The Feasibility of Screening for Sleep Problems in Early Childhood Education Programs.

OBJECTIVES: Assess the feasibility and staff experience of screening for behavioral sleep problems (BSP) and sleep disordered breathing (SDB) in early childhood education (ECE) settings; examine BSP/SDB prevalence and caregivers' knowledge/attitudes, perception of child sleep problems, and sleep health engagement in this sample. METHOD: Eight staff representatives from four ECE sites involved with sleep problem screening procedures within a larger RCT on ECE sleep health, discussed their experiences in a focus group; transcript content reviewed. A random subset of caregiver-child dyads (n = 59) from the four ECE sites completed sleep problem measures (BSP: Children's Sleep Habits Questionnaire, Short form [SF-CSHQ], Tayside Children's Sleep Questionnaire [TCSQ-sleep disturbance and difficulty] and SDB: Pediatric Sleep Questionnaire [PSQ], in addition to RCT measures (Parent Knowledge/Attitude/Self-efficacy/Beliefs survey and sleep health goals). Caregiver sleep health engagement was measured by the sleep health goals set. RESULTS: ECE staff reported sleep problem screening as self-explanatory and doable but sometimes administratively burdensome. BSPs were identified in 44% (SF-CSHQ) to 63% (TCSQ-sleep disturbance) of children; SDBs in 13%. Only 11% of caregivers endorsed their child having a sleep "difficulty" (TCSQ). Sleep health goals were set by 85% of caregivers; 63% employed educational materials' language. CONCLUSION: Sleep problem screening in ECE is feasible, and problems are elicited. While caregivers readily engage in setting healthy sleep goals, few endorse sleep as difficult. ECE education could improve caregiver understanding/recognition of sleep problems.

Infusing intellectual and Developmental disability training into Medical School curriculum: a Pilot intervention.

PURPOSE: Despite the rising prevalence of developmental disabilities (DD) in the US, there remains insufficient training for healthcare professionals to care for this medically underserved population - particularly adults. The National Inclusive Curriculum for Health Education (NICHE) aims to improve attitudes and knowledge towards people with intellectual and developmental disabilities (PWIDD); herein we describe one such intervention. METHOD: The intervention integrated didactic, panel presentation and clinical skills components into a 2nd year medical school curriculum.  The didactic session, covering  health and assessment of PWIDDs, history of IDD, stigma, etc., was co-taught by a developmental pediatrician, family medicine physician and social worker.  A panel of 3 adult self-advocates (SAs) with DD and a parent of a child with DD spoke about their lived experiences.  One week later, students practiced taking clinical histories of SAs within small group settings with adult PWIDDs, facilitated by medical school faculty. Students completed the NICHE Knowledge(49 items) and Attitudes (60 items) surveys. The evaluation analyzed pre/post intervention differences in a) knowledge and attitude scores overall and b) by student age, gender, intended medical specialty, and prior experiences with PWIDDs. Open-ended comments were analyzed with content analysis. RESULTS: Overall Knowledge scores increased from pre-to posttest (n = 85; 65[19] vs. 73[17], p = 0.00), while Attitudes score improved (i.e., decreased) (n = 88; 0.55 [.06] vs. 0.53 [0.06]); p = 0.00).  Higher pretest knowledge was found among female identified students (vs. others; p = 0.01) and those knowing > = 5 PWIDD (vs < 5; p = 0.02).  Students characterize their IDD training and experience prior to intervention as 'lacking' and described the sessions as effective. CONCLUSIONS: A brief (4 hours total) intervention was associated with modest but significant improved knowledge and attitudes towards PWIDDs. Replication and sustainability of this and other NICHE interventions are needed to fill gaps in PWIDDs' health care.

Corrigendum: Association of parent-child interactions with parental psychological distress and resilience during the COVID-19 pandemic.

[This corrects the article DOI: 10.3389/fped.2023.1150216.].

Association of parent-child interactions with parental psychological distress and resilience during the COVID-19 pandemic.

