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Objective: Individuals with sickle cell disease (SCD) are at increased risk for complications from their disease during their adolescent and young adult (AYA) years. The risk of morbidity in AYAs with SCD can be decreased with improved self-management. Existing self-management interventions typically focus on one aspect of self-management (e.g., adherence) and do not address factors that activate patients (knowledge, motivation, self-efficacy, and social support) to self-manage. Sickle Cell Thrive (SCThrive) is a mixed in-person/online, technology-enhanced (use of a mobile app), group self-management intervention that targets patient activation. To determine the most clinically significant intervention components, a qualitative study was conducted. Method: Participants were 19 AYAs (Mage = 17.05) with SCD who participated in individual semistructured phone interviews after completing SCThrive. Interview content was coded using a grounded-theory approach to generate themes related to SCThrive’s feasibility, acceptability, and motivation for and impact on self-management. Results: SCThrive was reported to be highly feasible due to the mixed in-person/online format and acceptable because they learned skills to manage SCD in a group of AYAs with SCD. Action planning and pain/mood tracking appeared to be key factors in motivating AYAs for self-management. Participants reported continuing to use self-management skills post-SCThrive (self-efficacy) including applying them to other domains of their lives (e.g., educational/vocational). Conclusions: Study results provide data that can be leveraged to enhance the feasibility, acceptability, and impact of SCThrive and other self-management interventions. Findings can also inform clinical and mobile health interventions to increase self-management in this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

BACKGROUND: Extant literature warns of elevated suicide risks in adults post-bariatric surgery, making understanding risks for adolescent patients imperative. OBJECTIVES: To examine prevalence and predictors/correlates of suicidal thoughts and behaviors (STBs) in adolescents with severe obesity who did/did not undergo bariatric surgery from presurgery/baseline to 4 years postsurgery. SETTING: Five academic medical centers METHOD: Utilizing a prospective observational design, surgical adolescents (n=153; 79% female, 65% White, M(age)=17, M(BMI)=52) and nonsurgical comparators (n=70; 80% female, 54% White, M(age)=16, M(BMI)=47) completed psychometrically sound assessments at presurgery/baseline and postsurgery Years 2 and 4 (Year 4: n=117 surgical [M(BMI)=38], n=56 nonsurgical [M(BMI)=48]). RESULTS: For the surgical group, rates of STBs were low (Year 2 [1.3–4.6%]; Year 4 [2.6–7.9%], similar to national base rates. Groups did not differ on a Year 4 postsurgical STBs composite (PostSTBs: ideation/plan/attempt; n=18 surgical [16%], n=10 nonsurgical [18%]; OR=0.95,p=0.90). For the surgical group, predictors/correlates identified within the broader suicide literature (e.g., psychopathology [ps

OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is the leading chronic liver disease in youth, yet little is known about the adolescent patient’s experience with NAFLD, which is key for treatment engagement. We examined adolescents’ experiences with NAFLD diagnosis, thoughts on how NAFLD affects their daily life, understanding and perceptions of diagnosis and treatment, and impressions of how to improve care. METHODS: Utilizing a mixed-method design, adolescents with NAFLD (N=16; Mean(age)=15.8 years; Mean(BMI)=37 kg/m(2)) participated in focus groups. To supplement qualitative data, adolescents and their caregiver completed measures assessing illness perceptions, adolescent quality of life, and eating/activity behaviors. RESULTS: Focus group themes suggested reactions to diagnosis varied from unconcerned to anxious. NAFLD diagnosis occurred within the context of other psychological/medical concerns and was not perceived to affect most adolescents’ daily lives. While adolescents understood general contributors to NAFLD, comprehension of their diagnosis varied. Adolescents were more likely to make lifestyle changes when families were supportive, and they preferred tailored recommendations for health behavior change from the healthcare team. Notably, 62.5% of adolescents were more concerned about their weight than NAFLD. Almost half (43.8%) identified as food insecure. CONCLUSIONS: Adolescents with NAFLD may benefit from personalized treatment. Care could be enhanced by ensuring comprehension of diagnosis, problem-solving personal and family barriers and increasing family support. Harnessing adolescents’ desire for weight loss may be a more salient driver for change in disease status. Interventions should also address systemic barriers such as food insecurity to ensure equitable care.

