Examining where to go: pediatric psychology trainees' perception of their graduate training in culture and diversity.

OBJECTIVE: Culture and diversity-related training is critical to the development of competent pediatric psychologists. Evaluation of training efforts have been conducted at the program level, yet evaluation of trainee experiences in culture and diversity-related training remains unassessed. This trainee-led study was the first formal assessment of pediatric psychology trainee experiences of culture and diversity-related training and the impact of training on their own cultural humility. METHODS: Study overview and a survey link was distributed across 2 listservs associated with the American Psychological Association (Division 53, Division 54) and sent directly to directors of graduate, internship, and fellowship training programs with a request to share with trainees. Surveys assessing integration of cultural training and trainee cultural humility were completed. Trainees also provided qualitative feedback regarding their multicultural training and development. RESULTS: Pediatric psychology trainees (N = 90) reported inconsistent integration of culture and diversity topics into their training. Of the 34 training areas assessed, 10 were perceived as thoroughly integrated into formal training by at least half of the respondents. Trainees often sought independent cultural training outside of their programs, and no relationship was detected between perceived integration of cultural training and trainee cultural competence. DISCUSSION: Results indicate room for improvement regarding integration of cultural training and a need to better understand driving forces behind trainees independently seeking training outside of their formal training programs. Moreover, understanding the aspects of training that are most contributory to trainee development is needed given that no relationship between training and development emerged in the current study.

Superhero Pretense, Superhero Identification, and Risk-Taking in Preschool-Aged Children.

OBJECTIVE: The preschool years represent a stage of rapid human development, hallmarked by exploring the environment through gross and fine motor movement and imaginative pretend play. This exploration is developmentally appropriate but also presents risks for injury, the leading cause of death for preschool-aged children. Common injuries reflect exploration and risk-taking exhibited during play, and play may be particularly risky when children imitate risky models like superheroes. Frequent exposure and subsequent identification with superheroes are concerning because the media glorifies superheroes, creating social learning effects on children and promoting play situations where children may attempt superhuman abilities and hurt themselves. This study examined the relations between pretend play, superhero identification, and children's risk-taking. METHODS: One hundred five children aged 4-5 years old were randomly assigned to either a superhero- or school-themed, story-based protocol. In both conditions, children engaged in three identical behavioral tasks to assess risk-taking. Identification with superheroes was measured using parent-report questionnaires and child interviews. RESULTS: Pretending to be a superhero was not associated with increased risk-taking behavior acutely, but identification with superheroes was associated in some analyses with preschool children's broader risk-taking behavior. Across risk-taking behavior tasks, children with high superhero identification pretending to be superheroes tended to take the most risks. CONCLUSIONS: Given the popularity of superhero media and the present results suggesting superhero identification may relate to injury-risk situations during play, prevention efforts should consider ways to reduce young children's exposure to superheroes and/or mitigate injury risk during active pretend play.

Sleep and Inflammation during COVID-19 Virtual Learning in Adolescents with Overweight or Obesity.

(1) Background: Adolescents present as a high-risk group for a range of adverse physical health outcomes during the pandemic, including sleep and C-reactive protein (CRP) levels. As adolescents with overweight or obesity (OWOB) present as an even higher risk group, the present study assessed relationships between sleep and CRP levels before and during COVID-19 in adolescents with OWOB. (2) Methods: Fourteen adolescents with OWOB participated in a pre-COVID1, pre-COVID2, and during-COVID-19 lab visit, measuring sleep and CRP levels. The sample size was limited by the number of participants who provided data before COVID-19 and who were enrolled in virtual school during the recruitment phase. However, our power analyses indicated needing a minimum of 10 participants to achieve adequate power. Pre-COVID1, pre-COVID2, and during-COVID-19 normative expected CRP levels were calculated based on age, sex, race, and body mass index percentile-matched data. Analyses compared pre-COVID1 and pre-COVID2 sleep with during-COVID-19 sleep, during-COVID-19 sleep and during-COVID-19 CRP levels, during-COVID-19 CRP levels with normative expected during-COVID-19 CRP levels, change in CRP levels from pre-COVID1 and pre-COVID2 to during-COVID-19 with normative expected CRP levels during those time periods, and change in CRP levels before COVID-19 with change in CRP levels during COVID-19. (3) Results. During COVID-19, participants experienced decreased sleep efficiency (p = 0.001), later wake time (p < 0.001), longer time in bed (p = 0.021), and onset latency (p = 0.004), compared to pre-COVID1, and decreased sleep efficiency (p = 0.002), longer onset latency (p = 0.006), and later wake time (p < 0.001) and bedtime (p = 0.016) compared with pre-COVID2. During-COVID-19 CRP levels were positively correlated with during-COVID-19 wake times (p = 0.01) and times in bed (p = 0.008). During-COVID-19 CRP levels were greater than normative expected CRP levels (p < 0.001). CRP levels increased more from pre-COVID1 and pre-COVID2 to during-COVID-19 than normative expected changes in CRP levels (p < 0.003). Changes in CRP levels before and during COVID-19 were not significantly different. (4) Conclusions. These findings highlight the consequential effects of COVID-19, including impairments in sleep, on adolescents with OWOB. CRP levels increased more (~5 mg/L) during COVID-19 than normative expected change.

