Food Insecurity and Health Inequities in Food Allergy.

PURPOSE OF REVIEW: The intersection of food insecurity among those with food allergy is a growing public health concern. Both food allergy and food insecurity have profound implications on health, social, and economic outcomes. The interaction of social determinants of health, poverty, racism, housing insecurity, and access to care has direct impact on individuals with food allergy. RECENT FINDINGS: There is increasing evidence that universal screening for food insecurity is vital in the routine care of patients with food allergy. Individuals with food allergy who are also burdened by food insecurity face unique challenges related to the need to maintain dietary modifications often with expensive specialized diets, which are difficult to access. This may lead to limited dietary options, malnutrition, increased financial burden, and social isolation. While there are available resources and support systems that can assist individuals with food allergies in managing food insecurity, there is an increasing need for advocacy and inclusivity in policy frameworks involving multiple stakeholders. Multi-sector efforts involving healthcare providers and advocacy and government agencies are necessary to support policy changes that protect the rights and well-being of individuals affected by food allergy and food insecurity. By increasing awareness, improving access to safe, affordable, allergen-free food, and advocating for policy change, we can work toward ensuring universal access to safe, nutritious food for all individuals, regardless of their food allergy status or socioeconomic background.

Love on the developing brain: Maternal sensitivity and infants' neural responses to emotion in the dorsolateral prefrontal cortex.

Infancy is a sensitive period of development, during which experiences of parental care are particularly important for shaping the developing brain. In a longitudinal study of N = 95 mothers and infants, we examined links between caregiving behavior (maternal sensitivity observed during a mother-infant free-play) and infants' neural response to emotion (happy, angry, and fearful faces) at 5 and 7 months of age. Neural activity was assessed using functional Near-Infrared Spectroscopy (fNIRS) in the dorsolateral prefrontal cortex (dlPFC), a region involved in cognitive control and emotion regulation. Maternal sensitivity was positively correlated with infants' neural responses to happy faces in the bilateral dlPFC and was associated with relative increases in such responses from 5 to 7 months. Multilevel analyses revealed caregiving-related individual differences in infants' neural responses to happy compared to fearful faces in the bilateral dlPFC, as well as other brain regions. We suggest that variability in dlPFC responses to emotion in the developing brain may be one correlate of early experiences of caregiving, with implications for social-emotional functioning and self-regulation.

Empathy across three generations: From maternal and peer support in adolescence to adult parenting and child outcomes.

This study examined the development of empathic care across three generations in a sample of 184 adolescents in the United States (99 female, 85 male; 58% White, 29% African American, 8% mixed race/ethnicity, 5% other groups), followed from their family of origin at age 13 into their parenting years (through their mid-30s). Mothers' empathic support toward adolescents at age 13 predicted teens' empathy for close friends across adolescence (13-19 years). Participants' empathic support for friends in late adolescence predicted more supportive parenting behavior in adulthood, which in turn was associated with their children's empathy at age 3-8 years. Results suggest that individuals "pay forward" the empathic care they receive from parents, and that skills developed in adolescent friendships may inform later parenting.

Developmental trajectories of adolescent internalizing symptoms and parental responses to distress.

Parents' responses to their children's negative emotions are a central aspect of emotion socialization that have well-established associations with the development of psychopathology. Yet research is lacking on potential bidirectional associations between parental responses and youth symptoms that may unfold over time. Further, additional research is needed on sociocultural factors that may be related to the trajectories of these constructs. In this study, we examined associations between trajectories of parental responses to negative emotions and adolescent internalizing symptoms and the potential role of youth sex and racial identity. Adolescents and caregivers (N = 256) completed six assessments that spanned adolescent ages 13-18 years. Multivariate growth models revealed that adolescents with higher internalizing symptoms at baseline experienced increasingly non-supportive parental responses over time (punitive and distress responses). By contrast, parental responses did not predict initial levels of or changes in internalizing symptoms. Parents of Black youth reported higher minimization and emotion-focused responses and lower distress responses compared to parents of White youth. We found minimal evidence for sex differences in parental responses. Internalizing symptoms in early adolescence had enduring effects on parental responses to distress, suggesting that adolescents may play an active role in shaping their emotion socialization developmental context.