To explore how chronic stress, reactivity to acute stress, and obesogenic eating are linked in adolescent females predisposed to obesity.Participants included 21 adolescent females (msubage/sub = 14.57 years) and their biological mothers with obesity (body mass index [BMI] ≥ 30 kg/msup2/sup). The pilot and feasibility study involved adolescent self-report of chronic stress, an acute stress-induction paradigm (Trier Social Stress Task, TSST), salivary cortisol collection to assess stress reactivity, and both subjective (self-report) and objective (snack buffet) measures of obesogenic eating.Adolescent females reporting high chronic stress were significantly more likely to engage in self-reported emotional and external eating and to have higher food cravings (p'slt; .05) compared to adolescents with low chronic stress. Effect size estimates suggested a blunting effect of cortisol in the high chronic stress group. Blunted cortisol reactivity significantly predicted higher self-reported food cravings for the high chronic stress group (p = .04). Associations among chronic stress, cortisol, and self-reported and objective obesogenic eating reflected medium to large effect sizes.This study built on limited extant research on stress and eating to demonstrate that chronic stress was associated with self-reported obesogenic eating patterns in adolescent females predisposed to obesity. Different patterns of cortisol reactivity and eating emerged depending on chronic stress group (low versus high). Understanding these eating patterns in the context of chronic stress can inform interventions to reduce obesity risks in adolescence.

Statement of purposePreventing opioid misuse and opioid use disorder (OUD) is necessary given the opioid epidemic Prevention programs for adolescents/young adults are needed to alter risk trajectories We developed interventions using telemedicine (synchronous video conference) and a patient portal-like messaging system to address risk factors for opioid misuse/OUD among young Emergency Department (ED) patients Our presentation describes these promising interventions and their feasibility and acceptability Methods/ApproachIn Spring 2020, N = 40 ED patients ages 16–30 who were at risk for opioid misuse/OUD enrolled in a pilot trial involving screening/baseline assessments, motivational interviewing-based remote interventions (baseline telemedicine brief intervention [BI], 1-month of portal messaging), and a 1-month follow-up Before COVID-19, N = 10 enrolled in the ED (in-person cohort: IPC);during COVID-19, N = 30 recent ED patients enrolled via phone recruitment (remote cohort: RC) Feasibility data are presented by cohort;acceptability data are combined ResultsAmong the N=40, the sample had a mean age of 22 9 years Gender was: 70% female, 5% non-conforming, 25% male Race was: 75% White, 15% Black/African American, and 10% other racial identities;17 5% were Hispanic/Latinx Regarding feasibility, eligibility rates were similar (IPC: 17%, RC: 15%);consenting rates differed (IPC: 100%, RC: 56%), likely due to the RC’s telephone approach Portal engagement increased from the IPC (60%) to the RC (93%), possibly due to addressing technical difficulties and IPC user feedback BI and portal satisfaction were high (M = 9 3 on a 1–10 scale and M = 8 5, respectively) Interventions exceeded motivational interviewing fidelity thresholds (adapted for portal messaging) Follow-up rates were high (IPC: 80%, RC: 93%) SignificancePreventing opioid misuse is critical to avoiding escalation of opioid use and overdoses, and emergency department patients are at increased risk This study demonstrates the feasibility and acceptability of these intervention approaches via telemedicine for preventing future injuries

Historically, youth with sickle cell disease (SCD) were at risk for being underweight, but recent data suggests this population is replicating obesity trends of youth in the United States. The current observational study assessed the weight status and health behaviors of 44 adolescents and young adults with SCD via a self-report survey and chart review. Using height and weight data closest to survey completion date, 27% of participants were either overweight or obese. With respect to obesogenic risk behaviors, 77% ate fast food 1-3 times per week, 25% had no fruits/vegetables with any of their meals, 11% drank no water, and 57% watched 4 or more hours of television per day. Though more research is needed, this preliminary study adds to the SCD literature suggesting an emerging shift toward obesity in this population. As such, adolescents with SCD may benefit from interventions to decrease obesity risk factors as being overweight or obese has the potential to worsen SCD-related symptoms and complications.

