Mobile device screen time is associated with poorer language development among toddlers: results from a large-scale survey.

BACKGROUND: Despite young children's widespread use of mobile devices, little research exists on this use and its association with children's language development. The aim of this study was to examine the associations between mobile device screen time and language comprehension and expressive language skills. An additional aim was to examine whether three factors related to the domestic learning environment modify the associations. METHODS: The study uses data from the Danish large-scale survey TRACES among two- and three-year-old children (n = 31,125). Mobile device screen time was measured as time spent on mobile devices on a normal day. Measurement of language comprehension and expressive language skills was based on subscales from the Five to Fifteen Toddlers questionnaire. Multivariable linear regression was used to examine the association between child mobile device screen time and language development and logistic regression to examine the risk of experiencing significant language difficulties. Joint exposure analyses were used to examine the association between child mobile device screen time and language development difficulties in combination with three other factors related to the domestic learning environment: parental education, reading to the child and child TV/PC screen time. RESULTS: High mobile device screen time of one hour or more per day was significantly associated with poorer language development scores and higher odds for both language comprehension difficulties (1-2 h: AOR = 1.30; ≥ 2 h: AOR = 1.42) and expressive language skills difficulties (1-2 h: AOR = 1.19; ≥ 2 h: AOR = 1.46). The results suggest that reading frequently to the child partly buffers the negative effect of high mobile device screen time on language comprehension difficulties but not on expressive language skills difficulties. No modifying effect of parental education and time spent by the child on TV/PC was found. CONCLUSIONS: Mobile device screen time of one hour or more per day is associated with poorer language development among toddlers. Reading frequently to the child may have a buffering effect on language comprehension difficulties but not on expressive language skills difficulties.

Classification of loneliness using the T-ILS: Is it as simple as it seems?

Student well-being is a growing issue in higher education, and assessment of the prevalence of conditions as loneliness is therefore important. In higher education and population surveys the Three-Item Loneliness Scale (T-ILS) is used increasingly. The T-ILS is attractive for large multi-subject surveys, as it consists of only three items (derived from the UCLA Loneliness Scale). Several ways of classifying persons as lonely based on T-ILS scores exist: dichotomous and trichotomous classification schemes and use of sum scores with rising levels indicating more loneliness. The question remains whether T-ILS scores are comparable across the different population groups where they are used or across groups of students in the higher education system. The aim was to investigate whether the T-ILS suffers from differential item functioning (DIF) that might change the loneliness classification among higher education students, using a large sample just admitted to 22 different academy profession degree programs in Denmark (N = 3,757). DIF was tested relative to degree program, age groups and gender. The framework of graphical loglinear Rasch models was applied, as this allows for adjustment of sum scores for uniform DIF, and thus for assessment of whether DIF might change the classification. Two items showed DIF relative to degree program and gender, and adjusting for this DIF changed the classification for some subgroups. The consequences were negligible when using a dichotomous classification and larger when using a trichotomous classification. Therefore, trichotomous classification should be used with caution unless suitable adjustments for DIF are done prior to classification.

The Parental Stress Scale revisited: Rasch-based construct validity for Danish parents of children 2-18 years old with and without behavioral problems.

BACKGROUND: Experiencing parental stress is common among parents of children of all ages and is elevated in families characterized by stressors such as poverty, mental health problems, and developmental problems. The Parental Stress Scale (PSS) is a short measure for the assessment of perceived stress resulting from being a parent. METHODS: This study examines the construct validity and psychometric properties of the Danish PSS using Rasch and graphical loglinear Rasch models in a sample of parents of 2-18-year-old children with and without known behavior problems. We emphasized analyses of differential item functioning, to ascertain whether the scale yields unbiased scores for subgroups of parents. RESULTS: The 18-item PSS did not fit the Rasch model or a graphical loglinear Rasch model. After dichotomizing item responses and eliminating items 2 and 11, we found the PSS to consist of two distinct subscales measuring parental stress and lack of parental satisfaction. For the total sample, the Parental Stress subscale fit a very complex graphical loglinear Rasch model with differential item functioning relative to parental education and whether children had behavior problems or not. The Lack of Parental Satisfaction subscale fit a simple graphical loglinear Rasch model with differential item functioning only relative to subsample. When dividing into subsamples of parents of children with and without behavior problems, the Parental Stress subscale fit a simple graphical loglinear Rasch model, though still with differential item functioning, while the Lack of Parental Satisfaction subscale fit the Rasch model in each subsample of parents. Both subscales performed best for parents of children with behavior problems. CONCLUSIONS: The PSS should be used in a 16-item version and scored as two subscales. The PSS appears better suited for use among parents of children with behavior problems than within a sample without any known difficulties.

