The Eye of the Beholder: Attitudes toward divorced parents and perception of children's happiness in Peru and Spain.

Studies of divorce's effects on children have been oriented toward the parents' characteristics, ignoring their extended families. In the current study we collected data from 414 participants, both divorced parents and the children's extended families in Peru (155) and Spain (259). Participants completed a questionnaire on attitudes toward the parents, and the Short Dark Tetrad questionnaire. Multivariate tests were conducted on participants' responses, showing that negative attitudes toward parents are not very strong but that attitudes toward fathers are more negative than attitudes toward mothers. Custodial parents are perceived less negatively, and parents who share custody are perceived the least negatively. Extended family members hold more negative attitudes against parents than the parents themselves. Mothers have significantly more negative attitudes toward fathers than the fathers towards mothers. Dark traits are a significant predictor of negative attitudes toward the mother but not toward the father. The perception of unhappiness in the child was predicted by negative attitudes toward the parents. Non-parents tend to evaluate both parents more negatively compared to parents' mutual perceptions. There was an effect on dark traits, negative attitudes against parents, and perception of unhappiness in the child. Peruvians scored significantly higher in all variables.

Using Grounded Theory to Develop a Substantive Theory for Grandparent-Caregiving in Uganda: The GRACE Model.

INTRODUCTION: Few studies have focused on developing theories to explain caregiving as performed by grandparents who provide care for their grandchildren in any setting. Theory development that is grounded in the experiences and cultural context of those being studied is needed to inform research, subsequent care, and overall well-being, especially of populations that are understudied. METHODS: This manuscript was informed by Constructivist Grounded Theory, semi-structured in-depth and individual interviews. Also, three methodological phases were followed: (a) concurrent data collection and analysis procedures, (b) developing categories and relationships among them, and (c) defining the core category and building the substantive theory. RESULTS: The methodological steps involved in generating a substantive theory, the GRAndparent-CarEgiving (GRACE) model, are reported. DISCUSSION: Research, and subsequently the well-being and health care of grandparent-caregivers, needs to be informed by culturally congruent theories that are founded in the experiences and cultural context of the individuals being investigated.

Latinx Grandparents' Child Feeding Practices and Interaction with Parents.

Despite Latinx grandparents' substantial involvement in child rearing, there is limited understanding of their child feeding practices. A survey examined 80 Latinx mothers' perception of Latinx grandparents' feeding practices and interaction with parents. Results showed grandparents engaged in positive feeding somewhat frequently and negative feeding somewhat infrequently. Mother-grandparent disagreement and grandparent-parent(s) communication on child feeding occurred at a moderate level of frequency. Mother-grandparent disagreement was associated with higher frequency of grandparents' negative feeding, while grandparent-parent(s) communication was associated with higher frequency of positive feeding by grandparents. Finally, grandparents' behaviors and practices varied depending on characteristics of grandparents, mothers, and children.

The Intergenerational Transfer of Mental Disorders: A Population-Based Multigenerational Linkage Study: Le transfert intergénérationnel des troubles mentaux : une étude sur les liens multigénérationnels basée sur la population.