OBJECTIVE This study aimed to track conventional cigarette smoking behaviors and associated correlates in adolescents with severe obesity who did or did not undergo metabolic and bariatric surgery to 4 years after surgery/baseline. METHODS Utilizing a prospective controlled design, surgical (n = 153; mean BMI = 52) and nonsurgical (n = 70; mean BMI = 47) groups that completed assessments before surgery/at baseline and at Years 2 and 4 post surgery (Year 4: n = 117 surgical [mean BMI = 38]; n = 56 nonsurgical [mean BMI = 48]) were compared. Separate logistic regression models tested correlates of Year 4 current smoking. RESULTS More than half of participants (surgical: 55%; nonsurgical: 60%) had ever smoked a cigarette, with current smoking increasing with time. Groups did not differ in Year 4 current smoking (surgical: 23%; nonsurgical: 33%), with ≈ 50% meeting criteria for "heavy" smoking (≥ half pack/day) and ≈ 40% smoking their first cigarette before ninth grade. Factors associated with higher odds of Year 4 current smoking included dysregulation (P

This pilot study evaluated a brief sleep treatment for children presenting with emotional/behavioral disorders. Parents of children ages 6 to 11 years (n = 27) completed measures of emotion...

Depression and anxiety are prevalent and impairing forms of psychopathology in children and adolescents. Deficits in early executive control (EC) may contribute to the development of these problems, but longitudinal studies with rigorous measurement across key developmental periods are limited. The current study examines EC in preschool as a predictor of subsequent depression and anxiety symptoms in elementary school in a community sample (N = 280). Child participants completed a battery of nine developmentally-appropriate tasks designed to measure major aspects of EC at age 5 years, 3 months. Children later participated in an elementary school follow-up phase, during which they completed validated norm-referenced self-report questionnaires of depression and anxiety symptoms in fourth grade. Results indicate that poorer preschool EC was significantly associated with both greater depression and anxiety symptoms in elementary school, controlling for baseline depression and anxiety symptoms in preschool and other relevant variables. These findings suggest that poor EC may be an important risk factor for the development of internalizing psychopathology in childhood. Given emerging evidence for the modifiability of EC, particularly in preschool, EC promotion interventions may hold promise as a potential target in psychopathology prevention.

The transition to elementary school is accompanied by increasing demands for children to regulate their attention and behavior within the classroom setting. Executive control (EC) may be critical for meeting these demands; however, few studies have rigorously examined the association between EC and observed classroom behavior. This study examined EC in preschool (age 5 years 3 months) as a predictor of classroom learning engagement behaviors in first grade, using a battery of performance-based EC tasks and live classroom observations in a longitudinal sample of 313 children. Multilevel modeling results indicated that stronger EC predicted more focused engagement and fewer task management and competing responses, controlling for socioeconomic status, child sex, and age at observations. Results suggest that early EC may support subsequent classroom engagement behaviors that are critical for successful transition to elementary school and long-term learning trajectories. (PsycINFO Database Record

Objective To examine the longitudinal associations among sleep, executive control (EC), and attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood. Methods In this longitudinal study (N = 271), parents answered questions about sleep problems when children were 3 years old, children completed a comprehensive EC task battery at 4.5 years, and teachers completed standardized measures of child ADHD symptoms in 4th grade. Results Latent moderated structural equation models demonstrated that sleep problems at 3 years and EC deficits at 4.5 years were associated with ADHD symptoms in 4th grade. EC moderated the relationship between sleep problems and hyperactivity/impulsivity, such that children with both sleep problems and poor EC were particularly at risk for hyperactivity/impulsivity. Conclusions Sleep problems and EC deficits early in development were associated with increased risk for ADHD symptoms in elementary school. Early assessment and intervention to promote healthy sleep and EC development may be helpful in ADHD prevention.

Objectives To determine the longitudinal association between preschool extraversion and weight/dieting outcomes in adolescence. Methods Children (N = 180) were recruited as part of a longitudinal study, with child temperament assessed in preschool (age 5.25 years), weight assessed in 2nd grade and early adolescence, and eating outcomes assessed in early adolescence (mean age = 12.02 years). Results Preschoolers high in extraversion were significantly more likely to have higher body mass index z-scores (zBMI) and more restrained eating behaviors in adolescence. zBMI was found to mediate the relationship between extraversion and restrained eating, such that children with high levels of extraversion were more likely to have higher zBMI in adolescence and, owing to this higher weight status, to engage in more restrained eating. Conclusions Temperament is an important predictor of later maladaptive weight/dieting outcomes in adolescence, making it a potentially important early factor to consider in weight management interventions.

