Paternal depression in the postpartum year and children's behaviors at age 5 in an urban U.S. birth cohort.

OBJECTIVE: To investigate associations between postpartum depression in fathers and children's behaviors at age 5 in a national high-risk U.S. sample. STUDY DESIGN: A secondary data analysis of 1,796 children in a national birth cohort study that oversampled non-marital births was conducted. Paternal depression was assessed 1 year after the child was born and children's behaviors were assessed by their primary caregivers when the children were 5 years old. Unadjusted and adjusted negative binomial regression models of associations between paternal depression and child behavior scores and logistic regression models of associations between paternal depression and high scores (at least 1.5 or 2.0 standard deviations above the mean) were estimated. RESULTS: In negative binomial regression models that adjusted for child, paternal, and family characteristics and maternal depression, paternal depression was associated with a 17% higher total externalizing behavior score (Incidence Rate Ratio (IRR): 1.17; 95% Confidence Interval (CI): 1.07-1.27), a 17% higher aggressive subscale score (IRR: 1.17; 95% CI: 1.08-1.27), and an 18% higher delinquent subscale score (IRR: 1.18; 95% CI: 1.03-1.35). In adjusted logistic regression models for scores ≥2.0 standard deviations above the mean, paternal depression was associated with high total externalizing scores (e.g., Odds Ratio (OR): 3.09; 95% CI: 1.77-5.41), high aggressive behavior scores (OR: 2.40; 95% CI: 1.30-4.43), and high delinquent behavior scores (OR: 2.08; 95% CI: 1.01-4.27). There were suggestive but non-robust associations between paternal depression and attention problems and no associations between paternal depression and internalizing behaviors or social problems. CONCLUSION: Fathers' depression at age 1 was associated with children's externalizing behaviors at age 5, an important developmental stage when children transition to school. These findings suggest a need to identify and support fathers with depressive symptoms to promote optimal child development.

Chronic health conditions and adolescents' social connectedness.

This study investigated associations between chronic developmental/behavioral and physical health conditions and social connectedness of adolescents using rich population-based data from a national U.S. birth cohort study. Potentially disabling health conditions were reported by caregivers and categorized by our team as developmental/behavioral or physical. Social connectedness was assessed using a validated scale that measured adolescents' reports of positive social connectedness across relevant contexts (family, friends, school). Of the 3,207 adolescents included, over one third had at least one chronic health condition. Unadjusted and adjusted linear and logistic regression models of associations between the presence of chronic health conditions (any developmental/behavioral health condition and any physical health condition, compared to no conditions) and adolescents' social connectedness outcomes were estimated. Compared to those with no chronic health conditions, adolescents with developmental/behavioral health conditions had lower odds of high positive social connectedness scores (adjusted odds ratio [AOR]: 0.80; CI [0.67, 0.94]), having friends they really care about (AOR: 0.76; CI [0.61, 0.94]), having people who care (AOR: 0.65; CI [0.50, 0.84]), and having people with whom to share good news (AOR: 0.77; CI [0.63, 0.94]). Adolescents with chronic physical health conditions had lower odds of reporting having people who care about them (AOR: 0.72; CI [0.55, 0.94]). The findings point to the need for interventions designed to foster the development of positive interpersonal relationships, reduce loneliness, and increase positive social identity among adolescents with chronic health conditions, particularly those with developmental/behavioral health conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Stress and Infant Media Exposure During COVID-19: A Study Among Latino Families.