OBJECTIVES: The aetiology of mental disorders involves genetic and environmental factors, both reflected in family health history. We examined the intergenerational transmission of multiple mental disorders from parents and grandparents using population-based, objectively measured family histories. METHODS: This population-based retrospective cohort study used administrative healthcare databases in Manitoba, Canada and included adults living in Manitoba from 1977 to 2020 with linkages to at least one parent and one grandparent. Index date was when individuals turned 18 or 1 April 1977, whichever occurred later. Mental disorder diagnoses (mood and anxiety, substance use and psychotic disorders) were identified in individuals, parents and grandparents from hospitalization and outpatient records. Cox proportional hazards regression models included sociodemographic characteristics, individual's comorbidity and mental disorder history in a grandparent, mother and father. RESULTS: Of 109,359 individuals with no mental disorder prior to index date, 47.1% were female, 36.3% had a mental disorder during follow-up, and 90.9% had a parent or grandparent with a history of a mental disorder prior to the index date. Both paternal and maternal history of a mental disorder increased the risk of the disorder in individuals. Psychotic disorders had the strongest association with parental history and were mostly influenced by paternal (hazards ratio [HR] 3.73, 95% confidence interval [CI] 2.99 to 4.64) compared to maternal history (HR 2.23, 95% CI, 1.89 to 2.64). Grandparent history was independently associated with the risk of all mental disorders but had the strongest influence on substance use disorders (HR 1.42, 95% CI, 1.34 to 1.50). CONCLUSIONS: Parental history of mental disorders was associated with an increased risk of all mental disorders. Grandparent history of mental disorders was associated with a small risk increase of the disorders above and beyond parental history influence. This three-generation study further highlights the need for family-based interventional programs in families affected by mental disorders. PLAIN LANGUAGE SUMMARY TITLE: The Intergenerational Transfer of Mental Illnesses.

ObjectivesBoth genetics and environmental factors, such as poverty, maltreatment and parental education, have a role in the development of mental illnesses. Some genetic and environmental risk factors for mental illnesses are shared within families. We conducted a large study to test the extent to which mental illnesses are passed down through generations.MethodsThis study used healthcare data from Manitoba, Canada captured during the delivery of healthcare services for administrative purposes. These data included all adults from 1977 to 2020 who had at least one parent and one grandparent with linked data. Mental illnesses were diagnosed in individuals, parents and grandparents by doctors during hospitalizations or physician visits. The illnesses included mood and anxiety, substance use, and psychotic illnesses. We estimated the likelihood of developing a mental illness when parents and/or grandparents had a mental illness as well.ResultsThe study included 109,359 individuals; a third developed a mental illness during the study period. The majority had a history of a mental illness in a parent or grandparent. We found that a history of mental illness in a mother and father increased the chance of developing the illness. Psychotic illnesses had the strongest relation with parental history. In particular, having a father with a psychotic illness increased the chance of developing the illness by four times. The likelihood of developing a mental illness was higher if a grandparent had a mental illness, above and beyond parental history influence, particularly for substance use disorders.ConclusionsHaving a parent or grandparent with a mental illness increases an individual's chance of developing a mental illness. Family-based intervention programs are needed to support families affected by mental illnesses in coping with their heavy burden.

The contributions of grandparents to preadolescent grandchildren's social skills in rural Malaysia.

This study aimed to generate localized knowledge by investigating the perceptions and experiences of preadolescent grandchildren and grandparents regarding grandparenting and intergenerational interactions and how these processes were related to the social skills of preadolescents from three ethnic groups in Malaysia. Using a concurrent quantitative-qualitative mixed method research design, Chinese, Malay, and Indian preadolescents (N = 465; ages 9-12 years old; M = 10.27 years; SD = 1.03) from rural areas in Malaysia completed a self-administered quantitative survey; furthermore, 25 grandparents participated in one-on-one interviews. Survey findings showed that preadolescent grandchildren who reported higher grandparental warmth and support had greater social skills, mediated by positive grandparent-grandchildren (GP-GC) relationships. The GP-GC relationship and preadolescent social skills association was stronger for skipped generation compared to three-generation households. Interview findings revealed that grandparents expressed unconditional love and autonomy support in their grandparenting roles by guiding and encouraging their preadolescent grandchildren to make decisions. The GP-GC interactions served as a dynamic force in promoting preadolescents' social skills. By employing a decolonized approach and drawing on the lived experiences of grandparents from three ethnic backgrounds in rural Malaysia, the study provided an understanding of grandparenting practices and their general implications across the three ethnic groups. The interview responses highlighted both commonalities and specificities in grandparenting practices and relationship dynamics shaped by religious, class, and sociocultural dimensions in rural Malaysia.

Grandparent Caregivers Lived Experiences and Resource Needs/Use During the COVID-19 Pandemic.

