Associations of Pre- and Postnatal Air Pollution Exposures with Child Blood Pressure and Modification by Maternal Nutrition: A Prospective Study in the CANDLE Cohort.

BACKGROUND: Limited data suggest air pollution exposures may contribute to pediatric high blood pressure (HBP), a known predictor of adult cardiovascular diseases. METHODS: We investigated this association in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study, a sociodemographically diverse pregnancy cohort in the southern United States with participants enrolled from 2006 to 2011. We included 822 mother-child dyads with available address histories and a valid child blood pressure measurement at 4-6 y. Systolic (SBP) and diastolic blood pressures (DBP) were converted to age-, sex-, and height-specific percentiles for normal-weight U.S. children. HBP was classified based on SBP or DBP ≥90th percentile. Nitrogen dioxide (NO2) and particulate matter ≤2.5µm in aerodynamic diameter (PM2.5) estimates in both pre- and postnatal windows were obtained from annual national models and spatiotemporal models, respectively. We fit multivariate Linear and Poisson regressions and explored multiplicative joint effects with maternal nutrition, child sex, and maternal race using interaction terms. RESULTS: Mean PM2.5 and NO2 in the prenatal period were 10.8 [standard deviation (SD): 0.9] µg/m3 and 10.0 (SD: 2.4) ppb, respectively, and 9.9 (SD: 0.6) µg/m3 and 8.8 (SD: 1.9) ppb from birth to the 4-y-old birthday. On average, SBP percentile increased by 14.6 (95% CI: 4.6, 24.6), and DBP percentile increased by 8.7 (95% CI: 1.4, 15.9) with each 2-µg/m3 increase in second-trimester PM2.5. PM2.5 averaged over the prenatal period was only significantly associated with higher DBP percentiles [ß= 11.6 (95% CI: 2.9, 20.2)]. Positive associations of second-trimester PM2.5 with SBP and DBP percentiles were stronger in children with maternal folate concentrations in the lowest quartile (pinteraction= 0.05 and 0.07, respectively) and associations with DBP percentiles were stronger in female children (pinteraction= 0.05). We did not detect significant association of NO2, road proximity, and postnatal PM2.5 with any outcomes. CONCLUSIONS: The findings suggest that higher prenatal PM2.5 exposure, particularly in the second trimester, is associated with elevated early childhood blood pressure. This adverse association could be modified by pregnancy folate concentrations. https://doi.org/10.1289/EHP7486.

Family science and family-based research in integrated and health care contexts: Future considerations for Families, Systems, & Health.

The focus on families and application to health sets Families, Systems, & Health apart from other sister journals. Family science is a thriving field of study experiencing rapid advances in the discovery, verification, and application of knowledge about families (Burr, Day, & Bahr, 1993; Doherty, Boss, LaRossa, Schumm, & Steinmetz, 1993; National Council on Family Relations [NCFR] Task Force on the Development of a Family Discipline, 1988). It is essential that these advances in family science are transferable to research focused on families in integrated health care contexts, and it is our hope that Families, Systems, & Health with be at the forefront in disseminating this work. While there is an abundance of research focused on families and health outcomes, there is much less focused on the dissemination and implementation of family-based interventions in health care and integrated health care contexts. In order to advance our understanding how family members are included in family-based interventions, it is essential to operationalize how family-based interventions involve and assess families. In this editorial, we describe the foundations of family science and health, how these foundations inform family-based research, and the translational bridge of family-based research in health care. We conclude by describing a tiered approach for family involvement and assessment in family-based interventions taking place in health care, with specific attention on dissemination and implementation research in integrated care settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Sleep intervention for children with asthma and their parents (SKIP Study): a novel web-based shared management pilot study.

