Examining the Association Between Digital Stress Components and Psychological Wellbeing: A Meta-Analysis.

Extant research suggests that digital stress (DS) and its various components (Hall et al. in Psychol Assess 33(3):230-242, 2021) may mediate the association between social media use and psychosocial distress among adolescents and young adults. Yet no systematic review and meta-analysis has been conducted to examine the direct associations among DS components (i.e., approval anxiety, availability stress, fear of missing out [FOMO], connection overload, and online vigilance) and psychological outcomes. Thus, we aimed to comprehensively synthesize and quantify the association between these five DS components and psychosocial distress, and to examine whether these associations were statistically different from one another. Our search of PubMed, PsycINFO, and Communication and Mass Media Complete yielded a wide range of article abstracts across the five DS components. After reviewing inclusion and exclusion criteria, 7, 73, 60, 19, and 16 studies were included for availability stress, approval anxiety, FOMO, connection overload, and online vigilance, respectively. The results suggested that all five digital stress components had significant medium association with psychosocial distress (r = .26 to .34; p < .001). Age and sex did not significantly moderate the association between most digital stress components and psychosocial distress. However, age moderated the association between connection overload and psychosocial distress. Our findings further suggested no statistical differences among the associations between the five digital stress components and psychosocial distress. Notwithstanding its limitations, our outcomes help integrate the disparate effect sizes in the literature, indicate the strength of associations, and suggest directions for clinical intervention and future research.

Development and initial evaluation of a multidimensional digital stress scale.

Digital stress is believed to play a role in the association between social media use and psychosocial outcomes. However, the literature is limited by a lack of measures that conform to published theoretical models of the construct. The present investigation details the development of a new multidimensional measure of digital stress. Based on an earlier conceptualization of Digital Stress (Steele et al., 2020), Study 1 identified items from extant measures of digital stress, conducted a qualitative review of the literature to compose new items, and conducted focus groups with young adults and adolescents (N = 23) to improve item wording and interpretation. Study 2 conducted an exploratory factor analysis (EFA) of items with a young adult sample (N = 247) collected online, yielding support for four hypothesized factors (i.e., availability stress, approval anxiety, fear of missing out [FoMO], and connection overload) plus one unanticipated factor (i.e., online vigilance). In Study 3, college students (N = 174) completed paper-and-pencil surveys, and EFA results showed a similar structure as detected in Study 2. In Study 4, confirmatory factor analysis examining the five-factor model was conducted on data from adolescents (N = 163) and college students (N = 152). These procedures yielded 24 items measuring 5 components of digital stress: availability stress, approval anxiety, FoMO, connection overload, and online vigilance. Associations between digital stress and psychosocial distress and functioning are reported to demonstrate convergent and divergent validity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Systematic Review on the Application of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Preschool-Aged Children.

Trauma-focused cognitive behavioral therapy (TF-CBT) is one of the most widely studied and disseminated treatments for posttraumatic stress disorder (PTSD) and other comorbid conditions, and has been identified as a "level one" or "well-established" intervention for school-aged children and adolescents. The present systematic review examined the literature on the application of TF-CBT within a preschool-aged population (i.e., children ages three to six), as well as the developmental literature that could increase the efficacy of TF-CBT for preschool-aged children. Information on the use of TF-CBT with preschool-aged children was extracted from randomized controlled trials, case studies, meta-analyses, and other forms of empirical evidence, as part of the evidence-based practice in psychology framework. In comparison to research with school-aged children and adolescents, fewer studies have directly assessed the efficacy of TF-CBT for preschool-aged children who have been exposed to trauma. Given the few studies published to date and difference in treatment protocols for TF-CBT used with preschool-age children, TF-CBT appears to meet criteria as a "level two" or "probably efficacious" intervention for preschool-aged children specifically. According to the available literature, language and cognitive abilities, family context, culture, and clinician expertise are considered as potential variables to address when contemplating the use of TF-CBT for preschool-aged children with symptoms of post-traumatic stress.

Conceptualizing Digital Stress in Adolescents and Young Adults: Toward the Development of an Empirically Based Model.

