US Immigration Policy Stressors and Latinx Youth Mental Health.

Importance: The youth mental health crisis is exacerbated for Latinx adolescents, a group whose families are targets of anti-immigrant rhetoric and policy. Objective: To investigate how immigration-related stressors are associated with disruptions in parent-child relationships and, in turn, the mental health symptoms of Latinx adolescents. Design, Setting, and Participants: Data for this prospective cohort study of adolescent-mother dyads were derived from surveys completed at 3 time points spanning 4 years (time 1 [T1] in 2018, time 2 [T2] in 2020, and time 3 [T3] in 2022). Mediation analyses estimated paths from immigration-related stressors to parent-child relationship qualities to mental health symptoms from early to late adolescence. Multivariable and multivariate linear models within a structural equation modeling framework regressed mediators and outcome variables on their own T1 values, offering a scientifically rigorous test of mediation. The setting was a school district in suburban Atlanta, Georgia, and included Latinx adolescents (ages 11-16 years) randomly selected from grade and gender strata. Data were analyzed from June 2023 to March 2024. Exposures: The primary independent variables were T1 mother reports of anti-immigrant worry and behavioral modification and adolescent reports of family member detention or deportation. Mediating variables were the reports of parental support and parent-child conflict of T2 adolescents. Main Outcomes and Measures: T3 adolescent reports of past 6-month internalizing and externalizing symptoms. Results: A total of 547 Latinx adolescents (mean [SD] age, 13.3 [1.0] years; 303 female [55.4%]; 244 male [44.6%]) were included in this study. Response rates were 65.2% (547 of 839) among contacted parents and 95.3% (547 of 574) among contacted adolescents with parental permission. Four-year retention rates were 67% (366 of 547 adolescents) and 65% (177 of 271 mothers). Structural model results showed that T1 anti-immigrant worry and behavioral modification was associated with T3 increases in externalizing symptoms indirectly through T1 to T2 increases in parent-child conflict (ß = 0.03; SE = 0.02; 95% CI, 0-0.08). For girls, T1 family member deportation or detention was associated with T1 to T3 increases in internalizing and externalizing symptoms indirectly through T1 to T2 declines in parental support (internalizing: ß = 0.04; SE = 0.02; 95% CI, 0-0.08; externalizing: ß = 0.03; SE = 0.02; 95% CI, 0-0.07). Sensitivity analyses supported structural model findings. Conclusion and Relevance: Results of this cohort study suggest that legislative bodies, the health care system, and educational institutions should implement safeguards to mitigate potential harm conferred by anti-immigrant environments for parent-child relationships and, in turn, Latinx adolescents' mental health.

Brief Parent-Child Substance Use Education Intervention for Black Families in Urban Cities in New Jersey: Protocol for a Formative Study Design.

BACKGROUND: Substance use continues to remain a public health issue for youths in the United States. Black youths living in urban communities are at a heightened risk of poor outcomes associated with substance use and misuse due to exposure to stressors in their neighborhoods, racial discrimination, and lack of prevention education programs specifically targeting Black youths. Many Black youths, especially those who live in urban communities, do not have access to culturally tailored interventions, leaving a critical gap in prevention. Since family is a well-known protective factor against substance misuse for Black youths, it is essential to create sustainable and accessible programming that incorporates Black youths' and their families' voices to develop a suitable prevention program for them. OBJECTIVE: We aim to understand the cultural and environmental level factors that influence substance use among Black youths and develop a prevention program to increase parent-child substance use education among Black families. METHODS: This study will take place within urban cities in New Jersey such as Paterson and East Orange, New Jersey, which will be the main study sites. Both cities have a large population of Black youths and this study's team has strong ties with youths-serving organizations there. A formative, qualitative study will be conducted first. Using the first 3 steps of the ADAPT-ITT (Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing) framework we begin the development of an intervention for Black families. Three aims will be described: aim 1, collect qualitative data from Black parents and youths aged 11-17 years from parent-child dyads (N=20) on the challenges, barriers, and facilitators to communicating about substance use; aim 2, adapt a selected evidence-based intervention for Black families and develop a family advisory board to guide the adaptation; and aim 3 assess the feasibility of the intervention through theater testing, involving the family and community advisory board. RESULTS: This study is part of a 2-year research pilot study award from the National Institutes of Drug Abuse. Data collection began in May 2023, and for aim 1, it is 95% complete. All aim 1 data collection is expected to be complete by December 30, 2023. Data analysis will immediately follow. Aim 2 activity will occur in spring 2024. Aim 3 activity may begin in fall 2024 and conclude in 2025. CONCLUSIONS: This study will be one of the few interventions that address substance use among youths and uses parents and families in urban communities as a protective factor within the program. We anticipate that the intervention will benefit Black youths not only in New Jersey but across the nation, working on building culturally appropriate, community-specific prevention education and building on strong families' relationships, resulting in a reduction of or delayed substance use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55470.