OBJECTIVE: The COVID-19 pandemic disproportionately harmed Latino families; however, its effects on their stress and media routines remain understudied. We examined economic and parenting stress patterns during the COVID-19 pandemic and estimated associations between these forms of stress and nonadherence to American Academy of Pediatrics (AAP) infant media exposure recommendations among Latino families. We also explored how nonadherence with AAP recommendations varied with COVID-19 cases. METHODS: We analyzed baseline data from an ongoing clinical trial recruiting low-income Latino parent-infant dyads. Nonadherence with AAP media exposure recommendations (ScreenQ) and economic and parent stress were measured using parent reports. Additional variables included epidemiological data on COVID-19 cases. Linear models examined associations between the pandemic and both stress variables as well as between stress and ScreenQ. Using locally weighted scatterplot smoothing curve fitting, the rise and fall of NJ COVID-19 cases were overlayed with ScreenQ scores over time to visualize and explore trends. RESULTS: All parents identified as Latino (62.6% unemployed, 91.5% limited English proficiency). Mean infant age was 8.2 months. Parent stress increased over time during the COVID-19 pandemic (r = 0.13, p = 0.0369). After covariate adjustment, economic and parent stress were associated with increased nonadherence with AAP recommendations (standardized beta = 0.16, 95% confidence interval [CI], 0.03-0.29; standardized beta = 0.18, 95% CI, 0.04-0.31, respectively). Nonadherence to media exposure recommendations seemed to track with rises in the number of COVID-19 cases with a lag of 7 days. CONCLUSION: Parent and economic stress were associated with nonadherence to infant media exposure recommendations among Latino families. These findings highlight the need for practitioners to support families from under-resourced communities and to promote healthy media routines.

Maximizing the impact of reach out and read literacy promotion:anticipatory guidance and modeling.

BACKGROUND: Reach Out and Read (ROR) is a multi-component pediatric literacy promotion intervention. However, few studies link ROR components to outcomes. We examine associations between receipt of (1) multiple ROR components and (2) clinician modeling, a potential best practice, with enhanced home literacy environments (EHLEs) among Latino families. METHODS: We conducted secondary analyses of cross-sectional enrollment data from a randomized clinical trial at three urban community health centers between November 2020 and June 2023. Latino parents with infants 6-<9 months old were surveyed about ROR component receipt (children's book, anticipatory guidance, modeling) and EHLE (StimQ2- Infant Read Scale). We used mixed models with clinician as a random effect, adjusting for covariates. RESULTS: 440 Latino parent-infant dyads were included. With no components as the reference category, receipt of 1 component was not associated with EHLE. Receipt of 2 components (standardized beta = 0.27; 95%CI: 0.12-0.42) and 3 components (standardized beta = 0.33; 95% CI: 0.19-0.47) were associated with EHLE. In separate analyses, modeling was associated with EHLE (standardized beta = 0.16; 95%CI: 0.06-0.26). CONCLUSION: Findings support modeling as a core ROR component. Programs seeking to enhance equity by promoting EHLE should utilize such strategies as anticipatory guidance and clinician modeling in addition to book distribution. IMPACT: Reach Out and Read, a multi-component literacy promotion intervention, leverages primary care to promote equity in children's early language experiences. However, few studies link Reach Out and Read components to outcomes. Among Latino parent-infant dyads, we found that implementation of two and three components, compared to none, was associated with enhanced home literacy environments, following a dose response pattern. Parent report of clinician modeling was associated with enhanced home literacy environments. Literacy promotion programs seeking to enhance equity by promoting enhanced home literacy environments should utilize strategies in addition to book distribution, including anticipatory guidance and modeling, to maximize impact.

Early Literacy Promotion Using Automated Hovering Among Young Minority Children.

OBJECTIVE: To determine feasibility, acceptability, and explore outcomes of behavioral economic (BE) strategies to increase parent-child shared reading within a Reach Out and Read program. METHODS: We conducted rapid-cycle interviews with 10 parents to assess text messages followed by an 8-week randomized controlled trial of 3 BE strategies at 2 urban primary care practices: daily text messages (texting); daily text messages and regret messaging (regret); or daily text messages, regret messaging, and lottery participation (lottery). Parent-child dyads were eligible if children were <24 months old, Medicaid-eligible, and had access to phones capable of receiving and sending text messages. Parents completed the Read Subscale of the StimQ and Parenting Stress Index-short form (PSI-SF) pre- and postintervention, MacArthur Communicative Development Inventory (CDI), Devereux Early Childhood Assessment (DECA), and a satisfaction measure postintervention. Differences between groups were assessed using intention-to-treat analysis. RESULTS: Of 45 dyads randomized, 41 (91%) completed the study. Most participants were Black with incomes <$55,000. Parents reported reading on average 4 d/wk with no change in the reading frequency over time. StimQ scores increased over time, but there were no significant differences in StimQ, PSI-SF, CDI, and DECA scores between groups. Parents in all 3 groups reported satisfaction (3.8/5.0) with the intervention. CONCLUSIONS: Implementation of BE strategies in 2 Reach Out and Read programs was feasible, near acceptable, and improved home reading environment scores. Future study should investigate BE strategies vis-à-vis usual care and be of sufficient duration and intensity to engage participants to assess its impact on patient and parent outcomes.

