Investigating the relationship between prenatal alcohol exposure and children's behavioural and emotional development: analysis of the Growing Up in New Zealand study.

AIMS: To examine the relationship between prenatal alcohol exposure (PAE) and children's behavioural and emotional development in a large generalizable sample of women and their children in Aotearoa New Zealand. METHODS: Using data from the Growing Up in New Zealand longitudinal cohort, we investigated the relationship between maternal PAE and behavioural and emotional development in 8-year-old children. We explored secondary outcomes including measures of language, executive function, academic achievement, and adaptive behaviour. RESULTS: We found no significant differences in the measures of behavioural and emotional development in children 8 years old based on alcohol consumption. No significant differences in behavioural and emotional development were found based on amount of PAE and when PAE occurred, despite controlling for a range of potential confounding factors, such as neighbourhood deprivation and maternal health measures. PAE was associated with significantly higher scores for parent-rated oral language indicating better oral language. In Maori mothers, PAE was significantly associated with an increased risk of higher scores on two of the Strengths and Difficulties Questionnaire subscales. CONCLUSIONS: We did not find an association between PAE and behavioural and emotional development in children aged 8 years. PAE and behavioural and emotional development are difficult to measure accurately, and the moderating variables between them are complex. Future analyses will require larger cohorts of mothers and their children using precise measures of PAE and outcomes to enable more precise estimates of association.

'I tried to take my phone off my daughter, and i got hit in the face': a qualitative study of parents' challenges with adolescents' screen use and a toolbox of their tips.

BACKGROUND: Concerns about adolescent screen use are often expressed but poorly understood, particularly in terms of how parents are supposed to respond in ways that balance safety, care and developing independence and autonomy. This qualitative study investigated parental perceptions and concerns about screen use of adolescents aged 13 to 17. Current strategies to manage screen use and barriers to doing so were explored, and parents were asked to outline recommended interventions for better outcomes. METHODS: Interviews and focus groups were held with 33 adults in Auckland, Aotearoa New Zealand (mean age 48 years) who were parenting adolescents (mean age 14 years). Interviews were transcribed verbatim, then inductive analysis and interpretation by the research team distilled the key ideas and illustrative quotes. A table of recommendations for a practical 'toolbox' was developed from these in-depth conversations. RESULTS: Parents reported extensive use of screens by their adolescents, constantly throughout the day (and night, instead of sleeping). Four areas of specific concern included: (1) addict-like behavior, (2) exposure to harmful (and inane) content, (3) living in a virtual world, and (4) negative impacts on physical, mental, and cognitive wellbeing. To manage adolescent screen use, family rules and restrictions (on time and place) were common. Some used technical control via software or accessing the adolescent's devices and/or accounts to check for inappropriate content (such as pornography). Communication about device use and self-regulation were important. Barriers to managing screen use included trying to avoid conflict with their child; difficulties with consistency or follow-through on rules; lack of technical knowledge; parental screen use that set a bad example; and device use needed for school or other purposes. Recommendations from parents are presented in a toolbox of tips and techniques they shared, and their 'wish list' for better access to practical, local, scientific information, examples of techniques that have worked for other families, tools for problematic behavior and risk (including how to begin conversations with adolescents about their concerns), and having schools and young people involved in developing interventions to build digital citizenship. CONCLUSIONS: Rich, nuanced accounts from parents about adolescent screen use in their families and communities underpinned their practical ideas for more skillful responses to young people grappling with an addictive digital existence.

Lived experience of fetal alcohol spectrum disorder: A qualitative scoping review.

