Associations between social loneliness trajectories and chronotype among adolescents.

Late chronotype during adolescence is a critical risk factor for poor physical and mental health among adolescents. While social loneliness is confirmed to negatively influence sleep behaviors, the long-term effect of social loneliness on chronotype remains unknown. This study aims to investigate whether social loneliness trajectories from middle childhood to adolescence are associated with chronotype in late adolescence and examine the potential sex differences in these associations. Data were obtained from 2398 adolescents who participated in the Child and Adolescent Behaviors in Long-Term Evolution project. Chronotype was calculated as the midpoint of sleep on free days adjusted for sleep debt. Group-based trajectory modeling and multiple linear regression were employed to establish social loneliness trajectories and determine their associations with chronotype. Social loneliness trajectories were significantly associated with chronotype and varied by sex. Specifically, boys following a high-decreasing trajectory had earlier chronotype during late adolescence than did those following a low-decreasing trajectory (B = - 0.07; p < 0.05). By contrast, girls following a low-to-moderate-increasing trajectory exhibited later chronotype than did those following a low-stable trajectory (B = 0.07; p < 0.01). Social loneliness trajectories, especially those displaying significant fluctuations over time, are critical indicators influencing chronotype among adolescents. Furthermore, these trajectories and their associations with chronotype display sex differences. These findings highlight the need for early interventions for psychological factors such as social loneliness to ensure that the late chronotype can be prevented. In addition, sex variations must be considered.

Associations between social jetlag trajectories and body mass index among young adults.

STUDY OBJECTIVES: This study employed longitudinal data collected repeatedly from individuals over the course of several years to examine the trajectories of social jetlag from ages 11 to 22 years and their associations with subsequent body mass index (BMI). Potential sex differences were also investigated. METHODS: Data were obtained from two longitudinal studies conducted in Taiwan (N = 4287). Social jetlag was defined as ≥ 2 hours of absolute difference in sleep midpoint between weekdays and weekends. BMI was calculated using weight (kg)/height(m)2 and categorized as underweight (<18 kg/m2), normal weight (18 kg/m2 ≤ BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 27 kg/m2), and obese (≥27 kg/m2). Group-based trajectory modeling and multinomial logistic regression were applied to investigate study objectives. RESULTS: Four distinct trajectories of social jetlag throughout the adolescent years were identified, with corresponding proportions as follows: low-stable (42%), moderate-decreasing (19%), low-increasing (22%), and chronic (17%) trajectories. Among males, the risk of being underweight (aOR, 1.96; 95% CI: 1.35 to 2.84) or obese (aOR, 1.40; 95% CI: 1.02 to 1.92) was higher in individuals with a low-increasing trajectory than in those with a low-stable trajectory. Among females, those with a low-increasing (aOR, 1.61; 95% CI: 1.02 to 2.54) or chronic (aOR, 2.04; 95% CI: 1.27 to 3.25) trajectory were at a higher risk of being obese relative to those with a low-stable trajectory. CONCLUSIONS: Addressing the development of increasing or chronic social jetlag during adolescence can help prevent abnormal BMI in young adulthood. Practitioners should consider sex differences in treatment or consultation.

The effect of childhood depression trajectories on sugar-sweetened beverage habit trajectories in adolescence: Exploring sleep problems as a mediator.

Although depression has been linked to the habit of consuming sugar-sweetened beverages (SSBs), little is known about their long-term relationships and the mediating role of sleep problems. This study examines the associations between childhood depressive symptoms trajectories and adolescent SSB-habit trajectories and whether these associations were mediated by sleep problems. Data came from 1560 adolescents participating in a longitudinal study across grades 1 through 12 in northern Taiwan. Group-based trajectory modeling was used to identify development of childhood depressive symptoms and an SSB habit in adolescence. Multinomial logistic regression was conducted to examine the influence of childhood depressive symptoms and adolescent SSB habit. Mediation analysis was conducted to test whether sleep problems mediated the associations examined. Four distinct trajectories of childhood depressive symptoms were identified: low-stable (30.79%), moderate-stable (42.32%), increasing (12.29%), and high-stable (11.60%). Three distinct trajectories of SSB habit in adolescence were identified: low-stable (44.32%), increasing (15.02%), and high-stable (40.65%). Children who had moderate-stable (aOR = 1.35; CI: 1.04-1.77), high-stable (aOR = 2.01; CI: 1.28-3.15), or increasing (aOR = 1.97; CI: 1.26-3.06) trajectories of depressive symptoms relative to those in the low-stable group were significantly more likely to belong to the high-stable trajectory of SSBs than to the low-stable SSBs group. The Z-mediation test showed that sleep problems significantly mediated the associations between trajectories of childhood depressive symptoms and trajectories of SSBs during adolescence (all p < 0.05). Childhood depressive symptoms conferred risks for adolescent SSB habits; and the effects were seen, in part, through increasing sleep problems.