Modifiable parental factors associated with the mental health of youth from immigrant families in high-income countries: A systematic review and meta-analysis.

Parental factors play a major role in youth mental health and many youth in high-income countries have at least one overseas-born parent. It is, hence, important to understand how immigrant parenting is associated with youth mental health in high-income countries. Following PRISMA guidelines, this review sought to identify modifiable parental factors to inform parenting interventions to prevent mental health problems in youth aged 0-18 years whose parents migrated voluntarily for economic reasons from low and middle-income countries to high-income countries. Sixteen parental factors were identified from 56 studies that were associated with five outcomes - youth self-esteem (k = 17), general stress (k = 4), acculturative stress (k = 4), anxiety symptoms (k = 9), and depressive symptoms (k = 41). A sound evidence base was found for one or more of these outcomes associated with protective factors - caring and supportive parenting and parental monitoring; and risk factors - parent-youth acculturative and general conflict, parental withdrawal, interparental conflict, and parent mental health problems. This systematic review and meta-analysis identified immigrant parental factors that have robust associations with youth mental health outcomes. These findings can be used to inform parenting interventions and support immigrant parents in preventing youth mental health problems.

We got this: Evaluating racial socialization competency among diverse ethnic-racial groups.

Historically, research on racial socialization (RS) has centered on frequency, beliefs, and content of parent-child communications, with varied applications and implications across racial and ethnic subgroups. The Racial Socialization Competency Scale (RaSCS; Anderson et al., 2020) was developed to assess three dimensions of a novel construct, RS competency (confidence, skills, stress), among Black caregivers. In this article, we investigated the psychometric properties of the RaSCS across diverse ethnic-racial groups. Participants were 778 caregivers (Mage = 44.4 years) of youth between the ages of 10 and 18 recruited from across the United States. The sample was intentionally racially and ethnically diverse, with 26.1% identifying as Black, 24.2% identifying as Latinx, 24.9% identifying as Asian American, and 24.8% identifying as White. Confirmatory factor analyses replicated the previously identified structure of the RaSCS subscales, and scores were reliable. Multigroup measurement invariance analyses supported full scalar invariance across the four racial/ethnic subgroups for the Confidence, Skills, and General RS Stress subscales and partial scalar invariance for the Call to Action RS Stress subscale. These findings suggest that the RaSCS is an appropriate tool for assessing RS competency across racial and ethnic groups and that RS competency as a universal construct is relevant across groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Black and Latiné parents' perspectives on supporting their children's emotional and physical health.

Informed by integrative models of cultural resilience, the purpose of this study was to (a) explore how parents are promoting their children's emotional and physical health, with a focus on race and ethnic-racial socialization strategies, and (b) identify the barriers and challenges parents are experiencing in supporting their children's health. Ethnically racially matched qualitative interviews were conducted with 33 parents (82% women, 64% Black, 36% Latiné). Results of thematic analysis revealed three overarching themes: (a) Strategies for Promoting Children's Physical and Emotional Health, (b) Challenges Promoting Children's Physical and Emotional Health, and (c) Impact of Racism on Parenting and Children's Health. Most parents believed that racism had an impact on their parenting decisions and their children's health; however, there were some differences in ethnic-racial socialization practices between Black and Latiné parents. Findings have implications for culturally relevant parenting approaches to support children's emotional and physical health.

Parent childhood experiences, parenting strategies, and youth health-related outcomes in Hispanic families with unhealthy weight: An intergenerational study.

