Search

Aggressogenic parenting styles are associated with increased rates of callous and unemotional traits, and in turn, with antisocial behaviours. Traumatic brain injury is also associated with antisocial behaviour, but not callous and unemotional traits specifically. No study has previously investigated these three variables, aggressogenic parenting, traumatic brain injury, and callous and unemotional traits, in a single study. The study setting was Cape Town, South Africa. The sample included high school boys ( N = 54), aged 13–21 years in an observational, descriptive study. We hypothesised that boys who reported that they had sustained a traumatic brain injury and who had been exposed to aggressogenic parenting would display increased levels of callous and unemotional traits, and that those with traumatic brain injury but had experienced positive parenting would display lower levels of such traits. The main measures included the Comprehensive Health Assessment Tool, the Inventory of Callous/Unemotional traits, and the Alabama Parenting Questionnaire. Results show that almost 41% (22/54) of participants reported sustaining a traumatic brain injury. Aggressogenic parenting significantly moderated callous and unemotional traits only in participants with traumatic brain injury, F(1.46) = 4.76, p = .03, while positive parenting and substance use did not. In conclusion, traumatic brain injury in the presence of aggressogenic parenting is associated with greater callous and unemotional traits in this sample of adolescent boys.

Parental engagement in parenting programs is essential for good outcomes but can be challenging for many families. In low- and middle-income countries, where resources are limited and there are fewer support services, there is little research examining the factors that influence engagement. This mixed-methods study explored factors associated with parent engagement, as well as barriers and supports, in a pilot evaluation of a parenting program with 140 parents in North Macedonia, Republic of Moldova, and Romania. The relationship between various quantitative types of engagement (e.g., premature drop-out, participation) and a range of demographic, personal, and implementation factors were examined. Qualitative parent interviews explored barriers and supports to program engagement. Implementation variables (e.g., phone calls with parents, program fidelity and text messages sent to parents) were consistently positively associated with different types of engagement after controlling for other factors. Parents of boys, being a victim of intimate partner violence, more children in the household and better parental well-being were positively associated with premature drop-out whilst having a child enrolled in school was positively associated with participation. Barriers included logistical factors such as timing and lack of childcare facilities. Factors that increased engagement included facilitator skills/support, weekly text messages and phone calls and engagement strategies such as transport and childcare. The results emphasise the importance of implementation factors in increasing parent engagement in parenting programs and will help to inform the next phase of the project as well as other family-support initiatives in the three countries. The trial is registered on ClinicalTrials.gov (ID: NCT03552250).

Funder: Jacobs Foundation; doi: http://dx.doi.org/10.13039/501100003986, Funder: UBS Optimus Foundation; doi: http://dx.doi.org/10.13039/501100008391, Funder: Fondation Botnar; doi: http://dx.doi.org/10.13039/501100011318, Funder: Consuelo Zobel Alger Foundation, Funder: British Academy, Funder: Cambridge Humanities Research Grants Scheme, Funder: ESRC Impact Acceleration Account Programme, Funder: University of Edinburgh College Office for the College of Arts, Funder: Humanities and Social Sciences SFC ODA Global Challenges Internal Fund, Funder: University of Cambridge GCRF Quality Research Fund, Funder: Wolfson Professor of Criminology Discretionary Fund, Funder: British Academy Wolfson Foundation Fellowship, Maternal prenatal stress places a substantial burden on mother's mental health. Expectant mothers in low- and middle-income countries (LMICs) have thus far received less attention than mothers in high-income settings. This is particularly problematic, as a range of triggers, such as exposure to traumatic events (e.g. natural disasters, previous pregnancy losses) and adverse life circumstances (e.g. poverty, community violence), put mothers at increased risk of experiencing prenatal stress. The ten-item Perceived Stress Scale (PSS-10) is a widely recognised index of subjective experience of stress that is increasingly used in LMICs. However, evidence for its measurement equivalence across settings is lacking. This study aims to assess measurement invariance of the PSS-10 across eight LMICs and across birth parity. This research was carried out as part of the Evidence for Better Lives Study (EBLS, vrc.crim.cam.ac.uk/vrcresearch/EBLS). The PSS-10 was administered to N = 1,208 expectant mothers from Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam during the third trimester of pregnancy. Confirmatory factor analysis suggested a good model fit of a two-factor model across all sites, with items on experiences of stress loading onto a negative factor and items on perceived coping onto a positive factor. Configural and metric, but not full or partial scalar invariance, were established across all sites. Configural, metric and full scalar invariance could be established across birth parity. On average, first-time mothers reported less stress than mothers who already had children. Our findings indicate that the PSS-10 holds utility in assessing stress across a broad range of culturally diverse settings; however, caution should be taken when comparing mean stress levels across sites.

