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Although emotional and behavioural problems among young children are common and, if unaddressed, can lead to multi-facetted problems later in life, there is little research investigating the implementation of parenting programs that target these problems. In this study, the RE-AIM framework was used to evaluate the implementation of the Triple P parenting program in a preschool setting at a medium-sized municipality in Sweden. Reach increased over time, showing an overall increase in participating fathers and parents with lower education. Effectiveness outcomes showed an improvement in emotional and behavioural problems in children and less mental health-related symptoms and higher self-efficacy in parents. Adoption rate was 93.3%. To ensure staff "buy-in", designated coordinators made changes in recruitment procedures, and provided supervision and training to all Triple P practitioners. Implementation adaptations were made, such as minor revisions of parenting strategies and other program content, as well as providing child care during seminars and groups, and setting up weekend-groups. Maintenance assessed through 12 month follow-up data suggested that several child and parent outcomes were maintained over time. Uppsala municipality continues to offer Triple P to parents. The reach, effectiveness, adoption, implementation and maintenance of the program were all satisfactory and demonstrated the suitability of delivering evidence-based parenting support using preschools as an arena., Competing Interests: Raziye Salari and Karin Fängström are Triple P trainers and Anton Dahlberg is an accredited Triple P practitioner. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Joint physical custody (JPC) refers to a practice where children with separated parents share their time between the parents' respective homes. Studies on parents' views of JPC for young children are scarce. The aim of this interview study was to explore parents' perceptions on how they experience and practice equally shared JPC for their 1-4 year-olds in Sweden. Forty-six parents (18 fathers and 28 mothers) of 50 children (31 boys and 19 girls) under 5 years of age were interviewed. Parents were recruited through information in the media and represented a broad range of socioeconomic backgrounds, as well as both voluntary and court-ordered custody arrangements. The interviews were semi-structured and analyzed using systematic text condensation. Two themes emerged regarding the research question. In the first theme, Always free, never free, parents described their striving to coparent without a love relationship. While they appreciated the freedom of being a "half-time parent", doing things one's own way, they felt constrained by the long-term commitment to live close to and keep discussing child rearing issues with the ex-partner. Good communication was key and lessened parent's feelings of being cut-off from half of the child's life. When JPC was ordered by court or conflicts were intense, parents tried to have less contact and worried when the children were in the other home. The second theme, Is it right, is it good?, included descriptions of how the parents monitored the child's responses to the living arrangement and made changes to optimize their adjustment. Adaptations included visits for the child with the other parent mid-week, shared meals or adapting schedules. In conclusion, these parents worked hard to make JPC work and cause minimal damage to their children. Most parents were pleased with the arrangements with the notable exception of couples experiencing ongoing conflict., Competing Interests: All authors disclose any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, our work.

Background: Child behaviour problems are common and can lead to later mental health problems. Poor maternal mental health and adverse parenting practices are known risk factors for child behaviour problems. Less is known about the association between paternal mental health and parenting, and child behaviour. We aimed to explore the association between paternal psychological distress and parenting (harsh discipline, low warmth, unreasonable expectations, and overinvolved/protectiveness) with children's internalising and externalising behaviour at 3 years of age., Methods: Cross-sectional surveys of 669 (80% response) fathers of 3-year-old children, nested within a randomised controlled trial. Main outcomes of behaviour (Child Behavior Checklist), parenting (Parent Behavior Checklist and overinvolved/protective parenting scale), and psychological distress (Kessler-6) were measured. Regression modelling examined the associations between paternal factors and child behaviour, adjusting for maternal mental health and parenting, as well as child and family variables., Results: In adjusted analyses, paternal psychological distress (b = 0.43, 95% confidence interval [CI] [0.26-0.60], p < 0.001), harsh discipline (b = 0.20, 95% CI [0.13-0.27], p < 0.001), and maternal mental health (b = 0.08, 95% CI [0.03-0.12], p = 0.001) were associated with externalising symptoms. However, only paternal psychological distress, harsh discipline, and being a boy were associated with borderline/clinical levels of externalising problems (all p < 0.05). Paternal psychological distress, harsh discipline, overinvolved parenting, maternal mental health, and difficult child temperament were associated with internalising symptoms (all p < 0.05). However, only paternal harsh discipline and overinvolved parenting were associated with borderline/clinical internalising problems., Conclusions: Paternal mental health and parenting are independently associated with child behaviour. Treatments for children with behavioural problems should also address paternal mental health and parenting., (© 2018 John Wiley & Sons Ltd.)