Associations of timing, level, and pattern of secondhand smoke exposure with early alcohol initiation: A cohort study.

BACKGROUND: Few studies explored the longitudinal link between early-life secondhand smoke (SHS) exposure and later alcohol initiation despite its risk for child behavioral difficulties. We examined the associations of the timing, level, and pattern of SHS exposure from pregnancy to childhood with early alcohol initiation and evaluated the sex differences in these associations. METHODS: Data were from 16,440 participants of the Taiwan Birth Cohort Study conducted when the children were aged 6 months, 18 months, 3 years, 5.5 years, 8 years, and 12 years. Group-based trajectory modeling was applied to identified patterns of SHS exposure. A series of multiple logistic regression were conducted to examine study hypotheses. RESULTS: Exposure to prenatal SHS was associated with an increased risk of early alcohol initiation (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.06, 1.30). Compared with the adolescents with a persistent-low-exposure trajectory, those who exhibited prenatal-high-decreasing (aOR = 1.18, 95% CI = 1.04, 1.35) or persistent-high-exposure (aOR = 1.27, 95% CI = 1.12, 1.45) patterns exhibited increased risks of early alcohol initiation. Those with higher cumulative levels of SHS exposure also exhibited an increased risk of early alcohol initiation (aOR = 1.03, 95% CI = 1.01, 1.04). Sex differences were also observed. CONCLUSIONS: Varying timing, levels, and longitudinal patterns of SHS exposure during early life had differential effects on early alcohol initiation, with the effects differing by sex. Targeting SHS exposure while considering the nature of exposure and sex differences could help prevent and curb alcohol use in adolescents.

Family environment characteristics and sleep duration in children: Maternal mental health as a mediator.

BACKGROUND: Family environment is a key factor affecting children's health. However, little is known about whether and how the family environment affects sleep duration in children. This study investigated the effects of both physical and social characteristics of the family environment on sleep duration in children and determined whether these associations were mediated by maternal mental health. METHODS: Data were obtained from the Taiwan Birth Cohort Study. A total of 19,400 children who completed 6-month, 18-month, 3-year, 5.5-year, and 8-year surveys were analyzed. The physical family environment characteristics were household crowding and housing quality. Family functioning was used as an indicator of family social environment. Multiple linear regression and path analysis were performed to test the hypotheses. RESULTS: The children living in crowded households had shorter sleep durations (ß = -0.03, p < .001). Superior housing quality and family functioning were associated with longer sleep durations (ß = 0.04 and 0.02, respectively, ps < .01). The effects of housing quality and family functioning on sleep duration were mediated by maternal mental health. CONCLUSIONS: Both physical and social characteristics of the family environment are critical to sleep duration in children. The effects of family environment characteristics on sleep duration in children are in part mediated by maternal mental health. Interventions to improve sleep during childhood by targeting the family environment may be more effective when maternal mental health is considered.

Childhood Handwashing Habit Formation and Later COVID-19 Preventive Practices: A Cohort Study.