AIM: To explore the lived experiences of individuals with fetal alcohol spectrum disorder (FASD), their caregivers, and professionals working with individuals with FASD. METHOD: We conducted a scoping review using qualitative methods to explore what it is like to live with FASD from the perspective of those living with FASD, their caregivers, and stakeholders experienced in working with individuals with FASD. We searched electronic databases and grey literature for research published between 2005 and 2022. RESULTS: The 47 studies included in this scoping review show that FASD affects people's lives on a daily basis. Individuals with FASD are aware of their disability and its effects. Caregivers face daily challenges raising children with FASD and are often left unsupported by professionals. Professionals are unprepared and frustrated when supporting someone with FASD. INTERPRETATION: FASD affects individuals, caregivers, and families on a daily basis; and they require improved support and funding.

Knowledge, Attitudes, and Practices Towards Fetal Alcohol Spectrum Disorder in New Zealand Educators: An Online Survey.

Background:Fetal alcohol spectrum disorder (FASD) is a common form of developmental disability but may be poorly understood by professionals working with people with FASD. The aim of the research is to understand the FASD knowledge, attitudes, awareness, and practices among people employed by the education sector in Aotearoa New Zealand and identify gaps in knowledge. Methods: We conducted an online survey of New Zealand Education professionals. The survey focused on the following areas: Awareness of FASD; Knowledge and beliefs about FASD; Impact of FASD on professional practice; and Training needs. Results: Of the 419 participants, most had some knowledge of FASD and its effects on learning; however, there are still gaps that need to be addressed so educators can provide support to individuals living with FASD. Conclusion: There is a need to improve workforce capacity and develop guidelines that address the needs of front-of-line staff working with children with FASD in education settings.

Knowledge, attitudes, and practices towards fetal alcohol spectrum disorder in the New Zealand social and community sector: An online survey.

Background: Fetal Alcohol Spectrum Disorder (FASD) is a common neurodevelopmental disorder but may be underrecognized and misunderstood by people who provide health and social support services. The aim of the research is to understand the FASD knowledge, attitudes, and practices among people employed by the social and community sector in New Zealand. Methods: We conducted an online survey of people working in the New Zealand social and community sector (i.e., social workers, support workers). The survey focused on the following areas: awareness of FASD; knowledge and beliefs about FASD; the impact of FASD on professional practice; and training needs. Results: Most participants reported a basic understanding of FASD, however only 5% felt very well prepared to support someone with FASD. A large majority of participants believed that FASD diagnosis may be stigmatising for individuals or families. Conclusion: There is a need to improve training, professional development, and workplace support for social and community workers in New Zealand to support people with FASD.

Unfitness to stand trial and fetal alcohol spectrum disorder: Understanding and responding to FASD within the criminal justice system in New Zealand.

Fetal alcohol spectrum disorder (FASD) is an increasingly important issue in the New Zealand (NZ) Criminal Justice System (CJS). FASD may impact an offender's ability to participate meaningfully in the trial process, giving rise to the issue of unfitness to stand trial. Capacity to apprehend, comprehend, participate in, make decisions about and communicate within legal process intersect with the complexity and severity of charges. Courts are required to make a nuanced analysis of multiple and complex factors, merging medical and legal expertise into decisions made. We explore the nature of FASD and its implications for criminal justice in NZ. The legal and clinical issues in relation to fitness and FASD will be discussed.

Manaaki - a cognitive behavioral therapy mobile health app to support people experiencing gambling problems: a randomized control trial protocol.

BACKGROUND: The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems. METHODS: An innovative CBT mobile app, based on Deakin University's GAMBLINGLESS online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant's language and their name (e.g. Kia ora Tane) and by creating personalized feedback. A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention. DISCUSSION: If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services. ETHICS APPROVAL: NZ Health and Disability Ethics Committee (Ref: 19/STH/204) TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019.

Evaluation of MyTeen - a SMS-based mobile intervention for parents of adolescents: a randomised controlled trial protocol.