Introduction: The effects of psychological distress/resilience on parent-child engagement (e.g., family dinners, reading) during the COVID-19 pandemic have not been well studied. Among very young children from underrepresented backgrounds enrolled in the ongoing longitudinal Bronx Mother Baby Health Study of healthy term infants, we (1) examined associations between exposures to COVID-19-related events, demographic factors and parental psychological distress and resilience; and (2) correlated these factors with parent-child engagement activities. Methods: Between June 2020-August 2021, parents of 105 Bronx Mother Baby Health Study participants aged birth-25 months completed questionnaires related to exposures to COVID-19-related events, frequency of positive parent-child engagement activities, food and housing insecurity, and parental psychological distress and resilience. Families were also asked open ended questions about the pandemic's impact. Results: 29.8% and 47.6% of parents reported food and housing insecurity, respectively. Greater exposures to COVID-19-related events were associated with increased parental psychological distress. Positive parent-child interactions were associated with demographic factors and higher levels of maternal education, but not with exposures to COVID-19-related events. Discussion: This study adds to a growing body of literature on the negative impacts of COVID-19 exposures and psychosocial stressors on families during the pandemic, supporting the need for enhanced mental health resources and social supports for families.

COVID-19 Vaccines for Children with Developmental Disabilities: Survey of New York State Parents' Willingness and Concerns.

OBJECTIVE: While 1 in 6 US children have a developmental disability (DD), and such children are disproportionately affected by COVID-19, little is known about their vaccination status. We surveyed New York State parents of children with DDs to ascertain willingness and concerns regarding COVID-19 vaccines. METHODS: An online survey was distributed to statewide DD networks from June to September 2021 (vaccines were authorized for adolescents in May 2021). We report associations between vaccine willingness and concerns and race/ethnicity, child age, in-person schooling, routine/flu vaccinations, and DD diagnoses. Willingness was categorized as "got/will get ASAP" (high), "wait and see/only if required," or "definitely not." RESULTS: A total of 352 parents (49.1% White) responded. Willingness differed by age ( p < 0.001). High willingness was reported for 73.9%, 50.0%, and 36.0% of children aged 12 to 17, 6 to 11, and 0 to 5 years, respectively. Willingness differed by autism diagnosis ( p < 0.01) and routine and flu vaccination status ( p < 0.001). Predominant concerns included side effects (89%) and children with disabilities not being in trials (80%). Less common concerns were COVID not serious enough in children to warrant vaccine (23%) and misinformation (e.g., microchips, 5G, DNA changes) (24%). Concerns about vaccine safety differed by age ( p < 0.01) and were highest for older and then the youngest children. In age-stratified adjusted models, attention-deficit/hyperactivity disorder was negatively associated with high willingness for age 5 or younger (OR = 0.02, 95% confidence interval, <0.001-0.622). CONCLUSION: Parents of children with DD in New York seemed highly willing for them to receive COVID-19 vaccines. Although few factors predicted willingness to vaccinate, addressing safety and developmental concerns regarding young children is warranted. Given their increased vulnerability, improved COVID-19 surveillance for children with DD is warranted.

Effects of a Sleep Health Education Program for Children and Parents on Child Sleep Duration and Difficulties: A Stepped-Wedge Cluster Randomized Clinical Trial.