Pathways from adolescent close friendship struggles to adult negative affectivity.

This 19-year prospective study applied a social development lens to the challenge of identifying long-term predictors of adult negative affectivity. A diverse community sample of 169 individuals was repeatedly assessed from age 13 to age 32 using self-, parent-, and peer-reports. As hypothesized, lack of competence establishing and maintaining close friendships in adolescence had a substantial long-term predictive relation to negative affectivity at ages 27-32, even after accounting for prior depressive, anxious, and externalizing symptoms. Predictions also remained robust after accounting for concurrent levels of depressive symptoms, indicating that findings were not simply an artifact of previously established links between relationship quality and depressive symptoms. Predictions also emerged from poor peer relationships within young adulthood to future relative increases in negative affectivity by ages 27-32. Implications for early identification of risk as well as for potential preventive interventions are discussed.

Unique roles of adolescents' friends and fathers in predicting verbal aggression in future adult romantic relationships.

This 20-year prospective study examined verbal aggression and intense conflict within the family of origin and between adolescents and their close friends as predictors of future verbal aggression in adult romantic relationships. A diverse community sample of 154 individuals was assessed repeatedly from age 13 to 34 years using self-, parent, peer, and romantic partner reports. As hypothesized, verbal aggression in adult romantic relationships was best predicted by both paternal verbal aggression toward mothers and by intense conflict within adolescent close friendships, with each factor contributing unique variance to explaining adult romantic verbal aggression. These factors also interacted, such that paternal verbal aggression was predictive of future romantic verbal aggression only in the context of co-occurring intense conflict between an adolescent and their closest friend. Predictions remained robust even after accounting for levels of parental abusive behavior toward the adolescent, levels of physical violence between parents, and the overall quality of the adolescent's close friendship. Results indicate the critical importance of exposure to aggression and conflict within key horizontal relationships in adolescence. Implications for early identification of risk as well as for potential preventive interventions are discussed.

Adolescent responses to paternal verbal aggression: Assessing spillover and compensatory processes using random intercept cross-lagged panel models.

INTRODUCTION: Prior research suggests several pathways through which verbal aggression manifests across adolescent relationship contexts, including spillover (continuity of aggression across different relationships) and compensation (offsetting an aggressive relationship with less aggression in other relationships). These pathways vary across timescales in ways that between-person analytic approaches are unlikely to adequately capture. The current study used random intercept cross-lagged panel modeling (RI-CLPM) to examine adolescents' spillover and compensatory responses to paternal verbal aggression. METHODS: Participants were 184 adolescents (53.2% female) from a United States community sample participating in a longitudinal study. Annually from ages 13-17, participants reported on their experiences of verbal aggression in their paternal and maternal relationships and participated in observed interactions with a close peer that were coded for aggressive behavior. RESULTS: Spillover was observed from father-adolescent to mother-adolescent and adolescent-peer contexts in analyses at the between-person level, likely capturing long-term, cumulative effects of paternal aggression. Conversely, compensation was observed in analyses at the within-person level, likely capturing medium-term (i.e., year-to-year) adaptations to paternal aggression: Adolescents who experienced more aggression from their father than expected at a specific time point were less likely to both perpetrate and experience aggression in maternal and peer relationships the following year. Several findings differed across teen gender, with compensation more likely to occur in males than females. CONCLUSIONS: These findings highlight the multiple pathways by which father-adolescent aggression may be linked to behavior in other relationships in the medium- and long-term. They also support the value of RI-CLPM in decomposing these effects.

Fathers' contributions to attachment in adolescence and adulthood: the moderating role of race, gender, income, and residential status.