A Systematic Review and Meta-Analysis on the Efficacy of Virtual Reality Pedestrian Interventions to Teach Children How to Cross Streets Safely.

OBJECTIVE: Over 7,000 American children die from pedestrian injuries annually, and pedestrian injury ranks among the top 5 causes of unintentional child death. Prevention efforts are multifaceted. One strategy, use of virtual reality (VR) to teach children to cross streets, is of growing interest to public health practitioners. The present study is a systematic review and meta-analysis that examined the efficacy of using VR to teach children pedestrian safety. METHODS: Following PRISMA guidelines, searches among 7 databases were completed, followed by abstract/full-text screening and data extraction. Hedge's g was computed for the effect sizes of 3 outcomes: pedestrian knowledge, pedestrian-relevant cognition (attention to traffic, time to contact, start delay), and pedestrian behaviors (safe crossings, unsafe crossings). Risk of bias was assessed using Cochrane guidelines. Meta-regression analyses and subgroup analyses were conducted including 3 moderators: age, sex, and immersion level. RESULTS: A total of 20 studies, reported in 24 articles, were included in the qualitative analysis. Meta-analysis of the 12 studies with sufficient quantitative data available showed a statistically significant medium effect of VR safety interventions on child pedestrian knowledge and behavior. Mixed results emerged for the effect of VR safety interventions on children's pedestrian-relevant cognition. Age and sex moderated the effect of VR training on pedestrian knowledge. CONCLUSIONS: This synthesis of the literature on pediatric VR pedestrian safety interventions suggests an overall beneficial impact of VR interventions to teach children how to cross streets safely. Efforts should continue to develop and disseminate effective VR interventions. REGISTRATION ID: CRD42022309352.

The Effects of COVID-19 Virtual Learning on Body Fat and Insulin Resistance in Adolescents with Overweight or Obesity.

(1) Background: COVID-19 virtual learning reduced structural supports for adolescent physical activity and diet, threatening metabolic health, especially in teens with overweight or obesity (OWOB). (2) Methods: Adolescents (N = 14) with OWOB completed fasting blood draws (measuring insulin resistance, IR) and Dual Energy X-Ray Absorptiometry (DXA, measuring total body fat percent, TBF%) pre-COVID-19 and during COVID-19. Changes in TBF% and IR were calculated (1) pre-COVID-19 and (2) from pre-COVID-19 to during COVID-19. Age and body mass index (BMI) percentile-matched data assessed normative changes across similar, non-COVID-19 time periods. Paired t-tests compared TBF% change pre- to during COVID-19 with (1) TBF% change pre-COVID19 and (2) TBF% normative change. Two ANCOVAs compared IR change pre- to during COVID-19 with (1) IR change pre-COVID-19 controlling for BMI z-score and difference in time between assessments and (2) normative change in IR controlling for sex/race. (3) Results: The TBF% change pre-COVID-19 and the normative change were similar. The TBF% increased more (~six percentage points) during COVID-19 compared to normative change (p < 0.01). During COVID-19, IR increased more (~2.5 units) than change pre-COVID-19 (p = 0.03) and increased more (~3.5 units) than normative change (p = 0.01). (4) Conclusions: TBF% and IR increased exponentially during COVID-19 in teens with OWOB compared to pre-COVID-19 and normative changes.

The Impact of Longitudinal Patterns of Adolescent Sleep Duration on Adult C-Reactive Protein (CRP), Waist-To-Height Ratio, and Body Mass Index (BMI) Among Black and White Individuals.