Harsh parenting attitudes and behaviors negatively impact children’s behavior and development, and are linked to heightened levels of violence in children. Parent training programs are effective preventive interventions, but only reach caregivers who attend them. In this study, programs were implemented alongside a community mobilization process, intended to use caregivers’ social networks to disseminate new parenting skills community wide. We used social network analysis to explore whether this intervention, first, increased positive parenting, second, changed social networks of female caregivers (selection), and, third, influenced parenting behavior via connections (socialization), while controlling for psychiatric morbidity, parenting stress, alcohol misuse, and child’s age. “Colored” Afrikaans-speaking female caregivers (N = 235; mean age 35.92 years) in a rural community in South Africa, with children between 1½ and 18 years old, were included in the study; two waves of data were collected (January–April 2016 and June–October 2017). We detected community-wide increases in positive parenting behavior (involvement, supervision, consistent discipline, and reduced corporal punishment). Attending at least one session of a parenting skills training program (n = 51; 21.7%) significantly predicted increases in network centrality (i.e., outdegree and indegree). Caregivers appeared to use similar parenting behavior to other caregivers they were connected to within the network, especially when those others attended a parenting skills training program. Overall, the results suggest that the information in the intervention was spread throughout the community through social interactions with program attendees and the community mobilization process. The results also illustrate the value of social network analysis for ascertaining the processes by which the intervention achieved its impact.

Understanding gang disengagement is important for the development of effective interventions. This research sought to examine how former South African gang members understand their gang disengagement. Two rounds of life history interviews were conducted with 12 former gang members. Thematic narrative analysis was used to analyze the interview data. Findings revealed that personal agency was key to the participants’ disengagement, which included forming a purposive intention to change, committing to and maintaining this change, despite challenges faced, and taking personal responsibility for their pasts. It also involved actively drawing on protective resources—such as meaningful and practical support from loved ones—and prosocial identities available to them within their environments, thus illustrating how the disengagement process is an interaction between inner and outer resources. Therefore, it is imperative that gang-related interventions ensure that individuals have access to the kinds of resources that will support their disengagement.

Background: \ud Parenting interventions and conditional cash transfer (CCT) programmes are promising strategies to reduce the risk of violence against children, but evidence of the effectiveness of combining such programmes is lacking for families in low- and middle-income countries with children over two years of age. This study examined the effectiveness of a locally adapted parenting programme delivered as part of a government CCT system to low-income families with children aged two to six years in Metro Manila, Philippines.\ud \ud Methods: \ud Participants were randomly assigned (1:1) to either a 12-session group-based parenting programme or treatment-as-usual services (N = 120). Participation in either service was required among the conditions for receiving cash grants. Baseline assessments were conducted in July 2017 with one-month post-intervention assessments in January-February 2018 and 12-month follow-up in January-February 2019. All assessments were parent-report (ClinicalTrials.gov: NCT03205449).\ud \ud Findings\ud One-month post-intervention assessments indicated moderate intervention effects for primary outcomes of reduced overall child maltreatment (d = -0.50 [-0.86, -0.13]), emotional abuse (d = -0.59 [-0.95; -0.22]), physical abuse (IRR = 0.51 [0.27; 0.74]), and neglect (IRR = 0.52 [0.18; 0.85]). There were also significant effects for reduced dysfunctional parenting, child behaviour problems, and intimate partner violence, and increased parental efficacy and positive parenting. Reduced overall maltreatment, emotional abuse, and neglect effects were sustained at one-year follow-up.\ud \ud Interpretation: \ud Findings suggest that a culturally adapted parenting intervention delivered as part of a CCT programme may be effective in sustaining reductions in violence against children in low- and middle-income countries.\ud \ud Funding: \ud This research was supported by UBS Optimus Foundation and UNICEF Philippines, and by the Complexity and Relationships in Health Improvement Programmes of the Medical Research Council MRC UK and Chief Scientist Office (Grant: MC_UU_00022/1 and CSO SPHSU16, MC_UU_00022/3 and CSO SPHSU18).

BackgroundThe International Society for Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool (Children's Version), known as the ICAST-C Version 3, is used widely to assess violence against children, but there is limited psychometric evidence, especially on content validity.ObjectiveThis study aimed to assess the content validity of the ICAST-C with adolescents in Romania, South Africa, and the Philippines.MethodsA purposive sample of adolescents (N = 53, 51 % female) were recruited from urban areas in Romania, the Eastern Cape Province of South Africa, and Metro Manila, Philippines. Semi-structured one-on-one in-depth cognitive interviews sought adolescent perspectives on the relevance, comprehensibility, and comprehensiveness of the ICAST-C. Data were analysed using template analysis.ResultsThe ICAST-C was broadly perceived to be relevant and comprehensive in measuring violence against children in all study locations. However, there were issues with the comprehensibility of the measure, described at three levels: interpreting items, undertaking coherent elaborations of relevant behaviors and places, and generating a coherent response to the questions.ConclusionsSuggestions to revise the ICAST-C include, among others, adding a practice or how-to section on answering the survey, clarifying the intent of questions, especially on neglect and sexual abuse, emphasizing that questions cover all locations, and asking more positive questions. Pilot studies testing the content validity and cultural appropriateness are needed as a matter of practice in large self-report surveys.

Background : Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. Methods : Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study – Foundational Research (EBLS-FR). Data were from the baseline measurement.Results : Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. Limitations : As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. Conclusions : The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage.

