Pandemic-Related Social Disruption and Well-Being in Pediatric Gastrointestinal Diseases.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has impacted everyone, but there are few data regarding how the pandemic has influenced the lives of children with gastrointestinal (GI) conditions. This cross-sectional study assessed pandemic-related social disruption (PRSD) in children with inflammatory bowel disease (IBD), celiac disease (CD), and irritable bowel syndrome (IBS), and the potential buffering effect of the parent-child relationship. METHODS: A survey completed between September and December 2020 asked 146 children (ages 8-17) diagnosed with IBD (n = 44), CD (n = 81), or IBS (n = 51) and 185 parents how the pandemic has contributed to social disruption (i.e., financial stability, COVID-19 exposure, school changes, GI needs, and isolation) and their social-emotional well-being. Structural equation modeling was used to examine the role of social disruption on well-being, and the moderating effect of the parent-child relationship. RESULTS: Increased social disruption predicted worse parent, ß = 0.24, p = .02, and child well-being, ß = 0.38, p < .01. The parent-child relationship moderated the relationship between parent and child well-being, ß = 0.21, p = .03. Strong parent-child relationships predicted a positive association between parent and child well-being, ß = 0.23, p = .003, whereas medium, ß = 0.09, p = .14, and poor, ß = -0.06, p = .52, relationships did not. CONCLUSIONS: PRSD negatively impacted the well-being of children with GI conditions, and the parent-child relationship moderated this relationship. These findings are relevant to pediatric psychologists treating the physical and mental health needs of children with GI conditions and their parents.

Parenting stress predicts longitudinal change in parental involvement among mothers living with HIV.

Mothers living with HIV (MLH) face unique challenges that may compound parenting stress and impede effective parenting practices. Among the general population, research has demonstrated bidirectional longitudinal relations between parenting stress and parenting practices; yet, despite the additional stressors faced by MLH, these processes have not been examined longitudinally in this population. Utilizing the process model of parenting, the present study examined the longitudinal relations between parenting stress and parental involvement among a sample of MLH with children aged 6-14 years (N = 174). MLH completed self-report measures on their parenting stress and parental involvement at four timepoints spanning 15 months. Latent change score modeling was employed to examine how changes in parenting stress and changes in parental involvement were related across time. Results revealed that increases in parenting stress-specifically distress within the parental role-predicted subsequent decreases in parental involvement. The effects were unidirectional; parental involvement did not predict subsequent changes in parenting stress. Other aspects of parenting stress (perceptions of dysfunctional parent-child interactions and perceptions of the child's temperament as difficult) did not have significant longitudinal associations with changes in parental involvement. Results highlight the central role of parenting stress for MLH as a potential driving factor of parenting quality. Beyond supporting the use of effective parenting skills, clinical prevention and intervention efforts with families affected by HIV should also incorporate stress reduction techniques to increase MLH's capacity for active parental involvement and thereby support positive outcomes for their children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal Bidirectional Relations among Parenting Quality, Parenting Stress, and Child Functioning in HIV-affected Families.

Mothers living with HIV (MLH) face unique stressors impacting parenting, parenting stress, and child psychosocial functioning, but longitudinal, bidirectional relations among family processes have not been examined in this population. This study examined relations among parenting quality, parenting stress, and child functioning in 174 MLH-child dyads (aged 6-14, Mage = 9.65, SD = 2.49; 51% female; 57% Black/African American; 35% Latinx). Families completed self-report questionnaires over four waves spanning 15 months. Cross-lagged panel analysis revealed unidirectional and bidirectional relations between parenting stress and child functioning; parenting quality and child functioning; and parenting quality and parenting stress. The findings suggest that prevention and intervention efforts with HIV-affected families should target both parent factors (e.g., communication skills) and child factors (e.g., emotion regulation), emphasizing parenting stress reduction in order to bolster family outcomes.

A Mixed-Methods Longitudinal Investigation of Mothers' Disclosure of HIV to Their Children.