Connect: Cultivating Academic-Community Partnerships to Address Our Communities' Complex Needs During Public Health Crises.

BACKGROUND: Black and Latino communities have been disproportionately impacted by coronavirus disease 2019 and we sought to understand perceptions and attitudes in four heavily impacted New Jersey counties to develop and evaluate engagement strategies to enhance access to testing. OBJECTIVE: To establish a successful academic/community partnership team during a public health emergency by building upon longstanding relationships and using principles from community engaged research. METHODS: We present a case study illustrating multiple levels of engagement, showing how we successfully aligned expectations, developed a commitment of cooperation, and implemented a research study, with community-based and health care organizations at the center of community engagement and recruitment. LESSONS LEARNED: This paper describes successful approaches to relationship building including information sharing and feedback to foster reciprocity, diverse dissemination strategies to enhance engagement, and intergenerational interaction to ensure sustainability. CONCLUSIONS: This model demonstrates how academic/community partnerships can work together during public health emergencies to develop sustainable relationships.

Exclusion of Families Who Speak Languages Other than English from Federally Funded Pediatric Trials.

OBJECTIVE: To determine whether individuals in the United States who speak languages other than English (LOE) are excluded from federally funded pediatric clinical trials and whether such trials adhere to the National Institutes of Health policy regarding inclusion of members of minority groups. STUDY DESIGN: Using ClinicalTrials.gov, we identified all completed, federally funded, US-based trials inclusive of children ≤17 and focused on one of 4 common chronic childhood conditions (asthma, mental health, obesity, and dental caries) as of June 18, 2019. We reviewed ClinicalTrials.gov online content, as well as published manuscripts linked to ClinicalTrials.gov entries, to abstract information about language-related exclusion criteria. Trials were deemed to exclude LOE participants/caregivers if explicit statements regarding exclusion were identified in the study protocol or published manuscript. RESULTS: Of total, 189 trials met inclusion criteria. Two-thirds (67%) did not address multilingual enrollment. Of the 62 trials that did, 82% excluded LOE individuals. No trials addressed the enrollment of non-English, non-Spanish-speaking individuals. In 93 trials with nonmissing data on ethnicity, Latino individuals comprised 31% of participants in trials that included LOE individuals and 14% of participants in trials that excluded LOE individuals. CONCLUSIONS: Federally funded pediatric trials in the United States do not adequately address multilingual enrollment, a seeming violation of federal and contractual requirements for accommodation of language barriers by entities receiving federal funding.

Use of Adolescent "Community Researchers" to Address Obesity Among Mexican Immigrant Families.

Background: Mexican-American immigrants have a disparate prevalence of overweight/obesity, and obesogenic illness. One approach is to train immigrant adolescents as "community researchers." Aims: (1) Design a program to train community researchers to address obesity among Mexican immigrant families and (2) identify the key components of a successful program. Methods: The content included an overview of community research/citizen science; obesity and food insecurity; study design and data collection and analysis for nutrition and physical activity. The students concluded by analyzing the results of group concept mapping (GCM) activities. Results: Post-session class discussions reflected an increased understanding of weekly topics. Analysis of GCM data suggests that members of the Mexican immigrant community may use emotional eating as a way to manage structural stigma, eventually leading to truncal obesity, T2DM and increased cardiovascular risk. Conclusions: Adolescents of Mexican heritage can have a major impact in promoting healthy lifestyles in their communities.

Feasibility and Acceptability of an Online Family Literacy Program in an Under-Resourced Community During the COVID-19 Pandemic.