We aimed to examine whether (a) parents' childhood family mealtime experiences (CFM) (e.g., mealtime communication-based stress) and parents' socio-demographic characteristics (e.g., education level) predict parents' health-related parenting strategies (e.g., discipline), (b) health-related parenting strategies for eating and physical activity predict youth's health-related outcomes (e.g., dietary intake), (c) parenting strategies mediate the relationship between CFM and youth outcomes. A path model was used to examine the above-mentioned relationships. Data were obtained from the baseline assessment of a randomized clinical trial evaluating the efficacy of a family-based intervention to promote quality diet and increase physical activity. Participants were 280 Hispanic youth (52.1 % female, Mage = 13.01 ± 0.83) with unhealthy weight (MBody Mass Index %tile = 94.55 ± 4.15) and their parents (88.2 % female, Mage = 41.87 ± 6.49). Results indicated that childhood mealtime communication-based stress and mealtime structure were positively associated with control. Appearance weight control was positively associated with monitoring, discipline, limit-setting, and reinforcement. Parental mealtime control had positive associations with discipline, control, and limit-setting. Emphasis on mother's weight was positively associated with reinforcement. We also found positive associations between parental monitoring and youth's physical QOL and between parental discipline and fruits and vegetables intake. No mediating effect was found. Findings demonstrated significant effects of parents' childhood experience on parenting strategies, which in turn was associated with the youths' health-related outcomes. These results suggest the intergenerational effects of parent's childhood experience on their youth's health-related outcomes.

Family obligation in Chinese adolescents: Consequences and parental antecedents.

Adolescents' family obligation is a cultural strength that shows enduring prevalence in China. Given that the meaning of family obligation has undergone rapid changes in recent decades, it is crucial to examine the role of family obligation in adolescent adjustment in contemporary China. More importantly, although past research has investigated the consequences of family obligation on adolescents' adjustment, little is known about the antecedents of Chinese adolescents' family obligation. Using a two-wave longitudinal sample of 450 Chinese adolescents (mean age = 13.78 years, SD = .71 years; 49% female) and their parents, the current research explored two questions. First, this study examined the role of family obligation in adolescents' academic achievement, externalizing problems, and internalizing problems over early adolescence. Second, this study explored the role of parents in predicting Chinese adolescents' family obligation, specifically whether parental expectations or parental acceptance was predictive of adolescents' family obligation over time. Third, this study investigated whether family obligation is an underlying mechanism between parenting and Chinese adolescents' adjustment. Results showed that Chinese adolescents' family obligation was longitudinally associated with increased academic achievement and reduced externalizing problems. Moreover, perceived parental acceptance, but not parental expectations, was longitudinally associated with Chinese adolescents' greater family obligation. Notably, family obligation mediated the longitudinal effect of parental acceptance on Chinese adolescents' externalizing problems. By studying both the consequences and antecedents of Chinese adolescents' family obligation, this study helps provide a comprehensive understanding of this cultural strength.

Mealtime conversations between parents and their 2-year-old children in five cultural contexts.

Children all over the world learn language, yet the contexts in which they do so vary substantially. This variation needs to be systematically quantified to build robust and generalizable theories of language acquisition. We compared communicative interactions between parents and their 2-year-old children (N = 99 families) during mealtime across five cultural settings (Brazil, Ecuador, Argentina, Germany, and Japan) and coded the amount of talk and gestures as well as their conversational embedding (interlocutors, function, and themes). We found a comparable pattern of communicative interactions across cultural settings, which were modified in ways that are consistent with local norms and values. These results suggest that children encounter similarly structured communicative environments across diverse cultural contexts and will inform theories of language learning. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Intergenerational Influence of African American, Caribbean and Hispanic/Latino Adults Regarding Decision to Participate in Health-Related Research.

Introduction: Identifying effective strategies to enroll African American, Caribbean, and Hispanic/Latino adults ≥65 years of age in health research is a public health priority. This study aimed to explore intergenerational influence (IGI) among these populations living throughout Florida. Methods: African American, Caribbean, and Hispanic/Latino adults ≥65 years of age and a trusted family member/friend between 25-64 years participated in virtual listening sessions (LS). Culturally matched facilitators used a semi-structured guide to lead LS that was recorded, transcribed, and uploaded into NVivo©. The constant comparative method was used for analysis. Results: 363 African American, Caribbean, and Hispanic/Latino participated in LS. Five (5) themes relate to IGI emerged: (1) parent-child relationships; (2) family caregiving/parental illness experiences; (3) historical research maltreatment; (4) transfer of cultural knowledge; and (5) future generations. Discussion: Our findings support that IGI can be leveraged to increase the participation of African American, Caribbean, and Hispanic/Latino older adults in health research.

Development of the Arabic Inventory of Parent and Domestic Worker Attachment (A-IPDWA): A tool to assess adolescents' attachment to secondary figures.

