Development and Evaluation of a Web-Based Family-Centered Decision Support Tool About Firearm Storage.

BACKGROUND: Many youth in the USA have access to a loaded and unlocked firearm in their home. Discussions between adult family members have the potential to positively influence firearm storage. PURPOSE: Work with firearm-owning parents to develop and obtain preliminary data about the efficacy of a family-centered decision support tool about firearm storage. METHODS: We adapted the Ottawa Personal Decision Guide for Two to the issue of firearm storage, producing the Family Safety Check-In. Subsequently, we evaluated its acceptability and impact on intentions to make a plan with their partner (or other adult sharing parental duties) about safer firearm storage. Participants were parents/guardians of at least one school-aged child, had firearms in their home, and resided in the USA (n = 402). They completed a web-based pre-test survey, were randomized to the Family Safety Check-In or an American Academy of Pediatrics (AAP) informational resource about firearm storage for families, and then completed a post-test survey. RESULTS: The Family Safety Check-In had higher ratings for acceptability (B = 1.24, 95% CI = 0.58-1.90) and appropriateness (B = 1.46, 95% CI = 0.72-2.19) than the AAP resource. Participants in the Family Safety Check-In condition also had greater intentions to make a plan with their partner about storing firearms more safely (OR = 1.90, 95% CI = 1.26-2.87). CONCLUSIONS: The Family Safety Check-In is a promising direction for harm reduction that warrants further evaluation.

The purpose of this study was to develop and obtain preliminary data about the efficacy of the Family Safety Check-In, a family-centered decision support tool about firearm storage. To develop this family-centered intervention, we adapted the Ottawa Personal Decision Guide for Two to the issue of firearm storage. Subsequently, we evaluated its acceptability and impact on intentions to make a plan with their partner (or other adult sharing parental duties) about safer firearm storage. Participants were parents/guardians of at least one school-aged child, had firearms in their home, and resided in the USA (n = 402). They completed a web-based pre-test survey, were randomized to the Family Safety Check-In or an American Academy of Pediatrics (AAP) informational resource about firearm storage for families, and then completed a post-test survey. The Family Safety Check-In had higher ratings for acceptability and appropriateness than the AAP resource. Participants in the Family Safety Check-In condition also had greater intentions to make a plan with their partner about storing firearms more safely. The Family Safety Check-In is a promising direction for harm reduction that warrants further evaluation.

Improving post-concussion discharge education for families seeking emergency department care: intervention development.

BACKGROUND: Pediatric emergency departments (ED) are where many families receive post-concussion medical care and thus an important context for helping parents build skills to support their child after discharge. OBJECTIVE: Develop a strategy for increasing parent provision of emotional and instrumental support to their child after discharge and conduct a pilot test of this strategy's acceptability. METHODS: In a large pediatric ED in the United States, we partnered with parents (n = 15) and clinicians (n = 15) to understand needs and constraints related to discharge education and to operationalize a strategy to feasibly address these needs. This produced a brief daily text message intervention for parents for 10 days post-discharge. We used a sequential cohort design to assess the acceptability this intervention and its efficacy in changing parenting practices in the 2-weeks post-discharge (n = 98 parents). RESULTS: Parents who received the messaging intervention rated it as highly acceptable and had meaningfully higher scores for emotionally supportive communication with their child in the two weeks post-discharge than parents in the control condition (Cohen's d = 0.65, p = 0.021). CONCLUSIONS: This brief messaging intervention is a promising strategy for enhancing discharge education post-concussion that warrants further evaluation.

Shared Decision-Making About Returning to Sport After Recovery From Pediatric Concussion: Clinician Perspectives.

OBJECTIVE: Describe how sports medicine clinicians support decision making about sport participation after concussion recovery with adolescent patients and their parents. Specific areas of inquiry related to how clinicians framed the decision, what factors they considered in how they approached the decision process, and how they navigated discordance within families. DESIGN: Qualitative study. SETTING: Tertiary care sports medicine clinics at 4 children's hospitals in the United States. PARTICIPANTS: Individual interviews were conducted with 17 clinicians practicing in sports medicine settings. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Semi-structured interviews explored clinician approaches to supporting decision making, with the question guide informed by components of the Ottawa Decision Support Framework. RESULTS: Clinicians routinely incorporated aspects of shared decision making (SDM) into their conversations with families. This included ensuring all parties were informed about risk and aligned behind a shared value of adolescent well-being. Mediation strategies were used to manage discordance between adolescents and their parents, and between parents. These strategies aimed to facilitate a decision that was adolescent centered. When clinicians believed that there was a medical benefit to modifying the adolescent's sport participation practices, or when they did not believe the athlete was psychologically ready to return to the sport in which they were injured, they initiated conversations about alternative activities. In such situations, they used persuasive communication practices to encourage families to strongly consider this option. CONCLUSION: The strengths and strategies used by sports medicine clinicians in this study provide a foundation for guidance or intervention development aimed at supporting SDM after concussion with adolescents and their families.

