Empathy across three generations: From maternal and peer support in adolescence to adult parenting and child outcomes.

This study examined the development of empathic care across three generations in a sample of 184 adolescents in the United States (99 female, 85 male; 58% White, 29% African American, 8% mixed race/ethnicity, 5% other groups), followed from their family of origin at age 13 into their parenting years (through their mid-30s). Mothers' empathic support toward adolescents at age 13 predicted teens' empathy for close friends across adolescence (13-19 years). Participants' empathic support for friends in late adolescence predicted more supportive parenting behavior in adulthood, which in turn was associated with their children's empathy at age 3-8 years. Results suggest that individuals "pay forward" the empathic care they receive from parents, and that skills developed in adolescent friendships may inform later parenting.

Adolescent responses to paternal verbal aggression: Assessing spillover and compensatory processes using random intercept cross-lagged panel models.

INTRODUCTION: Prior research suggests several pathways through which verbal aggression manifests across adolescent relationship contexts, including spillover (continuity of aggression across different relationships) and compensation (offsetting an aggressive relationship with less aggression in other relationships). These pathways vary across timescales in ways that between-person analytic approaches are unlikely to adequately capture. The current study used random intercept cross-lagged panel modeling (RI-CLPM) to examine adolescents' spillover and compensatory responses to paternal verbal aggression. METHODS: Participants were 184 adolescents (53.2% female) from a United States community sample participating in a longitudinal study. Annually from ages 13-17, participants reported on their experiences of verbal aggression in their paternal and maternal relationships and participated in observed interactions with a close peer that were coded for aggressive behavior. RESULTS: Spillover was observed from father-adolescent to mother-adolescent and adolescent-peer contexts in analyses at the between-person level, likely capturing long-term, cumulative effects of paternal aggression. Conversely, compensation was observed in analyses at the within-person level, likely capturing medium-term (i.e., year-to-year) adaptations to paternal aggression: Adolescents who experienced more aggression from their father than expected at a specific time point were less likely to both perpetrate and experience aggression in maternal and peer relationships the following year. Several findings differed across teen gender, with compensation more likely to occur in males than females. CONCLUSIONS: These findings highlight the multiple pathways by which father-adolescent aggression may be linked to behavior in other relationships in the medium- and long-term. They also support the value of RI-CLPM in decomposing these effects.

Love on the developing brain: Maternal sensitivity and infants' neural responses to emotion in the dorsolateral prefrontal cortex.

Infancy is a sensitive period of development, during which experiences of parental care are particularly important for shaping the developing brain. In a longitudinal study of N = 95 mothers and infants, we examined links between caregiving behavior (maternal sensitivity observed during a mother-infant free-play) and infants' neural response to emotion (happy, angry, and fearful faces) at 5 and 7 months of age. Neural activity was assessed using functional Near-Infrared Spectroscopy (fNIRS) in the dorsolateral prefrontal cortex (dlPFC), a region involved in cognitive control and emotion regulation. Maternal sensitivity was positively correlated with infants' neural responses to happy faces in the bilateral dlPFC and was associated with relative increases in such responses from 5 to 7 months. Multilevel analyses revealed caregiving-related individual differences in infants' neural responses to happy compared to fearful faces in the bilateral dlPFC, as well as other brain regions. We suggest that variability in dlPFC responses to emotion in the developing brain may be one correlate of early experiences of caregiving, with implications for social-emotional functioning and self-regulation.

Food Insecurity and Health Inequities in Food Allergy.

PURPOSE OF REVIEW: The intersection of food insecurity among those with food allergy is a growing public health concern. Both food allergy and food insecurity have profound implications on health, social, and economic outcomes. The interaction of social determinants of health, poverty, racism, housing insecurity, and access to care has direct impact on individuals with food allergy. RECENT FINDINGS: There is increasing evidence that universal screening for food insecurity is vital in the routine care of patients with food allergy. Individuals with food allergy who are also burdened by food insecurity face unique challenges related to the need to maintain dietary modifications often with expensive specialized diets, which are difficult to access. This may lead to limited dietary options, malnutrition, increased financial burden, and social isolation. While there are available resources and support systems that can assist individuals with food allergies in managing food insecurity, there is an increasing need for advocacy and inclusivity in policy frameworks involving multiple stakeholders. Multi-sector efforts involving healthcare providers and advocacy and government agencies are necessary to support policy changes that protect the rights and well-being of individuals affected by food allergy and food insecurity. By increasing awareness, improving access to safe, affordable, allergen-free food, and advocating for policy change, we can work toward ensuring universal access to safe, nutritious food for all individuals, regardless of their food allergy status or socioeconomic background.