BACKGROUND: Parents play an important role in the lives of adolescents and efforts aimed at strengthening parenting skills and increasing knowledge on adolescent development hold much promise to prevent and mitigate adolescent mental health problems. Innovative interventions that make use of technology-based platforms might be an effective and efficient way to deliver such support to parents. This protocol presents the design of a randomised controlled trial to investigate the effectiveness of a SMS-based mobile intervention (MyTeen) for parents of adolescents on promoting parental competence and mental health literacy. METHODS: A parallel two-arm randomised controlled trial will be conducted in New Zealand, aiming to recruit 214 parents or primary caregivers of adolescents aged 10-15 years via community outreach and social media. Eligible participants will be allocated 1:1 into the control or the intervention group, stratified by ethnicity. The intervention group will receive a tailored programme of text messages aimed at improving their parental competence and mental health literacy, over 4 weeks. The control group (care-as-usual) will receive no intervention from the research team, but can access alternative services if they wish, and will be offered the intervention programme upon completion of a 3-month post-randomisation follow-up assessment. Data will be obtained at baseline, post intervention (1-month), and 3-month follow up. The primary outcome is parental competence assessed by the Parental Sense of Competence Scale at 1-month follow up. Secondary outcomes include: mental health literacy; knowledge of help-seeking; parental distress; parent-adolescent communication; and programme satisfaction. DISCUSSION: To our knowledge this is the first randomised controlled trial on the effectiveness of delivering a parenting support intervention for parents of adolescents solely via a SMS-based mobile intervention. If effective, it could have great potential to reach and support parents of adolescents. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ( ACTRN12618000117213 ) Registered on 29/01/2018.

Using Information and Communication Technologies for Family Communication and Its Association With Family Well-Being in Hong Kong: FAMILY Project.

BACKGROUND: Family communication is central to the family and its functioning. It is a mutual process in which family members create, share, and regulate meaning. Advancement and proliferation of information and communication technologies (ICTs) continues to change methods of family communication. However, little is known about the use of different methods for family communication and the influence on family well-being. OBJECTIVE: We investigated the sociodemographic factors associated with different methods of family communication and how they are associated with perceived family harmony, happiness, and health (3Hs) among Chinese adults in Hong Kong. METHODS: Data came from a territory-wide probability-based telephone survey using the Family and Health Information Trend survey (FHInTs). Frequency of family communication using different methods (ie, face-to-face, phone, instant messaging [IM], social media sites, and email) were recoded and classified as frequent (always/sometimes) and nonfrequent (seldom/never) use. Family well-being was measured using 3 questions of perceived family harmony, happiness, and health with higher scores indicating better family well-being. Adjusted odds ratios for family communication methods by sociodemographic characteristics and adjusted beta coefficients for family well-being by communication methods were calculated. RESULTS: A total of 1502 adults were surveyed. Face-to-face (94.85%, 1408/1484) was the most frequent means of communication followed by phone (78.08%, 796/1484), IM (53.64%, 796/1484), social media sites (17.60%, 261/1484), and email (13.39%, 198/1484). Younger age was associated with the use of phone, IM, and social media sites for family communication. Higher educational attainment was associated with more frequent use of all modes of communication, whereas higher family income was only significantly associated with more frequent use of IM and email (P=.001). Face-to-face (beta 0.65, 95% CI 0.33-0.97) and phone use (beta 0.20, 95% CI 0.02-0.38) for family communication were associated with significantly higher levels of perceived family well-being. CONCLUSIONS: Socioeconomic disparities in using these information and communication technologies (ICT) methods for family communication were observed. Although traditional methods remain as the main platform for family communication and were associated with better family well-being, a notable proportion of respondents are using new ICT methods, which were not associated with perceived family well-being. Because ICTs will continue to diversify modes of family communication, more research is needed to understand the impact of ICTs on family communication and well-being.

Parent and adolescent effects of a universal group program for the parenting of adolescents.