Importance: Preschool-aged children often lack sufficient sleep and experience sleep difficulties. A consistent bedtime routine, falling asleep alone, and other sleep practices reduce difficulties and increase sleep duration. Objective: To evaluate the effects of a preschool-based sleep health literacy program on children's sleep duration and difficulties and on parent sleep knowledge, attitudes, self-efficacy, and beliefs 9 and 12 months after the program. Design, Setting, and Participants: This stepped-wedge cluster randomized clinical trial was implemented across the 2018-2019 school year. Head Start preschool personnel delivered interventions and collected outcomes data at baseline and 4 follow-ups. Seven Head Start agencies across New York State were randomized to implement interventions in either fall 2018 or winter and spring 2019. Outcomes were ascertained at 9- and 12-month follow-up. From March 19 through September 28, 2018, Head Start staff recruited (a) English- or Spanish-speaking parents (b) of children 3 years of age on or about September 2018 (c) who planned to remain at the site through the school year. Altogether, 519 parent-child (aged 3 years) dyads completed baseline and (any) follow-up data. Interventions: A 2-week classroom curriculum for children, a 1-hour parent workshop, and 1-on-1 parent discussions at home or school. Main Outcomes and Measures: Outcomes were the pre- vs postintervention differences measured at baseline and 9-month follow-up for parent-reported child school-night sleep duration per sleep logs, mild or moderate sleep difficulties per a validated questionnaire, and the total and domain scores for parent sleep knowledge, attitudes, self-efficacy, and beliefs. A modified intention-to-treat analysis excluding participants with only baseline data was used. Results: The mean (SD) age at enrollment of 519 children was 2.7 (0.1) years, 264 (50.9%) were girls, 196 (37.8%) lived in Spanish-speaking households, and 5 (0.9%) identified as Alaskan Native or American Indian, 17 (3.2%) as Asian American or Pacific Islander, 57 (10.8%) as Black, 199 (37.8%) as White, and 63 (12.0%) as other. Mean sleep durations increased nonsignificantly from baseline by 5.6 minutes (95% CI, -2.3 to 13.6 minutes; P = .17) at 9-month follow-up and by 6.8 minutes (95% CI, 0.2-13.7 minutes; P = .06) at 12-month follow-up. There was a slight improvement in parental knowledge (1.13 unit increase from baseline; 95% CI, 0.13-2.12 units), but no significant outcomes for parent sleep attitudes (0.16 unit increase from baseline; 95% CI, -0.46 to 0.77 units), self-efficacy (-0.13 unit decrease from baseline; 95% CI, -1.02 to 0.76 units) and beliefs (-0.20 unit decrease from baseline; 95% CI, -0.56 to 0.16 units). Intervention effects for child sleep difficulties were not significant (odds ratio, 1.13; 95% CI, 0.62-2.09). Fewer than 1 in 4 parents accurately perceived their child's sleep difficulty at 12 months. Conclusions and Relevance: The findings of this large pragmatic, stepped-wedge cluster randomized clinical trial, albeit largely negative, may have implications for the sustained impact, focus, and potential population-level effects of sleep education programs. Future research should evaluate the effects of more recurrent programming that emphasizes recognition of sleep problems and whether small increments of sleep across months and years in early childhood have meaningful effects. Trial Registration: ClinicalTrials.gov Identifier: NCT03556462.

Impact of the COVID-19 Pandemic on the Behavioral Health of People With Intellectual and Developmental Disabilities.

OBJECTIVE: The authors examined how the COVID-19 pandemic affected the behavioral health of people with intellectual and developmental disabilities (IDD). METHODS: A modified version of the Coronavirus Health Impact Survey-Adapted for Autism and Related Neurodevelopmental Conditions was sent to the authors' clinical networks and IDD-affiliated organizations from March to June 2021. RESULTS: In total, 437 people with IDD or their caregivers responded to the survey. Diagnoses included intellectual disability (51%) and autism spectrum disorder (48%). More than half (52%) of respondents reported worsened mental health. Losing access to services correlated with declining mental health. Interventions suggested to improve behavioral health included more time with friends and family (68%), more time outdoors (61%), and access to community activities (59%). CONCLUSIONS: COVID-19 affected the behavioral health of individuals with IDD. Survey results highlight the opportunity to leverage physical activity and pandemic-safe social supports as accessible means to mitigate gaps in services.

COVID-19 vaccine perceptions in New York State's intellectual and developmental disabilities community.