Substance use among adolescents is prevalent in the Western Cape, South Africa. Caregivers may be concerned about adolescent substance use, which may have a negative impact on both parties. We conducted a qualitative study consisting of three focus groups with caregivers (n = 21) in order to explore their perceptions of their child’s substance use, psychosocial support that they may require, as well as barriers to accessing services. Data were analysed using framework analysis, and three themes emerged: caregivers’ perceived capacity needed to assist adolescents with substance use and other problems, impact of adolescent substance use on caregiver well-being and the need for services for adolescent substance use problems. Findings indicated that study participants needed information and skills to deal with the physical and emotional consequences of adolescent substance use and to be empowered. This study suggests that future interventions for adolescent substance use may benefit from an accessible, family-based approach.

Aims This paper explores the number and characterization of latent classes of adverse childhood experiences across the Evidence for Better Lives Study cohort and investigates how the various typologies link to prenatal substance use (i.e., smoking, alcohol, and illicit drugs) and poor infant outcomes (i.e., infant prematurity and low birth weight). Participants and setting A total of 1,189 mother-infant dyads residing in eight diverse low- and middle-income countries (LMICs) were recruited. Methods Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions with distal outcomes were performed. Results The LCA identified three high-risk classes and one low-risk class, namely: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Overall, across all latent classes, there were low probabilities of prenatal substance use and poor infant outcomes. However, pairwise comparisons between classes indicate that class 1 and 3 had higher probabilities of prenatal illicit drug use compared to class 4. Additionally, class 2 had higher probability of low birth weight compared to the three remaining classes. Conclusion The results further our understanding of the dynamic and multifaceted nature of ACEs. More research grounded on LMICs is warranted with more attention to various parameters of risk exposure (i.e., severity, duration, chronicity).

Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the implementation and impact of these programs in respect to their delivery at a large scale or within existing service systems, particularly in low- and middle-income countries (LMICs). We advocate for greater collaboration between researchers, policymakers, donors, governments, non-governmental organizations, and program managers and staff to study how violence prevention programs operate on a large scale. We describe a new initiative aiming to foster such collaborations in the field of family strengthening programs.

Funder: Jacobs Foundation; doi: http://dx.doi.org/10.13039/501100003986, Funder: the Consuelo Zobel Alger Foundation, Funder: The British Academy, Funder: the Cambridge Humanities Research Grants Scheme, Funder: the University of Edinburgh College Office for the College of Arts, Funder: the Wolfson Professor of Criminology Discretionary Fund, Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18–48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk.

Rates of child maltreatment are higher in low- and middle-income countries due to risk factors such as social inequities, economic adversity, and sociocultural norms. Given the evidence showing the effectiveness of parenting interventions to prevent child maltreatment, this study embarked on a cultural adaptation of an evidence-based parenting program with the eventual goal of integrating it within a nationwide conditional cash transfer program for low-income Filipino parents with children aged 2-6 years. We document the systematic adaptation of the Parenting for Lifelong Health for Young Children program that was developed and tested in South Africa, for low-resource Filipino families using the heuristic framework for the cultural adaptation of interventions. We underscore the merits of conducting a multistage top-down and bottom-up process that uses a participatory approach among cultural insiders and outsiders to develop a parenting intervention that reflects the contextual realities and cultural values of end users. The adapted program, Masayang Pamilya Para sa Batang Pilipino, is the product of a delicate and deliberate effort to balance Filipino childrearing goals and values with the scientific evidence on components of parenting interventions known to promote positive parenting and prevent child maltreatment.Los índices de maltrato infantil son más altos en los países de ingresos medios y bajos debido a factores de riesgo, como las desigualdades sociales, las dificultades económicas y las normas socioculturales. Teniendo en cuenta los datos que demuestran la eficacia de las intervenciones en la crianza para prevenir el maltrato infantil, este estudio inició una adaptación cultural de un programa de crianza factual con el objetivo principal de integrarlo dentro de un programa de transferencia condicional de dinero en efectivo a nivel nacional para padres filipinos de bajos recursos con niños de entre dos y seis años. Documentamos la adaptación sistemática del programa “Crianza para una buena salud durante toda la vida” (Parenting for Lifelong Health, PLH) orientado a niños pequeños que se desarrolló y se probó en Sudáfrica, para familias filipinas de bajos recursos utilizado el marco heurístico para las adaptaciones culturales de las intervenciones. Subrayamos los méritos de llevar a cabo un proceso multietapa descendente y ascendente que emplea un método participativo entre personas conocedoras de las culturas y personas ajenas a ella para desarrollar una intervención en la crianza que refleje las realidades contextuales y los valores culturales de los usuarios finales. El programa adaptado, Masayang Pamilya Para sa Batang Pilipino, es el producto de un esfuerzo comprometido y deliberado de equilibrar los objetivos y los valores de la crianza de los niños filipinos con las pruebas científicas sobre los componentes de las intervenciones en la crianza que promueven la crianza positiva y previenen el maltrato infantil.由于社会不平等、经济困境和社会文化规范等风险因素，在低收入和中等收入国家里儿童受虐待的比率较高。鉴于那些能显示通过家长教育干预防止儿童虐待现象这种措施的有效性的证据, 本研究开展了以证据为基础的文化适应教育计划，其最终目的是为了将这种措施整合在一个全国性的有条件的现金转移计划中，对象为菲律宾低收入父母， 家有2 - 6岁儿童。我们记录了在南非开发和测试的儿童终身健康养育(PLH)项目在资源贫乏的菲律宾家庭的适用的情况，该项目使用启发式的框架来适应干预的文化适应性。我们强调，采用由上而下和由下而上的多阶段过程，在文化内部人士和外部人士之间采用参与式方法，以发展一种反映终端用户的环境现实和文化价值的育儿干预，这些做法是有诸多好处的。经过改编的节目Masayang Pamilya Para sa Batang Pilipino是一项细致而深思熟虑的努力的成果，目的是在菲律宾的育婴目标和价值观与促进积极育儿和防止虐待儿童的育儿干预措施组成部分的科学证据两者之间实现平衡。.

