Prevalence and determinants of postpartum depression among adolescent and adult mothers in Northwest Ethiopia.

Postpartum depression (PPD) is a common mental health issue in resource-limited settings that negatively affects the well-being of mothers and children. However, PPD often remains untreated, leading to long-term consequences for families. Therefore, we examined the prevalence and determinants of PPD among adolescent and adult mothers in northwest Ethiopia. Data were collected from 374 adolescent (10-19 years) and 760 adult (20-34 years) mothers 6 weeks after childbirth. Data were analyzed using binary and multiple logistic regression. Adolescent mothers had a significantly higher proportion of PPD (37.4%) than adult mothers (20.1%) and were more likely to report low self-esteem (13.1% vs. 8.2%) and low social support (28.3% vs. 23.3%). Factors associated with PPD differed between adolescent and adult mothers. Adolescent mothers with PPD were more likely to report household food insecurity, low self-esteem, low knowledge of postpartum complications, and working in agriculture or professional/technical occupations. For adult mothers, factors associated with PPD included distance to the nearest health facility, medium social support, inadequate dietary diversity, and food insecurity. Results suggest that targeted interventions by age group are needed to reduce the burden of PPD in Ethiopia.

Building Family Interventions for Scalability and Impact.

Family nursing researchers are charged with addressing the conceptual and methodological underpinnings of family research when developing family-focused interventions. Step-by-step guidance is needed that integrates current science of intervention development with family science and helps researchers progress from foundational work to experimental work with policy integration. The purpose of this manuscript is to provide pragmatic, evidence-based guidance for advancing family intervention research from foundational work through efficacy testing. Guidance regarding the development of family interventions is presented using the first three of Sidani's five-stage method: (a) foundational work to understand the problem targeted for change; (b) intervention development and assessment of acceptability and feasibility; and (c) efficacy testing. Each stage of family intervention development is described in terms of process, design considerations, and policy and practice implications. Examples are included to emphasize the family lens. This manuscript provides guidance to family scientists for intervention development and implementation to advance family nursing science and inform policy.

Understanding the role of parents' social connectedness in children's behavioral wellbeing in low-income communities: A study protocol.

Group-based parent-training (PT) is one of the most common and well-established approaches for strengthening parenting skills and reducing child behavior problems. When offered in school settings, the social connections formed among participants may generate additional benefits for parents, schools, and children. However, to date there has been limited research on the potential benefits or harms associated with social connectedness (SC) in group-based PT. This paper describes the study protocol for an ongoing National Institute of Nursing Research-funded mixed-methods study that aims to examine the extent to which group-based PT, delivered in elementary schools serving families from predominantly low-resource communities, generates SC among parents and if SC is associated with greater (a) reduction in child behavior problems and (b) engagement in their child's education. Using a prospective descriptive design, the study is nested within an ongoing quasi-experimental parent study evaluating the group-based PT intervention, the Chicago Parent Program (CPP) in Baltimore City schools. Challenges for this study include recruitment and retention of parents with constraints caused by the COVID-19 pandemic. The study uses multiple methods and informants to understand the potential mechanisms underlying PT group effects and results have the potential to serve as an important foundation for future studies focused on SC, its impacts on parent-child outcomes in low-resource settings, and strategies for strengthening SC in health promotion interventions. PATIENT OR PUBLIC CONTRIBUTION: Chicago Parent Program was developed with input from an advisory board of parents. Additionally, the parent study protocol was written and is co-led in partnership with a community organization.

Cost-Effectiveness a Parenting Skills Program Implemented in Public PreK Schools in Disadvantaged Urban Communities.

