Maternal empowerment, feeding knowledge, and infant nutrition: Evidence from rural China.

Background: Maternal empowerment - the capacity to make decisions within households - is linked to better child feeding and nutritional outcomes, but few studies have considered the mediating role of caregiver knowledge. Further, existing literature centres primarily on the husband-wife dyad while overlooking grandmothers as important childcare decision-makers. Methods: We collected primary data through household surveys in 2019 and 2021 from 1190 households with infants zero to six months living in rural western China. We identified the primary and secondary caregivers for each infant and assessed their feeding knowledge and practices, as well as infant nutritional status. We constructed a maternal empowerment index using a seven-item decision-making questionnaire and examined the relationship between maternal empowerment in childcare and household decisions, caregivers' feeding knowledge, and infant feeding practices and nutritional outcomes. Results: Mothers had significantly higher levels of feeding knowledge than secondary caregivers (most were grandmothers, 72.7%), with average knowledge scores of 5.4 vs. 4.1, respectively, out of 9. Mothers and secondary caregivers with higher levels of feeding knowledge had significantly higher exclusive breastfeeding rates by 13-15 percentage points (P < 0.01) and 11-13 percentage points (P < 0.01), respectively. The knowledge of secondary caregivers was even more strongly associated with not feeding formula (15 percentage points, P < 0.01). Mothers empowered to make childcare decisions were more likely to exclusively breastfeed (12-13 percentage points, P < 0.01), less likely to formula feed (9-10 percentage points, P < 0.05), and more likely to have children with higher Z-scores for length-for-age (0.32-0.33, P < 0.01) and weight-for-age (0.24-0.25, P < 0.05). Effects remained after controlling for maternal feeding knowledge. Conclusions: While mothers' and grandmothers' feeding knowledge was both important for optimal infant feeding, grandmothers' knowledge was particularly critical for practicing exclusive breastfeeding. Given the disparity in feeding knowledge between the two caregivers, our study further shows that mothers empowered in childcare decision-making were more likely to exclusively breastfeed their infants. This implies that some mothers with adequate knowledge may not practice optimal feeding because of lower decision-making power. Overall, our study highlights the role of secondary caregivers (grandmothers) in infant care and suggests that future child nutritional interventions may benefit from involving secondary caregivers (grandmothers). Registration: Parent trial registration: ISRCTN16800789.

Barriers and enablers to promoting grandchildren's physical activity and reducing screen time: a qualitative study with Australian grandparents.

BACKGROUND: With an increasing number of grandparents providing care to their grandchildren, calls have been made for these caregivers to be considered important stakeholders in encouraging children's engagement in health-promoting behaviors, such as physical activity. Understanding the perspectives of grandparents who provide care is crucial to informing efforts that aim to increase children's physical activity, yet little is understood about their perceptions of specific barriers and enablers to promoting children's physical activity and reducing screen time. The present study sought to explore these perceptions. METHODS: Semi-structured focus groups and individual interviews were conducted with grandparents who reported providing care to a grandchild aged 3 to 14 years. A total of 20 grandparents were sampled (mean age = 67.8 years). Data were subjected to reflexive thematic analysis. RESULTS: Key reported barriers to physical activity included (i) the effort (physical and logistical) and financial cost associated with organizing physical activities, (ii) grandparents' age and mobility issues (e.g., due to injury or illness), (iii) caring for children of different ages (e.g., older children having different physical activity interests than younger children), and (iv) a local environment that is not conducive to physical activity (e.g., lack of appropriate facilities). Barriers to reducing screen time included (i) parents sending children to care with electronic devices and (ii) children's fear of missing out on social connection that occurs electronically. Strategies and enablers of physical activity included (i) integrating activity into caregiving routines (e.g., walking the dog), (ii) involving grandchildren in decision making (e.g., asking them in which physical activities they wish to engage), (iii) encouraging grandchildren to engage in activity with other children, and (iv) creating a physical and social environment that supports activity (e.g., owning play equipment). A common strategy for reducing screen time was the creation of a home environment that is not conducive to this activity (e.g., removing electronic devices from view). CONCLUSIONS: Findings suggest that grandparents may benefit from resources that assist them to identify activities that are inexpensive and require minimal effort to organize. Activities that account for grandparents' age and health status, as well as any environmental barriers, are likely to be well-received.

The role of lack of grandparental support in perinatal depression.