Developmental trajectories of adolescent internalizing symptoms and parental responses to distress.

Parents' responses to their children's negative emotions are a central aspect of emotion socialization that have well-established associations with the development of psychopathology. Yet research is lacking on potential bidirectional associations between parental responses and youth symptoms that may unfold over time. Further, additional research is needed on sociocultural factors that may be related to the trajectories of these constructs. In this study, we examined associations between trajectories of parental responses to negative emotions and adolescent internalizing symptoms and the potential role of youth sex and racial identity. Adolescents and caregivers (N = 256) completed six assessments that spanned adolescent ages 13-18 years. Multivariate growth models revealed that adolescents with higher internalizing symptoms at baseline experienced increasingly non-supportive parental responses over time (punitive and distress responses). By contrast, parental responses did not predict initial levels of or changes in internalizing symptoms. Parents of Black youth reported higher minimization and emotion-focused responses and lower distress responses compared to parents of White youth. We found minimal evidence for sex differences in parental responses. Internalizing symptoms in early adolescence had enduring effects on parental responses to distress, suggesting that adolescents may play an active role in shaping their emotion socialization developmental context.

Pathways from adolescent close friendship struggles to adult negative affectivity.

This 19-year prospective study applied a social development lens to the challenge of identifying long-term predictors of adult negative affectivity. A diverse community sample of 169 individuals was repeatedly assessed from age 13 to age 32 using self-, parent-, and peer-reports. As hypothesized, lack of competence establishing and maintaining close friendships in adolescence had a substantial long-term predictive relation to negative affectivity at ages 27-32, even after accounting for prior depressive, anxious, and externalizing symptoms. Predictions also remained robust after accounting for concurrent levels of depressive symptoms, indicating that findings were not simply an artifact of previously established links between relationship quality and depressive symptoms. Predictions also emerged from poor peer relationships within young adulthood to future relative increases in negative affectivity by ages 27-32. Implications for early identification of risk as well as for potential preventive interventions are discussed.

Unique roles of adolescents' friends and fathers in predicting verbal aggression in future adult romantic relationships.

This 20-year prospective study examined verbal aggression and intense conflict within the family of origin and between adolescents and their close friends as predictors of future verbal aggression in adult romantic relationships. A diverse community sample of 154 individuals was assessed repeatedly from age 13 to 34 years using self-, parent, peer, and romantic partner reports. As hypothesized, verbal aggression in adult romantic relationships was best predicted by both paternal verbal aggression toward mothers and by intense conflict within adolescent close friendships, with each factor contributing unique variance to explaining adult romantic verbal aggression. These factors also interacted, such that paternal verbal aggression was predictive of future romantic verbal aggression only in the context of co-occurring intense conflict between an adolescent and their closest friend. Predictions remained robust even after accounting for levels of parental abusive behavior toward the adolescent, levels of physical violence between parents, and the overall quality of the adolescent's close friendship. Results indicate the critical importance of exposure to aggression and conflict within key horizontal relationships in adolescence. Implications for early identification of risk as well as for potential preventive interventions are discussed.

Social problem solving moderates emotion reactivity in predicting suicide ideation among college students.