Aim: Using a public health perspective, this study examined the characteristics of mothers and fathers who attended, compared to those who did not attend, a community-based practitioner-led universally offered parenting program., Method: Mothers (141) and fathers (96) of 4- to 5-year-olds completed a set of questionnaires, including their demographic characteristics, their child's behavioral and emotional problems, and their own parenting behavior. They were all then given the opportunity to attend level 2 of the Triple P--Positive Parenting Program. During the first six months of the study, 33 mothers and 11 fathers opted to attend the program., Results: The relation between program attendance and parental characteristics was similar for mothers and fathers. In general, fathers, non-native and lower educated parents were less likely to attend the program. Mothers, but not fathers, were more likely to attend if they reported more child behavior problems, while fathers, but not mothers, were observed at a trend level to attend if they perceived their child as having more emotional problems. In addition, parents in general were more likely to attend if they used more harsh parenting strategies., Conclusions: Although the universal offer did not reach parents universally, generally those parents who needed it were more likely to attend. Furthermore, this study shows that different factors may impact mothers' and fathers' attendance; therefore, parental data should be analyzed separately and different recruitment strategies should be used for mothers and fathers., (© 2015 the Nordic Societies of Public Health.)

Background: Parenting programmes are effective in improving child behaviour and parental well-being, but long follow-up studies of universally offered programmes are scarce., Methods: A cluster randomized controlled trial was conducted to assess the costs and effects of Triple P levels 2-3 on child externalizing behaviours and parental mental health. The programme was offered universally to parents of preschoolers (self-selection allowed). Preschools were randomized to Triple P or a waitlist control. Health outcomes were reduction in externalizing behaviours measured on the Eyberg Child Behaviour Inventory-22 and improvement in parental mental health measured on the Depression Anxiety Stress Scales collected at baseline, 6-, 12- and 18-month follow-up. Child outcomes were based on 355 children aged 3-5 years (child sample) and parental outcomes on 759 parents (parental sample) with baseline data. Costs were collected from a municipality perspective, including 312 children and 488 parents with baseline data in the intervention preschools., Results: Sixty-seven (29%) parents attended the intervention. Triple P showed no significant improvement in child externalizing behaviours or parental mental health at either of the follow-up points. Triple P had an average yearly total cost of 3007 Swedish Krona (SEK) (€323) per child or 1922 SEK (€207) per parent. Running Triple P cost 227 SEK (€24) per child or 145 SEK (€16) per parent yearly., Conclusion: Offering low intensity levels of Triple P with 29% attendance may not be a reasonable use of public resources, as no evidence of improvement in child externalizing behaviours or parental mental health was found., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Aims: We aim to examine the relationship between child behavioural problems and several parental factors, particularly parental behaviours as reported by both mothers and fathers in a sample of preschool children in Sweden., Methods: Participants were mothers and fathers of 504 3- to 5-year-olds that were recruited through preschools. They completed a set of questionnaires including the Eyberg Child Behavior Inventory, Parenting Sense of Competence Scale, Parenting Scale, Parent Problem Checklist, Dyadic Adjustment Scale and Depression Anxiety Stress Scale., Results: Correlational analyses showed that parent-reported child behaviour problems were positively associated with ineffective parenting practices and interparental conflicts and negatively related to parental competence. Regression analyses showed that, for both mothers and fathers, higher levels of parental over-reactivity and interparental conflict over child-rearing issues and lower levels of parental satisfaction were the most salient factors in predicting their reports of disruptive child behaviour., Conclusions: This study revealed that swedish parents' perceptions of their parenting is related to their ratings of child behaviour problems which therefore implies that parent training programs can be useful in addressing behavioural problems in Swedish children., (© 2014 the Nordic Societies of Public Health.)