Measuring positive mental health and flourishing in Denmark: validation of the mental health continuum-short form (MHC-SF) and cross-cultural comparison across three countries.

BACKGROUND: The Mental Health Continuum-Short Form (MHC-SF) is a measure of positive mental health and flourishing, which is widely used in several countries but has not yet been validated in Denmark. This study aimed to examine its qualitative and quantitative properties in a Danish population sample and compare scores with Canada and the Netherlands. METHODS: Three thousand five hundred eight participants aged 16-95 filled out an electronic survey. Both the unidimensional and multidimensional aspects of the Danish MHC-SF were studied through bifactor modelling. Cognitive interviews examined face validity and usability. RESULTS: The general score of the Danish MHC-SF was reliable for computing unit-weighted composite scores, as well as using a bifactor model to compute general factor scores or measurement models in an SEM context. Nonetheless, subscale scores were unreliable, explaining very low variance beyond that explained by the general factor. The participants of the qualitative interviews observed problems with wording and content of the items, especially from the social subscale. The general score correlated with other scales as expected. We found substantial variation in flourishing prevalence rates between the three cultural settings. CONCLUSIONS: The Danish MHC-SF produced reliable general scores of well-being. Most of the issues observed regarding the subscale scores have been shown in previous research in other contexts. The further analysis of indices of the bifactor model and the inclusion of qualitative interviews allowed for a better understanding of the possible sources of problems with the questionnaire's subscales. The use of subscales, the substantive understanding of the general score, as well as the operationalization of the state of flourishing, require further study.

Measuring child and adolescent well-being in Denmark: Validation and norming of the Danish KIDSCREEN-10 child/adolescent version in a national representative sample of school pupils in grades five through eight.

KIDSCREEN-10 is a generic instrument for measuring global health-related quality of life among 8-18-year-old children and adolescents. This study examines the criterion-related construct validity and psychometric properties of the Danish language version of the KIDSCREEN-10 using Rasch models. A further aim was to construct Danish norms based on the resulting person parameter estimates from the Rasch models. Data consists of a nationally representative cross-sectional survey of 8171 children in the 5th to 8th grade of primary school in Denmark. No adequate fit to the Rasch model or a graphical loglinear Rasch model could be established for the KIDSCREEN-10 in the full sample of children (n = 8171). Results based on analyses with increasing samples sizes showed that even with the smallest sample item 3 (Kid3) of the KIDSCREEN-10 did not fit the Rasch model. After elimination of Kid3, substantial local dependence and differential item functioning relative to gender and grade level was still present. Already with a sample size of 630 fit to the Rasch model or a graphical loglinear Rasch model adjusting for local dependence and differential item functioning was not established. Therefore, generation of Danish norms was not realizable, as this requires valid sum scores and estimates of the person parameters for an adequate number of cases. Thus, the Danish language version of the child/adolescent self-report KIDSCREEN-10 questionnaire cannot be recommended for use in population-level studies. Neither can use in small sample be recommended as adjustment for differential item functioning and local dependence is ambiguous.

Concordance within parent couples' perception of parental stress symptoms among parents to 1-18-year-olds with physical or mental health problems.