There is growing support for the large-scale implementation of parenting programs for the prevention of child behavior disorders and child maltreatment in younger children. However, there is only limited evidence on the efficacy of parenting programs in modifying risk and protective factors relating to adolescent behavior problems. This study examined the efficacy of Group Teen Triple P (GTTP), an eight-session parenting program specifically designed for parents of young adolescents. Seventy-two families with adolescents aged between 12 and 15 years were randomly assigned to either GTTP (n = 35) or a care as usual (CAU) control condition (n = 37). Compared to CAU parents, parents who received GTTP reported significant improvements in parenting practices, parenting confidence, the quality of family relationships, and fewer adolescent problem behaviors at post-intervention. Several of the parent-reported effects were corroborated by reports from adolescents, including decreases in parent-adolescent conflict and increases in parental monitoring. Adolescents whose parents participated in GTTP also reported significantly fewer behavioral problems than adolescents in the CAU condition. Many of these improvements were maintained at 6-month follow-up.

Towards the Objective Speech Assessment of Smoking Status based on Voice Features: A Review of the Literature.

BACKGROUND AND OBJECTIVE: In smoking cessation clinical research and practice, objective validation of self-reported smoking status is crucial for ensuring the reliability of the primary outcome, that is, smoking abstinence. Speech signals convey important information about a speaker, such as age, gender, body size, emotional state, and health state. We investigated (1) if smoking could measurably alter voice features, (2) if smoking cessation could lead to changes in voice, and therefore (3) if the voice-based smoking status assessment has the potential to be used as an objective smoking cessation validation method. METHODS: A systematic review of the scientific literature was conducted to compile studies on smoking status assessment based on voice features. We searched nine scientific databases for original studies involving the effects of smoking on voice features, the effects of smoking cessation on voice features. RESULTS: A total of 34 studies were identified for review. We found that fundamental frequency, jitter, shimmer, harmonics to noise ratio, and other voice features are affected by smoking and could be used to assess smoking status. CONCLUSION: Speech assessment of smoking status based on voice features has potential as a smoking status validation method, as it is simple, reliable, and less time-consuming. Furthermore, this study provides recommendations for future research on the objective speech assessment of smoking status based on voice features.

Towards a public health approach to parenting programmes for parents of adolescents.

BACKGROUND: Poor parenting practices have been associated with adolescent emotional and behavioural problems which are potentially preventable. Parenting interventions that are based on behavioural and social learning theories have been repeatedly shown to be effective. However, few evidence-based parenting programmes are implemented and sustained at a population level. Little research is available on supporting the general population of parents during the adolescent years. Further, a substantial research-practice gap exists regarding the impact of a universal approach to parenting programmes for parents of adolescents. METHOD: This article will first examine the effects of parenting practices on adolescent outcome. Afterwards, it addresses the effectiveness of parenting programmes for parents of adolescents. Finally, it discusses the need for a public health approach to parenting programmes.

Knowledge, attitudes, and practices of fetal alcohol spectrum disorder in health, justice, and education professionals: A systematic review.

BACKGROUND AND AIMS: Fetal alcohol spectrum disorder (FASD) is one of the most common forms of developmental disability, and yet, anecdotally, is poorly understood by both the public and professionals across health, justice, education, and social services. This review aims to understand the knowledge, attitudes, and practices of professionals who work across a range of sectors - specifically health, education and justice - where they may encounter people with FASD, their families and caregivers. METHOD: We conducted a systematic search for research using surveys or questionnaires to address knowledge, and attitudes of professionals in health, education, and justice with regards to FASD between 1990 and 2021. Our search consisted of electronic databases (APA PsychInfo, CINAHL, EMBASE, Medline, PubMed, and PAIS Index) and grey literature sources. RESULTS: Our search yielded 971 results, of which 58 were relevant. The studies surveyed professionals from health (n = 35), education (n = 10), justice (n = 8), social services (n = 1), and multiple settings (n = 4). Most studies were conducted in North America. The areas surveyed included knowledge of FASD, attitudes towards people with FASD, experience with FASD, practices towards people with FASD, and education and training needs. CONCLUSIONS: Knowledge, attitudes, and practices towards FASD have been surveyed extensively in healthcare professionals over the last 30 years, but less so with those working in justice and education sectors. Findings from surveys suggest that although most professionals had some knowledge of the effects of FASD, their knowledge of the specific criteria of Fetal Alcohol Syndrome (FAS) and FASD is poor across most professional groups, including most health professionals. Our review highlights the need to provide training and information across sectors ongoing surveillance to determine where gaps in knowledge are and what resources are needed. WHAT THIS PAPER ADDS: This study is the first to systematically synthesize knowledge, attitudes, and practices toward FASD across different sectors. Poor knowledge and insufficient training were common. Knowledge, attitudes, and practices about FASD have been surveyed extensively in the healthcare setting, but surveys are more limited outside of this setting. Continuous surveillance is needed to identify and respond to knowledge gaps and changes in practice.