BACKGROUND: Little is known about the cost-effectiveness of parent training programs when offered universally in U.S. elementary schools in disadvantaged urban communities. OBJECTIVE: To estimate the cost-effectiveness of a universal school-based implementation study of the Chicago Parent Program (CPP). METHODS: CPP was offered universally from 2014 to 2017 to parents of PreK students in 12 Baltimore City Title 1 schools (n = 380; 61.1% Black/African American, 24.1% Hispanic). CPP program implementation and operating costs were estimated using microcosting methods and data drawn from study records. A Complier Average Causal Effects (CACE) framework was used to estimate an Incremental Cost Effectiveness Ratio (ICER) for CPP's average cost per child per 1% decrease in conduct problem prevalence at follow-up. This ICER was then compared with comparable ICERs for four parenting interventions that have been implemented and evaluated in Europe: Connect, Incredible Years, COPE, and Comet. RESULTS: CPP cost $937.51 per child (95% CI: $902.09 to $971.92). Adjusted CACE estimates indicated that CPP resulted in a 31.4% reduction (95% CI: -39.7% to -23.9%) in conduct problem prevalence at follow-up among children whose parents attended CPP. The mean ICER for CPP was $29.86 per each 1% reduction in prevalence (95% CI: $21.05 to $50.71). CPP's ICER was similar to ICERs for Connect ($25.50) and COPE ($29.72), and less than ICERs for Incredible Years ($50.36) and Comet ($59.69). CONCLUSION: School-based CPP offered universally to parents of children transitioning to Kindergarten in extremely disadvantaged U.S. urban communities was found to offer relatively good value compared with similar parenting programs that are widely used in Europe.

Associations Between Social Determinants of Health, Chronic Absence From School, and Teacher Ratings of Parents' Engagement in Early Education.

This study examined associations between four indicators of social determinants of health (SDOH; parent education, poverty, material hardships, and child health problems), chronic school absence, and teachers' ratings of parents' engagement in their children's education. Surveys were collected from 304 parents and 26 teachers from eight Baltimore City Public Schools. Results revealed that teachers' ratings of parent engagement were consistently lower among families experiencing adverse SDOH and/or whose children were chronically absent; however, there was no significant relationship between teachers' ratings of parent engagement and child health problems. Additionally, chronic absence partially mediated the relationship between three SDOH indicators (total material hardships, parent education level, and child health problems) and teacher-rated parent engagement. Poverty was excluded from mediation analysis due to evidence of multicollinearity suppressive effects. Addressing the SDOH assessed in this study may be an effective strategy to reduce chronic absence, promote parent engagement, and foster equity in education.

Measuring child-rearing goals for parents with young children: A scoping review.

This scoping review summarizes and consolidates the parenting goals for young children captured in existing parent-report measures, and the characteristics of studies that employed them. Five electronic databases were systematically searched to identify original studies that used a self-report measure for parenting goals during the child's first 5 years. Characteristics of the parenting goals measures and the studies that employed them were extracted and synthesized. A deductive approach was used to reduce the parenting goals items across instruments into representative domains. Fourteen original parenting goals measures and their modifications (i.e., 24 unique measures in total) were identified in 44 research articles from 41 original studies. Items from these measures were synthesized into 33 representative domains. Findings will inform the direction of future research and the development of a comprehensive measure of parenting goals for parents with young children that can be applied across cultures, economic backgrounds, informants, and parenting contexts.

Esta revisión exploratoria resume y consolida los objetivos de crianza para los niños pequeños captados en medidas de informes actuales de los padres, así como las características de los estudios que las utilizaron. Se hicieron búsquedas sistemáticas en cinco bases de datos electrónicas para encontrar estudios originales en los que se utilizó un instrumento de medición de autoinforme para los objetivos de crianza durante los primeros cinco años del niño. Se extrajeron y se combinaron las características de las mediciones de los objetivos de crianza y los estudios que las utilizaron. Se usó un método deductivo para reducir los ítems de los objetivos de crianza de los instrumentos en áreas representativas. Se identificaron catorce instrumentos de medición de objetivos de crianza originales y sus modificaciones (p. ej.: 24 instrumentos de medición únicos en total) en 44 artículos de investigación de 41 estudios originales. Los ítems de estos instrumentos de medición se combinaron en 33 áreas representativas. Los resultados indicarán el rumbo de investigaciones futuras y el desarrollo de un instrumento de medición completo de los objetivos de crianza para padres con niños pequeños que se pueda aplicar a diferentes culturales, situaciones económicas, informantes y contextos de crianza.

Childhood adversity and mental health among Chinese young adults: The protective role of resilience.