BACKGROUND: People with intellectual and developmental disabilities (IDD) are at disproportionate risk for severe COVID-19 outcomes, particularly those living in congregate care settings. Yet, there is limited data on vaccine perceptions in the disability community. OBJECTIVE: To explore COVID-19 vaccine perceptions in individuals with IDD, their family members, and those who work with them, to inform a statewide vaccine information and messaging project. METHODS: A national survey, adapted in five languages for the IDD community, was distributed to a convenience sample of IDD organizations throughout New York State. Constructs included vaccine intention, reasons for vaccine hesitancy, and trusted sources of vaccine information. Zip code data were used to map respondent location and vaccine preferences. RESULTS: Of n = 825 respondents, approximately 75% intended to or had received the vaccine across roles (i.e., people with developmental disabilities, family members, direct care workers) and racial/ethnic groups. Greater vaccine hesitancy was reported in younger individuals and those making decisions on behalf of a person with IDD. Concerns included side effects and the swiftness of vaccine development. Black and Hispanic participants had heightened concerns about being an "experiment" for the vaccine. Trusted sources of information included healthcare providers and family members. Respondents who intended to/received the vaccine were dispersed throughout the state. CONCLUSIONS: Vaccine preferences in this New York State disability community sample align with national data. Identified concerns suggest the need for community education that addresses misperceptions. Age and race differences in perspectives highlight the need for tailored education, delivered by trusted messengers.

Language Disorders Research on Bilingualism, School-Age, and Related Difficulties: A Scoping Review of Descriptive Studies.

BACKGROUND: Developmental language disorder (DLD) often remains undetected until children shift from 'learning to read' to 'reading to learn,' around 9 years of age. Mono- and bilingual children with DLD frequently have co-occurring reading, attention, and related difficulties, compared to children with typical language development (TLD). Data for mono- and bilingual children with DLD and TLD would aid differentiation of language differences versus disorders in bilingual children. OBJECTIVE: We conducted a scoping review of descriptive research on mono-and bilingual children < and >= 9 years old with DLD versus TLD, and related skills (auditory processing, attention, cognition, executive function, and reading). DATA SOURCES: We searched PubMed for the terms "bilingual" and "language disorders" or "impairment" and "child[ren]" from August 1, 1979 through October 1, 2018. CHARTING METHODS: Two abstracters charted all search results. Main exclusions were: secondary data/reviews, special populations, intervention studies, and case studies/series. Abstracted data included age, related skills measures', and four language groups of participants: monolingual DLD, monolingual TLD, bilingual DLD, and bilingual TLD. RESULTS: Of 366 articles, 159 (43%) met inclusion criteria. Relatively few (14%, n = 22) included all 4 language groups, co-occurring difficulties other than nonverbal intelligence (n = 49, 31%) or reading (n = 51, 32%) or any 9-18 year-olds (31%, n = 48). Just 5 (3%) included only 9-18 year-olds. Among studies with any 9 to 18 year olds, just 4 (8%, 4/48) included 4 language groups. CONCLUSIONS: Future research should include mono- and bilingual children with both DLD and TLD, beyond 8 years of age, along with data about their related skills.

Sleep problem screening of young children by speech-language pathologists: A mixed-methods feasibility study.

Background & Aims: Poor sleep in young children imperils language learning and use. Both sleep and language problems are prevalent in early childhood. Speech-language pathologists are in a unique position to expand surveillance of sleep problems, which in turn may contribute to communication difficulties. We conducted a feasibility study of speech-language pathologist screening for behavioral sleep problems and sleep-disordered breathing symptoms at a multidisciplinary evaluation and treatment center. Methods: Speech-language pathologists administered screeners to parents of 2-6-year-olds: the Short Form-Children's Sleep Habits Questionnaire (for behavioral sleep problems) which includes an item asking if the child has a sleep problem (yes/no), and the pediatric sleep questionnaire (for sleep-disordered breathing). Speech-language pathologists participated in pre- and post-screening focus groups. Pre-screening topics included professional preparation and clinical experience regarding pediatric sleep issues. Post-screening, speech-language pathologists provided feedback about the screening experience and feasibility of incorporating such screening into practice. Results: Among 51 children, 31% (16/51) screened positive for sleep-disordered breathing, 78% for behavioral sleep problems (40/51), and 43% (12/28) per parent report. Parent-reported problems were associated with sleep-disordered breathing (p = 0.00) but not behavioral sleep problems (p = 0.24). During focus groups, speech-language pathologists reported no formal pediatric sleep training, high parent concern about sleep, and agreed that screening fit their professional mandate. Speech-language pathologists affirmed that the ≤15 min screenings integrated seamlessly into practice but that additional training, particularly for sleep-disordered breathing, was needed. Conclusions: The prevalence of sleep problems in 2-6-year-olds presenting to speech-language pathologists was higher than in community samples, but consistent with data from young children with developmental disabilities. Speech-language pathologists endorsed the utility and feasibility of sleep problem screening and education in their clinical practice. Implications: Integrating sleep problem screening and education into speech-language pathologist practice is feasible and could widen surveillance of both sleep problems and risk factors for developmental language disorders. Further research should include larger samples and other settings, e.g. home or school.