BACKGROUND: Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general social support and neglected the roles of grandparents. Here, we examine whether a lack of grandparental support is related to increased risk of a diagnosis of perinatal depression. In addition, we examine whether poor grandparental support is related to more depressive symptoms in mothers with and without previously diagnosed perinatal depression and whether perceived grandparental support buffers against parenting difficulties in mothers with perinatal depression. METHODS: The sample was drawn from an Australian pregnancy cohort study and consisted of 725 women, including 230 women who met criteria for Major Depression. At 12 months postpartum, women reported on grandparental geographical proximity and hours of grandparental childcare support. Perceived grandparental support was assessed with the Postpartum Social Support Questionnaire and parenting difficulties and depressive symptoms with the Parenting Stress Index and the Edinburgh Postnatal Depression Scale. RESULTS: Perceived grandparental support was related to fewer depressive symptoms among mothers with perinatal depression. In addition, higher levels of perceived grandparental support were related to lower parenting stress in mothers with and without perinatal depression. LIMITATIONS: Intergenerational conflicts and quality of grandparenting were not assessed. CONCLUSIONS: Our findings indicate that supportive grandparents may prevent the development of more severe perinatal depression in mothers experiencing perinatal mental health problems. Future studies should examine whether involving grandparents in treatment may add to the effectiveness of existing perinatal mental health interventions.

Does Social Intelligence Training Improve Daily Well-Being and Responsiveness to Daily Negative and Positive Events in Custodial Grandmothers?

OBJECTIVES: Custodial grandparents are grandparents who raise grandchildren on a full-time basis in absence of the grandchild's birth parents. Compared to noncaregiving grandparents, custodial grandparents report poorer mental and physical health and stronger changes in daily well-being when experiencing negative and positive events. We examine whether an online social intelligence training (SIT) program improves custodial grandmothers' (CGM) daily well-being, socioemotional skills, and changes in well-being when confronted with daily negative and positive events. METHODS: Multilevel models were applied to 200 CGM who were recruited from across the United States and completed a daily survey for 14 consecutive days prior to and following participation in a randomized clinical trial. Participants were randomized into the SIT program or an attention control condition focusing on healthy living habits. The outcomes of interest were daily well-being, social connectedness, emotional awareness, and perspective-taking. RESULTS: Multilevel analyses revealed that participants who participated in the SIT program, compared to the attention control condition, exhibited stronger emotional responsiveness (i.e., improvements) to daily positive events in the outcomes of positive affect, social engagement, and perspective-taking. DISCUSSION: Our findings illustrate that SIT improves key components of daily functioning in CGM, which may serve as a pathway linking the demands of custodial grandparenting to poorer mental and physical health. Our discussion focuses on the utility and accessibility of the SIT program for helping improve outcomes for this disadvantaged population.Clinical Trials Registration Number: NCT03239977.

Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents' sexual and reproductive health needs in rural Zambia.

INTRODUCTION: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents' access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents' SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents' SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents. METHODS: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz's grounded theory approach was used for the analysis. RESULTS: We present the core category "being both a grandmother and a CBHW", which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents' SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges. CONCLUSION: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people's sexual and reproductive health.

Through the eyes of grandparents: an in-depth exploration of the nexus between grandchild caring and the psychological well-being of older grandparents.

BACKGROUND: Grandchild caring has positive as well as negative impact on the grandparents' psychological well-being and the findings are varied by culture and country. METHODS: Present study was intended to understand the relationship between caring for grandchildren and psychological well-being of grandparents living in skipped (SGH) and multi-generational households (MGH) in Indian demographical context. The present research involved In-depth Interviews (IDI) focusing on grandparents above 60 and grandchildren below 18, where the elder played a crucial role in caregiving. The study area was Malda, a district of West Bengal in India. Purposively 24 IDIs were selected. Psychological well-being was measured using open-ended questions. Thematic and content analyses were adopted to understand the perspective of grandparents. RESULTS: Most of the grandparents from SGH reported depression word frequently, while grandparents from MGH reported happy. In the content analysis, grandparents from SGH expressed tension, mental turmoil, and worry about grandchild's future. On the contrary, grandparents from MGH expressed happy, companionship, and worry about grandchild's future. Further, full time caring, compulsive reason behind grandchild caring, and working status were linked with living in SGH and grandchild caring, which were in turn connected with deteriorate psychological health. However, in MGH, a different scenario was observed, most grandparents were partially and non-compulsively engaged in grandchild caring and had expressed positive mental health. CONCLUSIONS: The Findings provide an intervention implication, particularly in the context of India's ageing population and their well-being by acknowledging the influence of household structure, caring intensity, motive behind grandchild caring, and working status on their psychological health. Understanding the importance of these key factors may help the policy maker and the individual to incorporate the most effective intervention to achieve sustainable development goal 3 and healthy ageing.