Parents of children with physical or mental health problems are at higher risk for experiencing parental stress. However, mothers and fathers may experience parental stress differently. The aim was to examine whether mothers and fathers of children with physical and/or mental health problems are equally inclined within the couples to experience different aspects of parental stress when considering child and parent couple characteristics. Single aspects of Parental stress were assessed with nine items from the Parental Stress Scale in 197 parent couples of children aged 1-18 years with physical and/or mental health problems. Agreement within parent couples for each item was tested using two tests of marginal homogeneity for dependent data: a nominal G2-test and an ordinal γ-test. Analyses were conditioned on child gender, child age, couple educational level, and overall parental stress. For seven aspects of parental stress, differences in agreement within the couples were found with at least one of the conditioning variables. For five aspects (item 3, 4, 9, 10, 13) addressing specific personal experience of daily stressors related to having children and feeling inadequate as a parent, the differences were systematic. Mothers were more inclined to experience these aspect of parental stress than fathers, specially mothers of boys, a younger child, in couples with an education above high school or with a higher stress level. Agreement was found for two aspects (item 14 and 16) of parental stress. This study suggests that mothers' and fathers' experience of most aspects of parental stress vary within the couples. Knowledge on systematic difference between parents' experience of parental stress may inform future interventions. For aspects where mothers generally experience the highest degree of stress, fathers may be involved as support. Future studies may explore the role of diagnoses, coping strategies and examine concordance in parental stress symptoms in other subgroups.

Effectiveness of a school-based road safety educational program for lower secondary school students in Denmark: A cluster-randomized controlled trial.

Road accidents are one of the leading causes of death and injuries among adolescents and young adults. Road safety education programs aim to promote safe traffic behavior through information, skills training or fear appeals. During the last decade, an intervention type using victim testimonials has been developed. These types of programs aim to promote road safety by connecting a personal narrative of choices and consequences to the beliefs and behaviors of the audience. Studies on the effectiveness of this type of road safety programs among youngsters who are not yet drivers are still limited. This study used a cluster-randomized and controlled trial design to examine the effect of a Danish school-based road safety educational program using testimonials for students in lower secondary schools in Denmark on a) knowledge of risks factors in traffic and b) two types of behavior specifically relevant for the pre-driver target group: seatbelt use and safe bicycle behavior. Our analysis sample comprised 1007 students from 57 schools with a matched baseline and four-month follow-up response. Linear regression analyses suggest a small positive effect on the students' knowledge of the three most important risk factors in traffic but not on the age group most at risk. Concerning seatbelt use or overall cycling behavior no effect was found, although a small positive effect was found on helmet use. Neither was the effectiveness modified by gender, parental educational background, or risky cycling behavior at baseline. Although classroom-based interventions using testimonials may have the potential to increase knowledge of risk factors in traffic among adolescents, translating knowledge into safe traffic behavior is challenging. More studies are needed on how to further adapt the intervention to an age group who are not yet drivers. Such research may focus on mechanisms of change including the age-specific relevance of the ambassador's testimonial and on employing strong elements of action guidance.

Measuring mental well-being in Denmark: Validation of the original and short version of the Warwick-Edinburgh mental well-being scale (WEMWBS and SWEMWBS) and cross-cultural comparison across four European settings.

This study examined the psychometric properties of the Danish WEMWBS and its short version (SWEMWBS) in a Danish population sample, and compared scores in Denmark with scores representative of three other European settings. A total of 3,508 Danish men and women aged 16-95 filled out an electronic survey. Face validity was examined by cognitive interviews. Content validity was assessed by examining response distributions and construct validity by confirmatory factor analysis, measurement invariance, and relations to other or similar measures. Overall mental well-being scores were calculated, as well as stratified by sex and age. Support was found for the single-factor hypothesis, yielding good model fits for both versions of the scale. Both scales have high internal consistency. Correlations with mental health measures were largely in line with expectations. The highest mental well-being scores were reported for Catalonia, followed by Denmark, Iceland, and England. The (S)WEMWBS appear to be appropriate instruments to measure mental well-being in the Danish population. The present findings encourage the use of the scales, particularly SWEMWBS, in epidemiological, intervention and evaluation studies in research and practice. Cross-cultural comparisons like the one reported here may be essential to inform international mental health policy.