OBJECTIVE: This study identified developmental patterns of handwashing habit formation during childhood and examined their associations with later COVID-19 preventive practices. METHODS: We used data from the Taiwan Birth Cohort Study, which included 11,254 adolescents with complete data on childhood handwashing behavior and age-15 COVID-19 survey items. Bias-adjusted 3-step latent class analysis was used to test study hypotheses. RESULTS: The rates of handwashing and mask-wearing during the pandemic were 63.8% and 93.8%, respectively. Five distinct patterns of handwashing habit formation were identified: early formation (14.89%), delayed formation (17.73%), gradual formation (42.98%), inconsistent formation (9.78%), and nonformation (14.62%). Compared with adolescents with an early formation pattern of handwashing habits, those with other patterns exhibited lower odds ratios (ORs) of handwashing during COVID-19; these ORs were 0.67 (95% confidence interval [CI], 0.49-0.85), 0.60 (95% CI, 0.44-0.77), 0.29 (95% CI, 0.08-0.49), and 0.21 (95% CI, 0.01-0.40) for those with delayed formation, gradual formation, inconsistent formation, and nonformation patterns, respectively. Moreover, relative to that of adolescents with the early formation pattern, mask-wearing was less common among adolescents with gradual formation, inconsistent formation, and nonformation patterns, with ORs of 0.54 (95% CI, 0.16-0.92), 0.50 (95% CI, 0.03-0.96), and 0.26 (95% CI, 0.00-0.65), respectively. CONCLUSIONS: The early formation of hygienic habits is associated with higher adherence to pandemic preventive practices among adolescents. Our findings suggest that interventions to promote hygienic behaviors can start as early as age 3 through the introduction of healthy habits such as handwashing.

Patterns and Correlates of Changes in Emotional and Behavioral Problems Among Children with Congenital Heart Disease.

OBJECTIVE: The objective of this study was to examine patterns of changes in emotional and behavioral problems among children with congenital heart disease (CHD) and investigate associated factors in different domains. METHOD: The study sample comprised 327 pairs of children with CHD (aged 1.5-12 yrs) and their parents who participated in 2 waves of a survey in Taiwan from 2017 to 2019. The Child Behavior Checklist was used to evaluate the children's emotional and behavioral problems during both waves. The scores were later used to determine the patterns of changes in emotional and behavioral problems. Multinomial logistic regression was then applied to examine factors associated with varied patterns of changes in emotional and behavioral problems. RESULTS: Five patterns of changes in emotional and behavioral problems were identified: "persistent normal," "initial problematic," "worsening," "persistent problematic," and "subclinical." Among the factors examined, parenting stress was consistently associated with different patterns of change in emotional and behavioral problems. Specifically, children with parents who had higher levels of parenting stress were more likely to belong to the "initial problematic," "persistent problematic," or "subclinical" groups than to the "persistent normal" group. Other significant factors included sex, number of surgeries, and perceived health of parents. CONCLUSION: This study highlights the potential role of parenting stress in changes in emotional and behavioral problems. Accordingly, intervention programs aimed at relieving parenting stress may help reduce the development and worsening of emotional and behavioral problems among children with CHD.

Resilience buffers the effects of sleep problems on the trajectory of suicidal ideation from adolescence through young adulthood.

OBJECTIVES: To examine both the between-person and within-person effects of sleep problems on the trajectory of suicidal ideation from ages 14 to 22 and investigate whether resilience moderates the effects. Age and sex differences were explored in the main and interaction effects of sleep problems and resilience on suicidal ideation. METHODS: The study sample included 2491 adolescents (1260 males and 1231 females) who participated in a prospective study spanning 2009 through 2016 in northern Taiwan. Sex-stratified multilevel models were used to examine the between-person and within-person effects of sleep problems and the moderating effects of resilience on the trajectory of suicidal ideation in males and females. RESULTS: Across adolescents, higher levels of sleep problems contributed to an elevated risk of suicidal ideation for both sexes. Within individuals, a higher risk of suicidal ideation was observed when an adolescent's sleep problems exceeded their typical levels. The within-person effects of sleep problems were further determined to vary by age in males, with the effects gradually decreasing throughout late adolescence but increasing again in young adulthood. The buffering effects of resilience were only observed in females. The relationships between the within-person effects of sleep problems and suicidal ideation were only significant in female adolescents with low levels of resilience. CONCLUSIONS: Our findings extend the research by demonstrating both the between-person and within-person association between sleep problems and suicidal ideation. We further revealed age and sex differences in the within-person effects of sleep problems and the buffering effects of resilience. Prevention and intervention programs that target sleep problems could be tailored based on individuals' age, sex, and levels of resilience to prevent suicidal ideation.

Age Differences in the Mediating Effects of Parenting Stress on the Relationship Between Cyanotic Congenital Heart Disease and Externalizing Problems in Children and Adolescents.