OBJECTIVE: The objective of this study was to examine the feasibility and acceptability of an online family literacy program (FLP) among low-income Latino families during the COVID-19 pandemic. METHODS: We conducted a mixed methods pilot study. Latino parent-child dyads participated in an 8-week online FLP conducted on video conferencing software, developed through a cross-sector health care-education partnership. We conducted surveys and structured observation to assess feasibility and acceptability and in-depth interviews to gain insight into the context of participants' experiences during the pandemic. RESULTS: The 35 participating parent-child dyads all identified as Latino, 83% reported limited English proficiency, and 60% of parents did not achieve a high school diploma. Nearly two-thirds of families participated in at least half of the sessions. On average, parents welcomed, liked, approved, and found the program appealing. While 86% experienced a technology problem at least once during sessions, all were resolved with minimal assistance. During qualitative interviews, we identified 3 themes that provide insight into their experiences with the FLP within the broader context of the pandemic: (1) disruption in family routine and financial strain caused by COVID-19 intensified family stress, (2) the forced transition to remote learning highlighted the inequities experienced by Latino preschool children, and (3) the FLP empowered parents and enhanced health and education experiences. CONCLUSION: Latino families had high participation levels in an online FLP and found it acceptable. Additional work is needed to understand how similar primary care programs can be leveraged to promote optimal development during a time of heightened need.

Reach Out and Read Implementation: A Scoping Review.

BACKGROUND: Reach Out and Read (ROR) is an evidence-based literacy promotion intervention that leverages the near-universal access to children of primary care practices to promote optimal child development. While several studies document ROR's effectiveness, its implementation remains understudied. OBJECTIVE: This scoping review examines the existing literature to better understand ROR implementation. DATA SOURCES: PubMed, ERIC, Web of Science, Academic Search Premier, ProQuest Education Database, and CINAHL. STUDY SELECTION: We included peer-reviewed English-language papers focusing on ROR in an ambulatory setting in North America. DATA EXTRACTION: Extracted variables were informed by the Template for Intervention Description and Replication checklist and included publication year, title, author(s), clinic location, study design, study aim, ROR implementation, modifications, implementation assessment, barriers, facilitators, and outcomes. RESULTS: Seventy-one papers were included, of which 43 were research articles. We identified substantial variation in ROR implementation including differences in components delivered. A considerable number of research articles did not assess ROR implementation. The most common barriers to ROR implementation were at the system level (ie, financing and inadequate time). Modifications and enhancements to ROR are emerging; most address barriers at the clinician and family level. LIMITATIONS: This review was limited to published English language papers focusing on ROR. CONCLUSIONS: ROR implementation varies across studies, and many did not assess implementation. Consistent reporting and assessment of ROR implementation could create opportunities to better understand the mechanisms underlying ROR's effects and inform other early childhood interventions that seek to promote optimal development at the population level.

A Mixed-Methods Investigation Examining Site-Level Variation in Reach Out and Read Implementation.

OBJECTIVE: Reach Out and Read (ROR) is an evidence-based early childhood intervention that has been implemented at scale, yet description of ROR implementation is inconsistent. This study engages implementation science to examine ROR delivery and site-level variation. METHODS: As part of an ongoing clinical trial, we conducted a mixed-methods study in 3 community health centers (CHCs) that serve low-income Latino families. We integrated quantitative parent survey data, qualitative data from monthly key informant interviews with ROR site leaders over 1 year, and in-depth interviews with 18 additional clinicians. At enrollment, parents reported whether they received a children's book, guidance on reading, and modeling from clinicians. We analyzed quantitative data using descriptive statistics, and qualitative data iteratively engaging emergent and a priori codes drawn from the Template for Intervention Description and Replication Checklist. RESULTS: Three hundred Latino parents (mean age: 31; 75% ≤HS education) completed surveys. The mean child age was 8 months. Overall, most parents reported receiving a book (84%) and guidance (73%), but fewer experienced modeling (23%). Components parents received varied across CHCs. Two themes emerged to explain the variation observed: 1) differences in the perceived purpose of shared reading and book delivery aligned with variation in implementation, and 2) site-level barriers affected what components were implemented. CONCLUSION: Because of substantive variation in ROR implementation across sites, systematic descriptions using established frameworks and corresponding measurement to characterize ROR implementation may enhance our understanding of mechanisms underlying ROR's effects, which clinicians and policymakers can use to maximize ROR's impact.

Community- Versus Health Care Organization-Based Approaches to Expanding At-Home COVID-19 Testing in Black and Latino Communities, New Jersey, 2021.