AIM: The aims of this study were to examine the prevalence of adverse childhood experiences (ACEs) among health science students in China; associations between the number of ACE exposures and severity of depressive and anxiety symptoms; and the extent to which resilience moderates the effect of ACEs on mental health outcomes. DESIGN: This descriptive, cross-sectional study was conducted May-August 2020. METHODS: Five hundred and sixty-six health science students (18-38 years) from China completed online surveys measuring ACEs using the Simplified Chinese version of the ACE-International Questionnaire, depressive and anxiety symptoms and resilience. Descriptive statistical analysis, ANOVA with Tukey HSD post hoc tests and multiple regression analysis were performed using SPSS 27. RESULTS: 88.5% of participants reported at least one ACE; 42.6% reported four or more ACEs. Higher number of ACEs was associated with more symptoms of depression and anxiety. Four or more ACEs were associated with significantly worse mental health outcomes than those with no ACEs and those with one to three ACEs. Greater resilience significantly attenuated the effects of ACEs on mental health symptoms. CONCLUSIONS: ACEs are highly prevalent among Chinese health science students but their impact on mental health can be buffered by higher levels of resilience. IMPACT: Screening for ACEs and strength-based, trauma-informed interventions on fostering resilience is needed to promote mental health among Chinese young adults.

Social connectedness among parents raising children in low-income communities: An integrative review.

Social isolation has been linked to numerous health risks, including depression and mortality. Parents raising children in low-income and under-resourced communities are at an increased risk for experiencing social isolation and its negative effects. Social connectedness (SC), one's sense of belongingness and connection to other people, or a community, has been linked to reduced social isolation and improved health outcomes in the general population, yet little is known about the impact SC has on parents with low incomes. This integrative review aims to describe the current state of the science surrounding SC in parents with low incomes, summarize how SC is being defined and measured, evaluate the quality of the science, and identify gaps in the literature to guide future research. Five electronic databases were searched, yielding 15 articles for inclusion. Empirical studies meeting the following criteria were included: population focused on parents who have low incomes or live in low-income communities and have dependent children, outcomes were parent-centered, SC was a study variable or a qualitative finding, and publication date was before March 2021. Findings emphasize SC as a promising construct that may be protective in the health and well-being of parents and children living in low-income communities. However, a lack of consensus on definitions and measures of SC makes it difficult to build a strong science base for understanding these potential benefits. Future research should focus on understanding the mechanisms by which SC works to benefit parents and their children.

Low-Income Parents' Perceptions of and Engagement With a Digital Behavioral Parent Training Program: A Mixed-Methods Study.

BACKGROUND: Parent training is a method for strengthening parenting skills, reducing child behavior problems, and promoting positive parent-child relationships. However, few parents have access to these evidence-based programs. The ezParent program, a tablet-based delivery adaptation of the group-based Chicago Parent Program, is a parent training program designed to address the needs of families raising young children in urban poverty. AIMS: This study aimed to explore (a) parents' perceptions of the benefits and barriers associated with their use of the ezParent program and (b) the ways in which the ezParent components and perceived usability varied by program use (module completion). METHOD: An explanatory mixed-methods design was used with the overall intent to use the qualitative data to help explain in greater detail the quantitative results. RESULTS: Fifty-nine parents of 2- to 5-year-old children from two pediatric primary care clinics serving predominantly low-income and racial/ethnic minority families in Chicago (Cohort 1) and Baltimore (Cohort 2) participated in follow-up interviews. Among those interviewed, 23 (38.9.5%) parents completed all six modules and 12 parents (20.3%) completed none of the modules. However, of those 12, 8 (67%) logged in to the program and completed portions of Module 1. Parents who completed more modules reported more program benefits, and those who completed fewer modules reported more barriers. CONCLUSIONS: Exploring users' experience with current digital applications, researchers and application developers can better design future tablet-based interventions to be both effective and acceptable by consumers.

Parent Involvement in Maternal, Infant, and Early Childhood Home Visiting Programs: an Integrative Review.

Despite the evidence and investment in evidence-based federally funded maternal, infant, and early childhood home visiting, substantial challenges persist with parent involvement: enrolling, engaging, and retaining participants. We present an integrative review and synthesis of recent evidence regarding the influence of multi-level factors on parent involvement in evidence-based home visiting programs. We conducted a search for original research studies published from January 2007 to March 2018 using PubMed, Embase, Cochrane, and CINAHL databases. Twenty-two studies met criteria for inclusion. Parent and family characteristics were the most commonly studied influencing factor; however, consistent evidence for its role in involvement was scarce. Attributes of the home visitor and quality of the relationship between home visitor and participant were found to promote parent involvement. Staff turnover was found to be a barrier to parent involvement. A limited number of influencing factors have been adequately investigated, and those that have reveal inconsistent findings regarding factors that promote parent involvement in home visiting. Future research should move beyond the study of parent- and family-level characteristics and focus on program- and home visitor-level characteristics which, although still limited, have demonstrated some consistent association with parent involvement. Neighborhood characteristics have not been well studied and warrant future research.