Impact of prenatal alcohol exposure on neurodevelopmental outcomes: a systematic review.

Background: Prenatal exposure to alcohol (PAE) represents a significant public health concern. Previous research linking PAE to neurodevelopmental outcomes has been mixed and often has limited focus on residual confounding or moderating factors. Methods: A systematic review of prospective cohort studies (n = >1000) assessing the impact of PAE on neurodevelopmental outcomes was undertaken (neurophysiology, motor skills, cognition, language, academic achievement, memory, attention, executive function, affect regulation, and adaptive behaviour, social skills, or communication). Electronic searches of EMBASE, Medline, CINAHL, and Psychinfo were conducted in May 2021. A quality assessment was conducted using an adapted version of the Newcastle-Ottawa Scale (NOS). Results: Thirty longitudinal cohort studies met the inclusion criteria. Evidence of the impact of PAE was mixed across domains. We found no evidence that PAE affects executive function, but there were impacts on motor skills, cognition, language, academic achievement, attention, affect regulation, and adaptive behaviour. The most consistent adverse effect was on affect regulation (nine out of thirteen studies, six of which found an association between heavy alcohol consumption or binge drinking during pregnancy). We found no protective factors. Few studies controlled for variables in the postnatal environment. Discussion: This review was unable to conclude a safe level of alcohol consumption during pregnancy. Methodological improvements are needed to improve the quality and consistency in which PAE is studied. Further research into residual confounding variables is vital, including a greater focus on the postpartum environment.

Adapting an Evidence-Based e-Learning Cognitive Behavioral Therapy Program Into a Mobile App for People Experiencing Gambling-Related Problems: Formative Study.

BACKGROUND: Many people who experience harm and problems from gambling do not seek treatment from gambling treatment services because of personal and resource barriers. Mobile health (mHealth) interventions are widely used across diverse health care areas and populations. However, there are few in the gambling harm field, despite their potential as an additional modality for delivering treatment and support. OBJECTIVE: This study aims to understand the needs, preferences, and priorities of people experiencing gambling harms and who are potential end users of a cognitive behavioral therapy mHealth intervention to inform design, features, and functions. METHODS: Drawing on a mixed methods approach, we used creators and domain experts to review the GAMBLINGLESS web-based program and convert it into an mHealth prototype. Each module was reviewed against the original evidence base to maintain its intended fidelity and conceptual integrity. Early wireframes, design ideas (look, feel, and function), and content examples were developed to initiate discussions with end users. Using a cocreation process with a young adult, a Maori, and a Pasifika peoples group, all with experiences of problem or harmful gambling, we undertook 6 focus groups: 2 cycles per group. In each focus group, participants identified preferences, features, and functions for inclusion in the final design and content of the mHealth intervention. RESULTS: Over 3 months, the GAMBLINGLESS web-based intervention was reviewed and remapped from 4 modules to 6. This revised program is based on the principles underpinning the transtheoretical model, in which it is recognized that some end users will be more ready to change than others. Change is a process that unfolds over time, and a nonlinear progression is common. Different intervention pathways were identified to reflect the end users' stage of change. In all, 2 cycles of focus groups were then conducted, with 30 unique participants (13 Maori, 9 Pasifika, and 8 young adults) in the first session and 18 participants (7 Maori, 6 Pasifika, and 5 young adults) in the second session. Prototype examples demonstrably reflected the focus group discussions and ideas, and the features, functions, and designs of the Manaaki app were finalized. Attributes such as personalization, cultural relevance, and positive framing were identified as the key. Congruence of the final app attributes with the conceptual frameworks of the original program was also confirmed. CONCLUSIONS: Those who experience gambling harms may not seek help. Developing and demonstrating the effectiveness of new modalities to provide treatment and support are required. mHealth has the potential to deliver interventions directly to the end user. Weaving the underpinning theory and existing evidence of effective treatment with end-user input into the design and development of mHealth interventions does not guarantee success. However, it provides a foundation for framing the intervention's mechanism, context, and content, and arguably provides a greater chance of demonstrating effectiveness.

