Effect of a Mobile Game-Based Intervention to Enhance Child Safety: Randomized Controlled Trial.

BACKGROUND: Evidence supports the effectiveness of serious games in health education, but little is known about their effects on the psychosocial well-being of children in the general population. OBJECTIVE: This study aimed to investigate the potential of a mobile game-based safety education program in improving children's safety and psychosocial outcomes. METHODS: Safe City is a mobile roleplaying game specifically designed to educate children in Hong Kong about safety. This randomized controlled trial included 340 children in grades 4 through 6. Intervention arm participants (n=170) were instructed to play the Safe City mobile game for 4 weeks, whereas control arm participants (n=170) received a safety booklet. All participants completed a survey on safety knowledge and behaviors and psychosocial problems at baseline (T1), 1 month postintervention (T2), and 3 months postintervention (T3). Cumulative game scores and mini-game performance were analyzed as a proxy for the extent of exposure to the game. Outcome data were analyzed using 2-sample 2-tailed t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. The association of game use with outcome changes postintervention was analyzed using generalized additive models. RESULTS: No significant differences were found in mean changes between the intervention and control arms. However, use analyses showed that higher game scores were associated with improvements in safe behavior (P=.03) and internalizing problems (P=.01) at T3. Matching and Spot the Danger mini-game performance significantly predicted improvements in safety knowledge at T2 and T3. CONCLUSIONS: Analysis of use has shown that playing the Safe City mobile game can result in significant improvements in safety knowledge and reductions in unsafe behavior and internalizing problems. These findings provide evidence for the positive impact of serious games on psychological and social well-being, highlighting the potential of technology-driven interventions to assist children in learning about safety and preventing injuries. TRIAL REGISTRATION: ClinicalTrials.org NCT04096196; https://clinicaltrials.gov/show/NCT04096196. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/17756.

Longitudinal associations between child discipline methods and physical growth patterns across preschool years.

OBJECTIVE: Research has documented the associations of child maltreatment with a range of physical health problems, but little is known about the physical growth patterns of children who experience maltreatment in early childhood. This study aimed to examine the association between various discipline approaches and physical growth in preschool-aged children. METHODS: In the first year of preschool, parents of 661 Chinese preschool-aged children completed a questionnaire with items pertaining to the frequency of using physical maltreatment, psychological aggression, neglect, and nonviolent discipline toward the child. Children's weight and height were assessed annually using direct assessment in the first and two subsequent years. Longitudinal analyses were performed using multiple regression models. RESULTS: More frequent neglect and psychological aggression during the first year of preschool were associated with a higher likelihood of a decreased BMI z score in subsequent years. Conversely, increased experience of physical maltreatment in the first year was associated with an increased likelihood of having overweight or obesity in the third year. CONCLUSIONS: Results indicate that early maltreatment experience can impact physical growth. This highlights the importance of preventing abusive parenting and encouraging healthy habits in young children who have experienced maltreatment to decrease their future risk for weight problems.

Associations between childhood maltreatment and psychiatric disorders: analysis from electronic health records in Hong Kong.

There has been a lack of high-quality evidence concerning the association between childhood maltreatment and psychiatric diagnoses particularly for Axis II disorders. This study aimed to examine the association between childhood maltreatment exposure and Axis I and Axis II psychiatry disorders using electronic health records. In this study, the exposed group (n = 7473) comprised patients aged 0 to 19 years with a first-time record of maltreatment episode between January 1, 2001 and December 31, 2010, whereas the unexposed group (n = 26,834) comprised individuals of the same gender and age who were admitted into the same hospital in the same calendar year and month but had no records of maltreatment in the Hong Kong Clinical Data Analysis and Reporting System (CDARS). Data on their psychiatric diagnoses recorded from the date of admission to January 31, 2019 were extracted. A Cox proportional hazard regression model was fitted to estimate the hazard ratio (HR, plus 95% CIs) between childhood maltreatment exposure and psychiatric diagnoses, adjusting for age at index visit, sex, and government welfare recipient status. Results showed that childhood maltreatment exposure was significantly associated with subsequent diagnosis of conduct disorder/ oppositional defiant disorder (adjusted HR, 10.99 [95% CI 6.36, 19.01]), attention deficit hyperactivity disorder (ADHD) (7.28 [5.49, 9.65]), and personality disorders (5.36 [3.78, 7.59]). The risk of psychiatric disorders following childhood maltreatment did not vary by history of childhood sexual abuse, age at maltreatment exposure, and gender. Individuals with a history of childhood maltreatment are vulnerable to psychiatric disorders. Findings support the provision of integrated care within the primary health care setting to address the long-term medical and psychosocial needs of individuals with a history of childhood maltreatment.