At-home COVID-19 testing offers convenience and safety advantages. We evaluated at-home testing in Black and Latino communities through an intervention comparing community-based organization (CBO) and health care organization (HCO) outreach. From May through December 2021, 1100 participants were recruited, 94% through CBOs. The odds of COVID-19 test requests and completions were significantly higher in the HCO arm. The results showed disparities in test requests and completions related to age, race, language, insurance, comorbidities, and pandemic-related challenges. Despite the popularity of at-home testing, barriers exist in underresourced communities. (Am J Public Health. 2022;112(S9):S918-S922. https://doi.org/10.2105/AJPH.2022.306989).

Parental Depression Screening in Pediatric Health Care Settings: A Scoping Review.

BACKGROUND AND OBJECTIVES: Parental depression affects as many as 1 in 5 US families. Pediatric professionals can play an important role in detecting parental depression, yet most studies on parental depression screening focus only on the postpartum period. The authors performed this scoping review to understand the existing literature on parental depression screening outside the postpartum period (child >12 months old) and to identify knowledge gaps. METHODS: Sources for this research include PubMed, CINAHL, SCOPUS, Web of Science, and APA Psych Info. We included English language papers concerning screening for maternal and/or paternal depression or mood disorders outside of the postpartum period by pediatric clinicians or in a pediatric health care setting. Extracted variables included publication year, title, author(s), country, geographic setting, clinical setting, child age range (in years), parental focus, sample size, study type, approach, screening instrument(s), and findings. RESULTS: Forty-one papers were included. The proportion of positive parental depression screens was consistently high across the included studies. Relatively few structured screening programs outside of the postpartum period were identified, especially for fathers. The included studies suggest that screening can be accomplished in pediatric settings, but appropriate referral and follow-up of positive screens poses a major challenge. This review was limited to English language papers concerning parental depression outside of the postpartum period. CONCLUSIONS: These findings suggest that screening for parental depressive symptoms outside the postpartum period could identify families in need of support. Research is required to identify best practices for referral and follow-up of parents who screen positive.

Association Between Adverse Childhood Experiences at Age 5 Years and Healthcare Utilization at Age 9 Years.

OBJECTIVE: To determine associations between adverse childhood experiences (ACEs) at age 5 years and healthcare utilization patterns at age 9 years. STUDY DESIGN: We conducted a secondary analysis using longitudinal data from the Fragile Families and Child Wellbeing Study. Caregivers (n = 2521) provided data on their child's ACEs at age 5 years and on 4 types of healthcare utilization at age 9 years: past-year well visits, dental visits, primary care sick visits for injury or illness, and emergency room (ER) visits. Logistic regression analysis was used to examine the association between ACEs at age 5 and each type of healthcare utilization, adjusting for relevant sociodemographic covariates. RESULTS: Among the 2521 children (51% male, 48% Non-Hispanic Black), 77% had ≥1 ACE at age 5. Children with ≥4 ACEs had lower odds of a dental visit (aOR, 0.51; 95% CI, 0.29-0.91) and higher odds of a primary care sick visit (aOR, 1.77; 95% CI, 1.20-2.64) and an ER visit (aOR, 1.70; 95% CI, 1.11-2.59) compared with children with no reported ACEs. CONCLUSION: Our findings demonstrate suboptimal healthcare utilization patterns among families with ACEs and indicate a need for targeted interventions that support appropriate healthcare utilization for children who endure adversity.

Experiences of Black and Latinx health care workers in support roles during the COVID-19 pandemic: A qualitative study.

Black and Latinx individuals, and in particular women, comprise an essential health care workforce often serving in support roles such as nursing assistants and dietary service staff. Compared to physicians and nurses, they are underpaid and potentially undervalued, yet play a critical role in health systems. This study examined the impact of the coronavirus disease 2019 (COVID-19) pandemic from the perspective of Black and Latinx health care workers in support roles (referred to here as HCWs). From December 2020 to February 2021, we conducted 2 group interviews (n = 9, 1 group in English and 1 group in Spanish language) and 8 individual interviews (1 in Spanish and 7 in English) with HCWs. Participants were members of a high-risk workforce as well as of communities that suffered disproportionately during the pandemic. Overall, they described disruptive changes in responsibilities and roles at work. These disruptions were intensified by the constant fear of contracting COVID-19 themselves and infecting their family members. HCWs with direct patient care responsibilities reported reduced opportunities for personal connection with patients. Perspectives on vaccines reportedly changed over time, and were influenced by peers' vaccination and information from trusted sources. The pandemic has exposed the stress endured by an essential workforce that plays a critical role in healthcare. As such, healthcare systems need to dedicate resources to improve the work conditions for this marginalized workforce including offering resources that support resilience. Overall working conditions and, wages must be largely improved to ensure their wellbeing and retain them in their roles to manage the next public health emergency. The role of HCWs serving as ambassadors to provide accurate information on COVID-19 and vaccination among their coworkers and communities also warrants further study.