Financial Incentives for Promoting Participation in a School-Based Parenting Program in Low-Income Communities.

Although financial incentives are a well-accepted strategy for raising parent participation rates in prevention studies, they are rarely employed in practice due to concerns about their ethics, sustainability, and public acceptability. We sought to address these common concerns in the context of a larger prevention study using financial incentives to boost parent participation in a group-based parenting program implemented in an urban school district. We examined the extent to which the financial incentives delivered via bank debit cards ($15 for attending weekly group sessions, $5 for completing weekly practice assignments) motivated parents to enroll in the program and were associated with higher attendance and practice completion but poorer participation quality in group sessions, and how parents used the extra cash. Over 3 years, 67.4% (n = 372) of eligible families enrolled in a parenting program called the Chicago Parent Program. Most parents were African American (68%) or Latinx (24%); 67% reported annual household incomes < $20,000. Although 71.2% of parents reported that the financial incentives motivated their enrollment, the most important motivators pertained to wanting to be a better parent. Parents citing incentives as motivating their enrollment had higher attendance than those who did not (p = .01). Quality of parent participation was high and unrelated to whether financial incentives motivated enrollment. Parents reported using the extra cash to purchase items for their children (92%) and groceries (56%). Results suggest that financial incentives targeting low-income families of young children may improve parent participation rates without diminishing their intrinsic motivation to improve their parenting.

Evaluating Implementation Fidelity of a School-Based Parenting Program for Low-Income Families.

Young children first develop the social-behavioral skills needed to succeed in school from parents. However, most school-based interventions designed to bolster children's social-behavioral skills have focused on strengthening teachers' skills. This study examined the extent to which a 12-session group-based program for strengthening parenting skills, the Chicago Parent Program (CPP), could be implemented with fidelity in 12 urban schools serving a large population of young children (>95% African American or Latino) living in poverty. Parents of 380 prekindergarten students enrolled in the CPP. Data were collected on child behavior problems; parent satisfaction, attendance, and weekly practice completion; and implementation adherence and competence. Results indicated that CPP group leaders were highly adherent and competent; parents rated groups highly and attended an average of 8 sessions indicating CPP was implemented with high fidelity. Barriers and supports to implementation are reviewed, and implications for long-term sustainability of school-based interventions like CPP are discussed.

The Costly Consequences of not Being Socially and Behaviorally Ready to Learn by Kindergarten in Baltimore City.

Social, emotional, and behavioral skills are foundational to learning and long-term success. However, poverty and exposure to adverse childhood experiences reduce the chances of children entering kindergarten socially-behaviorally ready to learn. This study examined the unique impact of 5-year-old children (N = 11,412) entering kindergarten not socially-behaviorally ready on three costly school outcomes by fourth grade in Baltimore City Public Schools: being retained in grade, receiving services and supports through an IEP or 504 plan, and being suspended/expelled. Controlling for all other types of school readiness, students not identified as socially-behaviorally ready for kindergarten were more likely to experience all three school outcomes. Findings underscore the importance of early prevention and intervention strategies targeting parents and social-behavioral readiness skills during the first 5 years of life.

Parenting Needs Among Mothers of Young Children During Military Deployment.

PURPOSE: To examine perceptions of what mothers of young children (birth to 5 years old) need to be a "good parent" while their military spouse is deployed. DESIGN: Q methodology was used to uncover different views on military spouses' parenting needs. METHODS: In Phase 1, 18 statements related to military spouses' parenting needs were elicited based on review of existing literature and seven supplementary qualitative interviews. In Phase 2, 143 military-connected mothers completed an anonymous online Q-sort to rank the importance of the 17 statements from least to most important for being a good parent during deployment. Written comments explaining rankings were also collected. FINDINGS: Across respondents, the most important needs during deployment were making sure their children were happy and healthy, keeping themselves and their children connected with the deployed parent, and being financially stable. Three unique views were uncovered, which differed by mothers' reliance on their family versus the military community for support, and the importance of self-care. CONCLUSIONS: Results highlighted the extent to which mothers of young children enter "survival mode" during their spouse's deployment, and differences were found in what was most important for being a good parent during this stressful period. CLINICAL RELEVANCE: Findings underscore the complexity of creating programs to support military parents whose different backgrounds, experiences, and expectations are likely to affect service uptake and benefit.

