Associations of latent patterns of parent‒child communication with communication quality and mental health outcomes among Chinese left-behind children.

BACKGROUND: Parent‒child communication in migrant families is essential to family bonds and the mental health of left-behind children (LBC). Little is known about the different patterns of communication between migrant parents and LBC and associated communication quality and mental health outcomes. METHODS: A sample of 2,183 Chinese children (mean age = 12.95 ± 1.29 years) from Anhui province, including LBC whose parents had both migrated (n = 1,025) and children whose parents had never migrated (never-LBC, n = 1,158), was analyzed. With the LBC sample, latent class analysis was applied to identify the patterns of parent‒child communication. Multinomial logistic regression analysis was conducted to assess the associations between the sociodemographic variables and class membership of LBC. Analysis of covariance and chi-square tests were used to compare communication quality and mental health outcome differences among the classes of LBC and between each of the classes and never-LBC. RESULTS: Five latent classes of communication formed through different media or channels between migrant parents and their LBC were identified. Higher household economic status (OR = 2.81, p < 0.05) was associated with adequate communication. LBC in Class 1, defined by frequent technologically-mediated and face-to-face communication, had a significantly higher quality of communication with their migrant parents (F = 8.92, p < 0.001) and better mental health than those in other latent classes; these children did not have significantly worse mental health outcomes compared to never -LBC. CONCLUSIONS: Facilitating multichannel parent‒child communication is a practical way of reducing mental health inequities between LBC and their peers.

Mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults: A population-based study on the mediating roles of lifestyle behaviors.

BACKGROUND: Despite substantial efforts to investigate the inequalities in mental health among people with marginalized identities, most research has concentrated on single social identities rather than complete persons. The current study aimed to explore the mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults. METHODS: Data for this study came from the National Health and Nutrition Examination Survey waves between 2015 and 2018, including a total of 11,268 US adults. A latent class analysis (LCA) was conducted to identify latent subpopulations based on sex, race/ethnicity, immigrant status, disability, household income, employment status, and education level. Interclass differences in lifestyle factors and depression were examined. Multiple mediation analysis was used to examine the mediating roles of lifestyle behaviors. RESULTS: LCA identified four potential subpopulations: "least marginalized", "immigrant minorities", "disabled, less-educated non-workers", and "low-income minorities" groups. There was enormous heterogeneity in mental health among immigrant minority individuals. The "disabled, less-educated non-workers" group had the highest rates of depression; in contrast, the "immigrant minorities" group had the best mental health, even better than that of the "least marginalized" group. Distributions of lifestyle factors followed a similar pattern. In addition, lifestyle behaviors significantly mediated the relationship between intersectional social identities and depression. LIMITATIONS: The cross-sectional design prevented establishment of the causality of relationships. CONCLUSIONS: This study suggests that applying a person-centered approach is important when examining intersectional inequalities in mental health and highlights the effects of structural social hierarchies on individuals' health behaviors and mental health.

Associations of Lifestyle Patterns With Overweight and Depressive Symptoms Among United States Emerging Adults With Different Employment Statuses.

Objective: To identify lifestyle patterns in emerging adults and examine the association of lifestyle patterns with overweight and depression. Methods: Data was from the National Health and Nutrition Examination Survey between 2011 and 2018. A latent class analysis (LCA) was conducted with 2,268 US emerging adults based on sedentary behavior, moderate-to-vigorous physical activity, diet, sleep, alcohol drinking, and cigarette smoking. The associations of lifestyle groups with overweight and depression were examined by logistic regression and were further stratified by employment status. Results: The LCA results favored a four-class solution: "unhealthy but non-substance use" (59%), "healthy but sleepless and drinking" (12%), "unhealthy lifestyle" (15%), and "healthy but sedentary" group (14%). Compared to the "unhealthy lifestyle" group, participants in the "unhealthy but non-substance use" (coef. = -1.44, SE = 0.27; OR = 0.40, 95% CI [0.26, 0.61]), "healthy but sleepless and drinking" (coef. = -1.49, SE = 0.35; OR = 0.38, 95% CI [0.20, 0.72]), and "healthy but sedentary" (coef. = -1.97, SE = 0.34; OR = 0.29, 95% CI [0.14, 0.57]) groups had lower depression severity and reported fewer depressive symptoms. Moreover, lifestyle groups and health outcomes showed different relationships among employed and unemployed participants. Conclusion: This study found that the combinations of lifestyle behaviors had synergistic effects on mental health, and such effects differed by employment status.