Adherence rates for pediatric sickle cell disease vary across treatment type and medication. Adherence tends to worsen with age, with adolescents and young adults at increased risk of morbidity and mortality. Suboptimal adherence to treatment can lead to a host of negative outcomes, including severe pain episodes, serious medical complications (e.g., infections, stroke, pulmonary hypertension), and mortality. Common barriers to adherence include forgetting, health status and beliefs, burden of regimen, socioeconomic factors, and healthcare system factors. Adherence may be improved through high-quality standardized assessment, use of both objective and subjective assessment measures, and engaging interventions that may integrate novel technologies.

Background Sickle cell disease (SCD) is associated with significant medical challenges that often worsen in adolescence when caregivers are beginning to transfer responsibility for disease management. Behavioral activation (BA) is an important precedent to improvements in self-management and ultimately health outcomes; however, few interventions targeting BA have been developed for the SCD population. The goal of the present study was to evaluate a technology-enhanced self-management intervention for adolescents and young adults (AYA) with SCD targeting BA domains (ie, disease knowledge, self-efficacy, motivation, and self-management skills). Design/methods Participants were randomized to one of two study arms. SCThrive participants (N = 26) completed six weekly group sessions, an in-person booster session, and used a companion app (iManage) to record symptoms, progress on goals, and connect with other group members. Each SCHealthEd participant (N = 27) received six weekly phone calls on SCD-related and general health education topics. All AYA completed questionnaires assessing BA at baseline and posttreatment. Results Separate mixed ANOVA analyses to assess for the effects of group (SCThrive/SCHealthEd), time (baseline/posttreatment), and group × time interaction indicated that there was a clinically meaningful improvement (8-point change) in self-efficacy, with a medium effect size, P = .09, η2 = .06, and there was statistically significant improvement in one self-management skill (tracking health), P = .001, d = .71, among SCThrive participants. Conclusions The results support the potential for a self-management intervention to improve self-efficacy in AYA with SCD. Health care providers are encouraged to target BA skills to support self-management of AYA with SCD.

Background/objectives Weight-related quality of life (WRQOL) and generic health-related quality of life (HRQOL) have been identified as important patient-reported outcomes for obesity treatment and outcome research. This study evaluated patterns of WRQOL and HRQOL outcomes for adolescents at 24-months post-bariatric surgery relative to a nonsurgical comparator sample of youth with severe obesity, and examined potential weight-based (e.g., BMI, weight dissatisfaction) and psychosocial predictors and correlates of these outcomes. Subjects/methods Multi-site data from 139 adolescents undergoing bariatric surgery (Mage = 16.9; 79.9% female, 66.2% White; MBody Mass Index [BMI] = 51.5 kg/m2) and 83 comparators (Mage = 16.1; 81.9 % female, 54.2% White; MBMI = 46.9 kg/m2) were collected at pre-surgery/baseline, 6-, 12-, and 24-months post-surgery/baseline with high participation rates across time points (>85%). Self-reports with standardized measures of WRQOL/HRQOL as well as predictors/covariates (e.g., weight dissatisfaction, social support, peer victimization, family dysfunction, loss of control eating, self-worth, and internalizing symptoms) were obtained. Growth curve models using structural equation modeling examined WRQOL/HRQOL over time and linear regressions examined predictors and correlates of WRQOL/HRQOL outcomes. Results Significant improvement in WRQOL and Physical HRQOL, particularly in the first postoperative year with a leveling off subsequently, was found for the surgical group relative to comparators, but with no significant Mental HRQOL change. At 24 months, the surgical group had significantly greater WRQOL/HRQOL across most subscales. Within the surgical group at 24 months, weight-based variables were significantly associated with WRQOL and Physical HRQOL, but not Mental HRQOL. Mental HRQOL was associated with greater internalizing symptoms and loss of control eating. Conclusions For adolescents undergoing bariatric surgery, most clinically meaningful changes in WRQOL and Physical HRQOL occurred early postoperatively, with weight-based variables as the primary drivers of 24-month levels. In contrast, expectations for Mental HRQOL improvement following surgery should be tempered, with 24-month levels significantly associated with psychosocial rather than weight-based correlates.