This project examined the impacts of the COVID-19 pandemic on grandparent caregivers, grandchildren, family dynamics, and resources to mitigate and navigate crises. Phone interviews were conducted with 24 grandparent caregivers using a semi-structured interview guide. Caregivers explained that the pandemic had impacted them and their grandchildren by increasing emotional distress, social isolation, financial difficulties, and challenges with education. Helpful resources consisted of financial support, respite care, and support for grandchildren. Thus, there is a need to provide grandparent caregivers with the same resources that foster care providers receive - particularly when faced with challenges such as the COVID-19 pandemic.

Exploring Social Determinants of Mental Health of Older Unforced Migrants: A Systematic Review.

BACKGROUND AND OBJECTIVES: Although the vulnerabilities stemming from the intersection of aging and migration are widely recognized, the migration contexts and the factors influencing the mental health of older unforced migrants have received scant attention. This review explores the drivers of unforced migrations in later life and the individual, relational, and structural factors influencing their mental health and well-being. RESEARCH DESIGN AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of 7 databases for English peer-reviewed journal articles was conducted. A total of 21 studies were identified and analyzed inductively. RESULTS: The review classified motivations for migration as push factors and pull factors: push factors such as escaping structural inequities in the homeland and pull factors included seeking better lifestyle opportunities and reuniting with family. The positive determinants of mental health included cordial family relationships, paid employment, the presence of a partner, and strong support networks. Advanced age, absence of a partner, lifestyle changes, lack of intergenerational support, poor language proficiency, unfavorable policies, lack of access to resources, and systemic biases negatively affected the mental health of older unforced migrants. DISCUSSION AND IMPLICATIONS: The review highlights the need to recognize the diversity among older migrants to develop policies and programs that address their specific circumstances. Recognizing their strengths, rather than focusing solely on their vulnerabilities will help create a more positive and supportive environment, enabling them to thrive in their new communities.

Evaluation of Prevention Programs for Grandparent Caregivers: a Systematic Review.

This systematic review critically evaluates 21 grandparent-focused prevention programs designed to benefit grandparent caregivers or target grandparent caregivers as agents of change for grandchild development. These grandparent programs were published in 35 peer-reviewed articles in the last 31 years. For each program, we described the phase of development of program (i.e., feasibility, pilot, and efficacy), delivery characteristics, and adaptations of existing evidence-based programs to meet the needs of grandparent caregivers in diverse sociocultural backgrounds. For programs tested under a controlled trial design, we evaluated core components and preliminary effects on targeted outcomes. Most studies targeted grandparents who served as primary or custodial caregivers in the USA, while limited studies targeted supplementary grandparent caregivers. Thirteen programs which were evaluated using pretest-posttest designs demonstrated feasibility and acceptability of the grandparent programs. Moreover, eight programs which were evaluated using randomized-controlled trials (RCTs; 5 pilot and 3 full-scale efficacy trials) demonstrated promising outcomes. Additionally, we identified six core components and 17 specific elements in eight programs evaluated using RCT designs. Overall, we provide a comprehensive critique of this body of literature as well as directions for future studies, including the need to develop programing tailored to grandparent caregivers with unique needs.

Interparental Conflict and Early Adolescent Depressive Symptoms: Parent-Child Triangulation as the Mediator and Grandparent Support as the Moderator.

A notable ambiguity persists concerning whether distinct forms of parent-child triangulation (unstable coercive coalition, stable coalition, detouring-attacking, detouring supportive, parentification) might mediate the association between interparental conflict and early adolescent depressive symptoms similarly within the context of Chinese Confucianism. Filling this research gap, this study aimed to examine the mediating role of the five dimensions of parent-child triangulation in the association between interparental conflict and early adolescent depressive symptoms, as well as the moderating effect of grandparent support on this mediating pathway. Data were drawn from a sample of 761 Chinese adolescents (M age = 12.82 ± 0.47, 49.1% girls). Structural equation model analyses indicated that unstable coercive coalition, stable coalition, and detouring-attacking behaviors partially mediated the association between interparental conflict and adolescent depressive symptoms, while detouring-supportive behaviors and parentification did not demonstrate such mediating effects. Unlike Western societies, a negative correlation was observed between interparental conflict and parentification in the context of China. Grandparent support mitigated the adverse effects of both interparental conflict and the unstable coercive coalition on early adolescent depressive symptoms.