Olfactory shifts linked to postpartum depression.

Postpartum Depression (PPD) is the most common non-obstetric complications associated with childbearing, but currently has poor diagnostic regimes. Sensory symptoms of PPD are understudied, particularly with regard to the sense of olfaction. The present study addresses this research gap by assessing differences in olfactory abilities between 39 depressed mothers, who were within the perinatal period (i.e., during pregnancy and up to 1-year post pregnancy) and assessed with Edinburgh Postnatal Depression Scale, and their case-matched healthy volunteers. The assessments include two olfactory testing sessions conducted 4-weeks apart, each comprising a standard odour detection threshold test (i.e., Snap & Sniff Olfactory Test System), and intensity and valence ratings for 3 "pleasant" and 3 "unpleasant" odorants. The results revealed no difference between patients (M = 5.6; SE = 0.3) and control group (M = 5.7; SE = 0.4) in terms of olfactory detection threshold. However, the patients group perceived the 3 "unpleasant" odours as significantly less pleasant (p < 0.05), and 2 odorants (1 "pleasant" and 1 "unpleasant") as less intense. Additionally, these results did not appear to be significantly interacted with the individual's perinatal stage. The present study is the first to evaluate associations between olfactory function and PPD. Findings from the study suggest that, while PPD has little effect on the early stages of olfactory processing, these conditions may have stronger influence on higher-order olfactory perception, including both hedonic and intensity perception. These novel findings add knowledge to sensory symptoms of PPD.

Recruitment and Retention of Parents of Adolescents in a Text Messaging Trial (MyTeen): Secondary Analysis From a Randomized Controlled Trial.

BACKGROUND: Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low. OBJECTIVE: This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials. METHODS: A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used. RESULTS: Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month follow-ups (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%). CONCLUSIONS: The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307.

Development of MyTeen Text Messaging Program to Support Parents of Adolescents: Qualitative Study.

BACKGROUND: Parents play an important role in the lives of adolescents, and supporting and addressing the needs of families continue to be the focus of many researchers and policy makers. Mobile health interventions have great potential for supporting parents at a population level because of their broad reach and convenience. However, limited evidence exists for such interventions for parents of adolescents. This study reports on the formative work conducted with parents and/or primary caregivers to identify their needs and preferences for the development of MyTeen-an SMS text messaging program on promoting parental competence and mental health literacy for parents of adolescents (aged 10-15 years). OBJECTIVE: The aim of this qualitative study was to explore parents and/or primary caregivers' perspectives around youth well-being, parenting, and parenting support and their input on the development of MyTeen SMS text messaging parenting intervention. METHODS: A total of 5 focus groups (n=45) were conducted with parents or primary caregivers of adolescents aged 10 to 15 years between October and December 2017 in New Zealand. A semistructured interview guideline and prompts were used. Data were audiotaped, transcribed, and analyzed using inductive thematic analysis. RESULTS: Participants were concerned about youth mental health (ie, stigma and increasing demand on adolescents), and a number of parenting challenges (ie, social expectations, time, impact of technology, changes in family communication pattern, and recognizing and talking about mental health issues) were noted. Importantly, participants reported the lack of services and support available for families, and many were not aware of services for parents themselves. A number of recommendations were given on the style, content, and frequency of developing the text messaging program. CONCLUSIONS: Findings from this qualitative work informed the development of MyTeen, an SMS text messaging program designed to increase parental competence and improve mental health literacy for parents of adolescents.