Physical activity and social interaction assessments in schoolyard settings using the System for Observing Outdoor Play Environments in Neighborhood Schools (SOOPEN).

BACKGROUND: The schoolyard environment provides key opportunities to promote physical activity and socioemotional development for children. Schoolyards can also serve as a community park resource outside of school hours. We aimed to: (i) implement and evaluate reliability of the System for Observing Outdoor Play Environments in Neighborhood Schools (SOOPEN), (ii) assess schoolyard use by children during recess and community members of all ages outside of school hours, and (iii) investigate relationships of schoolyard and children´s group characteristics with physical activity levels and prosocial interactions. METHODS: In this cross-sectional study, we observed student and community visitor behavior using SOOPEN at three urban elementary schoolyards in Tacoma, Washington, USA, prior to renovations intended to expand each facility's use as a community park in neighborhoods with poor park access. We assessed interrater reliability using intraclass correlation coefficients and described current levels of schoolyard use (at the group level), physical activity, and prosocial behavior. Physical activity was assessed on a five-point scale and dichotomized to indicate moderate-to-vigorous physical activity (MVPA). Social interactions were coded as prosocial, antisocial, or neutral. We examined associations of selected schoolyard features and group characteristics with group MVPA and prosocial behavior during recess using modified Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI). RESULTS: We observed a total of 981 activity-defined, informal groups in the schoolyards, and achieved good to excellent interrater reliability using SOOPEN. Community use of the schoolyards during evenings and weekends was limited (n = 56 groups). During 26, 25-50 min recess periods (n = 833 groups), 19% of groups were engaged in MVPA. Schoolyard areas with paved surfaces were associated with more MVPA (PR = 1.52, 95% CI: 1.04, 2.23) compared to field/grass areas; supervised groups were associated with less MVPA than groups not directly supervised by an adult (PR = 0.59, 95% CI: 0.36, 0.96). Schoolyard characteristics were not associated with prosocial behavior. Mixed-gender groups were associated with more MVPA and more prosocial behavior. CONCLUSIONS: Our study using SOOPEN, a reliable new activity observation tool, highlights the multi-dimensional dynamics of physical activity and social interactions in schoolyards, which could be leveraged to promote healthy behaviors during and outside of school hours.

Concussion education for youth athletes using Pre-Game Safety Huddles: a cluster-randomised controlled trial.

OBJECTIVES: Determine whether Pre-Game Safety Huddles, a novel and low-resource approach to concussion education, increase the expected likelihood of concussion reporting for youth athletes. METHODS: A cluster-randomised trial compared Safety Huddles to usual care. Safety Huddles bring together athletes and coaches from both teams before the start of each game for coaches to briefly affirm the importance of speaking up if a concussion is suspected. Participants were athletes from 22 competitive community-based American football and girls and boys soccer teams (ages 9-14), and randomisation into intervention or control occurred at the level of the bracket (group of teams that compete against each other during the regular season). The primary outcome was expected likelihood of reporting concussion symptoms to the coach, measured via validated athlete survey at the beginning and end of the season. RESULTS: Of 343 eligible participants, 339 (99%) completed baseline surveys and 303 (88%) completed surveys at season end. The mean (SD) age was 11.4 (1.1) years, 26% were female soccer athletes, 27% were male soccer athletes and 47% were football athletes. In adjusted analyses accounting for baseline values and clustering by sport and team via random effects, expected likelihood of concussion reporting at the end of the season was significantly higher in the intervention group compared to controls (mean difference=0.49, 95% CI 0.11 to 0.88; Cohen's d=0.35). CONCLUSIONS AND RELEVANCE: Pre-Game Safety Huddles increased the expected likelihood of athletes reporting concussion symptoms. While further study is warranted, sport organisations should consider this approach a promising low-resource option for improving concussion safety in their setting. TRIAL REGISTRATION NUMBER: NCT04099329.

Parent Communication and Decision Making About Firearm Storage.

BACKGROUND: Many youths in the United States have access to an unlocked firearm in their home, and accidental discharge of unlocked firearms is a prevalent cause of pediatric injury and death. Discussions between adult family members have the potential to positively influence firearm storage practices. PURPOSE: In families with two parenting adults, we tested the following hypotheses: (1) firearms will be more likely to be stored locked and unloaded when both parties are involved in the storage decision, and (2) both parties will be more likely to be involved in the storage decision when they have better relationship functioning and less avoidant communication. METHODS: Cross-sectional survey using a stratified random sample of an area probability- and address-based panel. Participants were 749 adults aged 18-64 living in the United States with firearms and children in their households. RESULTS: Overall, 62% of families stored guns locked and unloaded and in 55% both parenting adults were highly involved in storage-related decision making. Families where both parties were highly involved in these decisions had 1.65 times the odds of storing firearms safely (95% CI = 1.21-2.27). Odds of both being highly involved in these decisions were much lower in partnerships with more avoidant communication (OR = 0.16, 95% CI = 0.08-0.32) and higher in partnerships with more relationship satisfaction (OR = 1.08, 95% CI = 1.05-1.12). CONCLUSIONS: Safe storage is most likely when both parenting adults are involved in the storage decision. Further research is needed to determine how to support productive within-family communication and decision making about this issue.