Exploratory spatial analysis of autism rates in New York school districts: role of sociodemographic and language differences.

BACKGROUND: Literature on autism spectrum disorder (ASD) suggests lower ASD prevalence and higher age of diagnosis among children of color, from lower socioeconomic backgrounds, and from families with lower educational levels. These disparities have been attributed to factors such as limited access to diagnostic and treatment services, less opportunity for upward mobility to locales with ample resources, and linguistic barriers. However, few studies describe prevalence and geographic differences of ASD diagnoses by English Language Learner (ELL) status. OBJECTIVES: The primary objectives of this study are to (1) spatially explore the prevalence of ASD among New York State school districts and (2) examine differences of ASD prevalence rates between ELLs and native English-speaking peers. METHODS: Using the 2016-2017 district-level data on public and non-public school age students (3-21 years old) receiving special education services in New York, we analyzed sociodemographic trends among school districts with varying percentages (low, medium, and high ranges) of students with ASD and ELLs. To do this, we conducted exploratory spatial analyses using GIS software, analysis of school district level demographic data, and multivariate linear regression. RESULTS: In contrast to prior research on ASD prevalence among minority groups, we found disproportionately higher rates of ASD among school districts with higher proportions of Black and Hispanic students. Geographic analysis revealed statistically significant clustering of school districts with high ASD rates in New York City and Albany. Higher proportions of ELLs tended to be concentrated in densely populated, urban, and geographically smaller school districts and had higher proportions of Black, Hispanic, and Asian students. CONCLUSIONS: Schools with higher rates of ASD and ELL students tend to be concentrated in urban regions throughout New York and have higher representation of Black and Hispanic/Latino students, as well as higher rates of learning disabilities in general. Further research is warranted to explore possible reasons for this phenomenon.

National Parent Survey 2017: Worries, hopes, and child well-being.

Sociopolitical events impact population health; parents' perspective of such events crosses demographics, geography, and generations. We elicited changes in U.S. parents' hopes and worries for their children 1 year after the 2016 election via an online survey of school climate, discrimination against child, family health care and security, and macrolevel/future concerns (e.g., environment, postsecondary options). Among n = 1189 respondents, national security (39%), the environment (30.5%), and "continued place in America" (25.7%) were most worrisome. In general linear mixed models, employment buffered against social and material stressors such as discrimination (odds ratio [OR] = 0.67; 95% confidence interval [CI] = 0.49-0.92), and family health care/security (OR = 0.62; 95% CI = 0.45-0.86) while being of a dominant religion and ethnicity buffered future macrolevel (Christianity, OR = 70; 95% CI = 0.54-0.92/non-Hispanic, OR = 59; 95% CI = 0.39-0.90) and existential "continued place in America" (Christianity, OR = 69; 95% CI = 0.51-0.94/non-Hispanic, OR = 56; 95% CI = 0.36-0.88) worries. Qualitative comments underscored macrolevel worries. Parents represent a unique vantage for gauging how sociopolitical events impact health and well-being.