BACKGROUND: Cyanotic congenital heart disease (CHD) has detrimental effects on behavioral function in children and adolescents. However, few study authors have examined the underlying mechanisms of these effects. OBJECTIVE: The aims of this study were to investigate the mediating effects of parenting stress in the association between cyanotic CHD and externalizing problems and to explore whether age moderated these mediating effects. METHODS: A total of 697 children and adolescents (aged 2-17 years) with CHD (252 with cyanotic CHD and 445 with acyanotic CHD) in Taiwan were enrolled. The Child Behavior Checklist and the Parenting Stress Index were used to assess externalizing problems and parenting stress, respectively. Mediation analysis was performed to determine the mediating effects of parenting stress in the association between cyanotic CHD and externalizing problems. A moderated mediation model was used to investigate the moderating effect of age on the observed mediating effects. RESULTS: Parenting stress significantly mediated the relationship between cyanotic CHD and externalizing problems (unstandardized coefficient B = 0.98; 95% bootstrap confidence interval, 0.23-1.78). Children's age further moderated the mediating effects, with greater effects in older children. Age also moderated the association between cyanotic CHD and parenting stress, such that the effects were only significant in children older than 5.7 years. CONCLUSIONS: Our study revealed that age affected the mediating effects of parenting stress in the relationship between cyanotic CHD and externalizing problems. Efforts to reduce externalizing problems in children and adolescents with cyanotic CHD by targeting parenting stress may be more effective when age differences are considered.

Increased prevalence of inattention-related symptoms in a large cohort of patients with congenital heart disease.

The objective of this study is to assess the prevalence and risk factors for attention-deficit hyperactivity disorder (ADHD) in a large cohort of patients with congenital heart disease (CHD). Patients (n = 695) with CHD who were aged 6-15 years and visited the outpatient clinics in our hospital from June 2015 to May 2017 were enrolled. Their medical records were collected, and the Chinese version of the Swanson, Nolan, and Pelham rating scale (SNAP-IVc) and a questionnaire about neuropsychiatric care-seeking behavior were completed by parents and counselors. Of the 695 patients, the overall prevalence of ADHD was 12.4%, including 3.2% for the combined subtype, 6.8% for the inattentive-predominant subtype, and 2.4% for the hyperactivity/impulsive-predominant subtype. Only the inattention-predominant subtype was significantly more prevalent than in the general population. The prevalence of the inattention-predominant subtype was highest in the patients with cyanotic CHD, high severity index, and in those who had received surgery or cardiopulmonary bypass. Multivariate regression analysis indicated that the risk factors for inattention-related symptoms included postoperative seizure and previous cardiopulmonary bypass (odds ratio: 3.22 and 3.82; P = 0.027 and < 0.001, respectively). Only 58.7% of the patients with probable ADHD ever sought neuropsychiatric care, and only 27% regularly attended neuropsychiatric clinics. The inattention-predominant subtype of ADHD was more prevalent in our CHD patients, especially in those with cyanotic CHD, higher disease severity index, and in those who had undergone a surgical intervention. The percentage of patients receiving regular neuropsychiatric clinic follow-up was low.

Sex differences in the trajectories of and factors related to extracurricular sport participation and exercise: a cohort study spanning 13 years.

BACKGROUND: Extracurricular sport participation and exercise (ESPE) refers to regular exercise/sport participation in addition to the physical education in school among a school-aged population. Rather than general physical activity, ESPE is typically deliberately initiated and presents an efficient target for interventions. However, compared to physical activity, relatively few studies have investigated sex differences in the development of and factors associated with ESPE using a person-centered approach. This study aimed to examine the latent trajectories of ESPE from childhood to emerging adulthood across sexes, and to identify the associated sex-specific individual (i.e., body mass index, body dissatisfaction, stress, and screen behavior) and parental (i.e., parental exercise and parental screen behavior) factors. METHODS: This study used data from part of the Child and Adolescent Behavior in Long-term Evolution (CABLE) project, which comprised 2072 fourth graders (aged 9 years) in Northern Taiwan followed annually from 2001 to 2013 (13 waves). Repeated-measures latent class analysis was used to identify the trajectories of ESPE for males and females, respectively. Multinomial logistic regression was further used to identify sex-specific factors related to ESPE. RESULTS: Four trajectories of ESPE were identified for males and females. For males, these trajectories were Rarely-to-Never (20%), Often-to-Rarely (32%), Always-to-Never (21%), and Always (27%). For females, these trajectories were Rarely-to-Never (34%), Rarely (23%), Always-to-Rarely (33%), and Always (10%). We observed that the developmental patterns of ESPE varied by sex such that there was an earlier decline in the trajectories of ESPE in females than in males and that, compared with males, fewer females maintained exercise habits in young adulthood. Furthermore, we found several sex-specific factors related to ESPE, namely, stress, BMI, and parental exercise. Body dissatisfaction and individual screen behavior were associated with trajectories of ESPE for both sexes. CONCLUSIONS: We found distinct trajectories of ESPE from childhood to emerging adulthood for both sexes. The trajectories of ESPE for males and females, however, differ in terms of patterns and associated factors. Our findings suggest that efforts to increase ESPE should be initiated early, and may be made more effective by considering sex differences.