Adolescent Chronic Health Conditions and School Disconnectedness.

OBJECTIVE: The objective of this study was to examine associations between chronic health conditions and school disconnectedness, trouble getting along with others at school, and peer victimization at age 15. METHOD: We conducted a secondary analysis of population-based data from the Fragile Families and Child Wellbeing birth cohort to investigate associations between chronic developmental/behavioral and physical health conditions and school disconnectedness, trouble getting along with others at school, and peer victimization of adolescents using mother-reported child health conditions and youth-reported relationships/experiences at school ascertained from standardized scales. Associations were examined using linear and logistic regression models adjusting for confounding factors. RESULTS: Of the 2874 adolescents included, more than one-third had at least 1 chronic health condition. Compared with those with no chronic health conditions, adolescents with developmental/behavioral health conditions felt more disconnected from school (by 0.22 SDs), had more trouble getting along with others at school (0.22 SD), and were more victimized by peers at school (0.20 SD). Teens with physical health conditions also felt more disconnected from school (0.10 SD), had more trouble getting along with others at school (0.12 SD), and were more victimized by peers (0.12 SD). One noteworthy difference was that adolescents with developmental/behavioral conditions were more likely than those with no conditions to report trouble getting along with teachers, but adolescents with physical health conditions were not. CONCLUSION: Chronic health conditions were associated with disconnectedness from school and negative school social interactions in this study of US urban youth, suggesting that targeted resources and interventions for this population are needed.

Black and Latinx Community Perspectives on COVID-19 Mitigation Behaviors, Testing, and Vaccines.

Importance: Black and Latinx communities have been disproportionately affected by the COVID-19 pandemic, yet little work has sought to understand their perspectives. Objective: To explore the experiences of Black and Latinx communities during the pandemic to better understand their perspectives on COVID-19 mitigation behaviors (eg, mask wearing), testing, and vaccines. Design, Setting, and Participants: In this community-engaged qualitative study conducted with 18 community-based organizations and 4 health care organizations between November 19, 2020, and February 5, 2021, in New Jersey counties severely affected by the pandemic, group and individual interviews were used to purposively sample 111 Black and Latinx individuals. A total of 13 group interviews were organized by race/ethnicity and language: 4 English-speaking groups with Black participants (n = 34), 3 Spanish-speaking groups with Latinx participants (n = 24), and 4 English-speaking groups with Black and Latinx participants (n = 36). To understand the views of health care workers from these communities, 2 additional groups (n = 9) were convened and supplemented with individual interviews. Main Outcomes and Measures: Description of Black and Latinx participants' experiences during the COVID-19 pandemic and their perspectives on mitigation behaviors, testing, and vaccines. Results: The study included 111 participants (87 women [78.4%]; median age, 43 years [range, 18-93 years]). Participants described the devastating effects of the pandemic on themselves, loved ones, and their community. Their experiences were marked by fear, illness, loss, and separation. These experiences motivated intense information seeking, mitigation behaviors, and testing. Nevertheless, vaccine skepticism was high across all groups. Participants did not trust the vaccine development process and wanted clearer information. Black participants expressed that they did not want to be subjects of experiments. Conclusions and Relevance: The remaining unknowns about new vaccines need to be acknowledged and described for Black and Latinx communities to make informed decisions. Ultimately, scientists and public officials need to work transparently to address unanswered questions and work collaboratively with trusted community leaders and health professionals to foster partnered approaches, rather than focusing on marketing campaigns, to eliminate vaccine skepticism.

Promoting Early Literacy Using Digital Devices: A Pilot Randomized Controlled Trial.

