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Group well-child care (GWCC) is an alternative to traditional pediatric well-child care designed to increase parental social support and peer learning. This mixed methods study explored the adaptation and implementation of GWCC to a virtual format during coronavirus disease 2019 (COVID-19 pandemic) among Spanish-speaking Latino immigrant families.Interviews were conducted with eight providers and 10 mothers from May through September 2020. Qualitative analyses used a priori codes based on an implementation science framework. Quantitative data included demographics, the COVID-19 Impact Scale, and virtual group attendance. Bivariate analyses identified correlates of virtual visit attendance.Eighty percent of mothers reported the pandemic had moderately or extremely impacted at least one major life domain such as daily life, food security, or family conflict. Of 27 mothers offered virtual groups, 67% attended. Mothers who attended virtual groups reported lower English proficiency (Competing demands for those most impacted by COVID-19 may outweigh benefits of attendance. Virtual Spanish language GWCC appears acceptable and feasible for Spanish speaking Latina mothers. Thematic analysis and recommendations identify areas of improvement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This study examines the association between behavioral health symptoms and use of behavioral health care (BHC; i.e., past year counseling and/or regular use of psychiatric medication) among a diverse group of mothers of toddlers. Data were from the Fragile Families and Child Wellbeing study (N = 4205 mothers). The association between symptom profiles (i.e., depressive, anxiety, and alcohol and drug dependence) and use of BHC was estimated with logistic regression models. Potential moderation by race/ethnicity was examined. Complex symptom profiles, older age, functional limitations, prior behavioral health symptoms, and having Medicaid were associated with increased BHC use. While BHC use varied by symptom profile (but not by race/ethnicity), BHC use was low across profiles. Pregnant women and women of color were most likely to have unmet needs, underscoring the need to improve screening and management systems for these populations.

Although trauma exposure is a recognized risk factor for alcohol use, research on military populations has emphasized combat exposure, with minimal consideration of exposure to other potentially traumatic events (PTEs). We aimed to (a) identify, characterize, and quantify subgroups of service members based on PTE patterns; (b) examine associations between trauma exposure subgroups and alcohol use; and (c) examine these associations longitudinally. Data were drawn from Operation: SAFETY, a longitudinal study of health and well-being among U.S. Army Reserve/National Guard soldiers (N = 478). Exposure to 15 PTEs, including childhood maltreatment, noninterpersonal events (e.g., natural disasters, accidents), interpersonal trauma, and military-related exposures, was assessed at baseline. Latent profile analysis was conducted to characterize mutually exclusive trauma profiles; profile membership was used to longitudinally predict alcohol use in generalized estimating equation models. Four exposure profiles were identified: intimate partner violence (IPV)/combat trauma (8.4%, n = 40), combat trauma (24.7%, n = 118), childhood trauma (8.4%, n = 40), and low trauma (58.6%, n = 280). In adjusted models, compared to the low trauma profile, IPV/combat profile membership was longitudinally associated with alcohol problems, OR = 2.44, p =.005. Membership in other trauma profiles was not associated with alcohol use. Within the IPV/combat profile, men had a higher risk of frequent heavy drinking than women. Results suggest a need to comprehensively screen for lifetime PTE exposure, particularly IPV, in military populations. Given the high prevalence of nonmilitary PTEs, an inclusive, trauma-informed approach to health care and service provision is warranted.

Families are the most proximal and powerful context for the development, promotion, and disruption of health of individuals across the life course. Despite families’ critical role in health, U.S. nationally representative health surveys lack comprehensive and standardized assessments of family health and functioning. To foster research on family health in population surveys, we developed a conceptualization of family health using a modified Delphi process with family health experts. Experts responded online to produce consensus definitions of ‘family’ and ‘family health.’ Guided by these definitions, they responded to a survey to create a list of concepts for measurement of family health and ranked the importance and measurability of those concepts. We achieved consensus among 15 family health experts on definitions of ‘family’ and ‘family health.’ Thirty-one family health concepts were organized into six domains, then ranked by relevance and importance as follows: (1) “Family relationships” and “family social context” tied for first priority, (2) “family member health, (3) “family health-related practices,” (4) “family health resources,” and (5) “management of time and activities.” Social relationships and social environment were prioritized as more essential than other aspects of family environments typically assessed in population surveys, such as health practices and family members’ illness and disease. This study develops the scientific groundwork needed to advance routine monitoring of family health in national health surveys and in child/family performance measures.