Association between socioeconomic status and the trajectory of insufficient sleep: Maternal emotional support as a moderator.

OBJECTIVE: To examine the association between SES and the trajectory of insufficient sleep among children aged 0.5-8 years and to investigate whether these associations vary by age. The moderating role of maternal emotional support was further explored. METHOD: Data were obtained from 20,874 children participating in the Taiwan Birth Cohort Study. Multilevel models were conducted to explore the association between SES and the trajectory of insufficient sleep. The moderating role of maternal emotional support was examined by testing the significance of the interaction between SES and emotional support. RESULTS: Low parental education and poverty contributed to increased risk of insufficient sleep, and the observed associations varied by age. Specifically, the influences of parental education increased with age, and the effects of poverty were significant only among preschoolaged children. Poverty dynamics were also significantly associated with an elevated risk of insufficient sleep, but the association was mitigated by maternal emotional support. CONCLUSIONS: Children with low SES exhibited increased risk of insufficient sleep. Furthermore, the relationship between SES and insufficient sleep differed by age, with varying patterns emerging for different SES indicators. However, the negative influences of low SES could be mitigated by increasing maternal emotional support. Interventions that reduce SES disparity or enhance maternal emotional support could decrease the risk of insufficient sleep among children living with an SES disadvantage.

The mediating effect of dietary patterns on the association between mother's education level and the physical aggression of five-year-old children: a population-based cohort study.

BACKGROUND: Relatively few studies have investigated the effects of diet on behavior problems among preschoolers, particularly, physical aggression. In addition, children raised by poorly educated mothers usually have a higher probability of developing negative outcomes. Additionally, highly educated mothers have a higher probability of providing more healthy foods for their children. Thus, mothers providing healthy foods might mitigate children's behavior problems. The study aims to examine whether preschoolers' dietary pattern, as a manipulable factor, mediates the association between maternal education level and physical aggression. METHODS: Data came from the Taiwan Birth Cohort Study (TBCS), a nationally representative population-based cohort study, which included 18,513 five-year-old Taiwanese children. Mothers and primary caregivers reported the information on preschoolers' physical aggression and food consumption at age 5 and maternal education level at age 6 months. Two dietary patterns, namely a healthy diet and a high-fat-sugar-salt (HFSS) diet, were retrieved by exploratory factor analysis. Mediation hypotheses were tested by a series of multiple regression models conducted using the PROCESS macro of SAS 9.4. All models were adjusted for children's sex, parental marital status, household income, mental distress at age 5 and children's physical aggression at age 3. RESULTS: Maternal education positively linked to healthy dietary patterns (B = 0.014, p = 0.002) which was negatively associated with preschoolers' physical aggression (B = -0.096, p = 0.013), and it is negatively related to the HFSS dietary pattern (B = -0.042, p = 0.002) which was directly positively associated with preschoolers' physical aggression (B = 0.123, p = 0.008). The association between maternal education and preschoolers' physical aggression was partially mediated by preschoolers' healthy (B = -0.001, p < .001) and HFSS (B = -0.005, p = <.001) dietary patterns, respectively. The R-square of the mediation model is 0.178. CONCLUSIONS: Preschoolers' dietary patterns directly associate with their physical aggression. In addition, mothers with poor education may provide less healthy foods and more unhealthy foods to their children, which may increase the level of physical aggression. The results imply partial mediating effects of dietary patterns between maternal education and physical aggression. It is suggested that a parent-based nutritional education program focusing on healthy meal preparation for poor educated mothers might be beneficial for preschoolers' healthy development.

Disentangling the effects of intergenerational transmission of depression from adolescence to adulthood: the protective role of self-esteem.