Background Obesity is a chronic condition that has an intergenerational effect. The aims of the study were to better understand the impact of maternal bariatric surgery on obesogenic risks to child offspring in the home via documenting mothers’ thoughts, behaviors, and experiences around child feeding, family meals, and the home food environment during her first year postsurgery. Method Utilizing a mixed-method cross-sectional design, 20 mothers (Mage = 39.6 ± 5.7 years, 75% White, MBMI = 33.6 ± 4.3 kg/m2, Mtime = 7.7 ± 3.1 months post-surgery) of children ages 6–12 years completed validated self-report measures and participated in a focus group. Mother and child heights/weights were measured. Results The majority of children (N = 20; Mage = 9.2 ± 2.3 years, 65% White, 60% female) were overweight (N = 12; BMI≥85th percentile) and were not meeting the American Academy of Pediatrics healthy eating and activity recommendations to treat/reduce obesity risk. As child zBMI increased, mothers expressed significantly more weight concern (r = 0.59, p = 0.01) and lower obesity-specific quality of life (r = −0.56, p = 0.01), yet assumed less responsibility for child eating choices (r = −0.47, p = 0.04). Qualitative data demonstrated disconnects between mothers’ changes to achieve her own healthier weight and applying this knowledge to feeding her child/family. Conclusions While bariatric surgery and requisite lifestyle change are effective tools for weight loss at the individual level, there is a great need for innovative family-based solutions. Pediatric obesity is preventable or risk-diminished if addressed early. Maternal bariatric surgery may be a unique (yet missed) opportunity to intervene.

Objective The purpose of this study is to examine the role of outward anger expression on physical health outcomes (number of illnesses in the past year, 2-year medical service utilization, and health-related quality of life) while also expanding on previous research by assessing the moderating effect of parent-child dysfunction. Method An ethnically diverse sample of 125 children, ages 8 to 11 years, was recruited from a family medicine practice serving a low-income population. Results High levels of outward anger expression were related to a greater number of illnesses, greater medical service utilization, and lower health-related quality of life. Additionally, worse parent-child dysfunction exacerbated this relationship for a number of illnesses and medical service utilization. Conclusion Results suggest that health care providers should consider the influence of environmental and familial factors on the physical health of children with anger. Recommendations for identifying at-risk youth and improving anger expression as well as parent-child relationships are provided.

OBJECTIVE: To examine the acceptability, feasibility, and efficacy of a healthcare portal. OBSERVATIONS: Adolescents and young adults (AYA) with sickle cell disease (SCD) were taught how to use an SCD-conditions page in MyChart(®) and completed questionnaires at baseline, post-intervention (T2, 6 weeks after baseline) and after 3 months (T3). Forty-four participants (M age = 18.82, SD = 2.72) viewed an average of 58.07 pages from T1 to T2. The portal was highly accepted (90.32%). Efficacy data indicated that portal use was associated with improved patient-provider communication. CONCLUSIONS: Electronic portals are promising tools for improving medical self-management.

Despite being widely used, there has not yet been a confirmatory factor analysis (CFA) on the English version of the Parental Feeding Style Questionnaire (PFSQ). Preschool is a critical time to assess parental feeding styles, and the PFSQ is one of the few measures that can be used with young children. As such, the current study conducted the first CFA on the PFSQ in an English-speaking sample in the United States to establish preliminary evidence of its factor structure. Parents of preschoolers aged 3–5 years (N = 297; M = 33.47 years; 85.2% mothers) presenting to a pediatric dentistry office in the Midwest of the United States were recruited to participate in this cross-sectional study. Parents completed the PFSQ in the waiting room of the dental office. Robust maximum likelihood factor analyses were conducted on the PFSQ. The original four-factor model was not confirmed, but rather, results provided preliminary support for a five-factor solution: Control over Eating, Instrumental Feeding, Emotional Feeding, Encouragement of Variety, and Prompting of Eating, CFI = 0.91, SRMR = 0.06, RMSEA = 0.05. The PFSQ is a widely used measure for assessing parental feeding styles in young children. However, the CFA indicated that the originally proposed four-factor structure did not fit well. Certain modifications to the measure were necessary to improve model fit. A five-factor model fit better, and six items were removed, reducing the original 27-item scale to 21 items. Level V, cross-sectional descriptive study.