Special Education Disparities Are Social Determinants of Health: A Role For Medical-Legal Partnerships.

PROBLEM: Education is a key social determinant of health. The federal Individuals with Disabilities Education Act (IDEA) purportedly affords children the right to a free and appropriate education. Yet, racial, ethnic, and economic disparities exist regarding appropriate identification and classification of children with needs for special education, and access to services. PURPOSE: This article first highlights gaps and disparities in special educational services, and their structural linkage to poverty. The second section describe the first years of a medical-legal collaboration between a University Center of Excellence in Developmental Disabilities (UCEDD) and Fordham University, focused on special education. KEY POINTS: The collaboration's interdisciplinary training activities increased practical knowledge for law students and UCEDD clinicians. A legal clinic for UCEDD families enabled Fordham students to apply their skills. CONCLUSIONS: Because social determinants of health often lie beyond the medical domain, interdisciplinary collaborations are needed to remediate them.

Environmental Scan of Sleep Health in Early Childhood Programs.

OBJECTIVE: To ascertain how sleep health knowledge is translated to early care and education (ECE) programs, using a multi-component environmental scan. METHODS: A website scan identified organizations' sleep content re: recommended practices, developmental effects, and "actionable" ratings (0-2). ECE staff surveys assessed preparedness, practices, and beliefs about addressing sleep health and sleep problems in ECE programs. Semi-structured interviews with stakeholders from the ECE, pediatric and sleep communities assessed awareness, priorities, and practices at their organizations. RESULTS: Of 15 websites scanned, half lacked sleep content on links to development, optimal duration, or scientific background. ECE staff (n = 31) were comfortable speaking to parents about healthy sleep, and with incorporating sleep education and guidance into ECE. Stakeholders (n = 15) rated healthy sleep as a high relevance, but lower priority issue. Within ECE settings stakeholders reported that knowledge about specific links to health and development was poor and that sleep health was often obscured by "safe sleep" issues. Their recommendations included: linking sleep health to "hot topics" such as obesity or preschool suspensions and expulsions, integrating it with the teaching of routines, and raising public awareness. CONCLUSION: Despite understanding that healthy sleep promotes school readiness, there is insufficiently specific, actionable information in ECE training, programs, or policies. Findings suggest a need for an awareness campaign with clear, actionable messaging, dissemination of turnkey materials, and integration with policy and professional training systems. TRIAL REGISTRATION: - ClinicalTrials.Gov: NCT03556462.

Randomized control trial report on the effectiveness of Group Attachment-Based Intervention (GABI©): Improvements in the parent-child relationship not seen in the control group.

This paper reports on a randomized control trial involving children less than 3 years old and their mothers who were regarded at risk of maltreating their children by referral agencies. Mothers' risk status derived from a heavy trauma burden (average exposure over the first 18 years of their lives to 10 possible adverse childhood experiences [ACEs] was >5), mental health challenges (15%-28% had experienced a prior psychiatric hospitalization), and prior removal of a child to foster care (20%). Mothers were randomly assigned to either a widely used parenting class known as Systematic Training for Effective Parenting (STEP) or the Group Attachment-Based Intervention (GABI), a multifamily 26-week treatment. The resulting mother-child pairs available for consideration in this baseline versus end-of-treatment report were 35 families in the STEP arm and 43 families in the GABI arm. The focus of this paper is the outcome measure of observed parent-child relationship assessed with the Coding of Interactive Behavior (Feldman, 1998) collected at baseline and end of treatment. In comparison to STEP, results indicated that GABI was linked to significant improvements in maternal supportive presence and dyadic reciprocity, and significant declines in maternal hostility and dyadic constriction (proxies for risk of child maltreatment). These medium-to large-sized effects remained significant even after controlling for mothers' prior ACEs in analysis of covariance procedures. In addition, two small interaction effects of ACEs by treatment type were found, underlining the need for, and value of, treatments that are sensitive to parents' traumatic histories.