STUDY OBJECTIVES: The objective of this study was to describe the feasibility, acceptability, and preliminary efficacy of a novel Sleep Intervention for Kids and Parents (SKIP). Parent and child primary sleep outcomes were total sleep time, wake after sleep onset (WASO), sleep efficiency (SE), and bedtime range. METHODS: Children 6-11 years of age with asthma and 1 parent, both with behavioral sleep disturbance, enrolled in this single-group pilot. The 8-week shared management intervention included weekly online educational modules, goal setting, and progress reporting. Feasibility was measured by the number of dyads who were eligible, enrolled, and retained. Acceptability was measured by survey and semistructured interview. Total sleep time, WASO, SE, and bedtime range were measured by actigraphy at baseline, after the intervention, and 12-week follow-up. Mixed-effects regression models were used to determine change in sleep outcomes from baseline. RESULTS: Thirty-three of 39 eligible dyads enrolled; of 29 dyads that started the intervention, 25 (86%) completed all study visits. SKIP was acceptable for 61% of children and 92% of parents. Compared with baseline, at follow-up, children had significantly improved WASO (-37 minutes; 95% confidence interval [CI], -44.5 to -29.7; P < .001), SE (5.4%; 95% CI, 4.2-6.5; P < .001), and bedtime range (-35.2 minutes; 95% CI, -42.9 to -27.5; P < .001). Parents also had significantly improved WASO (-13.9 minutes; 95% CI, -19.5 to -8.2; P < .001), SE (2.7%; 95% CI, 1.7-.7; P < .001), and bedtime range (-35.3 minutes; 95% CI, -51.0 to -19.7; P < .001). CONCLUSIONS: SKIP was feasible, acceptable, and we observed improved child and parent sleep outcomes except total sleep time. Following refinements, further testing of SKIP in a controlled clinical trial is warranted. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Sleep Intervention for Kids and Parents: A Self-Management Pilot Study; URL: https://www.clinicaltrials.gov/ct2/show/study/NCT03144531; Identifier: NCT03144531.

Associations Among Behavioral Sleep Disturbance, Family Functioning, and Controller Medication Adherence in Children with Asthma.

OBJECTIVE: This study examined the associations among child sleep disturbances, family functioning, and asthma controller medication adherence in school-age children with persistent asthma. METHODS: Thirty-four children aged 6 to 11 years and a parent independently reported on asthma control and controller medication adherence. Parents also reported on family functioning (behavior control) and child sleep disturbances (bedtime resistance, daytime sleepiness). Hierarchical linear regression models tested sleep disturbance variables as predictors of family functioning and medication adherence. A mediation model tested behavior control as a mediator between sleep disturbance and medication adherence. RESULTS: Seventy-nine percent of the children had well-controlled asthma. Despite a mean of 9.48 hours of child sleep per night, 73% of the children had clinically significant disturbed sleep. Controlling for child age, bedtime resistance accounted for 32% of the variance in family behavior control (F(1,31) = 14.75, p < .01). Behavior control also significantly mediated the relationship between total sleep disturbance and medication adherence, with a standardized indirect effect of ß = -.17 (95% confidence interval [CI], -.47 to -.03) for parent-reported adherence and ß = -.12 (95% CI, -.36 to -.01) for child-reported adherence. CONCLUSION: Child behavioral sleep disturbances significantly predicted family behavior control. Although child sleep disturbances did not significantly predict asthma controller medication adherence, there was a significant indirect effect of sleep disturbance on medication adherence through compromised family behavior control. Developmentally appropriate behavioral sleep interventions may improve family functioning and child asthma controller medication adherence. Family functioning may also be an entry point for intervention to improve medication adherence.

Reformulating the Common Sense Model of Self-Regulation: Toward Parent-Child Shared Regulation.

Asthma is one of the most common chronic diseases of childhood with nearly 7 million children affected in the United States. Nonadherence to controller medication is a substantial issue that results in higher pediatric asthma disease morbidity. The common sense model of self-regulation is a useful theoretical framework to understand chronic disease self-management in adults, but has not been used in the context of pediatric chronic disease. Using Fawcett's framework, the authors analyze and evaluate the common sense model. To conclude, the authors propose a reformulation of the model that incorporates parent-child shared regulation of pediatric asthma.

Parent and child asthma illness representations: a systematic review.

OBJECTIVE: The purpose of this article is to synthesize the current literature on parent and child asthma illness representations and their consequent impact on parent-child asthma shared management. DATA SOURCES: This systematic review was conducted in concordance with the PRISMA statement. An electronic search of five computerized databases (PubMed, PsycINFO, CINAHL, Cochrane, and EMBASE) was conducted using the following key words: asthma, illness representation, and child. Due to the limited number of articles identified, the search was broadened to include illness perceptions as well. STUDY SELECTIONS: Studies were included if they were specific to asthma and included parent and/or child asthma illness representations or perception, were published after 2000, and available in English. Fifteen articles were selected for inclusion. All of the articles are descriptive studies that used cross-sectional designs. Seven of the studies used parent and child participants, eight used parents only, and none used only child participants. RESULTS: None of the selected studies describe child asthma illness representations, and only three describe parental asthma illness representations. Domains of illness representations, including symptoms, timeline, consequences, cause, and controllability were described in the remaining articles. Symptoms and controllability appear to have the most influence on parental asthma management practices. Parents prefer symptomatic or intermittent asthma management and frequently cite concerns regarding daily controller medication use. Parents also primarily rely on their own objective symptom observations rather than the child's report of symptoms. CONCLUSION: Asthma illness representations are an important area of future study to better understand parent-child shared asthma management.