Potential parental determinants of the pace of evidence-based practice change in children's mental health care.

BACKGROUND: Strength of evidence is key to advancing children's mental health care but may be inadequate for driving practice change. The Designing for Accelerated Translation (DART) framework proposes a multifaceted approach: pace of implementation as a function of evidence of effectiveness, demand for the intervention, sum of risks, and costs. To inform empirical applications of DART, we solicited caregiver preferences on key elements. METHOD: In March-April 2022, we fielded a population-representative online survey in Illinois households (caregivers N = 1,326) with ≥1 child <8 years old. Six hypothetical scenarios based on the DART framework were used to elucidate caregivers' preferences on a 0-10 scale (0 = never; 10 = as soon as possible) for pace of implementation of a family-based program to address mental health concerns. RESULTS: Caregivers' pace preference scores varied significantly for each scenario. The highest mean score (7.28, 95% confidence interval [95% CI: 7.06, 7.50]) was for a scenario in which the child's provider thinks the program would be helpful (effectiveness) and the caregiver believes the program is needed (demand). In contrast, the lowest mean score (5.13, 95% CI [4.91, 5.36]) was for a scenario in which online information implies the program would be helpful (effectiveness) and the parent is concerned about the program's financial costs (cost). Caregivers' pace preference scores did not vary consistently by sociodemographic factors. CONCLUSION: In this empirical exploration of the DART framework, factors such as demand, cost, and risk, in combination with evidence of effectiveness, may influence caregivers' preferred pace of implementation for children's mental health interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

What Parents Are Missing: Parental Knowledge of Adult-Use Cannabis Legislation and Health Effects, and Communication with Adolescents.

Background: The cannabis regulation landscape is ever evolving, and it may be difficult for parents to stay up to date. This study aimed to assess parental knowledge of recent cannabis legislation and cannabis health effects, as well as communication around cannabis use. Materials and Methods: Data were collected through the 2020 Voices of Child Health in Chicago Parent Panel Survey. Parents were asked about the veracity of statements on cannabis legislation and health effects, and about communication with their children. Descriptive statistics were calculated to characterize response frequencies. Rao-Scott chi-square test explored differences in the proportion of parents who answered all questions correctly or got at least one question wrong. Results: 75% and 74% of parents answered at least one legislation or health items incorrectly, respectively. Most parents reported talking to their children about legislation (56%), not using cannabis (75%) and rules around drug use (90%). Conclusions: While parents reported communicating with their children about cannabis, the majority had gaps in their knowledge. The results of this study indicate a need for effective cannabis education interventions.

Parent Awareness of and Attitudes Toward Gender-Affirming Pediatric Health Care: A Cross-Sectional Survey.

PURPOSE: We aimed to characterize parent attitudes toward gender-affirming healthcare for transgender youth, from a general parent sample in a diverse urban setting. METHODS: We surveyed Chicago parents through the Voices of Child Health in Chicago Parent Panel Survey via web and phone in English and Spanish from May-July 2022. We used both probability-based and nonprobability-based sampling, with calibration weights for the nonprobability sample. Parents responded about their awareness of a debate about and support for autonomy in gender-affirming healthcare for transgender youth and provided demographic information. We used descriptive analyses and logistic regression to examine predictors of awareness and support. Data were weighted to be representative of Chicago's parent population. RESULTS: Surveys were completed by 1,059 parents. The survey completion rate for the probability sample was 43.1% (a completion rate was not available for the nonprobability sample from online, opt-in surveys). Most parents were unaware of the debate about gender-affirming healthcare (56.0%). More than two-thirds of parents (68.9%) support decisions about gender-affirming healthcare being left to children, their parents, and their doctor. Parents who were aware of the debate were more likely to support gender-affirming healthcare (83.7%) than parents who were not aware (57.2%, p < .0001). Parents who were aware of the debate had higher odds of supporting gender-affirming care for youth (adjusted odds ratio = 3.00, 95% confidence interval: 1.93-4.66) in a multivariable logistic regression model. DISCUSSION: Broad parent support for gender-affirming healthcare for transgender youth is an important perspective to consider in policy discussions at state and federal levels.