Mothers living with HIV (MLH) must navigate disclosing their serostatus to their children, but the longitudinal impact on families remains unknown. This study examined HIV disclosure, parenting, parenting stress, and child adjustment among 174 MLH-child dyads (aged 6-14; 35% Latinx; 57% Black/African American). Quantitative data were collected over four waves spanning 15 months. Qualitative data were collected with 14 families in which disclosure had occurred. Latent change score modeling revealed that disclosure led to improvements in parenting stress, communication, and relationship quality. Disclosure did not predict child adjustment. Qualitative themes contextualized these findings, revealing stability and improvements in family functioning. MLH should be supported in disclosing their serostatus to their children to minimize parenting stress and bolster parenting skills.

Engaging community voices to assess Kenya's strengths and limitations to support a child maltreatment prevention program.

BACKGROUND: Preventing child maltreatment is a global mission of numerous international organizations, with parent support programs as the critical prevention strategy. In Kenya, 70 % of children are at risk of experiencing abuse and neglect, most often by their parents. Yet, there is a lack of evidence-based parent support programs, and a limited understanding of Kenya's capacity and infrastructures (e.g., policies, funding, service agencies) to support and sustain such programs. OBJECTIVE: The purpose of this study was to assess systematically Kenya's strengths and limitations to implement a parent support program using a mixed-methods study design. PARTICIPANTS AND METHODS: Twenty-one community stakeholders from Kenya completed the World Health Organization's (WHO) Readiness Assessment for the Prevention of Child Maltreatment to understand Kenya's preparedness to undertake a prevention program. In addition, 91 participants (e.g., parents, community health workers, community leaders) took part in focus group discussions or individual interviews to understand existing support networks around parenting programs. RESULTS: Kenya's overall 'readiness' score was comparable to the other countries that completed the WHO survey. The survey results revealed Kenya's strengths and limitations across the ten readiness dimensions. Several themes emerged from the focus groups and interviews, including the diverse sources of support for parents, specific programs available for parents, and gaps in services offered. CONCLUSIONS: The results document ways to build upon Kenyan's existing strengths to facilitate implementation of an evidence-based prevention program. These results also highlight the significant need to understand local context when adapting parenting programs for low/middle income countries (LMICs).

Protective parenting practices among mothers living with HIV and their adolescent children: a qualitative study.

Growing up with a mother living with HIV (MLH) is a unique experience for adolescents. Children in these families often thrive; however, many also exhibit behavioral health problems including HIV risk behaviors. Under a lens of youth risk reduction, we examined the role of protective parenting practices in their lives including parent-child communication about sex, parent-child relationship quality, parental monitoring, and mother-to-child HIV disclosure. For this exploratory study, we conducted four focus groups with MLH (n = 15) and 13 in-depth interviews with HIV-negative adolescent children of MLH. Participants were primarily African American and recruited from clinics and non-profit organizations in the southeastern United States. A thematic analysis of focus group and in-depth interview data revealed that mothers' prior experiences with HIV and HIV-related risks often underlie their strengths as parents - for example, confidence in their ability to discuss sexual risk topics with their children as well as enhanced motivation to monitor their children's whereabouts and exposure to risky environments. Nonetheless, many MLH face challenges, including problems with mother-to-child HIV disclosure and relationship disruptions, which likely hinder protective parenting. Implications of our findings include specific recommendations for adapting effective and culturally-informed prevention interventions for families affected by maternal HIV infection.

HIV and Mother-Child Conflict: Associations with Mother's Mental and Physical Health.

Maternal illness is a stressor that can disrupt family processes and contribute to negative child outcomes, and researchers have considered family variables that mediate or moderate the maternal illness-child outcome relationship. Through reliance on a diverse sample (ethnically and racially, as well as geographically), the current study expands prior literature with a focus on parent-child conflict. Specifically, associations between aspects of HIV positive mothers' illness and mother-child conflict were explored. One goal of the study was to determine if there were direct or indirect associations with aspects of mothers' HIV and mother-child conflict. HIV-positive mothers (N = 136) provided CD4 count and completed measures assessing their perceived level of physical functioning, depressive symptoms, HIV health-related anxiety, and mother-child conflict with their healthy school-age children. Path analysis considered the pattern of relationships across variables. Results showed maternal vitality and depressive symptoms were directly associated with mother-child conflict. CD4 cell count and health-related anxiety operated indirectly through maternal depressive symptoms. Mediation analyses further assessed the influence of maternal CD4 cell count on mother-child conflict behavior; results indicated an indirect effect was mediated by vitality. HIV health-related anxiety and vitality separately showed indirect effects on mother-child conflict, mediated by maternal depressive symptoms. These findings are the first to focus on mother-child conflict among children affected by maternal HIV and highlight the need for screening and intervention to address depressive symptoms among HIV-positive mothers.