Existing literature provides a complicated picture of the relationship between digital media use and psychological outcomes. Both correlational and some experimental studies suggest that social media use specifically can be associated with diminished psychological functioning in adolescents and young adults. However, these effect sizes are not large, and must be considered in light of studies that suggest some positive outcomes associated with some uses of digital media, and a range of moderators of the identified associations. Although a growing body of evidence suggests that digital stress may be an important intervening factor between digital media use and psychosocial outcomes, this literature is complicated by multiple nomenclatures for similar or identical constructs. Our review of the literature suggests four potentially related components of digital stress, including availability stress, approval anxiety, fear of missing out, and communication overload. This conceptualization is consistent with recent published frameworks for understanding digital media's influence on peer relationships. Clinicians working with adolescents and young adults are encouraged to assess digital media use in the context of clients' overall psychological and social functioning, and in consideration of clients' specific uses of media. Future research is needed to examine the associations among components of digital stress and clinical outcomes, and to provide valid measures to assess digital stress in research and clinical settings.

Trajectories of pediatric sleepiness and their associations with health-related quality of life.

The need for sleep in children has sparked extensive research, with inconclusive support for an association between sleep duration and sleep quality and health-related quality of life (HR-QOL). Daytime sleepiness, which captures a child's subjective sleep experience, has seldom been explored. Latent class growth analysis (LCGA) was employed to identify longitudinal trajectories of children's sleepiness. Trajectories were utilized to assess their association with HRQOL. The present sample included 158 children and their self-reports of sleepiness and HRQOL collected at three time points across an academic year. Results provided support for three trajectories of sleepiness, with significant associations between trajectory and later HRQOL. Post hoc tests revealed significant differences in HRQOL between trajectories. Children with high and stable sleepiness-experienced impairments in HRQOL comparable to children with chronic health conditions. Implications include the establishment of daytime sleepiness as a pervasive state with both statistical and clinical significance.

Physical activity and health-related quality of life in children and adolescents: A systematic review and meta-analysis.

OBJECTIVE: The purpose of this study was to quantify the effect of physical activity (in both descriptive and intervention studies) on health-related quality of life (HRQOL) in children and adolescents from both healthy and chronic illness populations. METHOD: A systematic review of PubMed, PsycINFO, and ProQuest identified 33 studies of physical activity and HRQOL in youth, including descriptive and prepost intervention designs. RESULTS: In descriptive studies (N = 14), there was a small, positive association between physical activity and HRQOL based on child-reports (Hedges' g = .302, p < .001, 95% confidence interval, CI [.178, .426]) and a negligible association based on parent-proxy reports (Hedges' g = .115, p = .101, 95% CI [-.023, .253]). Intervention studies (N = 19) yielded a small, positive effect of physical activity intervention on HRQOL based on child-reports (Hedges' g = .279, p = .014, 95% CI [.057, .500]) and a medium, positive effect based on parent-proxy reports (Hedges' g = .522, p = .012, 95% CI [.117, .928]). Intervention effects were attenuated by removal of a single study. Hypothesized and exploratory moderators did not moderate the relationship between physical activity and HRQOL. CONCLUSIONS: Findings supported the primary hypothesis that physical activity was related to better HRQOL in youth, although the magnitude of these effects did not represent a minimal clinically important difference (MCID) in most studies. Future studies are needed to assess HRQOL in youth before and after exercise interventions to quantify the type, frequency, duration, and intensity of physical activity needed to change HRQOL. (PsycINFO Database Record

Latent Profiles of Physical Activity and Sedentary Behavior in Elementary School-Age Youth:Associations With Health-Related Quality of Life.

Objective: The objectives were to identify and describe profiles of elementary school-age youth based on objective measurements of total time spent in moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) and in bouts of the activities, to examine predictors of profiles, and to examine whether profiles were differentially associated with physical and psychosocial health-related quality of life (HRQOL). Methods: Participants included 204 youth (aged 8-11 years) who wore accelerometers to gather objective activity data. The average proportion of time in MVPA and SB and average proportion of time in MVPA and SB bouts were used for analyses. Participants completed a self-report measure of HRQOL. Latent variable mixture modeling was conducted. Results: Overall, participants did not meet the MVPA guideline (M = 50.7 min) and spent 47% of waking hours in SB, indicating that elementary school is a critical developmental period to study activity levels. Three profiles emerged: "Active," "Inactive," and "Moderate." Boys were significantly more likely to be in the Active profile than the other profiles, and older youth were significantly more likely to be in the Inactive profile. After controlling for child sex and age, participants in the Active profile reported significantly higher psychosocial HRQOL than the participants in the other profiles; however, no significant differences were found in physical HRQOL. Conclusions: Identification of these naturally occurring profiles suggests need for interventions early in development focused on increasing the intensity of physical activity from light to moderate-to-vigorous for at least 60 min per day as way to improve psychosocial HRQOL.