INTRODUCTION: Adolescents' attachment security toward parental figures has been assessed in multiple cultures and languages. In some cultural contexts, the presence of a secondary parental figure is ubiquitous, though its effect on children's and adolescents' well-being has been understudied. The present study aimed to validate a culture-specific Arabic instrument of attachment security, in an adolescent sample of Qatar. Since foreign domestic workers (Khadama) play a key role as secondary caring figures in Middle Eastern countries, the new instrument included parents (i.e., mother and father) and domestic workers as providers of attachment security. METHODS: A sample of 387 adolescents (ages 12-17 years; 48.3% females) participated in the study in the 2020-2021 school term. While 286 students completed the version in modern Arabic, 101 counterparts attending international schools filled in the English version for comparison purposes. RESULTS: Confirmatory Factor Analysis for all three forms (i.e., mother, father, and domestic worker) showed the one-dimension of the Arabic tool. Optimal Tucker's Phi coefficient indicated a comparable one-factor structure of attachment security across linguistic versions. Moderate correlations (positive and negative, respectively) of attachment security towards father and mother (but not towards domestic workers) with family cohesion and family conflict dimensions of the Family Environment Scale provided evidence for the concurrent validity. DISCUSSION: Gender differences in the links between adolescents' attachment security and family conflict were observed; culturally relevant relationship family patterns are stressed. The practical implications of the Arabic Inventory of Parent and Domestic Worker Attachment (A-IPDWA) validation are discussed.

The relationship between impulsiveness and indirect aggression among Arab female adolescents in Israel: The mediating role of affiliation with delinquent peers and moderating role of closeness to parents.

This study examined the mediating role of affiliation with delinquent peers (ADP) and the moderating role of closeness to parents in the relationship between impulsivity and perpetration of indirect aggression. Arab female adolescents in Israel (aged 12-21; N = 404) completed a self-report questionnaire. The mediation-moderation model was examined after controlling for intersectional factors related to the females' unique social locations in Arab society. The study found that 66.1% of the girls had perpetrated at least one indirect act of aggression at least once during the past month. Moreover, most reported agreement with at least one item that examined their closeness to their father and mother (75.7% and 77%, respectively). The results also showed that the direct effect of impulsivity on perpetration of indirect aggression against others became significant after including the mediation factor (ADP). Finally, for high closeness to parents, the association between impulsivity and ADP was positive and significant, whereas it was insignificant for medium and low closeness. The findings highlight the importance of operationalized as parent-closeness to parents, child communication skills, boundary setting, and monitoring, which may decrease the tendency of adolescents to perpetrate aggression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Enhancing early language and literacy skills for racial/ethnic minority children with low incomes through a randomized clinical trial: The mediating role of cognitively stimulating parent-child interactions.

Parenting is a critical mediator of children's school readiness. In line with this theory of change, data from the randomized clinical trial of Smart Beginnings (tiered Video Interaction Project and Family Check-Up; N = 403, treatment arm n = 201) were used to examine treatment impacts on early language and literacy skills at child age 4 years (nLatinx = 168, nBlack = 198, nMale = 203), as well as indirect impacts through parental support of cognitive stimulation at child age 2 years. Although results did not reveal direct effects on children's early skills, there were significant indirect effects for early literacy (ß = .03, p = .05) and early language (ß = .04, p = .04) via improvements in parental cognitive stimulation. Implications for interventions targeting parenting to improve children's school readiness beginning at birth are discussed.

Asian American child-parent cultural value discrepancies, family conflict, life satisfaction, and self-esteem.

We examined Asian American college students' adherence to traditional values that are salient in Asian cultures, the students' perceptions of their mother's and father's adherence to the same values, and the discrepancies between the students and their mothers and fathers on the levels of adherence to these values. Based on the data from 301 participants who self-identified as Asian Americans, paired-samples t tests revealed that the child-parent cultural value discrepancies were present across all generational statuses of the participants with the children adhering less strongly to most of the value dimensions than their parents. The results based on correlational analyses showed that many types of value discrepancies were positively associated with the likelihood and seriousness of conflict. Several types of value discrepancies also were inversely associated with the participants' life satisfaction and self-esteem. In addition, the results from the PROCESS Macro for mediation analysis revealed significant mediation role of family conflict on the relationships between various types of value discrepancies and life satisfaction. The significant mediators were the likelihood and seriousness of family conflict and the family conflict about education and career decisions, and the value discrepancies centered on the values of conformity to norms, family recognition through achievement, and humility. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Scale of Parental Playfulness Attitude (PaPA): Psychometric Properties With Latino Caregivers in the United States.