Measures that produce valid and reliable antenatal depressive symptom scores in low resource country contexts are important for research efforts to better understand risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates cross-country analysis of similarities and differences across contexts. To date, however, very few studies have evaluated the psychometric properties and comparability of widely used antenatal depressive symptom measures across diverse cultural, political and social contexts. To address this gap, we used data from the Evidence for Better Lives Study – Foundational Research (EBLS-FR) to examine the reliability, validity, and cross-country invariance of the 9-item version of the Patient Health Questionnaire (PHQ-9) in antenatal samples across eight low- and middle-income countries (LMICs). We found that the PHQ-9 scores had good internal consistency and construct validity across all eight countries. However, in measurement invariance analyses, only partial metric invariance held and only across four of the countries. Further, there were some notable between-site contrasts in the nomological networks of PHQ-9 scores. Our results suggest that the PHQ-9 yields reliable scores when administered in antenatal populations; however, the meaning of the scores varies by country. Thus, interpretation of PHQ scores should consider local meanings of depression to ensure that local conceptualisations and manifestations of antenatal depressive symptoms are adequately reflected.

BackgroundThis pre-post trial of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention content associated with key mechanisms of change perceived by caregivers and facilitators.Method:Sixty primary caregivers of children aged 2–9 years were recruited for an 8-week parenting program embedded within the local health system. Mixed-methods approaches included quantitative caregiver-report and observational data from standardized instruments, and qualitative data from individual and group interviews with caregivers and program facilitators. Analyses involved Wilcoxon signed-rank tests, paired t-tests, Friedman’s ANOVA, and thematic analysis.ResultsParticipants reported that most (65%) were grandparents or great-grandparents. Study retention and response rates were high, and enrolled caregivers attended an average of 93% of sessions. Primary outcomes showed caregiver-reported pre-post reductions in overall child maltreatment (d=-0.58, p d=-0.58, p d=-0.40, p d=-0.52, p

Background: Parenting interventions and conditional cash transfer (CCT) programmes are promising strategies to reduce the risk of violence against children, but evidence of the effectiveness of combining such programmes is lacking for families in low- and middle-income countries with children over 2 years of age. This study examined the effectiveness of a locally-adapted parenting programme delivered as part of a government CCT system to low-income families with children aged 2 to 6 years in Metro Manila, Philippines. Methods: Participants were randomly assigned (1:1) to either a 12-session group-based parenting programme or a control group receiving usual family services ( N = 120). Participation in either service was required among the conditions for receiving cash grants. Baseline assessments were conducted in July 2017 with 1-month post-intervention assessments in January 2018 and 12-month follow-up in January 2019. Findings: One-month post-intervention assessments indicated moderate intervention effects for primary outcomes of reduced overall child maltreatment (d = -0·50 [-0·86, -0·13]), emotional abuse (d = -0·59 [-0·95; -0·22]), physical abuse (IRR = 0·51 [0·27; 0·74]), and neglect (IRR = 0·52 [0·18; 0·85]). There were also significant effects for reduced dysfunctional parenting, child behaviour problems, and intimate partner violence, and increased parental efficacy and positive parenting. Reduced overall maltreatment, emotional abuse, and neglect effects were sustained at 1-year follow-up. Interpretation: Findings suggest that a culturally-adapted parenting intervention delivered as part of a CCT programme may be effective in sustaining reductions in violence against children in low- and middle-income countries. Clinical Trial Registration Details: All assessments were parent-report (ClinicalTrials.gov: NCT03205449). Funding Information: This research was supported by UBS Optimus Foundation and UNICEF Philippines, and by the Complexity and Relationships in Health Improvement Programmes of the Medical Research Council MRC UK and Chief Scientist Office (Grant: MC_UU_12017/14 and CSO SPHSUU14, MC_UU_1201711 and CSO SPHSU11). Declaration of Interests: Dr. Ward reports grants from UBS Optimus Foundation, grants from UNICEF Philippines, during the conduct of the study; Dr. Hutchings reports I received grant funding to contribute to the design of the trial and supervision of group leaders; Lachman is the co-developer of a non-profit parenting program with the World Health Organization ‘Parenting for Lifelong Health’, under a creative commons license, and receives fees as a trainer for this; Dr. Alampay reports that she led the team that culturally-adapted the parenting program that is being evaluated in the study; Dr. GARDNER reports grants from WHO VIOLENCE PREVENTION, grants from UNICEF Thailand, grants from UBS Optimus Foundation, outside the submitted work; and I am a co developer of the programme, PLH, tested in the trial. PLH material are open access, under a creative commons licence, and I receive no fees, royalties or other compensation as a result of its testing or implementation; all other authors have nothing to disclose. Ethics Approval Statement: Ethical procedures were approved by the University of Oxford Central University Research Ethics Committee (Reference: R43041/RE001), the Ateneo de Manila University Research Ethics Committee (Reference: AdMUREC_16_014PA), and the University of Cape Town Department of Psychology Research Ethics Committee (Reference: PSY2016-041).