It takes a village: A multi-brain approach to studying multigenerational family communication.

Grandparents play a critical role in child rearing across the globe. Yet, there is a shortage of neurobiological research examining the relationship between grandparents and their grandchildren. We employ multi-brain neurocomputational models to simulate how changes in neurophysiological processes in both development and healthy aging affect multigenerational inter-brain coupling - a neural marker that has been linked to a range of socio-emotional and cognitive outcomes. The simulations suggest that grandparent-child interactions may be paired with higher inter-brain coupling than parent-child interactions, raising the possibility that the former may be more advantageous under certain conditions. Critically, this enhancement of inter-brain coupling for grandparent-child interactions is more pronounced in tri-generational interactions that also include a parent, which may speak to findings that grandparent involvement in childrearing is most beneficial if the parent is also an active household member. Together, these findings underscore that a better understanding of the neurobiological basis of cross-generational interactions is vital, and that such knowledge can be helpful in guiding interventions that consider the whole family. We advocate for a community neuroscience approach in developmental social neuroscience to capture the diversity of child-caregiver relationships in real-world settings.

Grandparents' pregnancy and neonatal loss network: Designing a website for grandparents bereaved by the perinatal loss of a grandchild.

Objectives: When a child dies during the perinatal period, grandparents lack the resources to navigate their loss. We applied principles of co-creation and consumer-informed design to seek grandparents' expertise in determining (1) whether an internet-based resource would be suitable/beneficial for grandparents, (2) if so, what design features and content should be included and, (3) any barriers to utilising an internet-based resource. Method: In Stage One, 152 grandparents responded to a survey regarding health and eHealth literacy and website design and content. In Stage Two, a draft website was developed, with 21 grandparents providing feedback about the website's design, content and navigability. Results: Health and eHealth literacy measures indicated that >60% of participants had adequate literacy, and over 70% considered an internet-based resource useful. Grandparents provided design and content preferences, valuing diversity and peer support, and offered recommendations to optimise the website. Directing grandparents to public internet facilities would reduce barriers to access. Conclusion: A website is a suitable resource for grandparents seeking information and support following the loss of a grandchild in the perinatal period. Innovation: Grandparents see benefits in internet-based resources and can contribute to co-design. Further work could explore cultural differences.

Socioemotional and Behavioral Problems of Grandchildren Raised by Grandparents: The Role of Grandparent-Grandchild Relational Closeness and Conflict.

This study examined the associations of grandparent-grandchild relational closeness and conflict with grandchildren's socioemotional and behavioral problems, including emotional symptoms, conduct problems, hyperactivity, peer problems, and abnormal prosocial behaviors. We analyzed primary cross-sectional survey data collected from custodial grandparents in the United States using logistic regression models. The results indicated that grandparent-grandchild relational closeness was significantly associated with lower odds of custodial grandchildren having emotional symptoms, conduct problems, peer problems, and abnormal prosocial behaviors, whereas grandparent-grandchild relational conflict was significantly associated with higher odds of emotional symptoms, conduct problems, hyperactivity, peer problems, and abnormal prosocial behaviors. Implications for increasing grandparent-grandchild relational closeness and decreasing relational conflicts among grandparent-headed families are discussed, which might improve grandchildren's socioemotional and behavioral well-being.

Acute and long-term psychosocial consequences in grandparents when a grandchild is diagnosed with cancer - the GROKids Project: a population-based mixed-methods study protocol.