Early-life activities mediate the association between family socioeconomic status in early childhood and physical fitness in early adolescence.

The graded association between family socioeconomic status (SES) and physical fitness is evident, but little is known about the mechanism underlying this association. This study investigated the role of early-life activities as mediators of the longitudinal relationship between early-life SES and health-related physical fitness in 168 adolescents (51.2% boys; final mean age: 12.4 years old). In Wave 1 (2011-12), their parents completed questionnaires about family socioeconomic status (SES), parent-child activities, and child screen time. In Wave 2 (2014-15), participants' physical activity levels were assessed through parent proxy-reports. In Wave 3 (2018-19), a direct assessment of handgrip strength, standing long-jump, and 6-min walk test (6MWT) performance was conducted. After controlling for demographic factors, results of mediation analyses revealed that (a) Wave 1 SES predicted Wave 3 long-jump and 6MWT performance; (b) child physical activity level in Wave 2 mediated the relation between Wave 1 SES and standing long-jump performance in Wave 3; and (c) recreational parent-child activities and child screen time in wave 1 mediated the relation between Wave 1 SES and 6MWT performance in Wave 3. Our findings suggest that the type and frequency of early-life activities play a role in the graded association between childhood SES and physical fitness in adolescence.

A Longitudinal Study of the Relation between Childhood Activities and Psychosocial Adjustment in Early Adolescence.

BACKGROUND: Although an increasing body of research shows that excessive screen time could impair brain development, whereas non-screen recreational activities can promote the development of adaptive emotion regulation and social skills, there is a lack of comparative research on this topic. Hence, this study examined whether and to what extent the frequency of early-life activities predicted later externalizing and internalizing problems. METHODS: In 2012/13, we recruited Kindergarten 3 (K3) students from randomly selected kindergartens in two districts of Hong Kong and collected parent-report data on children's screen activities and parent-child activities. In 2018/19, we re-surveyed the parents of 323 students (aged 11 to 13 years) with question items regarding their children's externalizing and internalizing symptoms in early adolescence. Linear regression analyses were conducted to examine the associations between childhood activities and psychosocial problems in early adolescence. RESULTS: Early-life parent-child activities (ß = -0.14, p = 0.012) and child-alone screen use duration (ß = 0.15, p = 0.007) independently predicted externalizing problems in early adolescence. Their associations with video game exposure (ß = 0.19, p = 0.004) and non-screen recreational parent-child activities (ß = -0.14, p = 0.004) were particularly strong. CONCLUSIONS: Parent-child play time is important for healthy psychosocial development. More efforts should be directed to urge parents and caregivers to replace child-alone screen time with parent-child play time.

Associations of Family Meals with Adolescent Perception of Family Relationship and Compliance with Parental Guidance in Hong Kong: Results of a Representative Cross-Sectional Survey.

Family meals are beneficial for adolescent development, but evidence from Chinese populations has been limited. This study aimed to examine the associations between family meal frequency and adolescent perception of family relationship and compliance with parental guidance in Hong Kong. During the period from October to December 2016, a stratified random sample of 3359 students were recruited from 25 secondary schools in Hong Kong. Students completed questionnaires about family characteristics, relationship quality, and meal frequency by paper-and-pencil in class. Multiple regression analyses were conducted to examine the associations between family meal frequency and perceived family relationship and compliance with parental guidance overall and by subgroups. After adjusting for sociodemographic and school confounders, family breakfast and dinner frequency were significantly associated with adolescent compliance (breakfast: B = 0.07, p < 0.001; dinner: B 0.07, p < 0.001) and perception of family relationship (breakfast: B = 0.10, p < 0.001; dinner: B = 0.25, p < 0.001). Risk factors for infrequent family meals included older age, not born in Hong Kong, less educated fathers, and unmarried parents. Our findings support the associations of regular family meals with adolescent perception of high family bond and compliance with parental guidance. Interventions are needed to enhance quality family meal interactions in disadvantaged families.

Risk of Child Maltreatment in Chinese Teenage and Young Mothers With Rapid Repeat Pregnancy: The Moderating Role of Family Cohesion and Support From Friends.