Violence against children is a widespread problem with devastating consequences, and corporal punishment is a risk factor for more serious forms of physical abuse. One reason for the persistence of corporal punishment may be the lack of awareness of positive disciplinary alternatives. Nonviolent options offered to caregivers and teachers must be effective in addressing challenging behavior, or they may be rejected in favor of a return to physical punishment. There is an urgent need to determine which discipline options are evidence-supported and what that evidence says so that robust alternatives to corporal punishment can be made available. The primary objective of this research was to find, and explore the state of the science on, individual nonviolent interventions for challenging behavior, in so doing forming a “tool kit” for use by caregivers and teachers. A systematic overview of systematic reviews was conducted. Included systematic reviews were peer-reviewed and published in English between 1999 and 2018. Screening, quality assessment using AMSTAR, and data extraction were performed independently by two reviewers. A total of 223 reviews were included, covering data from 3,921 primary studies. A wide range of evidence-supported interventions exist, many of which have been found effective with severely challenging behavior. Important positive outcomes shown suggest that the use of these tools should be promoted not only for the prevention of violence but also for optimum child development. More research is needed on the use of these methods in home situations and on de-escalation skills.

Funder: Consuelo Zobel Alger Foundation, Inc., Funder: British Academy; FundRef: http://dx.doi.org/10.13039/501100000286, Funder: Cambridge Humanities Research Grants Scheme, Funder: University of Cambridge GCRF Quality Research, Funder: Jacobs Foundation; FundRef: http://dx.doi.org/10.13039/501100003986, Funder: Wolfson discretionary research, Introduction: Violence against children is a health, human rights and social problem affecting approximately half of the world’s children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- and middle-income countries—Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam—to support effective intervention to reduce violence against children. EBLS-Foundational Research (EBLS-FR) tests critical aspects of the planned EBLS, including participant recruitment and retention, data collection and analysis. Alongside epidemiological estimates of levels and predictors of exposure to violence and adversity during pregnancy, we plan to explore mechanisms that may link exposure to violence to mothers’ biological stress markers and subjective well-being. Methods and analyses: EBLS-FR is a short longitudinal study with a sample of 1200 pregnant women. Data are collected during the last trimester of pregnancy and 2 to 6 months after birth. The questionnaire for participating women has been translated into nine languages. Measures obtained from mothers will include, among others, mental and physical health, attitudes to corporal punishment, adverse childhood experiences, prenatal intimate partner violence, substance use and social/community support. Hair and dry blood spot samples are collected from the pregnant women to measure stress markers. To explore research participation among fathers, EBLS-FR is recruiting 300 fathers in the Philippines and Sri Lanka. Ethics and dissemination: The study received ethical approvals at all recruiting sites and universities in the project. Results will be disseminated through journal publications, conferences and seminar presentations involving local communities, health services and other stakeholders. Findings from this work will help to adjust the subsequent stages of the EBLS project.

Objective: Birth cohort studies (BCS) have generated a wealth of invaluable basic scientific and policy-relevant information on a wide range of issues in child health and development. This study sought to explore what research questions are currently a priority for the next generation of BCS using a 3-round Delphi survey of interdisciplinary experts.Methods: Twenty-four (Round I, N = 17; Round II, N = 21; Round III, N = 18) experts across a wide range of fields (e.g., psychology, public health and maternal/child health) agreed to participate. In Round I, the expert panel was invited to freely respond to the question, “What are the key scientific questions future birth cohort studies should address?”. Content analysis of answers was used to identify 47 questions for rating on perceived importance by the panel in Round II and consensus-achieving questions were identified. Questions that did not reach consensus in Round II were posed again for expert re-rating in Round III. Results: Twenty six of 47 questions reached consensus in Round II, with an additional 6 reaching consensus in Round III. Consensus-achieving questions rated highly on importance spanned a number of topics, including environmental effects on child development, intergenerational transmission of disadvantage and designing BCS to inform intervention strategies. Conclusion: Investigating the effects of family/environmental factors and social disadvantage on a child’s development should be prioritised in designing future BCS. The panel also recommended that future BCS are designed to inform intervention strategies.