Childhood Exposure to Firearm Violence in Chicago and Its Impact on Mental Health.

OBJECTIVE: To describe how often Chicago children are exposed to firearm violence, the types of exposure, and the parent-reported impact of these exposures on child mental health symptoms. METHODS: Data were collected in May-July 2022 using the Voices of Child Health in Chicago Parent Panel Survey, administered to parents with children aged 2-17 years from all 77 Chicago neighborhoods. Firearm violence exposure was characterized as indirect (hearing gunshots or knowing someone who was shot) or direct (witnessing a shooting, being threatened with a firearm, being shot at but not injured, or being shot and injured). Parents indicated if children in their household had any of the following mental health symptoms associated with firearm violence exposure: fear, anxiety, sadness, isolation, difficulty concentrating, difficulty in school, or aggression. Chi-squared tests and multivariable logistic regression models were used for statistical analysis. RESULTS: Responses were received from 989 Chicago parents. More than one third (37%) of children were exposed to firearm violence with an indirect exposure prevalence of 32% and a direct exposure prevalence of 10%. Mental health symptoms associated with firearm violence exposure were reported for 20% of children. Mental health symptoms were reported for 7% of children without firearm violence exposure compared to 31% with indirect exposure (aOR 6.2, 95% CI: 3.7, 10.6) and 68% with direct exposure (aOR 36.1, 95% CI: 16.6, 78.6) CONCLUSIONS: Chicago children with indirect and direct exposure to firearm violence had more parent-reported mental health symptoms than unexposed children. Trauma informed care approaches to mitigate the negative mental health effects of both direct and indirect firearm violence exposure are critical.

Teleworking, Parenting Stress, and the Health of Mothers and Fathers.

This cross-sectional study examines the associations of telework during the COVID-19 pandemic with parents' general health, changes to mental health, and parenting stress.

Barriers and facilitators to recruitment of underrepresented research participants: Perspectives of clinical research coordinators.

Background: Insufficient recruitment of groups underrepresented in medical research threatens the generalizability of research findings and compounds inequity in research and medicine. In the present study, we examined barriers and facilitators to recruitment of underrepresented research participants from the perspective of clinical research coordinators (CRCs). Methods: CRCs from one adult and one pediatric academic medical centers completed an online survey in April-May 2022. Survey topics included: participant language and translations, cultural competency training, incentives for research participation, study location, and participant research literacy. CRCs also reported their success in recruiting individuals from various backgrounds and completed an implicit bias measure. Results: Surveys were completed by 220 CRCs. CRCs indicated that recruitment is improved by having translated study materials, providing incentives to compensate participants, and reducing the number of in-person study visits. Most CRCs had completed some form of cultural competency training, but most also felt that the training either had no effect or made them feel less confident in approaching prospective participants from backgrounds different than their own. In general, CRCs reported having greater success in recruiting prospective participants from groups that are not underrepresented in research. Results of the implicit bias measure did not indicate that bias was associated with intentions to approach a prospective participant. Conclusions: CRCs identified several strategies to improve recruitment of underrepresented research participants, and CRC insights aligned with insights from research participants in previous work. Further research is needed to understand the impact of cultural competency training on recruitment of underrepresented research participants.

Adverse childhood experiences, child behavioral health needs, and family characteristics associated with the presence of a firearm in the home: a survey of parents in Chicago.