Objective: To examine the differential associations between children’s anger expression styles and selected health constructs. Method: Measures assessed sleep problems, medical service utilization, and mental health in 125 children (M = 9.48 years). Results: Anger expression styles predicted health outcomes in a multivariate model. As hypothesized, anger-out significantly predicted sleep problems, number of medical visits, externalizing problems, and internalizing problems. Anger-in was not significantly related to any health outcome measure. Conclusion: This study demonstrates the importance of anger expression styles for health, as they are differentially related to impairments. Clinicians are urged to recognize anger problems to broadly impact children’s health.

The purpose of this article is to describe the health-related quality of life (HRQoL) of adolescents in residential care and to examine selected correlates. A sample of 229 adolescents (mean age=17 years) living in a residential care setting completed a validated measure of HRQoL (PedsQL 4.0 Generic Scales). Mean-level scores for Total HRQoL, Physical HRQoL, and Psychosocial HRQoL were examined, and the percentage of youth scoring below a clinical cutoff value was reported. Demographic and psychotropic medication data for each youth were accessed from an electronic database maintained by the residential care program and used to examine correlates of HRQoL. Approximately 25% of youth had at least 1 HRQoL score in the "at risk" range, indicating a significant proportion of youth in residential care have significant impairments in HRQoL. Younger age and female gender were associated with poorer HRQoL. Psychotropic medication prescriptions were associated with poorer HRQoL. A significant percentage of adolescents in residential care may experience suboptimal HRQoL, and certain demographic and clinical factors appear to be associated with greater risk. Systematic assessment of HRQoL is recommended for youth in residential care, and interventions to promote better HRQoL among youth at particularly high risk may be beneficial.

BACKGROUND AND OBJECTIVE:Parental perceptions of their children’s weight play an important role in obesity prevention and treatment. The objective of this study was to determine the proportion of parents worldwide who underestimate their children’s weight and moderators of such misperceptions.METHODS:Original studies published to January 2013 were chosen through literature searches in PUBMED, PSYCHINFO, and CINAHL databases. References of retrieved articles were also searched for relevant studies. Studies were published in English and assessed parental perceptions of children’s weight and then compared perceptions to recognized standards for defining overweight based on anthropometric measures. Data were extracted on study-level constructs, child- and parent-characteristics, procedural characteristics, and parental underestimates separately for normal-weight and overweight/obese samples. Pooled effect sizes were calculated using random-effects models and adjusted for publication bias. Moderators were explored using mixed-effect models.RESULTS:A total of 69 articles (representing 78 samples; n = 15 791) were included in the overweight/obese meta-analysis. Adjusted effect sizes revealed that 50.7% (95% confidence interval 31.1%–70.2%) of parents underestimate their overweight/obese children’s weight. Significant moderators of this effect included child’s age and BMI. A total of 52 articles (representing 59 samples; n = 64 895) were included in the normal-weight meta-analysis. Pooled effect sizes indicated that 14.3% (95% confidence interval 11.7%–17.4%) of parents underestimate their children’s normal-weight status. Significant moderators of this effect included child gender, parent weight, and the method (visual versus nonvisual) in which perception was assessed.CONCLUSIONS:Half of parents underestimated their children’s overweight/obese status and a significant minority underestimated children’s normal weight. Pediatricians are well positioned to make efforts to remedy parental underestimates and promote adoption of healthy habits.