Associations of parental attitudes and health behaviors with children's screen time over four years.

BACKGROUND: Parents are significantly important in shaping the screen use of children within a family system. This study aimed to examine the associations of Chinese children's screen time (ST) over four years with parents' attitudes toward their own screen use and physical activities (PA) and health behaviors including their ST, PA, cigarette smoking, and alcohol drinking. METHODS: The current study utilized data from two waves (2011 and 2015) of the China Health and Nutrition Survey (CHNS), including 1,941 mother-father-child triads in 2011 and 2,707 mother-father-child triads in 2015 (with children aged 0-17-years-old). The ST of children and the parental attitudes and health behaviors were measured via self-report or proxy-report (for children under 6 years old) questionnaires. Pool-OLS regression models were used to assess the associations of parental attitudes and health behaviors with the ST of children. Moderation models were built to assess whether these associations depended on the gender, age, and family income of children, as well as whether paternal and maternal influences were moderated by the other parent. A multilevel cross-lagged panel model (CLPM) was used to assess parental influences on children's ST over four years. RESULTS: Paternal ST (ß = 0.09, p < 0.001), maternal ST (ß = 0.10, p < 0.001), and paternal alcohol drinking (ß = 0.30, p < 0.05) were positively associated with children's ST. In addition, maternal smoking had a positive association with girls' ST (ß = 0.53, p < 0.05). Moreover, the association between maternal ST and children's ST was observed to decline as family income increased (ß = -0.03, p < 0.001). Paternal ST had a larger positive association with children's ST when the ST of mothers exceeded 14 h/week (ß = 0.06, p < 0.05). Furthermore, lagged associations were found between paternal attitudes toward PA (ß = -1.63, p < 0.05) or maternal cigarette smoking (ß = 1.46, p < 0.05) and children's ST measured four years later. CONCLUSION: Children establish a healthy lifestyle within the family system. From the perspective of the healthy family climate, the current study suggests that future programs for reducing children's ST should be built through an integrative approach with special attention to parental attitudes and health behaviors.

Effects of a Psychosocial Intervention on the Subjective Experiences of Children Living with Atopic Dermatitis: A Qualitative Study in Hong Kong.

Nonpharmaceutical interventions are important for addressing the psychosocial needs of children living with atopic dermatitis (AD). The current study aimed to investigate the effects of an integrative body-mind-spirit (IBMS) intervention on the subjective experiences of affected children and explore the mechanisms underlying the effects. Using a drawing-based, qualitative approach, the current study conducted two rounds of interviews with 13 children (aged 8-12 years) diagnosed with moderate or severe AD before and after they attended the IBMS intervention. Data were analyzed by using the thematic analysis method. The IBMS intervention worked by changing participants' perceptions at the cognitive level, improving their coping strategies at the behavioral level, and constructing their social support network at the environmental level. Cognitive, behavioral, and environmental factors might mediate the relationships between the IBMS intervention and participants' psychological and physical outcomes. This study highlighted the wider inclusion of child-centered qualitative research in the evaluation of the effects of psychosocial interventions designed for children.

A qualitative synthesis of drawing-based research on the illness-related experiences of children living with physical health problems.

The strengths of drawing-based approaches for encouraging children's participation in health research and facilitating communication with them have been increasingly acknowledged in the medical literature. However, there is a lack of methodological discussion on drawing-based approaches suitable for researching children living with physical health problems. The present study systematically reviewed qualitative research using drawing-based approaches on the experiences of children living with physical health problems and summarised how the approaches were used as well. We identified 54 studies from five databases. The characteristics of qualitative methods and drawing-based approaches were analysed. To obtain an overall understanding of the illness-related experiences of these children, qualitative data generated from the included studies were synthesised using the thematic synthesis approach. This systematic review highlights the appropriateness and accuracy of the use of drawings-based approaches in health research with children on their illness-related experiences, fostering inclusive participation and engagement of young generations.