This study aimed to disentangle time-stable and time-varying effects of maternal and paternal depression on trajectories of adolescent depression from ages 13 to 23 and examined whether self-esteem moderates the examined associations. Sex differences in the direct effects of parental depression and its interacted effects with self-esteem were further explored. Data were collected from a sample of 2502 adolescents and their parents participating in a panel study spanning from the year 2000 to 2009 in northern Taiwan. Multilevel modeling was conducted to disentangle the time-stable and time-varying effects of parental depression on adolescent depression. The moderating role of self-esteem and the potential sex differences in the transmission process were tested by adding two- and three-way interactions among parental depression, self-esteem, and sex of adolescents in the models. As predicted, significant time-stable intergenerational transmission of depression was found, indicating that adolescents of parents with higher levels of depression were at increased risks for depression. Self-esteem was further found to buffer the negative effects of maternal depression on development of depression in offspring. No sex-specific intergenerational transmission of depression was observed. In sum, both maternal and paternal depression contributed to elevated levels of adolescent depression. The effects of maternal depression, however, may not be uniform, but depend on levels of self-esteem. Intervention and prevention strategies that enhance self-esteem may help participants withstand the negative effects of maternal depression.

Optimal measuring timing of cystatin C for early detection of contrast-induced acute kidney injury: A systematic review and meta-analysis.

OBJECTIVE: The optimal measuring timing of serum/plasma Cystatin C (CysC) for early detection of contrast-induced acute kidney injury (CIAKI) remains un-studied. We elucidated further on this issue. METHODS: We searched PubMed, MEDLINE, and Embase from inception until March 2018 for studies evaluating diagnostic accuracy of CysC for detecting CIAKI in patients exposed to contrast agents during diagnostic examinations or cardiac/peripheral catheterizations. RESULTS: A total of 10 relevant studies, comprising 2554 patients, were included and divided into the <24 -h and 24 -h groups based on CysC measuring timing (i.e., hours after contrast agent exposure). Compared with creatinine, pooled diagnostic odds ratio of CysC for detecting CIAKI of the <24 -h and 24 -h groups was 7.59 (95 % confidence interval [CI]: 1.31-44.08) and 53.81 (95 % CI: 13.57-213.26). Pooled sensitivity of the <24 -h and 24 -h groups was 0.81 and 0.88. Pooled specificity of the <24 -h and 24 -h groups was 0.64 and 0.88, respectively. Area under the hierarchical summary receiver operating characteristic curve of the <24 -h and 24 -h groups was 0.75 and 0.93. CONCLUSIONS: Measuring CysC at 24 h after contrast agent exposure shows higher diagnostic accuracy for early detection of CIAKI than measuring CysC at <24 h after contrast agent exposure.

Parenting stress mediates the association between cyanotic congenital heart disease and internalising problems in children and adolescents.

BACKGROUND: Children and adolescents with cyanotic congenital heart disease have been found to be at an increased risk of internalising problems. The underlying mechanisms, however, remain uncertain. AIMS: To examine the association between cyanotic congenital heart disease and internalising problems and assess whether parenting stress mediates this association. METHOD: The study sample was 699 children and adolescents (aged 2-17 years) with congenital heart disease (253 with cyanotic congenital heart disease and 446 with acyanotic congenital heart disease) in Taiwan. The Child Behavior Checklist and the Parenting Stress Index were used to assess internalising problems and parenting stress, respectively. A series of multiple regression models was conducted using the SPSS PROCESS procedure to test the association between types of congenital heart disease and internalising problems and the mediating role of parenting stress. A bootstrapping approach was applied to determine the significance of mediation. RESULTS: Compared with acyanotic congenital heart disease, cyanotic congenital heart disease was associated with increased levels of internalising problems (B=2.52, P<0.01), and this association was mediated by parenting stress (B=0.97, 95% bias-corrected bootstrap confidence interval 0.24, 1.75). In particular, parents of children with cyanotic congenital heart disease reported significantly more parenting stress compared with parents of children with acyanotic congenital heart disease (B=4.63, P<0.01), which contributed to elevated levels of internalising problems in the offspring (B=0.21, P<0.001). CONCLUSION: Cyanotic congenital heart disease conferred risks for internalising problems in children and adolescents, and this association was mediated by parenting stress. Interventions to decrease internalising problems in children and adolescents with cyanotic congenital heart disease may be more effective by targeting parenting stress.