Objective: To evaluate the hypothesis that social problem solving (SPS) moderates strong emotion reactivity (ER) to stressful events in predicting suicide ideation (SI). Participants: 200 college students: mean age = 20.33; 75% women; 58% white. Methods: Participants completed the following self-report inventories: Beck Scale for Suicide Ideation, Emotion Reactivity Scale, and Social Problem-Solving Inventory-Revised. Results: Regression and slope analyses found SPS to moderate the association between ER and SI. Specifically, (a) as ER increased, SI increased significantly less for average problem solvers as compared to ineffective problem solvers, and (b) SI increased only slightly for effective problem solvers as ER increased. A secondary exploratory analysis found 20 college students who previously attempted suicide reported more negative ER, less effective SPS, and higher SI, as compared to a group of 20 sex-and age-matched peers. Conclusions: Effective social problem solving serves to decrease the likelihood that college students will experience higher levels of suicide ideation even when their negative emotion reactivity is high. Clinical implications for treatment and prevention are discussed.

Impact of antimicrobial stewardship interventions on peripartum antibiotic prescribing in patients with penicillin allergy.

BACKGROUND: Beta-lactam antibiotics (eg, penicillins, cephalosporins, and carbapenems) are preferred for group B streptococcus prophylaxis, intra-amniotic infection, and cesarean surgical site infection prophylaxis. Non-beta-lactam alternatives are associated with inferior efficacy and contribute to higher rates of surgical site infection and longer lengths of stay. Most patients who report a penicillin allergy can tolerate penicillins without any adverse reaction. There are low rates of cross-reactivity between penicillins and other beta-lactams, including cephalosporins and carbapenems. Efforts to evaluate penicillin allergy and promote the use of beta-lactams are needed. OBJECTIVE: This study aimed to evaluate whether an antimicrobial stewardship intervention improved the use of first-line antibiotics for peripartum indications in patients with a reported penicillin allergy, following updates to institutional guidelines. STUDY DESIGN: This was a retrospective study of adult patients presenting for vaginal or cesarean delivery at 2 hospitals within a healthcare system. Patients received at least 1 dose of antibiotics for a peripartum indication between May 1, 2018, and October 31, 2018 (preintervention group) and May 1, 2020, to October 31, 2020 (postintervention group). The stewardship intervention bundle, which was implemented between March 2019 and April 2020, included updates to institutional antibiotic guidelines, reclassification of severe penicillin allergy, development of obstetrical prophylaxis and treatment order sets, promotion of allergy referral services, and establishment of a physician champion. The primary outcome was the composite rates of patients with reported penicillin allergy who received a preferred antibiotic for a peripartum indication. The secondary measures included maternal and neonatal outcomes. RESULTS: A total of 192 patients with a history of documented penicillin allergy were evaluated (96 patients in the preintervention group and 96 patients in the postintervention group). Hives were the most commonly reported index symptom in both groups (40/96 [41.7%] vs 39/96 [40.6%]; P=.883). After stewardship interventions, there was a significant increase in the rate of preferred antibiotic use (33/96 [34.3%] vs 81/96 [84.3%]; P<.001). The effect was the greatest in patients with nonsevere allergy (14/76 [18.4%] vs 68/82 [82.9%]; P<.001). There was no difference in the rates of postpartum endometritis, 30-day readmission, 90-day surgical site infection, or neonatal early-onset sepsis between the pre- and postintervention groups. Of note, 1 patient in the postintervention group experienced itching, and another patient developed a rash, both of which resolved with medical management. CONCLUSION: A comprehensive antibiotic stewardship intervention was associated with a 50% increase in the use of preferred antibiotics for peripartum indications in patients with penicillin allergy. Allergic reactions with first-line beta-lactams were minimal and manageable.

Adolescent caregiving success as a predictor of social functioning from ages 13 to 33.

Adolescent success providing satisfying support in response to a close friend's call in a caregiving task was examined as a potentially fundamental developmental competence likely to predict future social functioning, adult caregiving security, and physical health. Adolescents (86 males, 98 females; 58% White, 29% African American, 8% mixed race/ethnicity, 5% other) were followed from ages 13 to 33 (1998-2021) using multiple methods and reporters. Early caregiving success was found to predict greater self- and partner-reported caregiving security, lower negativity in adult relationships, and higher adult vagal tone. Results are interpreted as advancing our understanding beyond simply recognizing that adolescent friendships have long-term import, to now identifying specific capacities within friendships that are linked to longer-term outcomes.