BACKGROUND: Firearm violence is the leading cause of pediatric mortality in the USA. The presence of a firearm in the home poses an immense risk to children with increased rates of suicide and unintentional injury by firearm. Recent literature has not explored child ACEs and child behavioral health needs with the presence of a firearm in the home. The objective of this study was to explore an association between these factors, parent health, family experience with firearm violence, and demographics, and the presence of a firearm in the home. RESULTS: Overall, 382 of 1,436 (weighted to 22.0%) responding parents reported the presence of a firearm in the home. In an adjusted model, the odds ratio of firearm presence increased incrementally with a child's increasing exposure to ACEs. Compared to a child in the household exposed to no ACEs, a child in the household exposed to two or more ACEs was associated with a 5.16 times higher odds of firearm presence in the home (95% confidence interval (CI) 2.92-9.10). Similarly, a child in the household who had used behavioral health services was associated with a 2.10 times higher odds of firearm presence in the home (95% CI 1.35-3.26), compared to a child in the household who had not. Presence of firearm in the home was also associated with higher household income, younger parent age (under 35 years), and male parent gender. CONCLUSIONS: Chicago parents have higher odds of reporting the presence of a firearm in the home when living in a household with a child exposed to ACEs and with behavioral health needs. These findings could inform future public health interventions and targeted safe storage messaging to prevent pediatric firearm injury in the home.

Targeted Vaccine Messaging to Promote COVID-19 Vaccines for Children and Youth.

OBJECTIVES: To assess the effectiveness of distinct message types in promoting coronavirus disease 2019 (COVID-19) vaccination intentions for parents of children and adolescents. METHODS: We collected data through the Voices of Child Health in Chicago Parent Panel Survey from October to November 2021. Parents were randomly assigned to read 1 of 4 vaccine message types and then report their intentions to vaccinate each COVID-19-unvaccinated child (0-17 years) in their household (n = 1453). RESULTS: The sample included 898 parents. Compared with a control group (37.5%), the proportion of parents who were very likely to vaccinate their children was higher when messages highlighted that other trusted parents have vaccinated their children (53.3%) or that the vaccine is safe and thoroughly tested (48.9%) but not when messages highlighted that the vaccine is well-tolerated (41.5%). After adjusting for parent and child characteristics, the odds of being very likely to vaccinate remained higher in the trusted parents group but not in the safe/thoroughly tested group. Unlike the control and well-tolerated groups, there were no racial/ethnic disparities in the unadjusted proportion of parents who were very likely to vaccinate in the trusted parents and safe/thoroughly tested groups. Message types affected the unadjusted proportion of COVID-19-unvaccinated parents who were very likely to vaccinate their children. CONCLUSIONS: Messages that focus on trusted parents choosing to vaccinate their children were more effective at promoting parents' COVID-19 vaccination intentions for their children than alternative messages. These findings have implications for public health messaging and pediatric providers' communications with parents.

Parental Concerns About Climate Change in a Major United States City.

OBJECTIVE: To examine climate change concerns among parents in Chicago, a large and diverse urban setting that experiences climate change-related weather events and rising water levels which have the potential to affect more than 1 million children living in the city. METHODS: We collected data through the Voices of Child Health in Chicago Parent Panel Survey from May to July 2021. Parents indicated their personal level of worry about climate change, concern about the impact of climate change on themselves and their families, and how well they understood the issue of climate change. Parents also provided demographic information. RESULTS: Parents reported high levels of concern about climate change in general and specifically about the impact on their families. Logistic regression indicated that parents who were Latine/Hispanic (vs White) and those who felt they understood climate change well (vs less well) had higher odds of reporting high levels of concern. Parents with some college (vs high school education or below) had lower odds of high concern. CONCLUSIONS: Parents indicated high levels of concern about climate change and its potential impact on their families. These results can help inform pediatricians' discussions with families about child health in the context of a changing climate.

Parental Perceptions on Use of Artificial Intelligence in Pediatric Acute Care.