OBJECTIVE: To determine feasibility and explore effects of literacy promotion using e-books versus board books on the home reading environment, book reading, television use, and child development. METHODS: Randomized controlled trial comparing digital literacy promotion (DLP) using e-books to standard literacy promotion (SLP) using board books among Medicaid-eligible infants. DLP participants received e-books on home digital devices, while SLP participants received board books at well visits between 6 and 12 months of age. Differences in StimQ Read Subscale (StimQ-Read) scores, parent-reported reading and television use, and Bayley Scales of Infant Development-3rd Edition (Bayley-3) scores between groups were assessed using intention-to-treat analysis. RESULTS: A total of 104 Medicaid-eligible infants were enrolled and randomized from 3 pediatric practices. There were no differences in sociodemographic characteristics between groups at baseline. Children in the DLP group initially had lower StimQ-Read scores but showed similar increases in StimQ-Read scores over time as children in the SLP group. Parents in the DLP group reported greater use of digital devices to read or engage their child (65% vs 23%, P < .001) but similar board book reading and television viewing. There were no differences between groups in cognitive or motor scale scores, but DLP participants had marginally lower language scales scores (DLP 85.7 vs SLP 89.7; P = .10) at the 6-month follow-up. CONCLUSIONS/DISCUSSION: Literacy promotion using e-books was feasible and associated with greater e-book usage but no difference in board book reading, television viewing, or home reading environment scores. A potential adverse impact of e-books on language development should be confirmed in future study.

Adverse Childhood Experiences and Teen Behavior Outcomes: The Role of Disability.

OBJECTIVE: To examine associations between adverse childhood experiences (ACEs) and teen behavior outcomes and whether the presence of disability moderates this relationship. METHODS: We conducted a secondary analysis of population-based data from the Fragile Families & Child Wellbeing Study urban birth cohort. Disability status included physical/developmental/behavioral conditions (ages 1-5) using mother-reported child health conditions and cognitive disability (age 9), measured by the Peabody Picture Vocabulary Test (PPVT), an assessment of receptive vocabulary. We investigated whether either disability type moderates the relationship between ACEs occurring between ages 5 to 9 and behavior outcomes at age 15, specifically, standardized scales of caregiver-reported externalizing and youth-reported internalizing and delinquent behaviors. Associations were examined using multivariate linear regression models, including interaction effects of ACEs with low PPVT score and disability conditions to assess for potential moderation. RESULTS: Of the 3038 children included, 15% had a cognitive disability and 24% had a disabling health condition. The presence of 2 or more ACEs (compared to none) is associated with more externalizing (by 0.34 standard deviations [SD]), internalizing (0.18 SD), and delinquent (0.18 SD) behaviors. Cognitive disability exacerbates this association for externalizing behaviors and delinquent behaviors while other disabling health conditions do not. CONCLUSIONS: ACEs were associated with more behavior problems among urban youth. Cognitive disability, but not other disabling health conditions, compounded this association for externalizing and delinquent behaviors, indicating these children may be particularly vulnerable to the effects of trauma and adversity. Targeted assessment and resources for youth with cognitive disability are critical.

Exploring the Experiences of Families of Latino Children Newly Diagnosed With Autism Spectrum Disorder.

OBJECTIVE: Understanding families' experiences from their initial developmental concerns through the first several months after autism spectrum disorder (ASD) diagnosis might help explain persistent disparities in age of diagnosis for low-income Latino children and those whose parents speak a primary language other than English. We explored these experiences among Latino parents of children recently diagnosed with ASD to develop a richer understanding of this critical juncture. METHOD: We conducted semistructured interviews with Latino parents of children diagnosed with ASD in the previous 3 months who were receiving follow-up care through a large, hospital-based outpatient practice. Interviews were recorded, transcribed verbatim, translated, and analyzed using an iterative process. RESULTS: Twenty parents participated in a semistructured interview approximately 3 months after their child was diagnosed with ASD. All respondents were female and Latina, 90% spoke Spanish, and 95% of children received Medicaid. We identified the following 3 themes from their experiences: (1) When parents first shared their concerns about their child's development with professionals, they felt unheard. (2) Parents were surprised that the diagnostic process for ASD relied on parental description of child development and behavior and observation of the child, not on medical tests. (3) Receiving an ASD diagnosis was a life-altering event for parents, and how that diagnosis was communicated by clinicians had a significant impact on families. CONCLUSION: Parents of young Latino children identified several barriers throughout the process of ASD identification and diagnosis that have important implications for improving clinician communication with families.