BACKGROUND: Grandparents play a crucial role in providing their families with love, support, and wisdom, often also supporting them in practical and financial ways. The psychosocial effects experienced by grandparents when a grandchild is diagnosed with an illness can be significant, including increased stress, anxiety, grief, and disruptions in their own lives. Yet, the experience of grandparents is often overlooked in the literature. METHODS/DESIGN: The GROKids Project aims to investigate how grandparents are affected by a grandchild's cancer diagnosis. It employs a mixed-methods approach and consists of three studies: a longitudinal cohort study (Study 1) and a qualitative study (Study 2) involving grandparents of children with a recent cancer diagnosis, and a cross-sectional study (Study 3) of grandparents of childhood cancer survivors. Study 1 covers four time points over two years after the cancer diagnosis, while Study 2 explores the lived experiences of a subsample of these grandparents. Study 3 collects data from grandparents of childhood cancer survivors diagnosed 3 to 10 years ago. Participants are recruited across eight pediatric oncology centers in Switzerland, and through patient advocacy and support groups. Eligibility criteria include having a grandchild diagnosed with cancer and being fluent in German, French, or Italian. Study procedures involve requesting grandparents' contacts from eligible families, and later contacting grandparents, providing study information, obtaining informed consent, and sending out questionnaires by post or online. Reminder calls and mails are used to improve response rates. Data analysis includes multilevel regression (Study 1), thematic analysis (Study 2), and regression analyses (Study 3). Various validated questionnaires are used to assess physical health and overall well-being, psychological health, internal, and external factors. DISCUSSION: This project addresses the gaps in understanding the psychosocial effects on grandparents having a grandchild diagnosed with cancer. It utilizes a comprehensive approach, including multiple methodologies and considering the broader family context. The project's strengths lie in its mixed-methods design, longitudinal approach, and inclusion of the perspectives of the sick children, siblings, and parents, besides grandparents. By gaining a more profound understanding of grandparents' experiences, researchers and healthcare professionals can develop targeted interventions and support services to address grandparents' unique needs.

Contact with grandparents and young people's explicit and implicit attitudes toward older adults.

BACKGROUND: Given the dramatic rise in population aging and widespread negative attitudes toward older people, it is necessary to understand the factors that affect age-related attitudes among young people in order to improve intergenerational solidarity and reduce ageism. The current study examined young people's contact with their grandparents and attitudes toward older people on both explicit and implicit levels. METHOD: The sample included 146 Chinese college students (Mage = 21.50 yrs, SD = 2.23, 101 females). Participants completed a questionnaire concerning contact with their grandparents(contact quantity and contact quality), perceived typicality of their grandparents, intergroup anxiety, inclusion of other in the self, and explicit attitudes toward older people (aged 65 years or older) in general. Participants were also invited to complete a single-category implicit association test (SC-IAT) to assess their implicit attitudes toward older people. RESULTS: The findings indicated that both quantity and quality of contact with grandparents predicted better explicit attitudes toward older people, and contact effects were stronger when one's grandparents were perceived as being typical of older adults. Contact quantity (not quality) was associated with more favorable implicit attitudes only when one's grandparents were perceived as highly typical older adults. Contact effects on explicit attitudes were mediated by intergroup anxiety and inclusion of other in the self. CONCLUSION: Our findings on the positive effects of contact with grandparents underscore the importance of promoting intergenerational contact within the family as a starting point to reduce prejudice toward older adults in age-segregated modern societies. Current results also provide insights on how to extend the benefits of grandparent-grandchild contact outside the family by promoting the perceived typicality of one's grandparents.

Learning about Grandparents' Past Life: Reflections of Grandchildren in an Intergenerational Reminiscence Project for Asian American Families.