Bidirectional Associations Between Disordered Eating and Health-Related Quality of Life in Elementary School-Age Youth.

Objective: To examine longitudinal, bidirectional associations between disordered eating and physical/psychosocial health-related quality of life (HRQOL) in a nonclinical community sample of elementary school-age youth. Methods: Participants included 130 children between the ages of 7 and 10 years ( M age = 8.62). Disordered eating and physical/psychosocial HRQOL were assessed using self-report measures at three time points. The potential bidirectional associations were examined using a longitudinal panel model. Results: Higher disordered eating predicted lower psychosocial HRQOL during a 6-month period within the same academic year, and lower HRQOL predicted higher disordered eating during a 6-month period across academic years. Conclusion: The current study found longitudinal, bidirectional associations between disordered eating and psychosocial, but not physical, HRQOL. The results provide evidence for psychosocial HRQOL as a potential predictor and consequence of disordered eating attitudes. Limitations, future directions, and implications of this research are discussed.

Impact of Social Networking Sites on Children in Military Families.

Youth in military families experience a relatively unique set of stressors that can put them at risk for numerous psychological and behavior problems. Thus, there is a need to identify potential mechanisms by which children can gain resiliency against these stressors. One potential mechanism that has yet to be empirically studied with military youth is social networking sites (SNSs). SNSs have gained significant popularity among society, especially youth. Given the significance of these communication tools in youths' lives, it is important to analyze how SNS use may affect military youth and their ability to cope with common military life stressors. The current review examines the potential positive and negative consequences associated with SNS use in coping with three common stressors of youth in military families: parent deployment, frequent relocation, and having a family member with a psychological or physical disability. By drawing from SNS and military literature, we predict that SNS use can be a positive tool for helping children in military families to cope with stressors. However, certain SNS behaviors can potentially result in more negative outcomes. Recommendations for future research are also discussed.

Change in health-related quality of life in the context of pediatric obesity interventions: A meta-analytic review.

OBJECTIVE: To quantitatively characterize change in health-related quality of life (HRQoL) in the context of behavioral (n = 16), surgical (n = 5), and pharmacological (n = 1) interventions for pediatric overweight and obesity. A secondary goal was to examine the relationship between change in HRQoL and change in body mass index (ΔBMI) by treatment type. The amount of weight loss necessary to observe a minimally clinically important difference (MCID) in HRQoL was determined. METHOD: Data were gathered from studies reporting on weight change and ΔHRQoL over the course of obesity interventions (N = 22) in youths (N = 1,332) with average ages between 7.4 and 16.5 years (M = 12.2). An overall effect size was calculated for ΔHRQoL. Moderation analyses were conducted using analysis of variance and weighted regression. MCID analyses were conducted by converting HRQoL data to standard error of measurement units. RESULTS: The overall effect size for ΔHRQoL in the context of pediatric obesity interventions was medium (g = 0.51). A significant linear relationship was detected between ΔBMI and ΔHRQoL (R2 = 0.87). This relationship was moderated by treatment type, with medical (i.e., surgical) interventions demonstrating a stronger relationship. Results indicated that it takes a change of 0.998 BMI units to detect true change in HRQoL. CONCLUSION: This study provides the first known quantitative examination of changes in HRQoL associated with weight loss in pediatric interventions. Medical interventions appear to offer a more substantial increase in HRQoL per unit of BMI change. These results offer a concrete weight loss goal for noticing positive effects in daily life activities. (PsycINFO Database Record

Pediatric Weight Management Interventions in Primary Care Settings: A Meta-Analysis.