PELO facilitates PLK1-induced the ubiquitination and degradation of Smad4 and promotes the progression of prostate cancer.

PLK1 and Smad4 are two important factors in prostate cancer initiation and progression. They have been reported to play the opposite role in Pten-deleted mice, one is an oncogene, the other is a tumor suppressor. Moreover, they could reversely regulate the PI3K/AKT/mTOR pathway and the activation of MYC. However, the connections between PLK1 and Smad4 have never been studied. Here, we showed that PLK1 could interact with Smad4 and promote the ubiquitination and degradation of Smad4 in PCa cells. PLK1 and PELO could bind to different domains of Smad4 and formed a protein complex. PELO facilitated the degradation of Smad4 through cooperating with PLK1, thereby resulting in proliferation and metastasis of prostate cancer cell. Changes in protein levels of Smad4 led to the alteration of biological function that caused by PLK1 in prostate cancer cells. Further studies showed that PELO upregulation was positively associated with high grade PCa and knockdown of PELO expression significantly decreased PCa cell proliferation and metastasis in vitro and vivo. PELO knockdown in PCa cells could enhance the tumor suppressive role of PLK1 inhibitor. In addition, blocking the interaction between PELO and Smad4 by using specific peptide could effectively inhibit PCa cell metastasis ability in vitro and vivo. Overall, these findings identified a novel regulatory relationship among PLK1, Smad4 and PELO, and provided a potential therapeutic strategy for advanced PCa therapy by co-targeting PLK1 and PELO.

Self-stigma Among Children Living with Atopic Dermatitis in Hong Kong: a Qualitative Study.

BACKGROUND: Stigma has been recently identified as a crucial factor associated with the psychosocial burden of those who have chronic skin diseases. The self-stigma experiences of children living with atopic dermatitis (AD) have yet to be fully investigated, and questions of how these children respond to public stigma and how AD symptoms further affect their self-stigma experiences remain unresolved. The current qualitative study aimed to (1) describe the main manifestations of self-stigma in children living with AD; (2) investigate factors that might influence their self-stigma experiences; and (3) explore the potential mechanisms underlying the impacts of AD on their psychosocial well-being from the self-stigma perspective. METHODS: We performed a secondary analysis of the qualitative literal transcription data which were collected earlier by using the participatory, drawing-based qualitative interviews with 17 children aged 8-12 who were diagnosed with severe or moderate AD. RESULTS: The qualitative findings indicated that the visible and invisible symptoms of AD and its management exerted unique influences on self-stigma in children living with AD, which manifested in cognitive, affective, and behavioral aspects and ultimately affected their psychosocial well-being. CONCLUSIONS: Findings of this study allowed us to advocate for eliminating public stigma of people with skin diseases and propose recommendations for helping children living with AD relieve their self-stigma.

Associations Between Parental Employment and Children's Screen Time: A Longitudinal Study of China Health and Nutrition Survey.

Objectives: Parents are often torn between their parenting roles in the family and working roles at the workplace. This study focused on the associations of parental employment with children's screen time (ST) on weekdays, weekends, and during the entire week. Methods: Unbalanced panel data including 2,977 children (aged 0-17 years) from five waves of the China Health and Nutrition Survey data from 2004 to 2015 were utilized. Two-way fixed effects models were fitted to examine the associations of parental employment status, working hours, and overwork with children's ST. Results: Compared to unemployment status, maternal formal employment positively predicted children's ST on both weekdays and weekends, while maternal informal employment was associated with increased children's ST on weekends. The more hours they worked, the more time their children spent using screens. Neither employment status nor the overwork of fathers was significant. Conclusion: Parental employment, especially maternal employment, was linked with the ST of children. More childcare-friendly labor policies are needed to promote healthy lifestyles among the next generation.

The Counterintuitive Relationship between Telomerase Activity and Childhood Emotional Abuse: Culture and Complexity.