Many youths in the United States have access to an unlocked firearm in their home. Accidental discharge of unlocked firearms is a common cause of youth injury and death. Discussions between adult family members have the potential to move families towards safer firearm storage practices. We surveyed 749 firearm-owning parents in the United States who live with a romantic partner and have at least one child under the age of 18. Nearly two-thirds of families stored all firearms locked and unloaded. In slightly more than half of families, the person responding to the survey and their romantic partner were both highly involved in storage-related decision making. Families where both parties were highly involved in these decisions were more than one and a half times more likely to store firearms locked and unloaded compared to families where both parties were not involved in these decisions. This shared involvement in decision making was more likely in higher quality relationships and in relationships where there was less avoidance of the topic of firearm storage. Learning how to support positive and useful discussions within families about firearm storage is an important direction for future work.

Family and developmental correlates of adolescent involvement in decision making about screen use.

Objective: Assess how child involvement in making rules about screen time relates to age, child prosocial functioning, and amount of screen use. Methods: NORC's AmeriSpeak Panel was used to recruit a nationally representative sample of parents or guardians of school-aged children (age 5-17) in the United States (n = 2084). Parents completed survey that included measures of screen time, child involvement in rule making about screen use, family functioning, and dimensions of child psychosocial functioning. Results: Across all age categories, most families had some form of rules about the allowable amount of screen-based digital media for uses other than schoolwork: 86% of elementary school-aged children (ages 5 to 10), 81% of middle school-aged children (ages 11-13), and 61% of high school aged children (ages 14-17). Across all age groups, having rules was associated with fewer hours of screen time (elementary school: B = -1.31, 95% CI = -1.80 to -0.81, p < 0.001; middle school: B = -1.40, 95% CI = -2.20 to -0.59, p < 0.001; high school: B = -0.97, 95% CI = -1.68 to -0.27, p = 0.007). Child involvement in making rules was significantly greater for high school students as compared to elementary school students (ß=0.12, p < 0.001), and not associated with high school- or middle-school aged child screen time. Across all age groups, child involvement in making rules was associated with higher levels of prosocial functioning (elementary school: ß=0.07, p < 0.001; middle school: ß=0.19, p = 0.001; high school: ß=0.21, p < 0.001). Conclusions: Child involvement in making rules about screen use may be an opportunity to strengthen developmentally important competencies, as part of a broader autonomy-supportive approach to parenting.

School-based physical activity during the COVID-19 pandemic.

School closures and restrictions related to the COVID-19 pandemic changed opportunities for youth physical activity (PA). We sought to identify school and other contextual conditions associated with youth PA during the COVID-19 pandemic. A nationally representative, United States sample consisted of 500 parents of children ages 6-10 years old and 500 parent-child dyads with children and adolescents ages 11-17 years old who completed a web-based questionnaire. Multivariable linear regression was used to assess the association between days per week of at least 60 minutes of PA with school, family, and neighborhood characteristics, controlling for child age and gender. Youth engaged in significantly more days per week of PA when they attended school in person; participated in school physical education (PE), school sports, and community sports; and had parents that engaged in high versus low levels of PA. The COVID-19 pandemic negatively impacted youth PA, in part, due to restriction of school-based PA opportunities. During future pandemics or conditions that necessitate remote learning, attention to opportunities for PA outside of PE class may be important for equitable PA promotion across school modalities.

Move & Thrive: Development of a Web-Based Training for Schools About Trauma-Informed Physical Activity.

BACKGROUND: Youth who have experienced trauma or other adverse childhood events have the potential to uniquely benefit from physical activity (PA). However, how PA is administered in schools can be re-traumatizing and fail to create positive experiences through movement. We sought to develop role-specific training to help increase the implementation of trauma-informed PA. METHODS: Guided by intervention mapping methodology, we developed "Move & Thrive"-a brief web-based training about trauma-informed PA. We then conducted a pilot evaluation of this training using a pre-posttest design with no control group in a sample of youth sport coaches, parents of school-aged children, and teachers (n = 150) recruited from an online opt-in non-probability panel. RESULTS: Mixed methods feedback found that "Move & Thrive" was highly acceptable. Across all roles (coaches, teachers, and parents/guardians) there were statistically significant increases in all targeted implementation determinants (knowledge, attitudes, self-efficacy, and perceived resources/support), with moderate to large effect sizes. CONCLUSIONS: These results provide the foundation for a larger, adequately powered trial with randomization and follow-up to assess the implementation of trauma-informed PA.

