longitudinal data from the National Survey of Children's Exposure to Violence (NatSCEV), conducted in 2008 and 2010, that comprised a telephone sample of 1,186 youth ages 10 to 17. Using structural equation modeling, we examine direct and indirect effects on distress symptoms of increased, decreased, and stable high poly-victimization between Waves 1 and 2 compared to no or low victimization in both waves. Specifically, we consider the extent to which reductions in core psychosocial resources, including family support, peer support, self-esteem, and mastery, mediate the relationship between these poly-victimization conditions and distress. Relative to stable low victimization, both increased poly-victimization and stable high poly-victimization were associated with declines in all four resources. However, only self-esteem and mastery significantly mediated the association between poly-victimization and distress, with mastery showing the strongest effect. Although significant indirect effects were evident, poly-victimization still had a strong direct effect on distress with resource factors controlled. Findings support the hypothesis that the potent effect of poly-victimization on youth mental health is, in part, due to its damaging influence on core psychosocial resources. [ABSTRACT FROM AUTHOR]

Purpose: Children who do not develop early literacy skills, especially phonological awareness (PA) and alphabet knowledge, prior to kindergarten are at risk for reading difficulties. We investigated a supplemental curriculum with children demonstrating delays in these skills. Method: A cluster randomized design with 104 preschool-age children in 39 classrooms was used to determine the efficacy of a supplemental PA curriculum, PAth to Literacy. The curriculum consists of 36 daily scripted 10-min lessons with interactive games designed to teach PA and alphabet skills. A vocabulary intervention (Story Friends), which also uses a small-group format, served as the comparison condition. Results: Multilevel modeling indicated that children in the experimental condition demonstrated significantly greater gains on the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) First Sound Fluency (Dynamic Measurement Group, 2006) and Word Parts Fluency (Kaminski & Powell-Smith, 2011) measures. Educational relevance was evident: 82% of the children in the experimental condition met the kindergarten benchmark for First Sound Fluency compared with 34% of the children in the comparison condition. Teachers reported overall satisfaction with the lessons. Conclusions: Results indicated that the vast majority of children demonstrating early literacy delays in preschool may benefit from a supplemental PA curriculum that has the potential to prevent reading difficulties as children transition to kindergarten. [ABSTRACT FROM AUTHOR]

Purpose:To test a model of child, family and service determinants of participation in family and recreational activities for young children with cerebral palsy (CP). Methods:Participants were a convenience sample of 429 children (242 males) with CP, aged 18 to 60 months, representing all levels of the Gross Motor Function Classification System (GMFCS). Children were divided into two groups by GMFCS levels, levels I to II and levels III to V. Data on impairments and gross motor function were collected by therapists; parents provided information about children’s health conditions and adaptive behaviour. Seven months later, parents reported on family life and services received. One year after the beginning of the study, parents reported their children’s participation. Data from the two groups of children were analysed separately using structural equation modelling. Results:The model explained 35% and 40% of the variance of frequency of participation in family and recreation and 28% and 38% of enjoyment in participation, for the two groups of children, respectively. Children’s adaptive behaviour, family ecology, and number of community recreational programs were associated with the frequency of participation for both groups. Gross motor function was only associated with the frequency of participation for children in levels III–V. Adaptive behaviour was associated with enjoyment for both groups. The extent services met children’s needs was associated with enjoyment for children in levels I to II and family ecology was a determinant of enjoyment for children in levels III to V. Conclusion:Supporting children’s adaptive behaviour, family ecology, and access to community recreational programmes may foster participation in family and recreational activities for young children with CP.Implications for RehabilitationParticipation in family and recreational activities for young children with CP is complex and influenced by child, family and environmental factors.Practitioners are encouraged to support children’s adaptive behaviour and access to community programs and family relationships, involvement in community activities and expectations of their children.Optimizing gross motor function for children who have limitations in self-mobility may enhance their participation in family and recreational activities.For children with a good prognosis for walking, providing services perceived by parents to meet their children’s needs may enhance children’s enjoyment of participation. [ABSTRACT FROM PUBLISHER]

This article examines the influence of pubertal timing on substance use patterns, specifically the relationship between onset of menarche and onset of substance use and substance abuse treatment outcomes. Findings show a significant relationship between pubertal timing and age of onset of substance use and age of onset of substance use and substance use severity at intake into treatment. The article concludes with a call for further research into the possible relationship between pubertal timing and treatment outcomes as well as effective gender-specific interventions for prevention and treatment of substance abuse among adolescent girls. [ABSTRACT FROM AUTHOR]