Influence of grandchildren on COVID-19 vaccination uptake among older adults in China: a parallel-group, cluster-randomized controlled trial.

The uptake of COVID-19 booster vaccination among older adults in China is suboptimal. Here, we report the results of a parallel-group cluster-randomized controlled trial evaluating the efficacy of promoting COVID-19 booster vaccination among grandparents (≥60 years) through a health education intervention delivered to their grandchildren (aged ≥16 years) in a Chinese cohort (Chinese Clinical Trial Registry: ChiCTR2200063240 ). The primary outcome was the uptake rate of COVID-19 booster dose among grandparents. Secondary outcomes include grandparents' attitude and intention to get a COVID-19 booster dose. A total of 202 college students were randomized 1:1 to either the intervention arm of web-based health education and 14 daily reminders (n = 188 grandparents) or control arm (n = 187 grandparents) and reported their grandparents' COVID-19 booster vaccination status at baseline and 21 days. Grandparents in the intervention arm were more likely to receive COVID-19 booster vaccination compared to control cohort (intervention, 30.6%; control, 16.9%; risk ratio = 2.00 (95% CI, 1.09 to 3.66)). Grandparents in the intervention arm also had greater attitude change (ß = 0.28 (95% CI, 0.04 to 0.52)) and intention change (ß = 0.32 (95% CI, 0.12 to 0.52)) to receive a COVID-19 booster dose. Our results show that an educational intervention targeting college students increased COVID-19 booster vaccination uptake among grandparents in China.

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

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

Look at Grandma! Joint visual attention over video chat during the COVID-19 pandemic.

Social interactions are crucial for many aspects of development. One developmentally important milestone is joint visual attention (JVA), or shared attention between child and adult on an object, person, or event. Adults support infants' development of JVA by structuring the input they receive, with the goal of infants learning to use JVA to communicate. When family members are separated from the infants in their lives, video chat sessions between children and distant relatives allow for shared back-and-forth turn taking interaction across the screen, but JVA is complicated by screen mediation. During video chat, when a participant is looking or pointing at the screen to something in the other person's environment, there is no line of sight that can be followed to their object of focus. Sensitive caregivers in the remote and local environment with the infant may be able to structure interactions to support infants in using JVA to communicate across screens. We observed naturalistic video chat interactions longitudinally from 50 triads (infant, co-viewing parent, remote grandmother). Longitudinal growth models showed that JVA rate changes with child age (4 to 20 months). Furthermore, grandmother sensitivity predicted JVA rate and infant attention. More complex sessions (sessions involving more people, those with a greater proportion of across-screen JVA, and those where infants initiated more of the JVA) resulted in lower amounts of JVA-per-minute, and evidence of family-level individual differences emerged in all models. We discuss the potential of video chat to enhance communication for separated families in the digital world.

Gender Differences in the Protective Role of Grandparenting in Dementia Risk.

OBJECTIVES: This study provides one of the first national longitudinal studies of the association between caring for grandchildren (i.e., grandparenting) and the risk of dementia in the United States, with a focus on gender-specific variations. METHODS: We estimated discrete-time event history models, drawing upon data from the Health and Retirement Study (2000-2016). The analytic sample included 10,217 community-dwelling White and Black grandparents aged 52 years and older at baseline. RESULTS: Noncoresident grandparenting was associated with a lower risk of dementia for both women and men compared to grandparents who did not take care of grandchildren. However, the cognitive advantage showed different patterns based on gender and the combination of care intensity and family structure. Grandmothers had a lower risk of dementia than noncaregiving grandmothers when providing a light level of noncoresident grandparenting, whereas grandfathers who provided intensive noncoresident grandparenting had a reduced risk of dementia compared to their noncaregiving counterparts. Grandparenting experiences within multigenerational households and skipped-generation households were not associated with dementia risk. DISCUSSION: Intergenerational caregiving plays a pivotal role in shaping cognitive health during later life; however, the impact is nuanced, depending on factors such as gender, care intensity, and family structure.

Investment by maternal grandmother buffers children against the impacts of adverse early life experiences.