Background: The field has made significant strides in understanding the mechanisms underlying pediatric sickle cell disease (SCD), and the coming years will likely see the approval of several new medications to treat SCD. The impact of these medications on clinical outcomes, however, will be dependent on patient adherence. Adolescents with SCD are at particular risk for non-adherence, and as disease management increasingly includes self-administration of oral medications, adherence assessment will become a critical component of research on medication effectiveness and clinical care. While electronic monitoring devices (bottles with computer chips that record date- and time-stamps of device openings) such as MEMS® bottles are considered the "gold standard" for adherence assessment in other populations, their feasibility among adolescents with SCD remains unknown. Objectives: The primary aims of this study were to examine data on MEMS® bottle use among adolescents (ages 13-21 years) with SCD to: 1) evaluate the feasibility of MEMS® bottle use; and 2) elicit barriers and facilitators to MEMS® bottle use. Methods: As part of a larger study of a self-management intervention, adolescents were asked to use a MEMS® bottle to store and administer their daily oral medication (hydroxyurea or deferasirox) for the 18-week study duration. The larger study included baseline, post-treatment, and follow-up assessments, at which adolescents were asked to provide their MEMS® bottle for data download. Descriptive statistics were calculated to assess multiple domains of MEMS® bottle feasibility including: initial uptake (% enrolled), MEMS® initiation (% initiated), and MEMS® sustained use (% completed; % provided bottles for download ±2 weeks of scheduled study visit = "on time"). Barriers and facilitators to MEMS® use were elicited via adolescent self-report. Results: In the larger study, 18 non-Hispanic African-American adolescents (M = 17.8 years, SD = 2.6; 61% male) with HbSS were asked to use a MEMS® bottle to store their hydroxyurea (n = 14) or deferasirox (n = 4). Initial uptake was 94.7%, with 18 of 19 eligible adolescents enrolling in the study. Of the 18 enrolled adolescents, all initiated MEMS® use (100%) and 11 sustained MEMS® use through the final study endpoint (61.1%). Eight (44.4%) and 2 (11.1%) adolescents provided their MEMS® bottle for download "on time" at post-treatment (42 days) and follow-up (126 days), respectively. Barriers to MEMS® use included medication changes (i.e., medication holds, dose timing changes) and transitioning from pediatric to adult care. Facilitators included tip sheets (e.g., places to store bottle, reminder to place refills in bottle) and reminder calls. Participants took a median of 26.2% of doses using the MEMS® across the 126 days (SD = 22.4; range 0.79% - 79.3%), illustrating that electronic monitoring devices are not a solution to medication adherence, but are one component of an adherence support strategy. See Figure 1 for adherence rates over time. Discussion: Data suggest that MEMS® are acceptable to adolescents with SCD. Ensuring sustained MEMS® use, however, will likely require additional supports. For example, electronic monitors which automatically transmit data in real-time via Bluetooth or cellular connections would eliminate the need for adolescents to bring bottles to study visits for data downloads. Researchers and clinicians interested in using electronic monitoring devices are encouraged to consider remote monitoring capabilities along with other device features when selecting a product. Larger studies are needed to evaluate concordance between rates of adherence obtained via electronic monitoring and other assessments and to validate electronically-monitored medication adherence with clinically-relevant outcomes for adolescents with SCD. Figure 1 Disclosures Quinn: Celgene: Membership on an entity's Board of Directors or advisory committees; Amgen: Other: Research Support.

Accurate parental perceptions of their children’s underweight status are needed to prevent overlooking potential disordered eating patterns or health conditions affecting growth. The aim of this study is to determine overall proportion of parents who misperceive children’s underweight status and correlates of such misperceptions. Original studies published to January 2013 were chosen through a literature search in established databases. Studies included assessed parental perceptions of their children’s underweight and then compared perceptions to recognized standards for defining underweight based on anthropometric measures. Random- and mixed-effects models were used. Thirty-seven articles (representing 39 studies; N = 4,039) were included. Pooled effect sizes indicated that 46.58 % (95 % CI 40.90–52.35 %) of parents misperceive their children’s underweight status, though the extent of misperceptions depended on a number of moderators. Nearly half of parents perceive their underweight children as weighing more than they actually do. Health care professionals are well positioned to take steps to remedy misperceptions and encourage healthy behaviors.

OBJECTIVE: Although numerous studies have documented the effects of sleep loss on executive control (EC) and related abilities, research examining the impact of early EC on subsequent sleep problems is lacking. Therefore, the current study reports on a longitudinal investigation of EC in preschool as a predictor of sleep/wake problems and daytime sleepiness in early adolescence. PARTICIPANTS: The participants were 141 children (48.6% female) recruited from the community for a longitudinal study spanning preschool through early adolescence, with an oversampling for high sociodemographic risk (34.1% based on eligibility for public medical insurance, free/reduced lunch status, and/or family income-to-needs below the federal poverty line). METHODS: Participants completed a battery of developmentally-appropriate tasks assessing major aspects of EC (working memory, inhibitory control, flexible shifting) during a laboratory visit at age 4 years, 6 months. Participants also completed a follow-up session in early adolescence (between ages 11 years and 13.5 years; mean age = 11.82 years, SD = .62 years), during which they completed self-report measures of sleep/wake problems and daytime sleepiness. RESULTS: Structural equation modeling results indicate that preschool EC (represented by a single latent construct) significantly negatively predicted both sleep/wake problems and daytime sleepiness in early adolescence, with poorer EC predicting greater subsequent sleep problems. CONCLUSIONS: Poorer EC abilities during the critical period of preschool may be a risk factor for later sleep problems in adolescence. Given that EC appears to be modifiable, early interventions to promote EC development may help prevent subsequent sleep problems and promote long-term health trajectories.