Rapid repeat pregnancy (RRP) often occurs in teenage and young mothers. Mothers with a history of RRP are more likely to experience high stress increasing their risk of child maltreatment. Despite these challenges, some mothers can continue to cope adaptively. Social support may play a role in empowering these mothers to overcome the childbearing difficulties. Although the protective effects of social support are well recognized, there has been little evidence on the relative importance of sources of support. For example, whether support from family and friends is equally important in relieving parenting stress remains unanswered. RRP, a social phenomenon encompassing various adverse living and parenting issues, provides an ideal research context to investigate the role of family and friends in preventing child maltreatment. This study examined whether family cohesion and friends' support moderated the association between RRP and child maltreatment in young mothers. We recruited 392 Chinese teenage and young mothers from a population-based integrated young mothers supporting program in Hong Kong. Questionnaires on pregnancy history, family cohesion, social support, and risk of child maltreatment were administered. Moderation analysis was conducted to examine the effect of RRP on child maltreatment as a function of family cohesion or friend support. Results showed that RRP was associated with a higher risk of child neglect (adjusted odds ratio [aOR] = 1.72, p < .05) and physical maltreatment (aOR = 1.91, p < .01), and that family cohesion was more important than friend support in mitigating the risk of child maltreatment for mothers with a history of RRP. Our findings suggest that interventions for young mothers, particularly those with a history of RRP, should be family-based so the whole family can be empowered to tackle the childrearing burden.

Disentangling the Effects of Exposure to Maternal Substance Misuse and Physical Abuse and Neglect on Child Behavioral Problems.

There is inconsistent evidence on the association between prenatal substance exposure and child behavioral problems. Children affected by maternal substance misuse are vulnerable to physical abuse and neglect. Few studies have examined factors contributing to internalizing and externalizing problems in these children. This study, with a focus on children with prenatal substance exposure, investigated whether family characteristics (the duration of maternal substance misuse postpartum or the existence of a sibling) moderated the association between adverse exposure (physical abuse or neglect) and behavior (internalizing or externalizing problems). We recruited 54 Hong Kong Chinese mothers with registered records of substance misuse during pregnancy and their children (2-9 years). Mothers completed questionnaires on drug use patterns during pregnancy and postpartum, abusive and neglectful parenting behaviors in the preceding year, and children's current behavioral problems. Moderated regression analyses tested whether abusive and neglectful parenting behavior interacted with family characteristics to affect child behavioral problems. The existence of a sibling moderated the relationship between neglect experience and internalizing problems, with a positive relationship observed only among single children (adjusted B [95% confidence interval] = 3.70 [0.98, 6.41], p = .012). The duration of maternal substance misuse postpartum moderated the relationship between physical abuse experience and externalizing problems, with a positive relationship observed only among children of mothers abusing substances beyond the child's infancy period (adjusted B [95% confidence interval] = 6.86 [2.34, 11.38], p = .008). The results show that the impact of physical abuse and neglect experiences depend on the type of behavior assessed and family and child characteristics. Positive sibling relationship and early detoxification in the mother can foster healthy behavioral development for children exposed prenatally to maternal substance misuse.

The association of grip strength with health outcomes does not differ if grip strength is used in absolute or relative terms: a prospective cohort study.

BACKGROUND: higher grip strength is associated with better health outcomes. The optimal way to report grip strength (i.e. absolute vs. relative) for prediction, however, remains to be established. METHODS: in participants (aged 37-73 at baseline) from the UK Biobank, we examined the associations of grip strength, expressed in absolute terms (kilograms) and relative to anthropometric variables, with mortality and disease incidence, after exclusion of the first 2 years of follow-up, and compared risk predictions scores of handgrip strength when differentially expressed. RESULTS: of the 356 721 participants included in the analysis 6,234 died (1.7%) and 4,523 developed CVD (1.3%) over a mean follow-up of 5.0 years (ranging from 3.3 to 7.8) for mortality and 4.1 years (ranging from 2.4 to 7.0) for disease incidence data. As expected, baseline higher grip strength was associated with lower risk of all-cause and cause specific mortality and incidence. These associations did not meaningfully differ when grip-strength was expressed in absolute terms, vs. relative to height, weight, fat-free mass, BMI, fat-free mass index and fat-free mass, or as z-scores. Similarly the different ways of expressing grip strength had little effect on the ability of grip strength to improve risk prediction, based on C-index change, of an office-based risk score. CONCLUSIONS: the ability of grip strength to predict mortality is not altered by changing how it is expressed.