Exogenous shocks during sensitive periods of development can have long-lasting effects on adult phenotypes including behavior, survival and reproduction. Cooperative breeding, such as grandparental care in humans and some other mammal species, is believed to have evolved partly in order to cope with challenging environments. Nevertheless, studies addressing whether grandparental investment can buffer the development of grandchildren from multiple adversities early in life are few and have provided mixed results, perhaps owing to difficulties drawing causal inferences from non-experimental data. Using population-based data of English and Welsh adolescents (sample size ranging from 817 to 1197), we examined whether grandparental investment reduces emotional and behavioral problems in children resulting from facing multiple adverse early life experiences (AELEs), by employing instrumental variable regression in a Bayesian structural equation modeling framework to better justify causal interpretations of the results. When children had faced multiple AELEs, the investment of maternal grandmothers reduced, but could not fully erase, their emotional and behavioral problems. No such result was observed in the case of the investment of other grandparent types. These findings indicate that in adverse environmental conditions the investment of maternal grandmothers can improve child wellbeing.

Revisiting the association between grandparenting and mental health in China: New evidence from the harmonized CHARLS.

BACKGROUND: In the context of the global aging challenge, an increasing number of middle-aged and older adults (MAOAs) are engaging in grandparenting. However, the effect of grandparenting on the mental health of caregivers has shown inconsistent findings. To effectively promote healthy aging, it is imperative to adopt a comprehensive perspective and employ a rigorous approach to further investigate the relationship between these two social phenomena. METHODS: The data from the Harmonized China Health and Retirement Longitudinal Study were analyzed, focusing on MAOAs with at least one grandchild. Mental health assessments used the center for epidemiologic studies depression scale scale. The study employed a series of difference-in-differences (DID) models, especially complemented by propensity score matching, to evaluate the average treatment effect for the treated (ATT) on mental health of caregivers, considering covariates like personal and family characteristics. The intervention perspective includes both the provision and cessation of grandparenting. RESULTS: The study found that providing grandchildren care does not have a significant effect on the mental health of grandparents, in comparison to those who have never engaged in such care (ATT = -0.172, T = 0.65, p = 0.517 in the PSM-DID model). Furthermore, ceasing this care also appears to have no substantial effect on the mental health of the caregivers, relative to individuals who have consistently offered grandchildren care (ATT = 0.060, T = 0.26, p = 0.795 in the PSM-DID model). Furthermore, subsequent robustness analyses consistently supported these findings, even when considering data from different survey waves. CONCLUSIONS: In contrast to many prior studies that have reported either positive or negative effects, our research reveals that grandparenting exerts no significant effect on the mental health of MAOAs. Consequently, health practitioners and policymakers should carefully consider the diverse cultural context when tailoring interventions and support strategies.

Discriminative Grandparental Investment in China : Evidence from an Undergraduate Questionnaire Study.

Many studies in Western societies show a pattern of discriminative grandparental investment as follows: maternal grandmothers (MGMs) > maternal grandfathers (MGFs) > paternal grandmothers (PGMs) > paternal grandfathers (PGFs). This pattern is in line with the expectation from evolutionary reasoning. Yet whether or not this pattern applies in China is in question. The present study was based on a questionnaire survey at a university in Central China (N = 1,195). Results show that (1) when grandparent-grandchild residential distance during grandchildren's childhood is controlled, in the case of grandsons and granddaughters as a whole and granddaughters only, both grandparental caregiving and grandchildren's emotional closeness to grandparents display a rank order of MGM > MGF > PGM > PGF, but in the case of grandsons only, this order is not statistically significant. (2) There are stable relationships between grandparental caregiving/grandchildren's emotional closeness and residential distance/similarity in appearance. (3) The effects of residential distance on either PGFs' or PGMs' caregiving exceed those on either MGFs' or MGMs'. (4) The PGF and PGM prefer grandsons to granddaughters in their caregiving, whereas the MGF and MGM do not have a sex preference, and (5) the fact that the PGF and PGM invest more in grandsons than in granddaughters does not depend on grandsons' duration of living in a rural area. Our results suggest that (1) in general, the Chinese display a pattern of differential grandparental investment predicted by an evolutionary perspective, (2) the evolutionary perspective that combines the two factors of paternal uncertainty and sex-specific reproductive strategies is applicable to grandparental investment in China, and (3) the traditional son-preference culture also plays some role in affecting grandparental investment in China, though the roles of culture and urban-rural cultural difference should not be exaggerated.