This work is based on research supported in part by the National Research Foundation of South Africa (grants numbered IFR2011033100037 and IFR170206222035) and the Economic and Social Research Council (ES/N01068X/1). The influence of perceived social norms on behaviour has been studied in a variety of domains. However, little research has examined their application to child discipline. This study explored social norms perceptions and their associations with parental discipline in greater Cape Town, South Africa. A cross‐sectional study of 195 mothers (using convenience sampling) from two Early Childhood Development centres examined self‐reported violent and non‐violent parenting behaviour, and perceived descriptive (usual behaviour in a group) and injunctive (appraisal of such behaviour) group norms. Parents overestimated the prevalence of violent parenting. Perceived descriptive norms of violent parenting were associated with self‐reported violent parenting behaviour; and perceived descriptive norms of non‐violent parenting were associated with self‐reported non‐violent parenting behaviour. Estimation of support for violent and for non‐violent parenting differed by centre, as did the relationship between perceived injunctive norms of non‐violent parenting and self‐reported non‐violent parenting behaviour. We also found significant effects of social identification, parent educational attainment and parent‐reported child misbehaviour. Parents' perceptions of group norms of parental discipline may be mistaken yet influence their own behaviour, providing the potential basis for violence prevention interventions. Publisher PDF

CITATION: Cluver, L. et al. 2020. Parenting in a time of COVID-19. Lancet, 395:e64, doi:10.1016/S0140-6736(20)30736-4.

Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes, arguing that these pathways represent potential targets to improve P-IPV intervention efforts. Using a narrative review of 112 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via key word searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via six core pathways: maternal stress and mental illness, maternal–fetal attachment, maternal substance use, maternal nutritional intake, maternal antenatal health-care utilization, and infection. We also included articles relevant for linking these pathways to P-IPV interventions. We conclude that developing comprehensive P-IPV interventions that target immediate risk to the mother as well as long-term child outcomes via the candidate mediating pathways identified have significant potential to help reduce the global burden of P-IPV.

Aims: This study aimed to explore how women who drank alcohol while pregnant understand and make sense of alcohol use. Methods: Using social representation theory and elements of Foucauldian discourse analysis, 14 narrative episodic interviews were conducted in a Western Cape, South African community with women who drank alcohol while pregnant, and two focus group discussions with 13 members of the pregnant women’s community. The interview and focus group data were analysed using thematic decomposition analysis. Findings: Drinking alcohol was represented by participants as a social activity, a way of coping with domestic problems, and also as connected to their experiences of motherhood. Access to social support through their partners and a desire to protect the fetus and care for their children helped some participants to cease drinking during their pregnancies. These representations highlight that alcohol use is not simply an individual decision but is embedded in a particular social context and...

Background Parenting programs based on social learning theory have increasing empirical evidence for reducing violence against children. Trials are primarily from high-income countries and with young children. Globally, we know little about how parenting programs work to reduce violence, with no known studies in low or middle-income countries (LMICs). This study examines mechanisms of change of a non-commercialized parenting program, Parenting for Lifelong Health for Teens, designed with the World Health Organization and UNICEF. A cluster randomized trial showed main effects on parenting and other secondary outcomes. We conducted secondary analysis of trial data to investigate five potential mediators of reduced violence against children: improved parenting, adolescent behaviour, caregiver mental health, alcohol/drug avoidance, and family economic strengthening. Methods The trial was implemented in rural South Africa with 40 sites, n = 552 family dyads (including adolescents aged 10–18 and primary caregivers). Intervention sites (n = 20) received the 14-session parenting program delivered by local community members, including modules on family budgeting and savings. Control sites (n = 20) received a brief informational workshop. Emotional and physical violence against children/adolescents and each potential mediator were reported by adolescents and caregivers at baseline and 9–13 months post-randomisation. Structural equation modelling was used to test simultaneous hypothesized pathways to violence reduction. Results Improvements in four pathways mediated reduced violence against children: 1) improved parenting practices, 2) improved caregiver mental health (reduced depression), 3) increased caregiver alcohol/drug avoidance and 4) improved family economic welfare. Improved child behaviour was not a mediator, although it was associated with less violence. Conclusions Simultaneously bolstering a set of family processes can reduce violence. Supporting self-care and positive coping for caregivers may be essential in challenging contexts. In countries with minimal or no economic safety nets, linking social learning parenting programs with economic strengthening skills may bring us closer to ending violence against children.

Burgeoning research on the well-being of young people in recent years has made it difficult to identify conceptual gaps in the literature. We conducted a review of South African research in this area to better understand the use and measurement of the construct, as well as factors associated with it. The search of multiple databases identified 28 studies published in academic journals between 2000 and 2016. Within this period, studies that referred to well-being and its related subjective components varied significantly in terms of how they defined and operationalised these constructs, resulting in a fragmented body of work. The review highlights the need for a coherent research agenda in this area given the centrality of well-being research in promoting optimal outcomes in young people. Recommendations for strengthening South African research in this area are provided.

