Caregiver Concern About Child Overweight/Obesity in Grandparent Versus Parent-Headed Households in the United States.

OBJECTIVE: To examine the association of caregivers' concern about children's overweight and obesity status with family structure (grandparent versus parent-headed households). METHODS: Caregivers reported their relation to the child aged 10 to 17 years and the child's weight and height (National Survey of Children's Health 2016-20). Overweight/obesity was calculated using Centers for Disease Control and Prevention growth charts. We estimated associations (prevalence odds ratio) of residing in a grandparent-headed household with lack of weight concern (responding "Yes, it's too low" or "No, not concerned" to "Are you concerned about this child's weight?") among propensity score-matched children with overweight and obesity. Covariates included child's sex, race, ethnicity, age, family poverty ratio, primary household language, highest level of education among reported adults, caregiver mental and emotional health, usual source of care and survey year. RESULTS: The prevalence of child overweight/obesity was higher in grandparent-headed households. Among children with overweight/obesity, 64.65 (SE = 3.27)% of grandparents and 66.55 (SE = 0.81)% of parents did not express concern about the child's weight status. Among children with obesity, it was 52.42 (SE = 4.63)% and 49.04 (SE = 1.28)%, respectively. Family structure was not associated with caregiver lack of weight concern in propensity score-matched samples. CONCLUSIONS: Appropriate caregiver concern about child's weight status was low in both grandparent and parent-headed households in the United States.

Family Well-being in Grandparent- Versus Parent-Headed Households.

BACKGROUND AND OBJECTIVES: Little is known about the 2% of US children being raised by their grandparents. We sought to characterize and compare grandparent- and parent-headed households with respect to adverse childhood experiences (ACEs), child temperament, attention-deficit/hyperactivity disorder (ADHD), and caregiver aggravation and coping. METHODS: Using a combined data set of children ages 3 to 17 from the 2016, 2017, and 2018 National Survey of Children's Health, we applied survey regression procedures, adjusted for sociodemographic confounders, to compare grandparent- and parent-headed households on composite and single-item outcome measures of ACEs; ADHD; preschool inattention and restlessness; child temperament; and caregiver aggravation, coping, support, and interactions with children. RESULTS: Among 80 646 households (2407 grandparent-headed, 78 239 parent-headed), children in grandparent-headed households experienced more ACEs (ß = 1.22, 95% confidence interval [CI]: 1.07 to 1.38). Preschool-aged and school-aged children in grandparent-headed households were more likely to have ADHD (adjusted odds ratio = 4.29, 95% CI: 2.22 to 8.28; adjusted odds ratio = 1.72, 95% CI: 1.34 to 2.20). School-aged children in these households had poorer temperament (ßadj = .25, 95% CI: -0.63 to 1.14), and their caregivers experienced greater aggravation (ßadj = .29, 95% CI: 0.08 to 0.49). However, these differences were not detected after excluding children with ADHD from the sample. No differences were noted between grandparent- and parent-headed households for caregiver coping, emotional support, or interactions with children. CONCLUSIONS: Despite caring for children with greater developmental problems and poorer temperaments, grandparent caregivers seem to cope with parenting about as well as parents.

Teen Driving Education in a Pediatric Emergency Department: Effectiveness of a Toolkit.