OBJECTIVE: Although the primary care setting has been recommended as an acceptable environment for pediatric overweight/obesity treatment, a quantitative analysis has not been conducted to determine the effectiveness of pediatric weight management interventions delivered in these settings. Therefore, the purpose of the current study was to conduct a meta-analysis of weight management interventions for youth in primary care settings. METHOD: A literature search using PsycINFO and PubMed was conducted to identify articles published through October 2015. Eighteen studies (3,358 participants) met inclusion criteria; studies included a treatment and comparison group and targeted individuals or families for treatment. Study characteristics were coded, and study rigor of articles was assessed. RESULTS: The overall effect size for change in body mass index (BMI) in primary care weight management interventions compared to control groups was small but statistically significant (d = 0.26, 95% CI [.14, .38]). The number of treatment contacts, treatment months, and visits with a pediatrician emerged as significant moderators of outcome, such that BMI reduction was positively related to greater contact. CONCLUSIONS: In comparison to control conditions, weight management programs in primary care settings can be effective for BMI reduction, suggesting that primary care is a suitable setting for treatment of pediatric overweight/obesity. Additionally, treatments that were longer in duration, included more contacts (in person or phone), and included more contacts by a pediatrician had greater impact on BMI reduction. Future studies should continue to examine other aspects of acceptability and accessibility as well as demonstrate the effectiveness of interventions on improving psychosocial outcomes. (PsycINFO Database Record

An Evaluation of the Children's Report of Sleep Patterns Using Confirmatory and Exploratory Factor Analytic Approaches.

OBJECTIVE: To explore the psychometric properties of the Children's Report of Sleep Patterns (CRSP) in school-aged children by conducting a factor analysis of the Sleepiness Scale and the Sleep Disturbances Scales. METHODS: Participants included 155 children from two elementary schools (Mage = 9.82) who completed the self-report CRSP. A confirmatory factor analysis (CFA) was conducted using the originally hypothesized structure. A subsequent exploratory factor analysis (EFA) was conducted to determine an alternative factor structure. RESULTS: CFA revealed that the hypothesized factor structure was not supported. The EFA produced an alternative six-factor solution, which supports the conceptualization of three new scales, Restless Legs Report, Sleep Initiation, and Sleep Maintenance/Night Wakings. CONCLUSION: The revised measure adds increased specificity with scales related to insomnia and restless leg symptoms. Researchers and clinicians interested in using the CRSP should continue to assess its validity by exploring the relationship between the measure and objective measures of sleep behavior.

The Effect of Body Mass Index, Negative Affect, and Disordered Eating on Health-Related Quality of Life in Preadolescent Youth.

OBJECTIVE: To examine the indirect effect of body mass index z-score (BMIz) on health-related quality of life (HRQOL) through disordered eating attitudes and behaviors in a community sample of preadolescent children, and the degree to which negative affect moderated the association between BMIz and disordered eating attitudes and behaviors. METHODS: Participants included 165 children between 8 and 12 years of age (M = 9.41). HRQOL, disordered eating attitudes and behaviors, and negative affect were assessed using self-report measures. Height and weight were collected by research staff. RESULTS: Consistent with previous research in treatment-seeking and adolescent samples, the indirect effect of BMIz on HRQOL through disordered eating attitudes and behaviors was significant. Negative affect did not moderate the relationship between BMIz and disordered eating attitudes and behaviors. CONCLUSION: Intervening on disordered eating attitudes and behaviors in preadolescents with higher weight status is critical to prevent the risk for poor HRQOL.

A Longitudinal Examination of Hope and Optimism and Their Role in Type 1 Diabetes in Youths.

OBJECTIVES: To test the longitudinal associations between hope and optimism and health outcomes (i.e., HbA1c and self-monitored blood glucose [SMBG]) among youths with Type 1 diabetes mellitus (T1DM) over a 6-month period. METHODS: A total of 110 participants (aged 10-16 years) completed study measures at Time 1, and 81 completed measures at Time 2. Analyses examined hope and optimism as predictors of change in health outcomes, and examined SMBG as a mediator of the relationship between hope and optimism, and HbA1c. RESULTS: Change in hope, but not optimism, was associated with change in SMBG and HbA1c. Change in SMBG mediated the relationship between change in hope and HbA1c, but not between optimism and HbA1c. CONCLUSIONS: It may be beneficial to assess hope in pediatric T1DM patients to identify youths who may be at risk for poor diabetes management, and to test the benefit of hope-based intervention efforts in clinical studies.