Exploring grandparents' psychosocial responses to childhood cancer: A qualitative study.

OBJECTIVE: A childhood cancer diagnosis is a traumatic experience for patients and their families. However, little is known about the effect on grandparents. We aimed to investigate the negative psychosocial impact, coping strategies, and positive outcomes of grandparents of childhood cancer patients in Switzerland. METHODS: We collected data using a semi-structured interview guide and applied qualitative content analysis. RESULTS: We conducted 20 interviews with 23 grandparents (57% female; mean age = 66.9 years; SD = 6.4; range = 57.0-82.4) of 13 affected children (69% female; mean age = 7.5 years; SD = 6.1; range = 1.0-18.9) between January 2022 and April 2023. The mean time since diagnosis was 1.0 years (SD = 0.5; range = 0.4-1.9). Grandparents were in shock and experienced strong feelings of fear and helplessness. They were particularly afraid of a relapse or late effects. The worst part for most was seeing their grandchild suffer. Many stated that their fear was always present which could lead to tension and sleep problems. To cope with these negative experiences, the grandparents used internal and external strategies, such as accepting the illness or talking to their spouse and friends. Some grandparents also reported positive outcomes, such as getting emotionally closer to family members and appreciating things that had previously been taken for granted. CONCLUSIONS: Grandparents suffer greatly when their grandchild is diagnosed with cancer. Encouragingly, most grandparents also reported coping strategies and positive outcomes despite the challenges. Promoting coping strategies and providing appropriate resources could reduce the psychological burden of grandparents and strengthen the whole family system.

Distinct patterns of grandparental involvement in childrearing and Chinese preschoolers' social-emotional development.

Grandparental involvement in childrearing has been associated with children's social-emotional development, yet findings are mixed. Grandparental involvement is a multidimensional concept that includes both quantity (i.e., the degree of grandparental involvement) and quality aspects (i.e., the quality of parent-grandparent coparenting and the quality of grandparenting practices). This study included both quantity and quality aspects to identify heterogeneous patterns of grandparental involvement and examined the associations between distinct patterns of grandparental involvement and children's social-emotional outcomes. Participants were 428 families with Chinese preschoolers (Mage = 53.75 months, SD = 10.32; 51.4% boys). Primary parental and grandparental caregivers completed the questionnaires. Four patterns of grandparental involvement emerged: the low-involvement mediocre-quality, the median, the high-involvement uneven-quality, and the high-involvement high-quality groups. Heterogeneous patterns of grandparental involvement exist and are differentially associated with children's social-emotional development. Children with grandparents in the high-involvement high-quality group demonstrated higher levels of social skills than those in the low-involvement mediocre-quality group and the high-involvement uneven-quality group. They also showed the lowest level of problem behaviors. This study highlights variations in grandparental involvement and helps to clarify previous inconsistent findings regarding the role of grandparental involvement in child development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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

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

A Randomized Clinical Trial of Online Social Intelligence Training With Custodial Grandmothers.

BACKGROUND AND OBJECTIVES: In this study, we investigated the efficacy of a self-administered, online Social Intelligence Training (SIT) program aimed at enhancing psychological and relational well-being among a nationwide U.S. sample of custodial grandmothers. RESEARCH DESIGN AND METHODS: A two-arm randomized clinical trial (RCT) was conducted, where 349 grandmothers raising grandchildren aged 11-18 years were assigned to either SIT or an attention control condition (ACC). Participants self-completed online surveys at baseline and immediately postintervention, in addition to follow-ups at 3-, 6-, and 9-month postintervention. First-order latent difference score models were used to compare SIT to ACC, across all times of measurement, along key indicators of psychological and relational well-being on an intent-to-treat basis. RESULTS: Although SIT was largely superior to ACC at yielding positive results, it appears that it attenuated longitudinal declines that occurred among ACC participants. SIT also exerted stronger effects on relational than psychological outcomes, with perceived relations with grandchildren being the most positively affected. DISCUSSION AND IMPLICATIONS: Given that the historical time of this RCT unpredictably corresponded with the coronavirus disease 2019 pandemic, we suspect that SIT helped offset declines in psychological and relational well-being that are widely documented to have resulted from the pandemic. Our overall positive findings support future use of the inexpensive and easily delivered SIT program under normal environmental conditions, with the vulnerable and geographically disperse population of custodial grandmothers. CLINICAL TRIALS REGISTRATION NUMBER: NCT03239977.