Background: There is large body of knowledge to support the importance of early interventions to improve child health and development. Nonetheless, it is important to identify cost-effective blends of preventive interventions with adequate coverage and feasible delivery modes. The aim of the Children and Parents in Focus trial is to compare two levels of parenting programme intensity and rate of exposure, with a control condition to address impact and cost-effectiveness of a universally offered evidence-based parenting programme in the Swedish context., Methods/design: The trial has a cluster randomised controlled design comprising three arms: Universal arm (with access to participation in Triple P - Positive Parenting Program, level 2); Universal Plus arm (with access to participation in Triple P - Positive Parenting Program, level 2 as well as level 3, and level 4 group); and Services as Usual arm. The sampling frame is Uppsala municipality in Sweden. Child health centres consecutively recruit parents of children aged 3 to 5 years before their yearly check-ups (during the years 2013-2017). Outcomes will be measured annually. The primary outcome will be children's behavioural and emotional problems as rated by three informants: fathers, mothers and preschool teachers. The other outcomes will be parents' behaviour and parents' general health. Health economic evaluations will analyse cost-effectiveness of the interventions versus care as usual by comparing the costs and consequences in terms of impact on children's mental health, parent's mental health and health-related quality of life., Discussion: This study addresses the need for comprehensive evaluation of the long-term effects, costs and benefits of early parenting interventions embedded within existing systems. In addition, the study will generate population-based data on the mental health and well-being of preschool aged children in Sweden., Trial Registration Isrctn: ISRCTN16513449.

Aim: To investigate how grandparents influence their young grandchildren's eating behaviors in Chinese three-generation families., Methods: This qualitative study used semi-structured in-depth interviews with 12 parents (3 male and 9 female) and 11 grandparents (4 male and 7 female) in Beijing, China., Results: Three domains emerged in this study: (1) grandparents were the primary caretakers of children in the three-generation families. They played an important role in planning and cooking family meals; (2) grandparents' attitudes influenced young children's nutrition and eating habits. They held the belief that children being heavy at a young age would assure that they had a good nutrition status and would become tall in the future. They showed a tendency towards urging the children to eat more meals and larger portions at served meals; (3) grandparents used food as an educational and emotional tool. They shaped the behavior of their grandchildren and expressed love and caring through food., Conclusions: Grandparents were dominant in shaping children's eating behavior in some three-generation families in Chinese urban areas. Nutrition education involving grandparents is a potential framework for developing a healthy dietary behavior in young children.

Aim: The aim of this narrative review was to evaluate the evidence for interventions for children's secure attachment relationships and parents' caregiving sensitivity that could potentially be implemented in the context of a well-baby clinic.Methods: Literature search on programmes for parental caregiving sensitivity and secure attachment for infants aged 0-24 months. Randomised controlled trials (RCTs) published 1995-2018 with interventions starting from one week postpartum, and with a maximum of 12 sessions (plus potential booster session) were included.Results: We identified 25 studies, of which 22 studied effects of home-based programmes using video feedback techniques. Positive effects of these interventions in families at risk were found on parental caregiving sensitivity and to a lesser extent also on children's secure or disorganised attachment. The effects of two of these programmes were supported by several RCTs. Three intervention studies based on group and individual psychotherapy showed no significant positive effects. Most of the interventions targeted mothers only.Conclusion: The review found some evidence for positive effects of selective interventions with video feedback techniques for children's secure attachment and strong evidence for positive effects on parental caregiving sensitivity. Important knowledge gaps were identified for universal interventions and interventions for fathers and parents with a non-Western background. [ABSTRACT FROM AUTHOR]

Aim: To examine the relationship between mothers' health-related quality of life (HRQoL) and child behaviour problems at age 2 years. To investigate whether the relationship between maternal HRQoL and child behaviour problems is independent of maternal mental health.Methods: Cross-sectional survey nested within a population-level, cluster randomised trial, which aims to prevent early child behaviour problems. One hundred and sixty mothers of 2-year-old children, in nine local government areas in Victoria, Australia. HRQoL was measured using the Assessment of Quality of Life 6D and child behaviour was measured using the child behaviour checklist (CBCL/1.5-5 years). Maternal mental health was measured using the Depression Anxiety Stress Scale. Data were collected at child age 2 years; demographic data were collected at child age 8 months.Results: HRQoL was lower for mothers with children that had borderline/clinical behaviour problems compared to those with children without problems (mean difference -0.14, 95% confidence interval (CI): -0.16 to -0.12, P < 0.001). The finding did not markedly change when adjusting for household income, financial security, child gender, child temperament and intervention group status at child age 8 months (mean difference -0.12, 95% CI: -0.15 to -0.09, P < 0.001), but did attenuate when additionally adjusting for concurrent maternal mental health (mean difference -0.03, 95% CI: -0.05 to -0.02, P < 0.001).Conclusions: Child behaviour problems were associated with lower maternal HRQoL. Child behaviour problems prevention programmes could consider this association with maternal HRQoL and be designed to improve and report both mothers' and their child's health and wellbeing. [ABSTRACT FROM AUTHOR]