Reducing pediatric caries and obesity risk in South Asian immigrants: randomized controlled trial of common health/risk factor approach.

BACKGROUND: This paper describes the design and methods of a multi-phase study to reduce early childhood caries and obesity in vulnerable South Asian (SA) immigrants in the United States. Early childhood caries and obesity are the most common diseases of early childhood. Risk factors for both diseases are rooted in early childhood feeding practices such as bottle feeding and intake of sweets and sweetened beverages. The Common Health/Risk Factor Approach to addressing oral health is widely promoted by the WHO and other policy makers. This approach recognizes links between oral health and other diseases of modernity. Our CHALO! ("Child Health Action to Lower Obesity and Oral health risk"--from a Hindi word meaning "Let's go!") study targets SA families at high risk for early childhood caries and obesity. CHALO! addresses common risk factors associated with these two common diseases of childhood. METHODS: This two part project includes a randomized controlled trial, and a Knowledge Translation campaign. A randomized controlled trial will enroll n =  360 families from pediatric practices serving South Asians in the New York metro area. The intervention group will receive home visits by SA community health workers at 6, 8, 10, 12, 14, and 16 months of age. Controls will receive culturally tailored educational material. Primary outcomes-- cariogenic and obesogenic feeding practices at 6, 12, and 18 months-- will be assessed with the MySmileBuddy iPad based tool. Secondary outcomes include: oral hygiene practices, anthropometrics, and caries incidence at 18 months. A public education campaign will focus on both families and health care providers. DISCUSSION: There are few Common Health/Risk Factor Approach published studies on obesity and oral health risk in children, despite health morbidity and costs associated with both conditions. CHALO! comprises a multi-level interventions designed to promote culturally competent, sustainable change. TRIAL REGISTRATION: ClinicalTrials.gov NCT03077425 .

Modified Children's sleep habits questionnaire for behavioral sleep problems: A validation study.

OBJECTIVES: Behavioral sleep problems (BSPs) are prevalent and consequential in young children. There is a need for screening tools that identify BSPs-which are often rooted in the parent-young child relationship-and typically respond to behavior management. Such a tool would increase capacity to identify and treat BSPs. We sought to validate a short-form version of the widely used Children's Sleep Habits Questionnaire (SF-CSHQ) that omitted items that would not be responsive to behavioral strategies. METHODS: The original 33-item CSHQ elicits parent report of "behaviorally-based" and "medically-based" sleep items (eg, parasomnias and sleep disordered breathing). We conducted analyses to develop a SF-CSHQ that excludes its "medically-based" items, to determine (a) the SF-CSHQ threshold score corresponding to the full CSHQ clinical cut-off score (≥41), and (b) preliminary validity of this SF-CSHQ. Data were re-analyzed from the original data that established the CSHQ's psychometric properties in 4-10 year olds, and a second dataset that established its validity in 24-66 month olds. RESULTS: In both datasets, a threshold score of 30 had correlations of 0.90-0.94 with the original cut-off. This 23-item SF-CSHQ cut-off functioned as well as the full CSHQ cut-off in discriminating between children with vs without a parent-reported behavioral sleep problem, and with vs without prolonged sleep latency (per actigraphy). CONCLUSION: We established preliminary validity of modified version of the widely-used CSHQ. This SF-CSHQ may be useful for widening screening and first-line guidance for behavioral sleep problems in young children, among professionals who are not sleep medicine specialists.

A Cluster Randomized Trial of Tailored Breastfeeding Support for Women with Gestational Diabetes.