BACKGROUND: A burgeoning literature has found relationships between telomere length, telomerase activity, and human health and longevity. Although some research links a history of childhood adversity with shortened telomere length, our review found no prior research on the relationship between child maltreatment history and telomerase activity in adulthood. We hypothesized a negative relationship between child maltreatment and telomerase activity and hypothesized that the association would be moderated by sex. METHODS: These relationships were tested on a sample of 262 Hong Kong Chinese adults (200 females versus 62 males) with mild to moderate depression. RESULTS: Counterintuitively, emotional abuse was positively associated with telomerase activity, while other maltreatment types were non-significant. The positive relationship between emotional abuse and telomerase activity was significantly moderated by the sex of the participant. CONCLUSIONS: We advance two possible explanations for this finding (1) a culturally informed resilience explanation and (2) a homeostatic complexity explanation. The two explanations are not mutually exclusive. This trial is registered under Hong Kong Clinical Trial Register number HKCTR-1929. SIGNIFICANCE STATEMENT: Emotional abuse was significantly positively associated with telomerase activity. There are at least two non-mutually exclusive explanations for the findings. Simply put, either (1) in the cultural context of Hong Kong emotional abuse was not a risk factor, and/or (2) the conceptualization of telomerase activity as a straightforward indicator of longevity is overly simplistic. The first story we might term a "resilience explanation" while the second we might call a "homeostatic complexity" story.

Trust as a mediator in the relationship between childhood sexual abuse and IL-6 level in adulthood.

Childhood sexual abuse (CSA) has been shown to predict the coupling of depression and inflammation in adulthood. Trust within intimate relationships, a core element in marital relations, has been shown to predict positive physical and mental health outcomes, but the mediating role of trust in partners in the association between CSA and inflammation in adulthood requires further study. The present study aimed to examine the impact of CSA on inflammatory biomarkers (IL-6 and IL-1ß) in adults with depression and the mediating role of trust. A cross-sectional survey data set of adults presenting with mood and sleep disturbance was used in the analysis. CSA demonstrated a significant negative correlation with IL-6 level (r = -0.28, p<0. 01) in adults with clinically significant depression, while trust showed a significant positive correlation with IL-6 level (r = 0.36, p < .01). Sobel test and bootstrapping revealed a significant mediating role for trust between CSA and IL-6 level. CSA and trust in partners were revealed to have significant associations with IL-6 level in adulthood. Counterintuitively, the directions of association were not those expected. Trust played a mediating role between CSA and adulthood levels of IL-6. Plausible explanations for these counterintuitive findings are discussed.

The wounded self-lonely in a crowd: A qualitative study of the voices of children living with atopic dermatitis in Hong Kong.

Atopic dermatitis (AD) imposes significant physical and psychosocial burdens on affected children. However, little has been done to learn from the subjective experiences, perspectives and emotions of children living with AD. Their voices are not heard in healthcare settings. This study aims to share these children's voices and provide a deep understanding of the subjective experiences of children living with AD. We conducted qualitative research by conducting semi-structured interviews and analysing the drawings of 17 children in Hong Kong aged between 8 and 12 years who were diagnosed with AD. Using a phenomenological approach, we transcribed, coded and described the interviews. We found that for the children in this study, living with AD meant contending with an accumulation of challenges and crises. At the individual level, the essential experience of living with AD manifested a vicious cycle of skin and mental issues. At the family level, conflicts between children and parents concerning AD management coexisted with parental support. The children commonly experienced bullying and isolation in school and discrimination and stigmatisation in their neighbourhood, thereby making living with AD a traumatic experience. The synergy between individual and environmental factors contributed to shaping an incapable and wounded "self" living with AD. Based on our findings, we propose a child-centred biopsychosocial framework for understanding the living experiences of children with AD. This study suggests different practice strategies for healthcare professionals working with the individual challenges experienced by children living with AD and the challenges these children experience in their family, school, and neighbourhood. The needs of these children should be addressed through an integrated, holistic approach for improving their long-term health outcomes.

Risk of Mental Disorders in Children and Adolescents With Atopic Dermatitis: A Systematic Review and Meta-Analysis.