BACKGROUND: Family engagement is critical in the implementation of artificial intelligence (AI)-based clinical decision support tools, which will play an increasing role in health care in the future. We sought to understand parental perceptions of computer-assisted health care of children in the emergency department (ED). METHODS: We conducted a population-weighted household panel survey of parents with minor children in their home in a large US city to evaluate perceptions of the use of computer programs for the care of children with respiratory illness. We identified demographics associated with discomfort with AI using survey-weighted logistic regression. RESULTS: Surveys were completed by 1620 parents (panel response rate = 49.7%). Most respondents were comfortable with the use of computer programs to determine the need for antibiotics (77.6%) or bloodwork (76.5%), and to interpret radiographs (77.5%). In multivariable analysis, Black non-Hispanic parents reported greater discomfort with AI relative to White non-Hispanic parents (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.03-2.70) as did younger parents (18-25 years) relative to parents ≥46 years (OR 2.48, 95% CI 1.31-4.67). The greatest perceived benefits of computer programs were finding something a human would miss (64.2%, 95% CI 60.9%-67.4%) and obtaining a more rapid diagnosis (59.6%; 56.2%-62.9%). Areas of greatest concern were diagnostic errors (63.0%, 95% CI 59.6%-66.4%), and recommending incorrect treatment (58.9%, 95% CI 55.5%-62.3%). CONCLUSIONS: Parents were generally receptive to computer-assisted management of children with respiratory illnesses in the ED, though reservations emerged. Black non-Hispanic and younger parents were more likely to express discomfort about AI.

Are adult attachment styles categorical or dimensional? A taxometric analysis of general and relationship-specific attachment orientations.

One of the long-standing debates in the study of adult attachment is whether individual differences are best captured using categorical or continuous models. Although early research suggested that continuous models might be most appropriate, we revisit this issue here because (a) categorical models continue to be widely used in the empirical literature, (b) contemporary models of individual differences raise new questions about the structure of attachment, and (c) methods for addressing the types versus dimensions question have become more sophisticated over time. Analyses based on 2 samples indicate that individual differences appear more consistent with a dimensional rather than a categorical model. This was true with respect to general attachment representations and attachment in specific relationship contexts (e.g., attachment with parents and peers). These findings indicate that dimensional models of attachment style may be better suited for conceptualizing and measuring individual differences across multiple levels of analysis.

Attachment and parental divorce: a test of the diffusion and sensitive period hypotheses.

One of the assumptions of attachment theory is that disruptions in parental relationships are prospectively related to insecure attachment patterns in adulthood. The majority of research that has evaluated this hypothesis, however, has been based on retrospective reports of the quality of relationships with parents-research that is subject to retrospective biases. In the present research, the authors examined the impact of parental divorce-an event that can be assessed relatively objectively-on attachment patterns in adulthood across two samples. The data indicate that parental divorce has selective rather than diffuse implications for insecure attachment. Namely, parental divorce was more strongly related to insecure relationships with parents in adulthood than insecure relationships with romantic partners or friends. In addition, parental insecurity was most pronounced when parental divorce took place in early childhood. This finding is consistent with hypotheses about sensitive periods in attachment development.

The Experiences in Close Relationships-Relationship Structures questionnaire: a method for assessing attachment orientations across relationships.

Most research on adult attachment is based on the assumption that working models are relatively general and trait-like. Recent research, however, suggests that people develop attachment representations that are relationship-specific, leading people to hold distinct working models in different relationships. The authors report a measure, the Relationship Structures questionnaire of the Experiences in Close Relationships-Revised (ECR-RS; R. C. Fraley, N. G. Waller, & K. A. Brennan, 2000), that is designed to assess attachment dimensions in multiple contexts. Based on a sample of over 21,000 individuals studied online, it is shown that ECR-RS scores are reliable and have a structure similar to those produced by other measures. In Study 2 (N = 388), it is shown that relationship-specific measures of attachment generally predict intra- and interpersonal outcomes better than broader attachment measures but that broader measures predict personality traits better than relationship-specific measures. Moreover, it is demonstrated that differentiation in working models is not related to psychological outcomes independently of mean levels of security.