PURPOSE: To assess the impact of longitudinal adolescent sleep duration on adult C-reactive protein (CRP), waist-to-height ratio (WtHR), and body mass index (BMI) by race. METHODS: Participants (N = 2,399; Mage = 15.7; 40.2% male; 79.2% White, 20.8% Black; Grades 7-12 at Wave I) from the Add Health database provided self-reported sleep duration in Waves I-IV. During Wave V, CRP, WtHR, and BMI were objectively measured. Trajectory analysis was performed using a group-based modeling approach. Chi-square test determined racial differences between groups. General linear models determined relationships between trajectory group, race, and group/race interaction with Wave V CRP, WtHR, and BMI. RESULTS: Three sleep trajectories emerged: Group 1 "shortest" (24.4%), Group 2 "stable recommended" (67.6%), and Group 3 "varied" (8%). Black individuals and older individuals were more likely to be in Group 1 compared with Group 2. Regardless of race, individuals with patterns of sleep duration increasing to above what is recommended across waves (Group 3) had elevated CRP. Individuals with stable patterns of adequate sleep (Group 2) had lower WtHR. Black individuals with consistently stable patterns of adequate sleep duration had lower BMI compared to those with low sleep duration. DISCUSSION: Black individuals were more likely to obtain chronically short sleep during the transition from adolescence to adulthood, highlighting a significant health disparity. Poor longitudinal sleep predicted elevated CRP and WtHR. Sleep only impacted BMI for Black individuals. This may relate to racial differences in BMI measurement.

Caregiver accounts of unintentional childhood injury events in rural Uganda.

OBJECTIVE: Complex environmental, social, and individual factors contribute to unintentional childhood injury events. Understanding context-specific antecedents and caregiver attributions of childhood injury events can inform the development of locally-targeted interventions to reduce injury risk in rural Uganda. METHODS: Fifty-six Ugandan caregivers were recruited through primary schools and completed qualitative interviews regarding 86 unintentional childhood injury events. Descriptive statistics summarized injury characteristics, child location and activity, and supervision at time of injury. Qualitative analyses informed by grounded theory identified caregiver attributions of injury causes and caregiver actions to reduce injury risk. RESULTS: Cuts, falls, and burns were the most common injuries reported. At the time of injury, the most common child activities were farming and playing and the most common child locations were the farm and kitchen. Most children were unsupervised. In cases where supervision was provided, the supervisor was typically distracted. Caregivers most often attributed injuries to child risk-taking but also identified social, environmental, and chance factors. Caregivers most often made efforts to reduce injury risk by teaching children safety rules, but also reported efforts to improve supervision, remove hazards, and implement environmental safeguards. CONCLUSION: Unintentional childhood injuries have a significant impact on injured children and their families, and caregivers are motivated to reduce child injury risk. Caregivers frequently perceive child decision-making a primary factor in injury events and respond by teaching children safety rules. Rural communities in Uganda and elsewhere may face unique hazards associated with agricultural labor, contributing to a high risk of cuts. Interventions to support caregiver efforts to reduce child injury risk are warranted.

Parenting style history in predicting harsh parenting and child abuse risk across the transition to parenthood: Role of gender.

BACKGROUND: Intergenerational transmission of abuse processes imply that individuals abused as children are more likely to abuse their own children when they become parents, with similar intergenerational patterns observed for parenting styles. OBJECTIVE: The present study addresses an important gap in the literature regarding the intergenerational cycle, investigating how perceived parenting style history predicts mothers' and fathers' child abuse risk across the transition to parenthood, with particular attention to the role of gender by comparing cross-gender and same-gender grandparent-parent dyads. PARTICIPANTS AND METHODS: The sample is drawn from a four-wave longitudinal study that enrolled 203 families beginning the final trimester of mothers' pregnancy until children were four years old. Parents responded to measures on parenting style history received from both their mothers and fathers as well as measures of their own child abuse risk, parent-child aggression, and personal parenting style. RESULTS: Mothers demonstrated more same-gender effects, whereas fathers demonstrated more cross-gender effects-both patterns supportive of a tendency to follow maternal influences when considering child abuse risk. With regards to behavior, both mothers' and fathers' reports of parent-children aggression were most influenced by perceived harsh parenting received from their fathers. CONCLUSIONS: Future development of parenting interventions could be more individualized to the participating parent's reported personal history of parenting style and gender.

Short- and Long-Term Effects of Superhero Media on Young Children's Risk-Taking Behaviors.