Fathers play a critical yet underappreciated role in adolescent development. To examine contributions of fathers' parenting to attachment in adolescence and adulthood, this longitudinal study followed 184 adolescents from ages 13-24. At age 13, adolescents reported on their fathers' parenting behavior and were observed in a father-teen conflict task; at ages 14 and 24, they completed the Adult Attachment Interview. Adolescents who lived with their father showed higher attachment security at age 14 (Cohen's d = .72), compared to those with non-residential fathers. Fathers' positive relatedness and support for teens' psychological autonomy predicted attachment security at age 14. Fathers' physical aggression predicted attachment insecurity in adolescence, whereas fathers' verbal aggression predicted insecurity in adulthood, illuminating developmental shifts. Pathways to security were moderated by father residential status, adolescent gender, and race. Findings underscore the importance of fathers' presence, autonomy support, and non-aggression in predicting adolescents' state of mind in close relationships.

Direct challenges are the gold standard for most antibiotic allergy evaluations.

Antibiotic allergies are frequently encountered in clinical practice, and delabeling of these allergies has individual and public health benefits. This review focuses on the evidence supporting graded challenges without preceding skin testing in adult and pediatric patients to the major groups of antibiotics including penicillins, cephalosporins, sulfamethoxazole, fluoroquinolones, tetracyclines, macrolides, metronidazole, carbapenems, and aztreonam. The cost savings, time savings, and evidence for performing graded challenges outside of an allergy/immunology office are also reviewed for graded challenges to penicillins.

Allergic rhinitis co-morbidity on asthma outcomes in city school children.

BACKGROUND: School based asthma programs have demonstrated that preventive asthma therapy administered in school reduces asthma morbidity. The burden of co-morbid allergic disease on asthma outcomes in a large school based asthma cohort has been unexplored. OBJECTIVE: Evaluate the prevalence of allergic rhinitis (AR) in historically minoritized school children with persistent asthma, and determine if AR is an independent risk factor for asthma morbidity. METHODS: We evaluated the prevalence of AR in children enrolled in 3 NIH funded school based asthma programs in Rochester, NY. We used linear regression and multivariate analyses to compare asthma outcomes for children whose caregivers did and did not report AR. RESULTS: We used data from 1,029 children with asthma (mean age 7.4, 60.4% Black, 29.5% Hispanic, 72.8% insured with Medicaid). 63% of children reported AR. Children with AR had significantly fewer symptom free days over 2 weeks compared to children without AR (7.2 vs. 8.3, p < 0.001). Children with AR also had more daytime symptoms, (4.7 vs. 3.7, p < 0.001), more rescue medication use (4.5 vs. 3.4, p < 0.01), and more activity limitation due to asthma (3.6 vs. 2.5, p < 0.001). Only 44% of children with AR reported allergy medication use. CONCLUSIONS: Among a large school-based cohort of minoritized children with asthma, we found that the majority of children have comorbid allergic rhinitis, which was associated with increased asthma morbidity. Inadequate recognition and treatment for allergic rhinitis likely represents substantial preventable morbidity for this group.

Adolescent caregiving success as a predictor of social functioning from ages 13 to 33.

Adolescent success providing satisfying support in response to a close friend's call in a caregiving task was examined as a potentially fundamental developmental competence likely to predict future social functioning, adult caregiving security, and physical health. Adolescents (86 males, 98 females; 58% White, 29% African American, 8% mixed race/ethnicity, 5% other) were followed from ages 13 to 33 (1998-2021) using multiple methods and reporters. Early caregiving success was found to predict greater self- and partner-reported caregiving security, lower negativity in adult relationships, and higher adult vagal tone. Results are interpreted as advancing our understanding beyond simply recognizing that adolescent friendships have long-term import, to now identifying specific capacities within friendships that are linked to longer-term outcomes.

Maternal depressive symptoms and child behavior problems: Attachment security as a protective factor.

Maternal depressive symptoms (MDS) have been linked to both child internalizing and externalizing behavior problems. Theory suggests that child attachment security may be a protective factor against the negative effects of MDS. This study examined child attachment security as a buffer of the link between MDS and child internalizing and externalizing behavior problems at two time points in a predominantly African American sample. Participants included mothers (N = 164; Mage = 29.68 years; 76% African American) and their preschool-aged children (60% girls; Mage = 44.67 months) recruited from four Head Start centers in low-income neighborhoods in Baltimore, Maryland. MDS were concurrently associated with child internalizing and externalizing behavior problems at both time points. No significant main effects of child attachment security on behavior problems emerged; however, child attachment moderated the association between MDS and child internalizing behavior problems at Time 2, such that MDS predicted greater child internalizing problems when attachment security was low, and the effect was attenuated when attachment security was high. No interaction emerged for child externalizing problems. Findings suggest that secure attachment in early childhood can serve as a protective factor in the context of parental risk. We discuss implications for intervention and the intergenerational transmission of psychopathology.