Pathways to emotion regulation in young Black children: An attachment perspective.

Attachment theory proposes that a central function of caregivers is to provide protection and co-regulation of children's distress in the context of threat, and that children's secure attachment (confidence in a secure base/safe haven when needed) precipitates positive developmental cascades in part by supporting children's emotion regulation. Yet the field of attachment has rarely considered the unique experiences of African American families, including the context of systemic racism in which caregivers must provide physical and emotional protection for their children, and in which children must learn to regulate emotion across different sociocultural contexts (emotional flexibility and "code-switching"; Dunbar et al., 2022a; Lozada et al., 2022; Stern et al., 2022b). This chapter brings attachment theory into conversation with the field of positive Black youth development to explore pathways to emotion regulation in African American children during early childhood. In doing so, we (a) highlight the strengths of African American caregivers in providing unique and specific forms of protection via racial and emotional socialization; (b) review research on predictors and consequences of secure caregiver-child relationships in Black families, with a focus on the outcome of child emotion regulation; (c) present a theoretical framework for understanding cascades of positive Black youth development via healthy relationships and emotion regulation; and (d) outline promising new directions for more inclusive and just attachment research.

Direct challenges are the gold standard for most antibiotic allergy evaluations.

Antibiotic allergies are frequently encountered in clinical practice, and delabeling of these allergies has individual and public health benefits. This review focuses on the evidence supporting graded challenges without preceding skin testing in adult and pediatric patients to the major groups of antibiotics including penicillins, cephalosporins, sulfamethoxazole, fluoroquinolones, tetracyclines, macrolides, metronidazole, carbapenems, and aztreonam. The cost savings, time savings, and evidence for performing graded challenges outside of an allergy/immunology office are also reviewed for graded challenges to penicillins.

Exploring the benefits of psychoeducation on college students' mental health during the COVID-19 pandemic.

OBJECTIVE: This study examines the effects of a scalable psychoeducation intervention to improve students' mental health during the COVID-19 pandemic. PARTICIPANTS: In a sample of racially diverse undergraduates from a highly selective university (N = 66), students in the control group (mostly women) participated in courses as usual and students in the intervention group (only women) participated in a psychoeducation course on evidence-based strategies for coping, designed for college students living through the pandemic. METHODS: Rates of psychological distress were measured through online surveys at baseline and follow-up assessments. RESULTS: Students in both the intervention and control groups had clinically elevated depressive symptoms. Consistent with hypotheses, students in the intervention group had lower levels of academic distress and more positive perceptions regarding mental healthcare at the follow-up assessment than students in the control group. Contrary to hypotheses, students in both groups had similar levels of depressive symptoms, feelings of being overwhelmed, and coping. Preliminary findings suggest that the intervention primarily improved help-seeking and may have reduced stigma. CONCLUSIONS: Psychoeducation in an academic setting may be one means by which to decrease academic distress and reduce mental health stigma at highly selective institutions.

Characterizing Emotional Support Development: From Adolescent Best Friendships to Young Adult Romantic Relationships.

This study examined development of emotional support competence within close friendships across adolescence. A sample of 184 adolescents (53% girls, 47% boys; 58% White, 29% Black, 14% other identity groups) participated in seven waves of multimethod assessments with their best friends and romantic partners from age 13 to 24. Latent change score models identified coupled predictions over time from emotional support competence to increasing friendship quality and decreasing support received from friends. Friend-rated emotional support competence in adolescence predicted supportiveness in adult romantic relationships, over and above supportiveness in adolescent romantic relationships. Teen friendships may set the stage for developing emotional support capacities that progress across time and relationships into adulthood.

Maternal depressive symptoms and child behavior problems: Attachment security as a protective factor.