Immigration, aging, and dementia often result in a triple jeopardy for Asian American older adults. To improve the well-being of Asian American older adults as well as generational bonding, an Intergenerational Grandparent-Grandchild Reminiscence Program was developed. This paper qualitatively reports on the weekly reflections from the grandchild participants of this program. Older grandparents received six sessions of life-review discussion with their grandchildren remotely or in person for approximately 1 h each week for 6 weeks. Each grandchild (n = 12) provided a written reflection each week after talking with their grandparent. The qualitative data were organized and analyzed using the five phases of the rigorous and accelerated data reduction (RADaR) technique. The results show three categories of themes, as follows: Category 1-Positive experience: more connection with the grandparent; learning more about the grandparent's past life experience; and more engagement; Category 2-Challenging experience: over-explaining things; language or vocabulary barriers; and overly-broad topics; Category 3-Strategy to lead the discussion: using guiding questions in the manual; using translators; spending time together; and taking notes. The results show that the intergenerational reminiscence program is promising for bonding and connection in the grandparent-grandchild relationship. Participants also gained knowledge and experienced challenges when talking with their grandparents during the program.

Intergenerational Reminiscence Approach in Improving Emotional Well-Being of Older Asian Americans in Early-Stage Dementia Using Virtual Reality: Protocol for an Explanatory Sequential Mixed Methods Study.

BACKGROUND: After a dementia diagnosis, Asian Americans experience anxiety, feelings of shame, and other negative effects. Emotional well-being is not only an important aspect of mental health, but also a quality of resilience that helps people bounce back faster from difficulties. However, few studies have addressed issues in developing, implementing, and testing intervention strategies to promote emotional well-being among older adults. Intergenerational solidarity between grandparents and grandchildren has been emphasized in Asian families and is beneficial for the health of persons with dementia. Reminiscence and life review have been identified as potentially effective intervention strategies for helping depression and emotional well-being for older adults. OBJECTIVE: This proposed study aims to develop and implement an intergenerational reminiscence approach and evaluate its potential feasibility and effectiveness in improving the emotional well-being of older Asian American adults who have a recent dementia diagnosis. METHODS: An explanatory sequential mixed methods design will be used in which quantitative data will first be collected and analyzed to identify subsamples of participants who report the greatest and least change in emotional well-being; then, these subsamples will be interviewed to further understand why or why not this intervention works for them. Older adults will receive 6 sessions of life review with grandchildren in virtual reality (VR; 1-1.5 hours each week for 6 weeks), aided by pictures and virtually traveling to important places in their life using Google Earth to look around at those places and remember important times. Quantitative survey data will be collected pre- and postintervention and at a 3-month follow-up. Qualitative interviews with selected participants will also be integrated into the study design. The quantitative data from the surveys will be entered into SPSS (IBM Corp) and analyzed using descriptive analyses, Pearson chi-square tests, nonparametric Friedman tests, or nonparametric Wilcox signed-rank tests (2-tailed). The qualitative data will be transcribed by research assistants, coded by the investigators independently, and analyzed with guidance from content analysis software (Atlas.ti; Atlas.ti Scientific Software Development GmbH). RESULTS: The project was delayed due to the COVID-19 pandemic. Data collection started in late 2021, and 26 participants were recruited as of December 2022. While we are still cleaning and analyzing the quantitative data, the qualitative interviews showed promising results of this intergenerational reminiscence approach in improving emotional well-being among older Asian American adults who have cognitive impairment. CONCLUSIONS: Intergenerational reminiscence provided by grandchildren is promising in improving the emotional well-being of grandparents. VR technology is likely to be accepted by older adults. Future research may consider scaling up this pilot into a trackable, replicable model that includes more participants and develops a more rigorous study design with control groups to test the effectiveness of this intervention for older adults with dementia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48927.

How Grandparents Inform Our Lives: A Mixed Methods Investigation of Intergenerational Influence on Young Adults.