Joint physical custody, i.e., children spending an equal amount of time in both parents' home after a separation or divorce, is increasing in many countries. In line with the national policy to promote paternal involvement in parenting, two-thirds of Swedish preschoolers with non-cohabiting parents live in two homes. Internationally, there has been a debate regarding the benefits or risks with joint physical custody for infants and toddlers. The aim of this qualitative study was to explore the reasons given by divorced parents for sharing joint physical custody of children 0–4 years of age. Interviews were conducted with 46 parents (18 fathers and 28 mothers) and analyzed using systematic text condensation. Two themes emerged in response to the research question. In the theme Same rights and responsibilities , parents described that joint physical custody was ‘a given’ as both parents were seen to have equal rights to and responsibility for the children. Both men and women described involved fatherhood as an ideal goal. In the theme For the sake of the child , parents emphasized that joint physical custody was in the best interest of the child. Some parents had conflicts with their ex-spouses, but were still convinced of the benefits of joint physical custody and strove to make it work. [ABSTRACT FROM AUTHOR]

Triple P is a parenting program that aims to prevent behavioral, emotional, and developmental problems in children. Because Triple P is a new parenting program in Sweden, it is important to see how parents felt about the intervention. The aim of this study was to find out why parents of preschool children chose to participate in Triple P in Sweden, what they thought of the Triple P curriculum, and how the program related to their parenting philosophy in general. This is a qualitative study using semi-structured interviews with seven mothers and three fathers who participated in Triple P. The interviews were transcribed verbatim and were analysed using Malterud's method of Systematic Text Condensation. Parents chose to participate in Triple P for several reasons: they wanted to learn more about the intervention; they had specific problems that they sought help for; or they felt encouraged to participate due to advertisements and recommendations from friends. Of the Triple P curriculum, the participants especially enjoyed the 'directed discussion' technique, the positive reinforcement sections, and the instructions on how to communicate effectively with their child by staying calm, close, and maintaining eye contact. It was important for many of the parents to feel validated and respected, and they liked having discussions with the preschool teacher rather than being told what to do. Parents in this Swedish sample generally liked and selectively used the strategies they learned from participating in Triple P, depending on how well these fit with their own parenting experiences and philosophy. [ABSTRACT FROM AUTHOR]

By reviewing the literature, we looked at how parental leave policies in Sweden have influenced two well-defined areas of early father involvement: participating in parental leave and at visits/activities at the Child Health Centers. Sweden has one of the most comprehensive and egalitarian parental leave policies in the world, permitting parents to take 480 days off of work, receive 80% of their pay for the first 15 months, and divide their leave however they see fit, barring that both parents receive 2 months of parental leave that is exclusive to them. Additionally, fathers are permitted to take the first ten working days off to be at home with his family. Most parents, especially mothers, use parental leave throughout their infant's first year. During the parents' time off from work, nearly all Swedish parents (95-99%) utilize the Child Health Centers between 11 and 13 times during the infant's first year of life. The Child Health Centers help to monitor a child's growth and development, provide parenting support, immunizations, health education, health screenings, and provide referral sources if the child has any special needs. However, fathers only use 22% of all parental leave days. Studies have pointed out that fathers may not use parental leave because of corporate, maternal, and financial attitudes. Despite the Child Health Centers' policy of including both parents, fathers do not utilize the Child Health Centers to the same extent as mothers. Research has shown that fathers may not use Child Health Centers as they are mainly only open during normal working hours, they are dominated by females (staff and mothers), and many conversations during the child's first year are directed towards mothers. Barriers for why father involvement is lower than mothers are discussed. [ABSTRACT FROM AUTHOR]