Maternal depressive symptoms (MDS) have been linked to both child internalizing and externalizing behavior problems. Theory suggests that child attachment security may be a protective factor against the negative effects of MDS. This study examined child attachment security as a buffer of the link between MDS and child internalizing and externalizing behavior problems at two time points in a predominantly African American sample. Participants included mothers (N = 164; Mage = 29.68 years; 76% African American) and their preschool-aged children (60% girls; Mage = 44.67 months) recruited from four Head Start centers in low-income neighborhoods in Baltimore, Maryland. MDS were concurrently associated with child internalizing and externalizing behavior problems at both time points. No significant main effects of child attachment security on behavior problems emerged; however, child attachment moderated the association between MDS and child internalizing behavior problems at Time 2, such that MDS predicted greater child internalizing problems when attachment security was low, and the effect was attenuated when attachment security was high. No interaction emerged for child externalizing problems. Findings suggest that secure attachment in early childhood can serve as a protective factor in the context of parental risk. We discuss implications for intervention and the intergenerational transmission of psychopathology.

Allergic rhinitis co-morbidity on asthma outcomes in city school children.

BACKGROUND: School based asthma programs have demonstrated that preventive asthma therapy administered in school reduces asthma morbidity. The burden of co-morbid allergic disease on asthma outcomes in a large school based asthma cohort has been unexplored. OBJECTIVE: Evaluate the prevalence of allergic rhinitis (AR) in historically minoritized school children with persistent asthma, and determine if AR is an independent risk factor for asthma morbidity. METHODS: We evaluated the prevalence of AR in children enrolled in 3 NIH funded school based asthma programs in Rochester, NY. We used linear regression and multivariate analyses to compare asthma outcomes for children whose caregivers did and did not report AR. RESULTS: We used data from 1,029 children with asthma (mean age 7.4, 60.4% Black, 29.5% Hispanic, 72.8% insured with Medicaid). 63% of children reported AR. Children with AR had significantly fewer symptom free days over 2 weeks compared to children without AR (7.2 vs. 8.3, p < 0.001). Children with AR also had more daytime symptoms, (4.7 vs. 3.7, p < 0.001), more rescue medication use (4.5 vs. 3.4, p < 0.01), and more activity limitation due to asthma (3.6 vs. 2.5, p < 0.001). Only 44% of children with AR reported allergy medication use. CONCLUSIONS: Among a large school-based cohort of minoritized children with asthma, we found that the majority of children have comorbid allergic rhinitis, which was associated with increased asthma morbidity. Inadequate recognition and treatment for allergic rhinitis likely represents substantial preventable morbidity for this group.

Maternal recognition of positive emotion predicts sensitive parenting in infancy.

Research on parent-child relationships demonstrates the importance of maternal sensitivity for the development of children's emotion regulation, social competence, and health; thus, it is important to understand the emotional-cognitive capacities underlying maternal sensitivity. We followed 120 mothers and their full-term infants from the newborn period to 5 months postpartum. Mothers' emotion recognition during the newborn period was measured using a validated facial emotion recognition task assessing discrimination (d') of six facial expressions of emotion: happiness, fear, anger, sadness, disgust, and neutrality. Maternal behavior at 5 months postpartum was coded from a mother-infant free-play session using Ainsworth's Sensitivity Scales. Preregistered analyses revealed that mothers' ability to detect happiness specifically (but not other emotions such as fear or sadness) in the neonatal period predicted greater observed sensitivity 4 months later, ß = .30, p = .002, ΔR² = .08. Results suggest that maternal recognition of positive emotion may be uniquely predictive of sensitive behavior in low-stress parent-infant interaction contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A social-development model of the evolution of depressive symptoms from age 13 to 30.

This 17-year prospective study applied a social-development lens to the challenge of identifying long-term predictors of adult depressive symptoms. A diverse community sample of 171 individuals was repeatedly assessed from age 13 to age 30 using self-, parent-, and peer-report methods. As hypothesized, competence in establishing close friendships beginning in adolescence had a substantial long-term predictive relation to adult depressive symptoms at ages 27-30, even after accounting for prior depressive, anxiety, and externalizing symptoms. Intervening relationship difficulties at ages 23-26 were identified as part of pathways to depressive symptoms in the late twenties. Somewhat distinct paths by gender were also identified, but in all cases were consistent with an overall role of relationship difficulties in predicting long-term depressive symptoms. Implications both for early identification of risk as well as for potential preventive interventions are discussed.