Pubertal Timing, Parenting Style, and Trajectories of Pornography Use in Adolescence: Peer Pornography Use as the Mediator.

This study examined the effect of pubertal timing, parenting style, and peer behaviors on the trajectories of pornography use among adolescents. Data consisted of 1272 boys and 1210 girls, who completed at least three waves of pornography use questions from 7th to 12th grade (the year 2007 to 2012). Group-based trajectory modeling was applied to identify the trajectories of pornography use. Multinomial logistic regression and the Z-mediation method were conducted to examine the influences of pubertal timing, parenting style, and peer behaviors on the trajectories and the mediating effect. The results showed that early puberty was associated with earlier exposure to pornography and more frequent exposure later. Parental monitoring protected adolescents from pornography use, whereas psychological control increased the chance of more exposure. Peer pornography use mediated the relationship between adolescent pornography use, pubertal timing, and parental style. This mediating effect was stronger among boys versus girls. These findings provide insight into the mechanism of pubertal timing, parental style, and peer influence on the trajectory of pornography use in adolescence.

The effects of family dysfunction trajectories during childhood and early adolescence on sleep quality during late adolescence: Resilience as a mediator.

RATIONALE: Sleep quality has been linked to several behavioral and psychological problems. No longitudinal study has examined the associations and underlying mechanisms between the trajectories of family characteristics and sleep quality in adolescents. OBJECTIVE: This study investigates the effects of heterogeneous trajectories of family dysfunction on sleep quality in adolescents and examines whether resilience mediates these associations. METHOD: Data came from 2280 adolescents participating in a longitudinal study across grades 2 through 11 in northern Taiwan. Group-based trajectory modeling was used to identify discrete developmental patterns of family dysfunction. Multiple linear regression was applied to examine the associations between family dysfunction trajectories and sleep quality. Mediation analysis was conducted to test whether resilience mediates the associations examined. RESULTS: Four distinct trajectories of family dysfunction were identified: low persistent (26%), escalating dysfunction (21%), moderate stable (25%), and high persistent (28%). Compared to adolescents in the low-persistent trajectory, those in the escalating-dysfunction, moderate-stable, and high-persistent trajectories had significant lower levels of sleep quality (B = -0.19, p < .001, B = -0.14, p < .01, and B = -0.13, p < .05, respectively). Resilience significantly mediated the effects of all family dysfunction trajectories (relative to the low-persistent trajectory) on sleep quality (95% bootstrap confidence intervals are -0.06 to -0.02, -0.05 to -0.02, and -0.08 to -0.03 for escalating-dysfunction, moderate-stable, and high-persistent trajectories, respectively). CONCLUSIONS: Family dysfunction conferred risks for poor sleep quality in adolescents and the negative effects, in part, were through decreasing resilience. Interventions to improve sleep quality in adolescents by targeting family function may be more effective when incorporating resilience.

Age and sex differences in the effects of peer victimization on depressive symptoms: Exploring sleep problems as a mediator.

BACKGROUND: Peer victimization contributes to an elevated risk of adolescent depression. Although theoretical evidence has noted that peer victimization may disrupt sleep and subsequently increase levels of depressive symptoms, this pathway has never been tested. This study explores a novel mechanism leading from peer victimization to depressive symptoms through sleep problems and considers whether the direct and indirect pathways vary by age and sex of adolescents. METHODS: Data were from 4072 adolescents (2042 males, 2030 females; age range 14-19 years) residing in northern Taiwan. Mediation analyses were first conducted to understand the mediating role of sleep problems in the association between peer victimization and depressive symptoms for males and females, respectively. Moderated mediation analyses were then applied to test age differences in the direct and indirect pathways from peer victimization to depressive symptoms. RESULTS: Sleep problems mediated the association between peer victimization and depressive symptoms in adolescent females but not in males. Age further moderated the indirect pathway from peer victimization to depressive symptoms through sleep problems, such that the mediating effects of sleep problems increased with age and were only significant in older females. No age differences were observed for the direct effects of peer victimization on depressive symptoms in either males or females. LIMITATIONS: Study was not designed to infer causality and all variables were assessed by self-report measures. CONCLUSIONS: Our analyses revealed age and sex differences in the link from peer victimization to depressive symptoms through sleep problems. Efforts to reduce depressive symptoms in adolescent females who have experienced peer victimization may be made more effective by targeting sleep problems, especially in older female adolescents.