Structural Inequities in Self-compassion and Parental Burnout.

Objectives: When parenting-related stressors and coping resources are chronically imbalanced, there is risk of parental burnout, and consequent negative impact on parent and child wellbeing. The objective of this study was to determine the relations between structural and social determinants of health inequities, self-compassion (a theoretically indicated coping practice), and parental burnout during the COVID-19 pandemic. Method: Participants were parents (n = 2324) with at least one child aged 4-17 in the household recruited from NORC's AmeriSpeak Panel (a probability-based panel providing coverage of 97% of the US household population). Parents completed an online or telephone questionnaire in English or Spanish in December 2020. Structural equation modeling was used to test a system of relations between income, race and ethnicity, parental burnout, and parent and child mental health. Indirect effects and moderation by self-compassion were also tested. Results: On average, parents experienced symptoms of burnout several days per week. Symptoms were the most frequent among parents with the least income, as well as female-identified and Asian parents. More self-compassion was associated with less parental burnout, and fewer parent and child mental health difficulties. Black and Hispanic parents were more self-compassionate compared to white parents, helping to explain similar levels of parental burnout and relatively better mental health outcomes, despite comparatively more stressors. Conclusions: Self-compassion is a potentially promising target for interventions aiming to address parental burnout; however, such efforts must not detract from critical structural changes to reduce parenting stressors, particularly those impacting parents experiencing systemic racism and other forms of socioeconomic disadvantage. Preregistration: This study is not preregistered. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-023-02104-9.

Development of a Measure of Parent Concussion Management Knowledge and Self-Efficacy.

Abstract Assessing parent readiness to support their child's post-concussion management requires valid and reliable measures. Therefore, the objective of this study was to develop and conduct preliminary tests of reliability and validity of survey measures of parent concussion management knowledge and self-efficacy. Additionally, we tested the hypothesis that among parents of youth who had sustained a concussion, higher scores on measures of knowledge and self-efficacy would predict greater likelihood of engaging in recommended concussion management behaviors during their child's recovery. Measure development occurred with reference to parenting behaviors included in the Center for Disease Control and Prevention's Pediatric Mild Traumatic Brain Injury (mTBI) Management Guidelines. A multi-stage mixed- methods approach was employed, including expert review, cognitive interviews with parents, quantitative item reduction, and tests of reliability and validity. All participants were English-speaking parents of school-aged children in the United States. A stepwise measure development process was followed, with different participant groups across steps (including opt-in web-based survey panels and in-person recruitment from the population of parents of pediatric patients seen in a large pediatric emergency department). In total, 774 parents participated in study activities. The final knowledge index had 10 items, and the final self-efficacy scale had 13 items across four subscales (emotional support, rehabilitation support, monitoring, and external engagement). Internal consistency reliability was 0.63 for the knowledge index and 0.79-0.91 for self-efficacy sub-scales, and validation tests were in the hypothesized directions. In a test of predictive validity, we observed that among parents of youth patients with recent concussion, higher self-efficacy scores at the time of discharge from the pediatric emergency department were positively correlated (r = 0.12) with greater likelihood of engaging in recommended support behaviors at 2-week follow-up. There was no association between concussion management knowledge at discharge and parenting behaviors at follow-up. Parents have the potential to play an important role in concussion management. The measures of knowledge and self-efficacy developed in this study can help identify parent needs and evaluate interventions aiming to support parenting post-concussion.

Problematic Child Media Use During the COVID-19 Pandemic.

OBJECTIVES: Assess how family stressors (including structural stressors, social determinants of health inequities, and parent psychological distress) relate to media rule implementation and problematic child media use during the coronavirus disease 2019 pandemic. METHODS: Nationally representative survey of 1000 United States parents with at least one 6 to 17 year old child was conducted in October through November 2020. RESULTS: Problematic use was greater in families where parents were employed full time, present in the home (eg, working from home), had low levels or formal educational attainment, and were experiencing more psychological distress. Although there was a small decline in the number of media-related rules implemented during the pandemic (fewer parents enforced screen limits on weekdays or weekends or limited screen use at mealtimes), there was no association between rule implementation and problematic media use. CONCLUSIONS: Family stressors were associated with problematic child media use during the coronavirus disease 2019 pandemic. As we emerge from the pandemic, it will be important to help parents adjust their family's media practices cognizant of the fact that additional children may have developed problematic screen use behaviors. Such efforts should center the role of structural and social determinants of health inequities on the stressors that families experience and that impact media use.