Characterizing Emotional Support Development: From Adolescent Best Friendships to Young Adult Romantic Relationships.

This study examined development of emotional support competence within close friendships across adolescence. A sample of 184 adolescents (53% girls, 47% boys; 58% White, 29% Black, 14% other identity groups) participated in seven waves of multimethod assessments with their best friends and romantic partners from age 13 to 24. Latent change score models identified coupled predictions over time from emotional support competence to increasing friendship quality and decreasing support received from friends. Friend-rated emotional support competence in adolescence predicted supportiveness in adult romantic relationships, over and above supportiveness in adolescent romantic relationships. Teen friendships may set the stage for developing emotional support capacities that progress across time and relationships into adulthood.

A social-development model of the evolution of depressive symptoms from age 13 to 30.

This 17-year prospective study applied a social-development lens to the challenge of identifying long-term predictors of adult depressive symptoms. A diverse community sample of 171 individuals was repeatedly assessed from age 13 to age 30 using self-, parent-, and peer-report methods. As hypothesized, competence in establishing close friendships beginning in adolescence had a substantial long-term predictive relation to adult depressive symptoms at ages 27-30, even after accounting for prior depressive, anxiety, and externalizing symptoms. Intervening relationship difficulties at ages 23-26 were identified as part of pathways to depressive symptoms in the late twenties. Somewhat distinct paths by gender were also identified, but in all cases were consistent with an overall role of relationship difficulties in predicting long-term depressive symptoms. Implications both for early identification of risk as well as for potential preventive interventions are discussed.

Maternal Depressive Symptoms and Preschoolers' Helping, Sharing, and Comforting: The Moderating Role of Child Attachment.

Maternal depressive symptoms (MDS) are inconsistently associated with lower rates of child prosocial behavior. Studies typically examine prosocial behavior as a unitary construct rather than examining its multiple dimensions, and rarely consider how the quality of the parent-child relationship could influence this association.Objective: The current study examines whether the security of the parent-child attachment relationship moderates the association between MDS and children's helping, sharing, and comforting behaviors.Method: Participants were 164 low-income, majority African American mothers and their preschool-aged children recruited from Head Start centers. Mothers reported the frequency of depressive symptoms at baseline; child attachment security and helping, sharing, and comforting behavior were observationally assessed 5 to 8 months later.Results: Moderation analyses revealed a positive main effect of security (but not MDS) on children's comforting behavior, a main effect of MDS on sharing, and no main effects of MDS or security on children's helping behaviors. Significant interactions between MDS and security predicted comforting and (marginally) helping behaviors, such that MDS were associated with both more helping and more comforting behavior only when children were more secure. No such interaction was observed for sharing.Conclusions: These findings suggest that children may adapt to maternal depressive symptoms in prosocial ways, but that this depends at least in part on the quality of the parent-child relationship, underscoring the importance of examining attachment quality as a moderator of parental influences on children's social-emotional development. We discuss potential explanations for these findings, as well as their implications for intervention.

Working toward anti-racist perspectives in attachment theory, research, and practice.

Recent social movements have illuminated systemic inequities in U.S. society, including within the social sciences. Thus, it is essential that attachment researchers and practitioners engage in reflection and action to work toward anti-racist perspectives in the field. Our aims in this paper are (1) to share the generative conversations and debates that arose in preparing the Special Issue of Attachment & Human Development, "Attachment Perspectives on Race, Prejudice, and Anti-Racism"; and (2) to propose key considerations for working toward anti-racist perspectives in the field of attachment. We provide recommendations for enriching attachment theory (e.g. considering relations between caregivers' racial-ethnic socialization and secure base provision), research (e.g. increasing the representation of African American researchers and participants), and practice (e.g. advocating for policies that reduce systemic inequities in family supports). Finally, we suggest two relevant models integrating attachment theory with perspectives from Black youth development as guides for future research.