IMPORTANCE: Parent-child play is a beneficial and meaningful co-occupation. Therapists who want to optimize parent-child play for Latino- and Latina-American dyads need valid, reliable measures to assess caregiver playfulness in addition to preexisting measures of child playfulness. OBJECTIVE: To evaluate data collected from Latino-American caregivers with the Scale of Parental Playfulness Attitude (PaPA), a 28-item parent self-report to determine its construct validity, internal reliability, and cross-cultural validity. DESIGN: Quantitative exploratory design applying a latent-trait psychometric model. SETTING: Online survey. PARTICIPANTS: Convenience sample of 50 Spanish-speaking parents from the mainland United States recruited via snowballing (88% mothers, ages 24-47 yr; M = 34.8 yr; 82% first-generation Americans). The inclusion criteria were age ≥18 yr; literate in Spanish; primary caregiver to a child age 2.5-7 yr. Data from an existing sample of 50 parents dwelling in Puerto Rico were used to examine cross-cultural validity. OUTCOMES AND MEASURES: Rasch analysis demonstrated evidence for adequate construct validity: positive point-measure correlations, 93% fit of items, logical item hierarchy, and good progression of the rating scale. Range and mean for parent playfulness exceeded those of the items; principal-components analysis revealed one contrast of 4.46 eigenvalues, bringing unidimensionality into question. Evidence suggested excellent internal reliability (person-reliability index = 0.85, strata = 3.55) and good cross-cultural validity (25 of 28 items formed a similar hierarchy for parents dwelling in the mainland United States and Puerto Rico). CONCLUSIONS AND RELEVANCE: Although the PaPA can be used to assess caregiver playfulness with culturally diverse Latino-American dyads, further research is required. What This Article Adds: This study provides evidence for the construct validity and internal reliability of a tool that measures parent playfulness in the context of parent-child play. The PaPA is an important tool for occupational therapists working with Latino-American families.

Autonomy-relatedness Patterns and their Association with Academic and Psychological Adjustment among Chinese Adolescents.

Establishing autonomy and maintaining relatedness with parents are two of the most crucial goals for adolescents and meeting these goals can be critical for academic and psychological adjustment. A two-dimensional framework was proposed for exploring the integrative synthesis of autonomy and relatedness, but its cultural applicability was limited. To better account for the situations associated with non-Western cultural context, this study extended the prior framework to three dimensions (volition, functional independence, and relatedness) and utilized latent profile analysis to explore the configurations and their concurrent and longitudinal (one year later) associations with adjustment (academic engagement, academic buoyancy, depressive symptoms, and externalizing problems). The study collected data from 3992 Chinese adolescents (51.33% girls, Mage = 15.41, SD = 0.55). Latent profile analyses identified five profiles: High, High Functional Independence, Moderate, Low Functional Independence, and Extremely Low Functional Independence. The High profile was the robust optimal pattern for academic and psychological adjustment, while the Low Functional Independence and Extremely Low Functional Independence were risk patterns over time. The High Functional Independence profile was only conducive to academic areas but not to psychological areas. Findings demonstrated the necessity of the three-dimensional framework in this field.

Stretched Kinship: Parental Rejection and Acceptance of Queer Youth in Chinese Families.

Kinship has been the primary concern among young queer people in today's China and other parts of Asia under the strong and ongoing familism, who often find it challenging to come out and negotiate their sexuality with their parental family. This paper adopts the concept of stretched kinship to critically analyze the digital videos released by PFLAG China (Parents and Friends of Lesbians and Gays in China) from 2015 to 2020, focusing on the experiences of the parents in their responses to young people's coming out. It both extends and challenges the concept of stretched kinship by turning the spotlight from queer youth to their parents-a topic often overlooked in queer Asian and Chinese studies-to examine how Chinese parents reject and accept their queer child contextualized in the rapid and ongoing social change in twenty-first-century China and Asia.

Age at Immigration and Depression: The Mediating Role of Contemporary Relationships With Adult Children Among Older Immigrants.

OBJECTIVES: For the growing population of older immigrants in the United States, both age at immigration and familial relationships are important factors affecting psychological well-being. This study explores how age at immigration and contemporary relationships with adult children combine to explain older immigrants' depressive symptoms. METHOD: This study uses 2014 Health and Retirement Study data from a sample of 759 immigrants aged 65 and older who have at least one adult child aged 21 or older. A series of ordinary least squares regressions and mediational analyses were conducted. RESULTS: Findings indicate that structural solidarity significantly mediates the association between age at immigration and depressive symptoms. Specifically, immigrating in later life was associated with a lower level of depressive symptoms through its relationship with structural solidarity. In addition, giving monetary support to children and providing care for grandchildren may alleviate depressive symptoms for older immigrants. DISCUSSION: This study suggests that relationships with adult children may differ with age at immigration. The types of support that older immigrants provide to their adult children may be crucial because such support may instill a sense of obligation and reciprocity that may be beneficial to the psychological well-being of older immigrants.