Background Parenting programs suitable for delivery at scale in low‐resource contexts are urgently needed. We conducted a randomized trial of Parenting for Lifelong Health (PLH) for Young Children, a low‐cost 12‐session program designed to increase positive parenting and reduce harsh parenting and conduct problems in children aged 2–9. Methods Two hundred and ninety‐six caregivers, whose children showed clinical levels of conduct problems (Eyberg Child Behavior Inventory Problem Score, >15), were randomly assigned using a 1:1 ratio to intervention or control groups. At t 0, and at 4–5 months (t 1) and 17 months (t 2) after randomization, research assistants blind to group assignment assessed (through caregiver self‐report and structured observation) 11 primary outcomes: positive parenting, harsh parenting, and child behavior; four secondary outcomes: parenting stress, caregiver depression, poor monitoring/supervision, and social support. Trial registration: ClinicalTrials.gov (NCT02165371); Pan African Clinical Trial Registry (PACTR201402000755243); Violence Prevention Trials Register (http://www.preventviolence.info/Trials?ID=24). Results Caregivers attended on average 8.4 sessions. After adjustment for 30 comparisons, strongest results were as follows: at t 1, frequency of self‐reported positive parenting strategies (10% higher in the intervention group, p = .003), observed positive parenting (39% higher in the intervention group, p = .003), and observed positive child behavior (11% higher in the intervention group, p = .003); at t 2, both observed positive parenting and observed positive child behavior were higher in the intervention group (24%, p = .003; and 17%, p = .003, respectively). Results with p‐values, Read the Commentary on this article at doi: 10.1111/jcpp.13172

Children living in low- and middle-income countries, such as South Africa, face elevated risks of child maltreatment. Although evidence-based parenting programs have been shown to reduce rates of abuse in high-income countries, few studies have examined their effectiveness in low- and middle-income countries. Moreover, local cultural contexts may require the adaptation of evidence-based approaches in order to assure program acceptability and effectiveness. This study focused on the systematic development of an evidence-informed, locally relevant parenting program for socioeconomically disadvantaged families with parents of children aged 3–8 years, in Cape Town, South Africa. Intervention development took place over three stages: (a) identification of common core intervention components in evidence-based parenting programs (b) formative evaluation using qualitative in-depth interviews and semi-structured focus groups with local practitioners and low-income parents, and (c) development of intervention structure, format, and protocols. The process resulted in a manualized, group-based, 12-session parenting program that integrated existing evidence of effective components within a local, culturally relevant context. Recommended next steps are rigorous piloting to test feasibility and preliminary intervention effects followed by experimental trials to examine intervention effectiveness in a real-world setting.

Background:Child mental health problems continue to be a major global concern, especially in low- and middle-income countries (LMICs).Parenting interventions have been shown to be effective for reducing child behavior problems in high-income countries, with emerging evidence supporting similar effects in LMICs. However, there remain substantial barriers to scaling up evidence-based interventions due to limited human and financial resources in such countries. Methods:This protocol is for a multi-center cluster randomized factorial trial of an evidence-based parenting intervention, Parenting for Lifelong Health for Young Children, for families with children ages two to nine years with subclinical levels of behavior problems in three Southeastern European countries, Republic of Moldova, North Macedonia, and Romania (8 conditions, 48 clusters, 864 families,108 per condition). The trial will test three intervention components: length (5 vs. 10 sessions), engagement (basic vs. enhanced package), and fidelity (on-demand vs. structured supervision). Primary outcomes are child aggressive behavior, dysfunctional parenting, and positive parenting. Analyses will examine the main effect and cost-effectiveness of each component, as well as potential interaction effects between components, in order to identify the most optimal combination of program components. Discussion:This study is the first factorial experiment of a parenting program in LMICs. Findings will inform the subsequent testing of the optimized program in a multisite randomized controlled trial in 2021. Trial registration:NCT03865485registered in ClinicalTrials.gov on March 5, 2019.

IntroductionFamilies in low-income and middle-income countries (LMICs) face multiple challenges (eg, poverty and adverse childhood experiences) that increase the risk for child mental health problems, while the context may provide them with few resources. Existing prevention-oriented parenting programmes have been shown to be effective in reducing child behaviour problems and associated risk factors. This project has the overall goal of adapting, implementing and testing a parenting intervention in three Southeastern European LMIC and uses the Multiphase Optimisation Strategy and dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. It is implemented over three phases: (1) preparation, (2) optimisation and (3) evaluation. The preparation phase, the subject of this paper, involves the adaptation and feasibility piloting of the parenting programme.Methods and analysisThis protocol describes the assessment of an evidence-informed indicated prevention programme for families with children aged 2–9 years (Parenting for Lifelong Health for Young Children) for implementation in FYR of Macedonia, Republic of Moldova and Romania. In this phase, officials, experts, parents and practitioners are interviewed to explore their views of suitability and needs for further adaptation. In addition, a small pre–post pilot study will test the feasibility of the programme and its implementation as well as the evaluation measures in the three countries with 40 families per country site (n=120). Quantitative data analysis will comprise a psychometric analysis of measures, testing pre–post differences using ANCOVA, χ2tests and regression analysis. For qualitative data analysis, a thematic approach within an experiential framework will be applied.Ethics and disseminationThe ethics review board of the Alpen-Adria University Klagenfurt and ethical review boards in the three LMIC sites have approved the study.Trial registration numberNCT03552250.

Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18-48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk.