Comparison of two measures of weight criticism in youth: associations with physical activity engagement and attitudes, weight status, and health-related quality of life.

The objective of this study was to examine the degree to which 2 measures of weight criticism, the Weight Criticism During Physical Activity (WCA) scale and the Perceptions of Teasing Scale (POTS), represent distinct constructs and in what circumstances each is most appropriately used. A community sample of 307 fourth and fifth graders completed these measures, as well as measures of health-related quality of life, physical activity engagement, and attitudes toward physical activity. Body mass index was also calculated. Results of confirmatory factor analysis indicated that the WCA scale and the POTS represented correlated but distinct constructs and related differently to measures of physical activity and weight status. Findings suggested that the WCA scale may be representing criticism regarding athletic competency, not criticism of weight status as described in the literature. The POTS subscales appear to be accurately described and used in the literature.

Weighing physical activity: the impact of a family-based group lifestyle intervention for pediatric obesity on participants' physical activity.

OBJECTIVES: To examine differences in self-reported physical activity (PA) between participants enrolled in the treatment versus active control condition of a pediatric obesity intervention, and to test associations between parent and child PA. METHODS: Participants (N = 93) included children aged 7-17 years and their parent. Analyses tested whether participants in the treatment condition reported greater PA at postintervention and 12-month follow-up compared with the control condition. Further, researchers examined change in PA across time and whether change in parent PA was associated with change in child PA. RESULTS: Children in the treatment condition reported greater PA at 12-month follow-up. Parents in the treatment group reported a significant increase in PA between baseline and postintervention. Change in parent PA was associated with changes in child PA across multiple periods. CONCLUSIONS: Family-based obesity interventions may promote long-term change in self-reported PA among youths, and change in parent PA may be a contributing factor.

Medium is the message: moderate parental control of feeding correlates with improved weight outcome in a pediatric obesity intervention.

OBJECTIVE: Previous studies have suggested complex associations among variables related to parental control of feeding and child/adolescent obesity. The current study examined associations between parental food control variables and weight outcomes in the context of a behaviorally based family treatment program. METHODS: Parents of youths (n = 93) enrolled in a clinical trial comparing 2 weight management interventions completed the Child Feeding Questionnaire pre- and post-treatment, and at a 12-month follow-up. RESULTS: Latent growth curve modeling indicated that mean levels of restriction decreased over the course of treatment in the Positively Fit (PF) condition. Youths in the PF treatment condition whose parents increased their restriction of food experienced greater decreases in zBMI over treatment. CONCLUSIONS: Results echo previous reports that high and low parental control over food intake are associated with higher zBMI. Moderate parental control can be associated with beneficial outcomes in youths enrolled in behavioral treatment programs for obesity.

Commentary: pediatric eHealth interventions: common challenges during development, implementation, and dissemination.

OBJECTIVE: To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. METHODS: The article draws on the existing eHealth literature and the authors' collective experience in pediatric eHealth research. RESULTS AND CONCLUSIONS: The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination.

Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity.

PURPOSE: To conduct a meta-analysis of randomized controlled trials examining the efficacy of comprehensive behavioral family lifestyle interventions (CBFLI) for pediatric obesity. METHOD: Common research databases were searched for articles through April 1, 2013. 20 different studies (42 effect sizes and 1,671 participants) met inclusion criteria. Risk of bias assessment and rating of quality of the evidence were conducted. RESULTS: The overall effect size for CBFLIs as compared with passive control groups over all time points was statistically significant (Hedge's g = 0.473, 95% confidence interval [.362, .584]) and suggestive of a small effect size. Duration of treatment, number of treatment sessions, the amount of time in treatment, child age, format of therapy (individual vs. group), form of contact, and study use of intent to treat analysis were all statistically significant moderators of effect size. CONCLUSION: CBFLIs demonstrated efficacy for improving weight outcomes in youths who are overweight or obese.