Measurement of alienation among adolescents: construct validity of three scales on powerlessness, meaninglessness and social isolation.

BACKGROUND: Psychological alienation is an important concept in the study of adolescents' health and behavior but no gold standard for measuring alienation among adolescents exists. There is a need for new scales with high validity for use in adolescent health and social research. The purpose of the present study was to develop and validate alienation scales in accordance with Seeman's conceptualization of alienation focusing on three independent variants specifically relevant in adolescent health research: powerlessness, meaninglessness and social isolation. METHODS: Cross-sectional data from 3083 adolescents aged 13 to 15 years from the Danish contribution to the cross-national study Health Behaviour in School-aged Children (HBSC) were used. We identified and developed items, addressed content and face validity through interviews, and examined the criterion-related construct validity of the scales using graphical loglinear Rasch models (GLLRM). RESULTS: The three scales each comprised three to five face valid items. The powerlessness scale reflected the adolescent's expectancy as to whether his/her behavior can determine the outcome or reinforcement he/she seeks. The meaninglessness scale reflected the expectancy as to whether satisfactory predictions regarding the effects of one's behavior are possible. Finally, the social isolation scale reflected whether the adolescent had a low expectancy for inclusion and social acceptance. All scales contained some uniform local dependency and differential item functioning. However, only to a limited degree, which could be accounted for using GLLRM. Thus the scales fitted GLLRMs and can therefore be considered to be essentially construct valid and essentially objective. CONCLUSION: The three alienation scales appear to be content and face valid and fulfill the psychometric properties of a good construct valid reflective scale. This suggests that the scales may be appropriate in future large-scale surveys to examine the relation between alienation and a range of adolescent health outcomes such as health, behavior and wellbeing.

Effects of universally offered parenting interventions for parents with infants: a systematic review.

OBJECTIVES: From a developmental perspective, infancy is a critical stage of life. Early childhood interventions aim to support caretakers, but the effects of universal interventions for parents with infants are unknown. The objective is to determine the effects of universal parenting interventions offered to parents with infants 0-12 months on measures of child development and parent-child relationship. DESIGN: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We extracted publications from 10 databases in June 2013, January 2015 and June 2016 and supplemented with grey and hand search. Risk of bias was assessed, and effect sizes were calculated. PARTICIPANTS: Inclusion criteria are: (1) randomised controlled trials of structured, psychosocial interventions offered to a universal population of parents with infants 0-12 months old in western OECD countries, (2) interventions that include a minimum of 3 sessions with at least half of the sessions delivered postnatally and (3) programme outcomes reported for child development or parent-child relationship. RESULTS: 14 papers representing 7 studies are included. There were no statistically significant effects of the intervention for the majority of the primary outcomes across the studies. CONCLUSIONS: The findings of this review are mixed. No clear conclusions can be drawn regarding the effects of universally offered parenting interventions on child development and parent-child relationship for this age group.

Close relations to parents and emotional symptoms among adolescents: beyond socio-economic impact?

OBJECTIVES: This study examined the relationship between trustful communication with parents and frequency of emotional symptoms in schoolchildren and whether this relationship was modified by the family's socio-economic position. METHODS: Pooled data (n = 15,646) from the Danish Health Behaviour in School-aged Children surveys 2002, 2006 and 2010 were analysed by multilevel multivariable logistic regression. RESULTS: 8 % of all schoolchildren reported emotional symptoms almost daily. Odds ratio for daily symptoms was 2.1 (1.8-2.4) for children without trustful communication with parents compared to children with trustful communication. This association appears unaffected by family occupational class. A substantial socio-economic gradient in emotional symptoms persisted, independent of parent-child communication. CONCLUSIONS: Trustful communication with parents might have a fundamental importance, regardless of socio-economic position.