The traumatic loss of muscle tissue, defined as volumetric muscle loss (VML) injury, has no definitive therapy. The purposes of this study were: (1) to develop a porcine model of VML and (2) to investigate autologous minced muscle grafts (1-mm pieces of muscle) as a potential therapeutic. Minced grafts were evaluated because they have promoted fiber regeneration and functional recovery in rat VML models and do not require US Food and Drug Administration approval for clinical use.In 5 female Yorkshire-cross pigs, ≈5 g (≈20%) of tissue was excised from the peroneous tertius muscle (≈3 × 3 × 1.5-cm defect) of each leg. The defect in one leg was treated with autologous minced grafts derived from the contralateral leg. Maximal isometric tetanic strength assessments of the dorsiflexor muscles (ie, the peroneous tertius muscle) were performed before and biweekly up to 12 weeks postinjury.VML injury resulted in a -43.5% ± 7.2% strength deficit 12 weeks postinjury in nonrepaired legs. Autologous minced muscle graft repair significantly improved strength over 12 weeks (32% strength increase 12 weeks postinjury vs. nonrepaired muscles with a remaining -27.8% ± 7.0% strength deficit; P0.001). Nonrepaired muscles developed extensive fibrosis and presented no evidence of muscle fiber regeneration within the defect area. Minced graft-treated muscles presented areas of putative de novo muscle fiber regeneration within the defect area, although extensive fibrotic tissue deposition was also present.Autologous minced muscle grafts partially restored neuromuscular strength in a novel porcine model of VML.

Objective: This mixed-methods process evaluation examined the feasibility of a parenting program delivered by community facilitators to reduce the risk of child maltreatment in low-income families with children aged 3–8 years in Cape Town, South Africa ( N = 68). Method: Quantitative measures included attendance registers, fidelity checklists, satisfaction surveys, and engagement in home practice activities. Qualitative data included parent interviews, facilitator focus groups, and transcripts from parent groups and facilitator supervision sessions. Results: Quantitative results show high levels of participant involvement, implementation, and acceptability. Thematic analyses identified seven themes related to program feasibility: (a) supporting participant involvement, (b) engagement in collaborative learning, (c) strengthening facilitator competency, (d) delivering nonviolent discipline skills, (e) contextualizing content, (f) receptivity to existing practices, and (g) resistance to new skills. Discussion: Findings suggest that parenting programs derived from evidence-based principles may be feasible in South Africa when situated within a culturally relevant context.

Summary Background We aimed to complete a nationally representative study of sexual violence against children in South Africa, and its correlates, since we could identify no other such study. Methods For this nationally representative, cross-sectional study in South Africa, households were selected by use of a multistage sampling frame, stratified by province, urban or rural setting, and race group, and schools were selected on the basis that they were closest to the area in which households were selected. Interviews and self-administered questionnaires in each location inquired into lifetime and last-year prevalence of sexual abuse, and its correlates among children aged 15–17 years, whose parents gave informed consent and they themselves gave informed assent. Findings The final household sample was 5631 (94·6% participation rate). 9·99% (95% CI 8·65–11·47) of boys and 14·61% (95% CI 12·83–16·56) of girls reported some lifetime sexual victimisation. Physical abuse, emotional abuse, neglect, family violence, and other victimisations were all strongly associated with sexual victimisation. The following were associated with greater risk of sexual abuse (adjusted odds ratio [OR]); school enrolment (OR 2·12, 95% CI 1·29–3·48); rural dwelling (0·59; 0·43–0·80); having a flush toilet (1·43, 1·04–1·96); parental substance misuse (2·37, 1·67–3·36); being disabled (1·42, 1·10–1·82); female (but not male) caregivers' poor knowledge of the child's whereabouts, friends, and activities (1·07, 0·75–1·53) and poor quality of the relationship with the child (ie, poor acceptance; 1·20, 0·55–2·60). The child's own substance misuse (4·72, 3·73–5·98) and high-risk sexual behaviour (3·71, 2·99–4·61) were the behaviours most frequently associated with sexual abuse, with mental health conditions found to be less prevalent than these factors but still strongly associated with sexual victimisation (post-traumatic stress disorder 2·81, 1·65–4·78; depression 3·43, 2·26–5·19; anxiety 2·48, 1·61–3·81). Interpretation Sexual violence is widespread among both girls and boys, and is associated with serious health problems. Associated factors require multisectoral responses to prevent sexual violence or mitigate consequences. Funding UBS Optimus Foundation.

Purpose: Violence against children increases in adolescence, but there is a research and practice gap in research-supported child abuse prevention for the adolescent years. A pilot program for low-resource settings was developed in collaboration with nongovernmental organizations, government, and academics in South Africa, using research-supported principles. Method: This study used a pre-post design to test initial effects of a 10-session parenting program with 60 participants (30 caregiver–adolescent dyads) in high-poverty rural South Africa. Areas requiring further testing and adaptation were also identified. Results: Pre-post findings show medium to large program effects in reducing child abuse and adolescent problem behavior, as well as large effects in improvements of positive parenting, and perceived parent and adolescent social support. Discussion: There is potential to reduce child abuse, improve parenting, and reduce adolescent problem behavior in rural South Africa through parenting programs. Further development, testing and longer term follow-up are required to ascertain potential for scale-up.