Behavioral health problems affect at least 15% of mothers, but few studies have examined how different problems cluster together. Characterizing symptom profiles and their correlates early in the family life cycle can extend existing understanding beyond that provided by studies based on single problems. Mothers in the Fragile Families and Child Wellbeing study, a national birth cohort of racially diverse and mostly unmarried mothers (N = 4205), reported depression, anxiety, and substance dependence symptoms. Latent class analysis (LCA) identified mothers' symptom profiles in their children's third year. We explored associations between symptom profiles and demographics, reproductive health outcomes, functional limitations, and postpartum behavioral health. LCA identified five profiles: (1) Depression only (14.5% of sample), (2) Severe depression and anxiety (5.3%), (3) Anxiety only (2.2%), (4) Depression and substance use (1.4%), and (5) Currently symptom free (76.6%). Depressive symptoms were more moderate when co-occurring with substance dependence and more severe when co-occurring with anxiety. Postpartum depression, postpartum anxiety, and smoking during pregnancy were the most robust correlates of being symptomatic in year 3. Mothers in the "Severe depression and anxiety" group were more likely to be in that profile if they reported functional impairment and/or relationship dissolution. Mothers in the "Depression only" profile were more likely to have higher parity and/or functional impairment. A quarter of mothers of young children had significant behavioral health symptoms, with most reporting depression symptoms. Psychosocial and physical health factors in the pregnancy and postpartum periods were associated with future symptoms, warranting obstetrician and pediatrician attention.

Few studies have examined the association between maternal and youth mental health among US Latinos, or its variation by nativity, country of origin, ethnic subgroup, and time in the mainland US. Using 2007–2014 Medical Expenditure Panel Survey data linking Latino youth (N = 15,686 aged 5–17 years) and their mothers, we estimated multivariate models of the relationship between probable maternal mental illness (a composite of measures) and youth mental health impairment (Columbia Impairment Scale). Children of mothers with probable mental illness were more than three times as likely to have impairment as children of mothers without mental illness (p

Having identified gaps in implementation of Rhode Island's syringe access law and police occupational safety education, public health and police professionals developed police training to boost legal knowledge, improve syringe access attitudes, and address needlestick injuries. Baseline data (94 officers) confirmed anxiety about needlestick injuries, poor legal knowledge, and occupational risk overestimation. Before training, respondents believed that syringe access promotes drug use (51%), increases likelihood of police needlestick injuries (58%), and fails to reduce epidemics (38%). Pretraining to posttraining evaluation suggested significant shifts in legal and occupational safety knowledge; changes in attitudes toward syringe access were promising. Training that combines occupational safety with syringe access content can help align law enforcement with public health goals. Additional research is needed to assess street-level effect and to inform intervention tailoring.

Mothers who are dually-diagnosed with HIV/ AIDS and drug abuse are particularly burdened and vulnerable to loss of child custody.This study explores factors associated with child custody loss among HIV+ women in drug abuse recovery, and compares mothers who have custody of their children to mothers who do not have custody of all of their children.Descriptive analyses were conducted on 68 HIV+ mothers in drug recovery, 46% who had custody of all of their children, and 54% who did not.The lost-custody group was less likely to be employed and had more history of violent impulses and arrest, particularly on drug charges. The groups reported similar recent and lifetime drug use patterns, but the custody group had received more drug treatment. Post-hoc analyses found the lost-custody group had lower rates of participation in the interventions offered in the parent clinical trial and higher avoidant coping.The sample in the current study supports that HIV+ women in drug recovery are at high risk of loss of child custody. Non-adherence to available treatment seems to be associated with loss of child custody.RESULTS suggest the need for further research and active treatment outreach for this population.

RATIONALE: This study assesses the relationships between ADHD symptoms, specific family asthma management domains, and pediatric asthma morbidity. METHODS: Participants were 110 children with asthma and a respective parent (ages 7-17, X = 11.6 years, 25% ethnic/racial minority). Parents completed measures of asthma morbidity and report of child ADHD symptoms. Children completed measures of attention, concentration, and impulsivity. Families participated in the Family Asthma Management System Scale (FAMSS) interview to assess the effectiveness of eight features of asthma management. RESULTS: Parent report of ADHD symptoms and poor child performance on a computerized task of sustained visual attention were associated with asthma morbidity. Paper and pencil tasks of visual attention, and an index of auditory attention, were not related to asthma morbidity. Modest associations were found between parent report of ADHD symptoms, child performance-based indicators of attention and concentration, and features of family asthma management, although not across all measures. The family response to asthma partially mediated the relationship between ADHD symptoms and morbidity. CONCLUSIONS: ADHD symptoms are modestly associated with difficulties in family asthma management.

Depression is one of the most debilitating chronic disorders in the United States, affecting 15 million children in homes with depressed mothers, many of whom endure household chaos, inconsistent nurturing, inadequate safety practices, and harsh discipline. Depressed mothers are under diagnosed and undertreated, yet there is broad consensus about the importance of identifying and managing maternal depression, as reflected in recommendations by pediatric and obstetric professional organizations to routinely screen for perinatal depression. Screening was shown to be acceptable to women and most pediatric providers, and adding a screening component need not impair clinic efficiency. Screening, however, is not sufficient, and there are few models in the literature to guide medical practices in implementing successful interventions to identify, treat, and prevent maternal depression, particularly in the pediatric setting. We reviewed the literature and identified six studies that evaluated models for screening and managing mothers' depression in pediatric primary care settings. Some of these interventions have promise, but no studies characterized health outcomes of the depressed mothers and children. We discuss the components of these models, their implementation, and the practice and research needed to create effective pediatrics-based systems to reduce the negative effects of maternal depression on mothers, children, and families.

