Adolescent Health Promotion Interventions Using Well-Care Visits and a Smartphone Cognitive Behavioral Therapy App: Randomized Controlled Trial.

BACKGROUND: Adolescent health promotion is important in preventing risk behaviors and improving mental health. Health promotion during adolescence has been shown to contribute to the prevention of late onset of the mental health disease. However, scalable interventions have not been established yet. OBJECTIVE: This study was designed to test the efficacy of two adolescent health promotion interventions: a well-care visit (WCV) with a risk assessment interview and counseling and self-monitoring with a smartphone cognitive behavioral therapy (CBT) app. Our hypothesis was that participants who had received both WCV and the CBT app would have better outcomes than those who had received only WCV or those who had not received any intervention. We conducted a prospective multi-institutional randomized controlled trial. METHODS: Participants were 217 adolescents aged 13-18 years. They were randomly divided into two intervention groups (WCV group and WCV with CBT app group) and a nonintervention group. WCV comprised a standardized physical examination along with a structured interview and counseling for youth risk assessment, which was designed with reference to the Guideline for Health Supervision of Adolescents of Bright Futures. A smartphone-based CBT program was developed based on the CBT approach. The CBT app comprised a 1-week psychoeducation component and a 1-week self-monitoring component. During the CBT program, participants created several self-monitoring sheets based on the CBT model with five window panels: event, thoughts, feelings, body response, and actions. The primary outcome was the change in scores for depressive symptoms. Secondary outcomes included changes in scores for self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale. These outcomes were evaluated at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. Intervention effects were estimated using mixed effect models. RESULTS: In total, 94% (204/217) of the participants completed the 4-month evaluation. Both intervention groups showed a significant effect in the form of reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The intervention effect was significantly more predominant in those scoring above cutoff for depressive symptoms. There was significantly less suicidal ideation in the intervention groups. As for secondary outcomes, there was significant increase in health promotion scale scores at the 4-month follow-up among junior high school students in the WCV group. Moreover, the CBT app was significantly effective in terms of obtaining self-monitoring skills and reducing depressive symptoms. CONCLUSIONS: Although adolescent health promotion interventions may have short-term benefits, the frequency of WCV and further revision of the CBT app should be considered to evaluate long-term effectiveness. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry UMIN 000036343; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041246.

[The relationship between parenting anxiety in mothers and the resources from which they routinely sought advice: The final "Healthy Parents and Children 21" survey].

Objectives　This study aimed to examine the relationship between parenting anxiety in mothers and the resources from which they routinely sought advice.Methods　Data consisted of the 75,662 survey responses from parents of children who had undergone health checkups between April and August of 2013. A logistic regression analysis was performed using parenting anxiety (computed using the responses to the two survey items "I don't feel confident as a parent" and "I wonder if I'm mistreating my child") as the response variable. The people or resources from which the mothers sought parenting advice and the number of such resources were used as the explanatory variables.Results　Across all ages, the percentage of mothers selecting "husband" as a parenting resource was the largest, and most mothers indicated they had three resources. Common across all ages, mothers who indicated that they had their husband or the child's grandmother or grandfather as resources had a significantly lower odds ratio of having parenting anxiety than mothers who did not. In contrast, mothers who selected "nursery school or kindergarten teachers" or "the Internet" as resources had a significantly higher odds ratio of having parenting anxiety than mothers who did not select these resources. Across all ages, no significant relationship was found between mothers' parenting anxiety and the number of resources they used for parenting advice. There was a significantly higher odds ratio of mothers of children aged 18 and 36 months who indicated that they wondered if they were mistreating their child if they had nobody to talk to than if they had one resource. When the number of resources increased to three, four, or five, the odds ratio was significantly reduced.Conclusion　For mothers of children of all ages, results showed that those who routinely sought advice from their husband or their child's grandparents had a significantly lower probability of experiencing parenting anxiety. On the other hand, this probability was significantly higher when their resources were nursery school or kindergarten teachers or the Internet. This study also suggests that, for mothers of young children, having a larger number of people from whom to routinely seek advice may reduce their anxiety about their parenting ability.

Awareness of cardiopulmonary resuscitation among parents of 3-year-old children.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) in infants or toddlers mainly occurs at home. Therefore, parents should be able to perform immediate cardiopulmonary resuscitation (CPR) when they witness OHCA. The status of knowledge regarding CPR among parents, however, remains unclear. The aim of the present study was therefore to determine the factors associated with awareness of CPR in parents of 3-year-old children. METHODS: We analyzed a subset of data from a population-based, cross-sectional survey that served as an evaluation of a national campaign for maternal and child health in Japan. The questionnaire was distributed to 32 897 parents who visited public health centers for medical check-ups for their children in 2013. Multivariate logistic regression analysis was carried out using the obtained demographic data. RESULTS: Overall, 26 971 parents (82.0%) responded to the questionnaire. On multivariate logistic regression analysis, birth order of the child, age of the mother at delivery, awareness of medical facilities for emergency services at night or during the weekend, current occupation status of the mother, and current economic status were independently associated with CPR awareness. When the mother was employed but the parents felt economically insufficient, the probability of having CPR knowledge decreased by 19%. Regardless of the parents' economic stability, the probability of having CPR knowledge declined by >35% when the mother was unemployed. CONCLUSIONS: The current occupation status of mothers and the current parent economic status should be considered when planning educational strategies regarding CPR training for parents.

Current situation and issues using maternal and child health-related information in the "Healthy parents and children 21" campaign across municipalities in Japan.

Objectives The use of maternal and child health-related information is an issue faced by the "Healthy parents and children 21" campaign, a national campaign to improve the health standards of mothers and children in Japan. This study described the current situation and issues faced by municipalities across Japan that use this information.Methods Data across municipalities selected for the current survey of promoting the "Healthy parents and children 21" campaign in 2013 were analyzed in this study. First, we chose prefectures where collected and analyzed maternal and child health-related information was provided by the municipalities. Then, we divided the municipalities according to those prefectures where the municipalities regularly reported the maternal and child health-related information and those that did not report it regularly. Finally, the characteristics about maternal and child health in those municipalities were investigated.Results Of the 47 prefectures analyzed, 35 prefectures (74.5%) collected and analyzed maternal and child health-related information provided by the municipalities. The 35 prefectures included 1,242 municipalities, of which 700 (56.4%) regularly reported maternal and child health-related information, and 542 (43.6%) did not report it regularly. The proportion of municipalities, where information about smoking during pregnancy, immunization, or low birth weight in infants was positively used, was significantly lower among municipalities that did not regularly report maternal and child health-related information than among those that regularly reported it (P<0.001). The proportion of municipalities that coordinated projects on prevention of child abuse or low birth weight in infants with the prefectures was significantly lower among municipalities that did not regularly report maternal and child health-related information than among those that regularly reported it.Conclusion Among municipalities that did not regularly report maternal and child health-related information, coordinating projects about child abuse with the prefectures might be associated with an increase in using the information. In addition to collecting and analyzing maternal and child health-related information provided by municipalities, prefectures should help municipalities coordinate projects about those issues to increase the use of the information in municipalities.