Assessing the psychological effects on children and adolescents of suffering atopic dermatitis (AD) is essential, when planning successful management. This study aimed to systematically review the literature regarding risk of mental disorders in children and adolescents with, or without, AD; and to explore confounders. We identified potentially relevant studies from EMBASE, MEDLINE, PsycINFO, ERIC, the British Nursing Index, the Family and Society Studies Worldwide, the Social Work Abstracts, and the Sociological Abstracts from inception to Sep 30, 2018. Investigators independently screened titles and abstracts, and then full-texts. Investigators independently extracted data from included studies. Meta-analyses using random-effects models were performed, reporting odds ratios (ORs; 95% CIs). Thirty-seven studies (n = 2,068,911 children/ adolescents) were included. Meta-analysis of 35 studies found that children and adolescents with AD had significantly higher risk of total mental disorders than those without AD (OR = 1.652; 95% CI, 1.463-1.864). There was no significant difference in risks for ADHD (OR = 1.563; 95% CI, 1.382-1.769); sleep disorders (OR = 2.100; 95% CI, 1.322-3.336); anxiety (OR = 1.339; 95% CI, 1.062-1.687); depression (OR = 1.402 95% CI, 1.256-1.565); conduct disorder (OR = 1.494 95% CI, 1.230-1.815); or ASD (OR = 2.574; 95% CI, 1.469-4.510; Q b = 8.344, p = 0.138). Race/ethnicity of child, target of comparison, type of studies, representativeness of the sample, measures of AD and mental disorders were significant moderators for total mental disorders. Integrated, holistic, multidisciplinary management of pediatric AD is significantly important, which emphasizes the well-being of the whole person.

Psychosocial Effects of Parent-Child Book Reading Interventions: A Meta-analysis.

CONTEXT: Parent-child book reading (PCBR) is effective at improving young children's language, literacy, brain, and cognitive development. The psychosocial effects of PCBR interventions are unclear. OBJECTIVE: To systematically review and synthesize the effects of PCBR interventions on psychosocial functioning of children and parents. DATA SOURCES: We searched ERIC, PsycINFO, Medline, Embase, PubMed, Applied Social Sciences Index and Abstracts, Social Services Abstracts, Sociological Abstracts, Family and Society Studies Worldwide, and Social Work Abstracts. We hand searched references of previous literature reviews. STUDY SELECTION: Randomized controlled trials. DATA EXTRACTION: By using a standardized coding scheme, data were extracted regarding sample, intervention, and study characteristics. RESULTS: We included 19 interventions (3264 families). PCBR interventions improved the psychosocial functioning of children and parents compared with controls (standardized mean difference: 0.185; 95% confidence interval: 0.077 to 0.293). The assumption of homogeneity was rejected (Q = 40.010; P < .01). Two moderator variables contributed to between-group variance: method of data collection (observation less than interview; Qb = 7.497; P < .01) and rater (reported by others less than self-reported; Qb = 21.368; P < .01). There was no significant difference between effects of PCBR interventions on psychosocial outcomes of parents or children (Qb = 0.376; P = .540). LIMITATIONS: The ratio of moderating variables to the included studies limited interpretation of the findings. CONCLUSIONS: PCBR interventions are positively and significantly beneficial to the psychosocial functioning of both children and parents.

What prevents Chinese parents from reporting possible cases of child sexual abuse to authority? A holistic-interactionistic approach.

The reporting of suspected CSA cases to authorities in a timely manner is important in preventing continued abuse and protecting abused children at early ages. The current study seeks to explore parents' intentions of reporting their own children's CSA experiences to authorities as well as their reporting willingness when they become aware of possible CSA cases happening to children in other families. Two rounds of semi-structured interviews were conducted among a sample of 26 parents in Beijing; these parents were purposefully selected so as to be diverse in terms of gender, age, and socioeconomic status. The data were analyzed thematically. The findings showed that the reporting of suspected CSA to authorities was a choice made by only a few Chinese parents; it was often even a last resort. By using a holistic-interactionistic approach, the interaction between Chinese parents' intentions of reporting CSA and the Chinese socio-cultural context was analyzed as a dynamic and continuously ongoing process. The impacts of the definition and perceptions of CSA on reporting, the balance of children's rights and parents' power, and the double effect of informal social control are discussed. The implications, both locally and globally, are also discussed.