Drug abuse has serious consequences for the wellbeing of persons with HIV/AIDS but suboptimal rates of client engagement limit the efficacy of interventions. The present study examines and compares client characteristics that predicted engagement (defined as attendance at two or more sessions) in a family intervention (SET) and a group intervention within a randomized trial aimed at preventing relapse and improving medication adherence for 126 predominantly African American HIV+ women in drug abuse recovery. Intervention engagement (60% overall) was not significantly different across the two interventions. Fewer physical and mental symptoms (malaise) (P < 0.05), living independently (P < 0.05), living with children (P < 0.05), and readiness to change (P < 0.05) were associated with engagement across the two interventions. Results from this study can be used to inform outreach and engagement approaches for women dually affected by drug abuse and HIV/AIDS.

BACKGROUND: More than 200,000 children are injured at playgrounds in the United States each year. Our goal was to introduce a composite measure of playground safety and use this instrument to correlate the incidence of supracondylar humerus fractures with playground safety in an ecologic study design. METHODS: We used a novel "overall-safety rating," defined as a composite of 3 previously validated instruments (National Program for Playground Safety School score, surface depth compliance, and the use zone compliance) to measure the overall safety of all playgrounds within a region. The regions were rated from most to least safe based on average playground safety as measured by this new method. The incidence of supracondylar fractures was calculated using Hasbro Children's Hospital Emergency Department data and state of Rhode Island Census data from 1998 to 2006. The incidence was then correlated with playground safety as defined by our composite measure. RESULTS: Compared with the neighborhood deemed the safest, the least safe district had 4.7 times greater odds of supracondylar humerus fracture. Overall composite safety score of the district was linearly correlated with the injury rate observed in the population at risk (R=0.98; P=0.04). CONCLUSIONS: Using our novel composite playground safety score, we found that the incidence of supracondylar humerus fractures was increased in districts with playgrounds with lower scores, suggesting that improvements in playground infrastructure may potentially reduce the incidence of supracondylar humerus fractures, and other injuries, in children. LEVEL OF EVIDENCE: Level IV. Language: en

HIV/AIDS is recognized as affecting and being affected by the family. HIV+ women in drug recovery and their families are particularly at risk due to family disruption and stigma. Yet family research with HIV+ adults is hampered by the challenges of defining the family, engaging family members into research, and tracking changes in family composition. In this paper we describe the family context of 144 HIV+ women in drug abuse recovery who are enrolled in a randomized trial of a family intervention to improve medication adherence and reduce relapse. “Family” was defined to include the women’s household members, romantic partners, children and their caregivers, and others identified as a major source of support. The women reported on a total of 651 family members. We describe the family and household networks, romantic partnerships and parenting arrangements of our participants. We also describe the engagement rate of family member enrollment in the research study, and the stability of romantic partnerships, parenting and living arrangements over one year. We conclude with methodological implications for future family-based clinical research with HIV+ adults.

Interventions that combine educational programs and discounted child safety seats have been demonstrated to improve parental child passenger safety knowledge and practices. An educational component consisting of an hour-long bilingual (English/Spanish) class for parents was added to a hospital-based safety seat program. Researchers sought to evaluate participant knowledge retention and safety practices after the class and to identify parental motivators and barriers for correct safety seat use. In particular, researchers were interested in evaluating a child passenger safety program that includes both individualized and group-based educational components in addition to a giveaway seat program, and also serves a subset of Latinos, mostly from the Dominican Republic and the Guatemala, that is less frequently studied.A 15-minute telephone survey was conducted in English or Spanish with past participants (n = 79) of the program. Descriptive statistics and odds ratios were generated to determine statistical significance. Qualitative data from open-ended questions were coded and grouped categorically.The final sample (n = 79) was mostly women (93.7%), Hispanic (78.5%), and foreign-born (77.2%). Six months after participating in the program, there was a statistically significant decrease in parental knowledge regarding appropriate safety seat transitions to booster seats and correct knowledge of the state child safety seat law-with odds ratios of 0.35 (95% CI: 0.13-0.93) and 0.16 (0.04-0.54), respectively. Most commonly reported motivators were safety and fear of police enforcement. Most commonly reported barriers to safety seat use were parents not understanding the importance of safety seats and being in a rush.Parents surveyedor =6 months after receiving the child passenger safety program displayed less correct safety seat knowledge compared with parents surveyed6 months after participating in the program. Parents noted multiple barriers to safety seat use. Programmatic changes that merit future study include (1) sending reminders to parents to refresh safety seat transition knowledge, particularly for older children, and (2) incorporating curriculum components that address the parental motivators and barriers to correct safety seat use in the class.