BACKGROUND: Substantial morbidity and excessive care variation are seen with pediatric pneumonia. Accurate risk-stratification tools to guide clinical decision-making are needed. METHODS: We developed risk models to predict severe pneumonia outcomes in children (<18 years) by using data from the Etiology of Pneumonia in the Community Study, a prospective study of community-acquired pneumonia hospitalizations conducted in 3 US cities from January 2010 to June 2012. In-hospital outcomes were organized into an ordinal severity scale encompassing severe (mechanical ventilation, shock, or death), moderate (intensive care admission only), and mild (non-ntensive care hospitalization) outcomes. Twenty predictors, including patient, laboratory, and radiographic characteristics at presentation, were evaluated in 3 models: a full model included all 20 predictors, a reduced model included 10 predictors based on expert consensus, and an electronic health record (EHR) model included 9 predictors typically available as structured data within comprehensive EHRs. Ordinal regression was used for model development. Predictive accuracy was estimated by using discrimination (concordance index). RESULTS: Among the 2319 included children, 21% had a moderate or severe outcome (14% moderate, 7% severe). Each of the models accurately identified risk for moderate or severe pneumonia (concordance index across models 0.78-0.81). Age, vital signs, chest indrawing, and radiologic infiltrate pattern were the strongest predictors of severity. The reduced and EHR models retained most of the strongest predictors and performed as well as the full model. CONCLUSIONS: We created 3 risk models that accurately estimate risk for severe pneumonia in children. Their use holds the potential to improve care and outcomes. [ABSTRACT FROM AUTHOR]

The present study examined the effects of teacher attunement to victimization on student perceptions of the bullying culture of their schools as a means of fostering a sense of belonging among early adolescents. Participants (n = 1,264) in sixth grade reported on the frequency that they had been bullied, and teachers were asked to report students who were “picked on.” Teacher attunement represented the correspondence between self-identified and teacher-identified victims. Attunement at the beginning of the school year was related to positive changes in student reports that their peers would intervene in bullying; in turn, sense of belonging was greater when students perceived that their peers would intervene in bullying. Teacher attunement was indirectly related to greater belonging through its impact on student perceptions of the bullying context. [ABSTRACT FROM AUTHOR]

The current study presents results from an autism spectrum disorder (ASD) public health surveillance project conducted in Minneapolis. The study was designed to compare ASD prevalence in Somali children (ages 7-9) to that of non-Somali children. The study adapted methodology used by the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network. Results indicated that Somali (1 in 32) and White (1 in 36) children were about equally likely to be identified with ASD, but more likely to be identified with ASD than Black and Hispanic children. Somali children with ASD were significantly more likely to have an intellectual disability than children with ASD in all other racial and ethnic groups. [ABSTRACT FROM AUTHOR]

Background: There is a critical need to understand better speech and language development in bilingual children learning two spoken languages who use cochlear implants (CIs) and hearing aids (HAs). The paucity of knowledge in this area poses a significant barrier to providing maximal communicative outcomes to a growing number of children who have a hearing loss (HL) and are learning multiple spoken languages. In fact, the number of bilingual individuals receiving CIs and HAs is rapidly increasing, and Hispanic children display a higher prevalence of HL than the general population of the United States. In order to serve better bilingual children with CIs and HAs, appropriate and effective therapy approaches need to be designed and tested, based on research findings. Aims: This study investigated the effects of supporting both the home language (Spanish) and the language of the majority culture (English) on language outcomes in bilingual children with HL who use CIs and HAs as compared to their bilingual peers who receive English-only support. Methods & Procedures: Retrospective analyses of language measures were completed for two groups of Spanishand English-speaking bilingual children with HL who use CIs and HAs matched on a range of demographic and socio-economic variables: those with dual-language support versus their peers with English-only support. Dependent variables included scores from the English version of the Preschool Language Scales, 4th Edition. Outcomes & Results: Bilingual children who received dual-language support outperformed their peers who received English-only support at statistically significant levels as measured by Total Language and Expressive Communication as raw and language age scores. No statistically significant group differences were found on Auditory Comprehension scores. Conclusions & Implications: In addition to providing support in English, encouraging home language use and providing treatment support in the first language may help rather than hinder development of both English and the home language in bilingual children with HL who use CIs and HAs. In fact, dual-language support may yield better overall and expressive English language outcomes than English-only support for this population. [ABSTRACT FROM AUTHOR]