Violence Victimization and Parenting Among Black South African Mothers.

PURPOSE: Black South African women and girls face high rates of violence victimization, including physical, sexual, and emotional abuse in childhood and intimate partner violence (IPV) in adulthood. U.S.-based research suggests that violence victimization predicts parenting difficulties, but this relation has not been examined in a South African context. METHOD: Among a sample of 99 Black South African female caregivers, we examined rates of child abuse, IPV, and cumulative trauma, and we explored the associations between caregivers' victimization history and current parenting quality (i.e., parent-child relationship quality & parental involvement with child). Caregivers completed self-report questionnaires using ACASI software. RESULTS: Hierarchical regression analyses revealed that caregivers reporting childhood physical or sexual abuse were less involved with their children. Caregivers with a history of emotional abuse reported significantly worse parent-child relationship quality. Cumulative trauma was associated with worse parental involvement and parent-child relationship quality. CONCLUSIONS: Results reveal relatively high rates of interpersonal violence victimization among this convenience sample of Black South African women, as well as unique relations between forms of victimization and specific parenting practices. The findings highlight the importance of behavioral parent training interventions with a focus on specific assessment of parents' victimization experiences.

South African Adolescents' Neighborhood Perceptions Predict Longitudinal Change in Youth and Family Functioning.

This study examined South African early adolescent youth (aged 10 to 14) and their female caregivers (N = 99 dyads) participating in an HIV prevention intervention over a period of eight months. We examined youth perceptions of neighborhood cohesion, safety, and collective monitoring as they related to concurrent and longitudinal associations with youth (externalizing behavior and hope about the future) and family (parent-youth relationship quality, parental involvement, and parental responsiveness to sex communication) functioning while controlling for baseline characteristics. Neighborhood perceptions were significantly associated (p < .05) with short- and longer-term outcomes. Gender differences suggested a greater protective association of perceived neighborhood conditions with changes in functioning for boys versus girls. Unexpected associations were also observed, including short-term associations suggesting a link between better neighborhood quality and poorer family functioning. We account for the culture of this South African community when contextualizing our findings and conclude with recommendations for interventions targeting neighborhood contexts.

Validation of a brief measure of HIV health-related anxiety among women living with HIV.

Anxiety symptoms related to health are often present in populations coping with chronic illness, and among women living with HIV (WLWH), anxiety has been linked to a range of negative outcomes. This paper describes the validation of a four-item instrument designed to measure health-related anxiety (HRA) in WLWH by assessing the impact of thinking about HIV status and health on difficulty sleeping, lack of appetite, reduced desire to socialize, and difficulty concentrating at school or work. The scale was administered to 238 adult WLWH across three studies. Exploratory factor analysis revealed a one-factor solution; multi-group confirmatory factor invariance analyses supported the single factor model. For construct and criterion validity, correlations between the HRA scale and validated instruments measuring psychological, psychosocial, and physical distress were as predicted. Results support the validity of the HRA scale among WLWH as a brief measure of anxiety related to HIV status and health.

Community Data Collection with Children of Mothers Living with HIV: Boundaries of the Researcher Role.