BACKGROUND: Women with gestational diabetes mellitus (GDM) and their infants are at increased risk of developing metabolic disease; however, longer breastfeeding is associated with a reduction in these risks. We tested an intervention to increase breastfeeding duration among women with GDM. MATERIALS AND METHODS: We conducted a cluster randomized trial to determine the efficacy of a breastfeeding education and support program for women with GDM. Women were enrolled between 22 and 36 weeks of pregnancy and cluster randomized to an experimental lifestyle intervention or wait-list control group. Breastfeeding duration and intensity were prespecified secondary outcomes of the trial. Duration of exclusive and any breastfeeding was assessed at 6 weeks and at 4, 7, and 10 months postpartum. We quantified differences in breastfeeding rates using Kaplan-Meier estimates, log-rank tests, and Cox regression models. RESULTS: We enrolled 100 women, of whom 52% were African American, 31% non-Hispanic white, 11% Hispanic, 9% American Indian or Alaskan Native, 2% Asian, 2% other, and 4% more than one race. In models accounting for within-cluster correlation and adjusted for study site, breastfeeding intention, and African American race, women allocated to the intervention group were less likely to stop breastfeeding (adjusted hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.21-0.74) or to introduce formula (adjusted HR 0.50, 95% CI 0.34-0.72). CONCLUSION: Our results suggest that targeted breastfeeding education for women with GDM is feasible and efficacious. CLINICAL TRIALS REGISTRATION: http://clinicaltrials.gov/ct2/show/NCT01809431.

Promoting Sleep Health Among Families of Young Children in Head Start: Protocol for a Social-Ecological Approach.

Inadequate or poor quality sleep in early childhood impairs social-emotional and cognitive function via effects on the developing brain and increases obesity risk via hormonal and endocrine effects. The prevalence of short sleep duration, behavioral sleep problems, and sleep-disordered breathing among children aged 3 to 5 years is 20% to 50%. Healthy sleep habits increase sleep duration and prevent behavioral sleep problems. Awareness of sleep-disordered breathing symptoms leads to its timely treatment. We designed a study that aims to empower families whose children are in early childhood programs with the knowledge and skills needed to obtain healthy sleep and to recognize a sleep problem. We used the social-ecological framework to guide individual, interpersonal, organizational, community, and policy interventions. This study builds on the Sweet Dreamzzz, Inc, Early Childhood Sleep Education Program (ECSEP) in Head Start. A stepped-wedge-cluster randomized trial will test effects on child, parent, and classroom outcomes; a policy evaluation will assess the impact of knowledge-translation strategies. The study has 3 aims. The first is to adapt educational materials into multimedia formats and build the capacity of Head Start agencies to implement the study. The second aim is to enroll 540 parent-child dyads in a primary prevention trial of sleep health promotion in Head Start and to analyze effects on children's sleep duration (primary outcome); parents' knowledge, attitudes, self-efficacy, and behavior; and children's sleep difficulties. The third aim is to conduct a secondary prevention feasibility study of screening and guidance for sleep problems. Secondary outcomes are changes in classroom behaviors and policies. Integrating sleep health literacy into early childhood programs could affect the life-course development of millions of children.

The Burden of Sleep Problems: A Pilot Observational Study in an Ethnically Diverse Urban Primary Care Setting.

INTRODUCTION: Sleep disorders affect up to 1 in 4 adults and can adversely affect a variety of health conditions. However, little is known about detection of sleep disorders in ethnically diverse urban primary care settings. METHODS: Patients in urban primary care settings completed surveys to screen for sleep problems and identify comorbid conditions. Providers were given screening results, and provided feedback regarding their clinical utility. RESULTS: Participants (n = 95) were predominantly women (76.8%) and black, non-Hispanic (46.3%), or Hispanic (38.9%). High proportion of participants screened positive for insomnia (31.6%) and screened high risk for sleep apnea (42.1%). Only one-third (32.6%) of participants reported sleeping the recommended 7 to 9 hours per night. The presence of chronic pain (χ(2) = 4.97, P = .03) was associated with clinically significant insomnia. Obesity was associated with fewer hours of sleep per night, t = 2.19(87), P = .03, and risk for sleep apnea (OR = 3.11, 95% CI = 1.28-7.50). Participants were interested in receiving help for sleep issues during their primary care visits (40%), and providers found the screening at least somewhat useful (74.4%). DISCUSSION: Results highlight the potentially high unmet need for screening and treatment of sleep problems in ethnically diverse urban primary care settings.