The Moderating Effects of the Families Improving Together (FIT) for Weight Loss Intervention and Parenting Factors on Family Mealtime in Overweight and Obese African American Adolescents.

Few studies have integrated positive parenting and motivational strategies to address dietary outcomes such as frequency of family mealtime. The Families Improving Together (FIT) for Weight Loss trial was a randomized group cohort trial (n = 241 dyads) testing the efficacy of integrating a motivational plus family weight loss (M + FWL) intervention for healthy eating and weight loss in overweight and obese African American adolescents. The current study tested the interaction of parenting styles (responsiveness, demandingness) and parental feeding practices (restriction, concern about child's weight, pressure to eat) and the FIT intervention on frequency of family mealtime over 16 weeks. Multilevel modeling demonstrated significant interactions between the group-based treatment and responsiveness (p = 0.018) and demandingness (p = 0.010) on family mealtime. For the group-based M + FWL intervention, increased responsiveness and reduced demandingness were associated with increased frequency of family mealtime from baseline to 16 weeks. There was also a negative association between parental restriction and frequency of family mealtime, but a positive association between parental concerns about their adolescent's weight and frequency of mealtime. These findings are the first to demonstrate that an authoritative or nurturing parenting style moderated intervention effects for improving the frequency of family mealtime in overweight and obese African American adolescents.

Filial Piety and Parental Depressive Symptoms: All Children Matter - Evidence from Rural Northern China.

Little research has considered all children while investigating adult children's role in their older parents' health and well-being. In this study, we examine the effect of filial piety across all children on parental depressive symptoms. A sample of 432 older parents with 1,223 adult children in a rural county in northern China rated the filial piety level for each child individually. Ratings were then combined across multiple children and organized into an ordinal variable of filial piety including three levels: all children being filial, some of the children being filial, and none of the children being filial. Ordinary least squares linear regression analyses were performed. The results reveal a significant and negative relationship between adult children's filial piety levels and older parents' depressive symptoms after controlling for age, gender, marital status, financial strain, chronic conditions, and social support from family and friends, respectively. That is, one level lower in the adult children's filial piety corresponds to increase in level of older parents' depressive symptoms. Filial piety seems to benefit older Chinese parents' mental health net of social support from family and friends in this sample. Including information from all children in the analyses is informative for better understanding the psychological significance of filial piety for healthy aging in China.

Improving Parent-Child Interactions in Pediatric Health Care: A Two-Site Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Heterogeneity in risk among low-income families suggests the need for tiered interventions to prevent disparities in school readiness. Smart Beginnings (SB) integrates two interventions: Video Interaction Project (VIP) (birth to 3 years), delivered universally to low-income families in pediatric primary care, and Family Check-Up (6 months to 3 years), targeted home visiting for families with additional family risks. Our objective was to assess initial SB impacts on parent-child activities and interactions at 6 months, reflecting early VIP exposure. METHODS: Two-site randomized controlled trial in New York City (84% Latinx) and Pittsburgh (81% Black), with postpartum enrollment and random assignment to treatment (SB) or control. At 6 months, we assessed parent-child interactions through surveys (StimQ, Parenting Your Baby) and observation (video-recorded play, coded by using Parent-Child Interaction Rating Scales - Infant Adaptation). RESULTS: A total of 403 families were enrolled at child's birth (201 treatment) with 362 (89.8%) assessed at 6 months. Treatment families had increased StimQ, including total score (Cohen's d = 0.28; P < .001) and domains reflecting reading (d = 0.23; P = .02) and teaching (d = 0.25; P = .01), and Parent-Child Interaction Rating Scales - Infant Adaptation, including a cognitive stimulation factor (d = 0.40; P < .001) and domains reflecting support for cognitive development (d = 0.36; P < .001), and language quantity (0.40; P < .001) and quality (d = 0.37; P < .001). Thus, significant effects emerged across a broad sample by using varied methodologies. CONCLUSIONS: Findings replicate and extend previous VIP findings across samples and assessment methodologies. Examining subsequent assessments will determine impacts and feasibility of the full SB model, including potential additive impacts of Family Check-Up for families at elevated risk.