Comprehensive models of derived polymorphemic word recognition skill in developing readers, with an emphasis on children with reading difficulty (RD), have not been developed. The purpose of the present study was to model individual differences in polymorphemic word recognition ability at the item level among 5th-grade children (N = 173) oversampled for children with RD using item-response crossed random-effects models. We distinguish between two subtypes of RD children with word recognition problems, those with early-emerging RD and late-emerging RD. An extensive set of predictors representing item-specific knowledge, child-level characteristics, and word-level characteristics were used to predict item-level variance in polymorphemic word recognition. Results indicate that item-specific root word recognition and word familiarity; child-level RD status, morphological awareness, and orthographic choice; word-level frequency and root word family size; and the interactions between morphological awareness and RD status and root word recognition and root transparency predicted individual differences in polymorphemic word recognition item performance. Results are interpreted within a multisource individual difference model of polymorphemic word recognition skill spanning item-specific, child-level, and word-level knowledge. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Quality improvement in surgery involves identifying patients at high risk for postoperative complications. We sought to assess the impact of race and procedure type on 30-day surgical morbidity in pediatric urology. METHODS: The National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) is a prospective registry of surgical cases from 50 and 56 pediatric hospitals in 2012 and 2013, respectively. We performed a cohort study of children followed in NSQIP-P who underwent urologic surgery. Forty unique operations were stratified into 6 clinically related procedure groups: ureteral, testicular, renal, urinary diversion, penile and urethral, or bladder procedures. Outcomes were 3 different composite measures of 30-day morbidity. Primary predictors were patient race and procedural group. Multivariate logistic regression was used to identify associations between race, procedure type, and postoperative morbidity. RESULTS: Of 114 395 patients in the NSQIP-P cohort, 11 791 underwent pediatric urologic procedures. Overall 30-day complication rate was 5.9% and was higher in bladder and urinary diversion procedures. On multivariate analyses, non-Hispanic black compared with non-Hispanic white children had higher odds of 30-day overall complications (odds ratio 1.34; 95% confidence interval, 1.03-1.74) and 30-day hospital-acquired infection (odds ratio 1.54; 95% confidence interval, 1.08-2.20). Bladder and urinary diversion procedures relative to testicular procedures had significantly higher odds of surgical morbidity across all composite outcome measures. CONCLUSIONS: Black race and bladder and urinary diversion operations were significantly associated with 30-day surgical morbidity. Future efforts should identify processes of care that decrease postoperative morbidity among children. [ABSTRACT FROM AUTHOR]

This research examines the interaction effect of message framing (gain vs. loss) and perceived susceptibility (i.e., perceived likelihood that one's child is at risk of contracting HPV) on African American parents' intentions to vaccinate their children against HPV. Results of an experiment (N = 193) in which parents were exposed to either a gain-framed or loss-framed message about HPV vaccination revealed a significant interaction between message framing and perceived susceptibility when parents were required to pay for the vaccine. The specific pattern of interaction suggested that parents who perceived their children to be at high risk of contracting HPV were more persuaded by the gain-framed message, whereas those who believed their children to be at low risk of contracting HPV were more persuaded by the loss-framed message. Implications of the findings for HPV vaccination messaging are discussed. [ABSTRACT FROM AUTHOR]

Summary: Background: Obesity in childhood is related to multiple lifestyle factors. Our objective was to evaluate the relationship between consumption of 100% fruit juice and weight status over time among pre‐school children. Methods: We used linear and logistic multivariable regression to evaluate body mass index (BMI) z‐score and overweight/obese status as a function of 100% fruit juice intake for 8950 children examined at ages 2, 4 and 5 years as part of the Early Childhood Longitudinal Study–Birth Cohort, a representative sample of the United States. Results: Cross‐sectional analysis at ages 4 and 5 years showed no difference in the prevalence of overweight and obesity between consistent juice drinkers and inconsistent/non‐drinkers. Longitudinal analysis found that children who drank 100% juice consistently at age 2 years had greater increases in BMI z‐score by age 4 years than infrequent/non‐drinkers (P < 0.0001), a difference driven by lesser increases in height z‐score (P = 0.0003) and slightly greater increases in weight z‐score (P = 0.0550) among consistent juice drinkers over the 2 to 4 year time period. Additionally, consistent juice drinkers at age 2 had higher odds of becoming overweight by age 4 (adjusted odds ratio 1.30; CI 1.06–1.60). These differences in growth parameters were not noted between ages 4 and 5 years. Conclusions: Drinking 100% fruit juice regularly at age 2 is associated with higher odds of becoming overweight between 2 and 4 years. Paediatricians and parents can discourage excessive fruit juice consumption as part of a larger effort to avoid unhealthy gain in BMI in young children. [ABSTRACT FROM AUTHOR]