While it is well documented that grandchildren benefit from strong, positive relationships with grandparents, less is known about the influence of these relationships as individuals establish their lives in early adulthood. Further, how this impact varies based on grandparent type (i.e., whether grandparents take on a "traditional" non-caregiving or "custodial" caregiving role) has not been investigated, despite the growing number of youth raised, at least in part, by their grandparents. Using an explanatory sequential mixed methods design, this study explores the influence of grandparent type during childhood on life satisfaction, perceived relationship quality, and life building in early adulthood. Descriptive and comparative analyses of survey data captured in the quantitative strand (N = 94) informed the subsample that completed semi-structured interviews in the emphasized qualitative strand (N = 9). The integrated findings revealed that past and present grandparent relationships remain salient in early adulthood, though the context and substance of these relationships is often nuanced with shifts over time and across individuals. Despite the importance of context, we failed to observe significant differences in life satisfaction or perceived relationship quality by grandparent type. Taken together, the findings suggest the substance of the relationship, more so than the structure, may be impactful for individuals building their life and reflecting on their values in early adulthood. In addition to elucidating areas for continued exploration, this work highlights the need for researchers and practitioners to consider variation in family structure when designing research and developing supports to reinforce positive, mutually beneficial grandparent-grandchild relationships.

Social support and subjective well-being of noncustodial grandparent caregivers in urban China: The mediating roles of generative acts.

While social support is generally beneficial, it remains unclear how it directly and indirectly affects subjective well-being among grandparents via generative acts. Multi-stage cluster random sampling was employed in a city in Eastern China, reaching 1013 noncustodial grandparent caregivers of kindergarten children (mean age = 58.3, range: 40-93, female = 71.9%, non-local = 508). Data were analyzed using structural equation modeling (SEM). The results reveal that social support positively affected three indicators of subjective well-being among noncustodial grandparent caregivers. Also, social support worked through agentic generative acts to positively affect life satisfaction and positive affect, while not through domestic generative acts. The present study contributes to grandparent caregiving research in urban China by advancing an integrated framework that considers the mechanism of generative acts. Policy and practice implications are also discussed.

The association between grandparents as caregivers and overdose mortality in Appalachia and non-Appalachia counties.

Objective: To assess the association of drug overdose mortality with grandparents serving as caregivers of children in Appalachia and non-Appalachia in the U.S. Methods: This study used a cross-sectional design, with percent of grandparents as caregivers and overdose mortality rates being of primary interest. County-level data were combined, and descriptive, bivariate, and multivariable statistics were applied. Multiple sociodemographic and geographic variables were included: median age of the population, percent of the population that is uninsured, percent of the population that is non-Hispanic white, teen birth rate, percent of high school dropouts, and rurality. Results: The percent of grandparents as caregivers increased as the overdose mortality rate increased (p < 0.01). For every 1% increase in the overdose mortality rate, the percent of grandparents as caregivers increased by 56% in Appalachian counties compared to 24% in non-Appalachian counties. After adjusting for sociodemographic characteristics, the interaction between overdose mortality and Appalachian vs. non-Appalachian counties was no longer significant (p = 0.3). Conclusions: Counties with higher overdose mortality rates had greater rates of grandparents as caregivers, with Appalachian counties experiencing greater rates of grandparents as caregivers than non-Appalachian counties. Sociodemographic characteristics that are often more prevalent in Appalachia may be driving the observed differences. Policy implications: Policies and programs are needed to support grandparents providing caregiving for children impacted by substance use disorders including reform to federal child welfare financing to support children, parents, and grandparent caregivers such as kinship navigation, substance use treatment and prevention services, mental health services and in-home supports.

Salivary Markers of Stress in Grandparents Rearing Grandchildren in Rural Appalachia: The Role of Mental Health, Religiosity, and Social Support.

This study examines changes in salivary cortisol and alpha-amylase among grandparents rearing grandchildren in rural Appalachia. Grandparent-caregivers experience greater stress than non-grandparent-caregivers. Participants included 20 grandparent-caregivers and a child for which they cared, who completed questionnaires assessing family functioning and mental health via interview. Grandparent-caregivers provided morning saliva samples once a year for two years. For grandparent-caregivers low in social support and religiosity, grandparent-caregiver depressive symptoms, child depressive symptoms, and child stress were associated with increased grandparent-caregiver salivary alpha-amylase. For grandparent-caregivers high in social support and religiosity, child depressive symptoms, child stress, and child aggression were associated with increased grandparent-caregiver cortisol.