Investigating the relationships among neighborhood factors and asthma control in African American children: A study protocol.

Over 2 million children in the US have uncontrolled asthma. African American children are disproportionately affected with a risk of dying from asthma that is 7.6 times higher than non-Hispanic White children. Racial disparities in childhood asthma are partially attributed to differential exposures to poverty; unsafe and stressful neighborhoods; and unhealthy physical environments. This paper describes the protocol for an ongoing National Institutes of Health/National Institute of Nursing Research-funded descriptive, cross-sectional study to investigate two neighborhood factors that may influence children's asthma. Building on an existing dataset, this study examines associations among neighborhood greenspace, neighborhood safety, and level of asthma control while controlling for indoor asthma triggers in an urban sample of predominantly low-income, African American children with persistent asthma. Two new variables are added to the dataset: availability of neighborhood greenspace and neighborhood violent crime rate. Greenspace is being accessed using geographic information systems and measured using the normalized difference vegetation index. Neighborhood violent crime rate is calculated using geocoded, point locations for crimes downloaded from the city police department. It is hypothesized that parents living in unsafe neighborhoods are likely to keep their children indoors, thereby increasing their children's exposure to indoor asthma triggers and limiting the potential benefits of neighborhood greenspace. The biggest challenges thus far are related to limited variability in greenspace and violent crime rates. Progress to date and strategies to address these challenges are discussed. Results have the potential to inform interventions to improve asthmatic children's health and influence public health policy.

Child Poverty, Toxic Stress, and Social Determinants of Health: Screening and Care Coordination.

Social determinants of health (SDOH) refer to the social, economic, and physical conditions in which people live that may affect their health. Poverty, which affects nearly 15 million children in the United States, has far-reaching effects on children's physical and mental health. Although it is difficult to change a family's economic circumstances, nurses can play a critical role to address SDOH through screening and effective coordination of care. As nurses, our role is to minimize the effects of SDOH, including poverty, on child health and well-being through our practice, research, and professional education. We present three exemplars of child poverty to demonstrate the impact on child health and well-being and propose a model of care for nurses to assess and address SDOH in the pediatric clinical setting.

Universal Mandatory Reporting Policies and the Odds of Identifying Child Physical Abuse.

OBJECTIVES: To examine the relationships between universal mandatory reporting (UMR), child physical abuse reporting, and the moderating effect of UMR on physical abuse report outcomes by report source. METHODS: We used a national data set of 204 414 children reported for physical abuse in 2013 to compare rates of total and confirmed reports by states or territories with and without UMR. We estimated odds and predicted probabilities of confirming a physical abuse report made by professional versus nonprofessional reporters, accounting for the moderating effect of UMR and individual-level characteristics. RESULTS: Rates of total and confirmed physical abuse reports did not differ by UMR status. Nonprofessionals were more likely to make reports in UMR states compared with states without UMR. Probability of making a confirmed report was significantly lower under UMR; this effect almost doubled for nonprofessionals compared with professional reporters. CONCLUSIONS: Universal mandatory reporting may not be the answer for strengthening the protection of children victimized by physical abuse. Implementation of child protection policies must be exercised according to evidence to exert the fullest impact and benefit of these laws.

Association of teen mothers' and grandmothers' parenting capacities with child development: A study protocol.

Children born to teen mothers may experience less responsive and supportive parenting and are at heightened risk for a range of social, developmental, and health issues. There is literature to support the positive impact of grandmothers on teen parents and their children. However, what if the teen's mother is also limited in her parenting capacities? How do parenting capacities across these two generations of mothers affect the developing child? In this ongoing study we are examining two important aspects of parenting capacities, attachment quality and executive functioning, in teen mothers (TM) and their biological, co- residing mothers or grandmothers (GM or GGM). Both are essential components of effective parenting, but little is known about their impact on young children's development when raised by two generations of parents. In a cross- sectional, descriptive design, a convenience sample of 50 TM/GM dyads with children 1 to 3 years old is being recruited from two urban teen-tot clinics. Participants complete a paper-and-pencil measure of attachment quality and a computerized measure of multiple aspects of executive function (working memory, inhibitory control, cognitive flexibility). A standardized maternal report measure is used to assess child developmental status. The biggest challenges of the study thus far include recruitment and transience of the study population. Progress to date and experiences from recruitment and data collection are discussed, as well as successful strategies to address challenges.