OBJECTIVE: Unintentional injuries, the leading cause of death for American children, are caused by a range of psychosocial factors, including risk behavior. One factor that may impact child risk-taking is modeling of superhuman risk-taking from superhero media, both immediately following superhero exposure and based on lifetime exposure and engagement. METHODS: Fifty-nine 5-year-olds were randomly assigned to view either a 13-min age-appropriate superhero television show or a comparable nonsuperhero show. After the viewing, children engaged in three risk-taking measures: (a) activity room, unsupervised play for 5 min with assortment of apparently dangerous items that might encourage child risk-taking; (b) picture sort, 10 illustrations of children in risk situations, with participant response concerning intended risk-taking in that situation; and (c) vignettes, 10 stories presenting situations with varying degrees of risk, with participant response on intended choice. Parents completed questionnaires concerning children's long-term superhero media exposure and individual superhero engagement (e.g., if child's most recent Halloween costume was of a superhero). Correlations and regressions evaluated effects of immediate superhero exposure, lifetime superhero exposure, and lifetime superhero engagement on children's risk-taking. RESULTS: Mixed results emerged. Lifetime superhero exposure was significantly related to children's risk-taking outcomes in two bivariate (vignettes and picture sort) and one multivariate (picture sort) model. Neither immediate superhero exposure nor lifetime superhero engagement was strongly related to risk-taking. CONCLUSIONS: Children's lifetime superhero exposure may influence children's risk-taking. Given American children's substantial media exposure, research should continue to unpack the role of superhero media on children's unintentional injury and other health risk behaviors.

The exploration of size and toddler interaction with liquid laundry detergent capsules.

Liquid laundry capsules have been involved in multiple poisoning incidents with young children in the home. There are a range of contributing factors for these incidents, including influences from industry, culture, home environments, and parenting/supervision. There also are influences from children's behaviour and decisions in reaction to potential hazards. Previous research examined the influence of capsule product appearance and colour on children's behaviour around hazardous household items, but little research examines the influence of product size. This research explored if differences in the size of liquid laundry capsules result in different levels of toddler interaction. We compared two commercially available capsule designs that are identical in physical appearance but differ in physical size. Our research was conducted using three studies: Study 1, forced-choice test in an out-of-context laboratory setting; Study 2, an ecologically-valid, simulated real-world setting replicating a home laundry cabinet with a container of capsules left open; and Study 3, a second ecologically-valid study replicating a home laundry cabinet, this time with a capsule left outside its container. Capsule interaction was measured by grasping choice among samples of 156 toddlers ages 9-36 months. The same sample was used for Studies 1 and 2, and a second identically sized sample recruited for Study 3. Results from Study 1 indicated toddlers selected the small (49.8% selection) and large (50.2%) capsule with nearly identical frequency. Study 2 largely replicated Study 1: Toddlers selected the small capsule or container of small capsules 26.8% of the time and the large capsule or container of large capsules 22.3% of the time. Study 3 also replicated previous findings: Toddlers selected the smaller capsule 18.0% of the time and the larger 19.2%. We discuss study results, which suggest no appreciable difference in toddler's grasping choice to smaller versus larger laundry capsules.

Children's Road-Crossing Behavior: Emotional Decision Making and Emotion-Based Temperamental Fear and Anger.

OBJECTIVE: Child pedestrian injuries represent a global public health burden. To date, most research on psychosocial factors affecting children's risk of pedestrian injury focused on cognitive aspects of children's functioning in traffic. Recent evidence suggests, however, that emotional aspects such as temperament-based fear and anger/frustration, as well as executive function-based emotional decision making, may also affect children's safety in traffic. This study examined the role of emotions on children's pedestrian behavior. Three hypotheses were considered: (a) emotion-based temperament factors of fear and anger/frustration will predict children's risky decisions and behaviors; (b) emotional decision making will predict risky pedestrian decisions and behaviors; and (c) children's pedestrian decision making will mediate relations between emotion and risky pedestrian behavior. The role of gender was also considered. METHODS: In total, 140 6- to 7-year-old children (M = 6.7 years, SD = 0.39; 51% girls) participated. Parent-report subscales of Child Behavior Questionnaire measured temperamental fear and anger/frustration. The Hungry Donkey Task, a modified version of Iowa Gambling Task for children, measured children's emotional decision making, and a mobile virtual reality pedestrian environment measured child pedestrian behavior. RESULTS: Greater anger/frustration, lesser fear, and more emotional decision making all predicted poorer pedestrian decision making. The mediational model demonstrated that pedestrian decision making, as assessed by delays entering safe traffic gaps, mediated the relation between emotion and risky pedestrian behavior. Analyses stratified by gender showed stronger mediation results for girls than for boys. CONCLUSIONS: These results support the influence of emotions on child pedestrian behavior and reinforce the need to incorporate emotion regulation training into child pedestrian education programs.