CONTEXT: Mixed findings exist on whether stimulant medications alter youth sleep. OBJECTIVE: To determine the effect of stimulant medications on sleep. DATA STUDIES: Studies published through March 2015 were collected via CINAHL, PsycINFO, and PubMed. References of retrieved articles were reviewed. STUDY SELECTION: Eligibility criteria included studies with children/adolescents who had attention-deficit/hyperactivity disorder (ADHD), random assignment to stimulants, and objective sleep measurement. Studies that did not include information about key variables were excluded. DATA EXTRACTION: Study-level, child-level, and sleep data were extracted by 2 independent coders. Effect sizes were calculated by using random effects models. Potential moderators were examined by using mixed effect models. RESULTS: A total of 9 articles (N = 246) were included. For sleep latency, the adjusted effect size (0.54) was significant, indicating that stimulants produce longer sleep latencies. Frequency of dose per day was a significant moderator. For sleep efficiency, the adjusted effect size (−0.32) was significant. Significant moderators included length of time on medication, number of nights of sleep assessed, polysomnography/actigraphy, and gender. Specifically, the effect of medication was less evident when youth were taking medication longer. For total sleep time, the effect size (−0.59) was significant, such that stimulants led to shorter sleep duration. LIMITATIONS: Limitations include few studies, limited methodologic variability, and lack of unpublished studies. CONCLUSIONS: Stimulant medication led to longer sleep latency, worse sleep efficiency, and shorter sleep duration. Overall, youth had worse sleep on stimulant medications. It is recommended that pediatricians carefully monitor sleep problems and adjust treatment to promote optimal sleep.

This study examined the differential associations between parent-reported child sleep problems in preschool and specific aspects of executive control in early elementary school in a large sample of typically developing children (N = 215). Consistent with expectations, sleep problems were negatively associated with performance on tasks assessing working memory and interference suppression inhibition, even after controlling for general cognitive abilities, but not with flexible shifting or response inhibition. The findings add to the literature on cognitive impairments associated with pediatric sleep loss and highlight the need for early intervention for children with sleep problems to promote healthy cognitive development.

This study examined child anxiety as a potential moderator of the relationship between parenting stress and child physical health. Low-income youth ( N = 109, M = 9.51 years old) and their parents completed measures of anxiety, health-related quality of life, and parenting stress in an outpatient clinic. As an objective measure of physical health, medical service utilization was extracted from medical records. Parenting stress was associated significantly with worse health-related quality of life and higher service utilization. Child anxiety moderated the relationship between stress and health. Health psychologists should target both family stress and child anxiety in promoting better health outcomes among low-income families.

Latino adolescents living in rural settings may be at increased risk of health problems; however, data describing the health status of this population are limited. This study examined 60 rural Latino adolescents and found high rates of health risk, including at-risk/clinical results for hemoglobin A1C (23.3%), high-density lipoprotein cholesterol (55%), systolic blood pressure (21.7%), and overweight/obesity (55%). Time in sedentary behaviors was high and physical activity was limited. Adolescent language use was associated with health risk status, with greater use of English associated with lower risk. Health psychologists could promote improved health by providing health behavior interventions to this underserved population.

Objective To examine maternal and child internalizing symptoms as predictors of early adolescent emotional eating in a longitudinal framework spanning three critical developmental periods (preschool, elementary school, and early adolescence). Methods Participants were 170 children recruited at preschool age for a longitudinal study. When children were 5.25 years, their mothers completed ratings of their own internalizing symptoms. During the spring of 4th grade, children completed measures of internalizing symptoms. In early adolescence, youth completed a measure of emotional eating. Results Maternal and child internalizing symptoms predicted adolescent emotional eating. The results indicated that child psychopathology moderated the association between maternal psychopathology (except for maternal anxiety) and early adolescent emotional eating. There was no evidence of mediation. Conclusions Pediatric psychologists are encouraged to provide early screening of, and interventions for, maternal and child internalizing symptoms to prevent children's emotional eating.