The TRACK-II program is a multi-site, community-based randomized controlled trial evaluating an intervention to assist mothers living with HIV (MLH) in disclosing their HIV status to their young children. Many participants-both mothers and children-reported significant depression and/or suicidal ideation, a phenomenon that presented ethical challenges. This article focuses on participants at one site (Atlanta). Through the vignette of "Jordan," we describe ethical challenges that may arise when faced with the responsibility of maximizing participants' safety while maintaining the boundaries of the researcher role. Guided by community psychology values, our team has taken measures within our role as researchers to empower and protect children and mothers endorsing suicidal ideation. For example, we have relied on relationships with community-based organizations and AIDS service organizations to connect HIV-affected families to mental health services. Furthermore, we have expanded our system of documentation to follow-up adequately with families at risk, and we track family resources to promote a strengths-based framework. We have solicited families' feedback about their supports and needs to understand how we may best serve them by connecting them to the resources they report needing most and empowering them to care for themselves.

Parenting and youth sexual risk in context: The role of community factors.

Black South African youth are disproportionately affected by HIV, and risky sexual behaviors increase youths' vulnerability to infection. U.S.-based research has highlighted several contextual influences on sexual risk, but these processes have not been examined in a South African context. In a convenience sample of Black South African caregivers and their 10-14-year-old youth (Mage = 11.7, SD = 1.4; 52.5% female), we examined the relation between parenting and youth sexual risk within the context of community-level processes, including neighborhood quality and maternal social support. Hypotheses were evaluated using structural equation modeling. Results revealed that better neighborhood quality and more social support predicted positive parenting, which in turn predicted less youth sexual risk. There was a significant indirect effect from neighborhood quality to youth sexual risk via parenting. Results highlight the importance of the community context in parenting and youth sexual risk in this understudied sample. HIV prevention-interventions should be informed by these contextual factors.

A Parent-Based Intervention to Prevent HIV Among Adolescent Children of Mothers Living with HIV: The Ms. Now! Program.

One group often overlooked by HIV prevention efforts is adolescent children of mothers living with HIV (MLH). Despite their potential vulnerability, very few evidence-based prevention programs exist for this population in the United States (U.S.) and elsewhere. The current study introduces a parent-based program adapted for families affected by HIV for the purpose of preventing adolescent HIV infection. Following a structured process of adaptation, 12 African American MLH-adolescent dyads were recruited from HIV clinics and non-governmental organizations in a southeastern U.S. city to participate in a feasibility pilot evaluation of the adapted program (Moms Stopping It Now! [Ms. Now]). The intervention consisted of group and individual sessions implemented in a university setting and at participants' homes, respectively. We determined feasibility through assessing participant acceptability and signs of intervention efficacy. Quantitative and qualitative process data revealed high levels of acceptability, as participants were largely satisfied and engaged with Ms. Now, and were willing to attend most sessions. In addition, positive intervention effects approaching medium to large effect sizes were observed for some protective parenting outcomes, including increases in parent-child relationship quality, parental monitoring, maternal HIV disclosure self-efficacy, and communication about maternal HIV infection. Other outcomes, namely communication about sex topics, did not show positive shifts due to ceiling effects and may be indicative of the pre-existing strengths these MLH possess. Ms. Now's approach and further refinement is discussed in the context of strengthening families affected by HIV. Moreover, we recommend that policy aimed at program development consider jointly targeting these populations (MLH and adolescents) due to the unique benefits of family intervention.

Safety-related moderators of a parent-based HIV prevention intervention in South Africa.

Our study examined factors influencing the effectiveness of a parent-based HIV prevention intervention implemented in Cape Town, South Africa. Caregiver-youth dyads (N = 99) were randomized into intervention or control conditions and assessed longitudinally. The intervention improved a parenting skill associated with youth sexual risk, parent-child communication about sex and HIV. Analyses revealed that over time, intervention participants (female caregivers) who experienced recent intimate partner violence (IPV) or unsafe neighborhoods discussed fewer sex topics with their adolescent children than caregivers in safer neighborhoods or who did not report IPV. Participants with low or moderate decision-making power in their intimate relationships discussed more topics over time only if they received the intervention. The effectiveness of our intervention was challenged by female caregivers' experience with IPV and unsafe neighborhoods, highlighting the importance of safety-related contextual factors when implementing behavioral interventions for women and young people in high-risk environments. Moderation effects did not occur for youth-reported communication outcomes. Implications for cross-cultural adaptations of parent-based HIV prevention interventions are discussed.