Effect of MyTeen SMS-Based Mobile Intervention for Parents of Adolescents: A Randomized Clinical Trial.

Importance: There is global pressure to respond to the burden posed by adolescent mental health problems. The National Mental Health Commission has made a call for investment in mobile health services directed at prevention and early intervention to relieve the demand on targeted mental health services that are costly to provide. Parents and primary caregivers play a significant role in the lives of adolescents and are important targets for such efforts. Currently, there is no evidence for the effectiveness of programs delivered solely via text message for parents of adolescents. Objective: To evaluate the effects of a text-messaging program (MyTeen) on promoting parental competence and mental health literacy for parents of adolescents. Design, Setting, and Participants: A parallel 2-group randomized clinical trial was conducted in New Zealand. A total of 221 parents and primary caregivers of adolescents aged 10 to 15 years were recruited from March 19 to August 17, 2018, via community outreach and social media and were randomly allocated 1:1 into the control or the intervention group. Statistical analysis was performed on the principle of intention to treat with adjustment for baseline factors and ethnicity. Intervention: A text-messaging program for parents of adolescents (age 10-15 years) to promote parental competence and mental health literacy. Participants received 1 daily text message over 4 weeks. Main Outcomes and Measures: Parental competence, assessed at 1 month after randomization by the Parenting Sense of Competence Scale. Results: In total, 221 participants (214 [96.8%] female) were randomized, 109 to the intervention group and 112 to the control group; 201 participants (91%) completed the trial at 3 months. Significant group difference was observed on the primary outcome at the end of 1 month of intervention, with participants reporting a higher level of parental competence than those in the control group (estimated mean difference, 3.33 points; 95% CI, 1.37-5.29 points; P = .002). Except for knowledge about mental health, all secondary outcomes were significant, including continued improvement in parental competence at 3 months (estimated mean difference, 4.08 points; 95% CI, 1.96-6.20 points; P < .001), knowledge of help seeking (estimated mean difference, 0.99 points; 95% CI, 0.49-1.50 points; P < .001), parental distress (estimated mean difference, -2.39 points; 95% CI, -4.37 to -0.40 points; P = .02), and parent-adolescent communication (estimated mean difference, 2.21 points; 95% CI, 0.48-3.95 points; P = .01), with participants in the intervention group reporting better parenting-related outcomes than the control group at 1 and 3 months after the intervention. Conclusions and Relevance: This text-messaging program for parents of adolescents appears to be an effective and feasible way to facilitate the implementation and delivery of evidence-based information to populations that are not easily reached with other intervention modalities. The program can be easily scaled up for delivery as an early preventive intervention and may represent a less expensive option for service delivery. Trial Registration: anzctr.org.au Identifier: ACTRN12618000117213.

Subcutaneous nicotine delivery via needle-free jet injection: A porcine model.

Subcutaneous delivery of nicotine was performed using a novel electrically-operated needle-free jet injector, and compared to hypodermic needle delivery in a porcine model. Nicotine was delivered as a single, one-milligram dose into the abdominal skin, formulated as a 50 microliter aqueous solution. Plasma levels of nicotine and cotinine, its main metabolite, were then monitored over 2 h, following which the injection site was excised for histological examination. No irritation or tissue damage were found at the injection sites, and the jet-injected nicotine exhibited comparable absorption into the systemic circulation to that injected using a conventional needle and syringe. The needle-free jet injection of nicotine is a promising and well tolerated method. The data presented from this porcine model will support a first in human trial towards a new promising nicotine replacement therapy.