Attachment perspectives on race, prejudice, and anti-racism: Introduction to the Special Issue.

Central to attachment theory is the idea that behavior in close relationships can best be understood in context. Although decades of research have illuminated cross-cultural patterns of caregiving and attachment, there remains a critical need to increase research with African American families, examine the specific sociocultural context of systemic anti-Black racism, and integrate the rich theory and research of Black scholars. The goal of this special issue is to bring together attachment researchers and scholars studying Black youth and families to leverage and extend attachment-related work to advance anti-racist perspectives in developmental science. The papers in this special issue, highlighted in the introduction, illuminate pathways of risk and resilience in Black children, adolescents, and families and point to the protective power of relationships (and the limits of such protection) for mental and physical health. We highlight critical questions to guide ongoing dialogue and collaboration on this important topic.

Attachment and attitudes toward children: effects of security priming in parents and non-parents.

The present two-study investigation is the first to examine whether experimentally boosting attachment security (security priming) affects attitudes in the parenting domain for both parents and non-parents. Mothers (n = 72) and childless undergraduates (n = 82) were randomly assigned to a neutral or a secure prime condition and then completed measures of implicit attitudes (a child-focused version of the Go/No-Go Association Task) and explicit attitudes (self-reported) toward children. Following the priming manipulation, mothers in the secure prime condition had more positive implicit attitudes toward their child compared to mothers in the neutral prime condition. Security priming also increased mothers' positive explicit attitudes toward their children, but only among mothers who scored high on self-reported attachment-related avoidance. No priming effects emerged among non-parents. These results provide the first evidence for a causal link between parental attachment security and parental attitudes toward children.

Pathways linking attachment and depressive symptoms for Black and White adolescents: do race and neighborhood racism matter?

Decades of evidence demonstrate that insecure attachment is associated with increased risk for depressive symptoms. Yet research has focused on predominantly White samples, with little attention to whether developmental pathways vary by social-contextual factors like racial identity and neighborhood racism. This study examines whether longitudinal links between attachment style and depressive symptoms differ for White and Black American adolescents or by exposure to neighborhood racism (N = 171, Mage at Time 1 = 14 years). Multigroup measured variable path analyses controlling for gender and household income revealed that attachment avoidance predicted relative increases in depressive symptoms for White adolescents, but not for Black adolescents. Links between attachment style and depressive symptoms did not differ based on exposure to neighborhood racism. Experiences of neighborhood racism were associated with greater attachment avoidance but not anxiety. Results highlight the importance of examining attachment in different socioecological contexts to illuminate the unique pathways characterizing Black youth development.

Parent and Romantic Partner Behaviors during Adolescence as Predictors of Young Adult Positive Personality, Relational Competence, and Functional Independence.

Experiences with parents and romantic partners during adolescence are theorized to have long-term effects on youth development. However, little research has empirically examined the relative contributions of experiences in each type of relationship at different points during adolescence to positive development in young adulthood. The goal of the present study was to predict relative changes in youth positive personality characteristics, relational competence, and functional independence during young adulthood from specific behaviors experienced from parents and romantic partners during early and late adolescence. A diverse community sample of 147 individuals (59 males, 88 females) from the southeastern United States was repeatedly assessed across a 14-year period from age 13 to age 27. As hypothesized, parental acceptance and successful parental positive influence behavior toward adolescents at age 13 predicted relative increases in positive personality traits (e.g., agreeableness, conscientiousness, emotional stability) between ages 23 and 27. These same parental behaviors measured at age 18 were less robust predictors of key outcomes relative to similar qualities of romantic relationships. Instead, romantic behaviors of toleration and appreciation at age 18 predicted relative increases in functional independence and relational competence between ages 23 and 27 (e.g., attachment closeness, reliable alliance, nurturance, and functional independence). Results suggest that parents' successful efforts to positively influence and accept their children during early adolescence may lay a foundation for future positive personality growth, and that similar positive behaviors experienced in late adolescent romantic relationships may help prepare youth to develop broader supportive social relationships and independence skills in young adulthood.