OBJECTIVES: In the United States, the leading cause of death for adolescents aged 16 to 24 years is motor vehicle crashes, with Alabama ranked as the second-worst state in the nation for teen driving deaths. We sought to determine the efficacy of teenage driving education within the setting of the pediatric emergency department and to assess the driving habits of teenagers and their parents and their understanding of the Alabama Graduated Driver's License (GDL) law. METHODS: Surveys were administered to noncritically ill teenagers aged 13 to 19 years and their parents who presented to the children's emergency department. Participation was voluntary and anonymous. Presurveys were administered to assess driving habits and knowledge. Intervention was then given in the form of a "safe driving toolkit," followed by postsurveys to measure educational outcomes. Pre- and postsurvey data were then analyzed and compared using Epistat. RESULTS: A total of 41 parents, 2 grandparents, and 45 teenagers were enrolled in this study. An additional 47 teenagers answered a single curfew question at a teen driving event. Of all of the participants, 63% had never heard of the Alabama GDL law, and of that 63%, 37% had been enrolled in a driver's education course. A χ2 analysis revealed no significant difference between parents and teenagers having taken a driver's education course. Of the participants, 22% responded that they knew the specifics of the Alabama GDL law, with only 1 correct on all 3 counts. The most common item missed was the curfew for teenagers, with 4 believing it to be 8 pm, 14 believing it to be 9 pm, 23 believing it to be 10 pm, and 7 believing it to be 11 pm. Sixty-nine percent of the respondents correctly answered that there was to be no cellular telephone use while driving for teenagers with a GDL. More than 97.2% of participants, both parents and teens, reported learning new information from this study. CONCLUSIONS: The majority of participants enrolled were not aware of the Alabama GDL law, which has been in place since 2002. More than 97% of those surveyed were given new information during the education session. There is a strong need for further public education regarding the law and safe driving habits. Sixty-one percent of respondents believe that the teen curfew is earlier than the present curfew. The authors believe that this shows support for revising the curfew in the present law to an earlier time. Nighttime driving restrictions starting at 10 pm or earlier have been shown to result in greater reductions in motor vehicle crashes involving teenagers. Our study affirmed that teen driving education within the pediatric emergency department setting is efficacious.

Effect of MyTeen SMS-Based Mobile Intervention for Parents of Adolescents: A Randomized Clinical Trial.

Importance: There is global pressure to respond to the burden posed by adolescent mental health problems. The National Mental Health Commission has made a call for investment in mobile health services directed at prevention and early intervention to relieve the demand on targeted mental health services that are costly to provide. Parents and primary caregivers play a significant role in the lives of adolescents and are important targets for such efforts. Currently, there is no evidence for the effectiveness of programs delivered solely via text message for parents of adolescents. Objective: To evaluate the effects of a text-messaging program (MyTeen) on promoting parental competence and mental health literacy for parents of adolescents. Design, Setting, and Participants: A parallel 2-group randomized clinical trial was conducted in New Zealand. A total of 221 parents and primary caregivers of adolescents aged 10 to 15 years were recruited from March 19 to August 17, 2018, via community outreach and social media and were randomly allocated 1:1 into the control or the intervention group. Statistical analysis was performed on the principle of intention to treat with adjustment for baseline factors and ethnicity. Intervention: A text-messaging program for parents of adolescents (age 10-15 years) to promote parental competence and mental health literacy. Participants received 1 daily text message over 4 weeks. Main Outcomes and Measures: Parental competence, assessed at 1 month after randomization by the Parenting Sense of Competence Scale. Results: In total, 221 participants (214 [96.8%] female) were randomized, 109 to the intervention group and 112 to the control group; 201 participants (91%) completed the trial at 3 months. Significant group difference was observed on the primary outcome at the end of 1 month of intervention, with participants reporting a higher level of parental competence than those in the control group (estimated mean difference, 3.33 points; 95% CI, 1.37-5.29 points; P = .002). Except for knowledge about mental health, all secondary outcomes were significant, including continued improvement in parental competence at 3 months (estimated mean difference, 4.08 points; 95% CI, 1.96-6.20 points; P < .001), knowledge of help seeking (estimated mean difference, 0.99 points; 95% CI, 0.49-1.50 points; P < .001), parental distress (estimated mean difference, -2.39 points; 95% CI, -4.37 to -0.40 points; P = .02), and parent-adolescent communication (estimated mean difference, 2.21 points; 95% CI, 0.48-3.95 points; P = .01), with participants in the intervention group reporting better parenting-related outcomes than the control group at 1 and 3 months after the intervention. Conclusions and Relevance: This text-messaging program for parents of adolescents appears to be an effective and feasible way to facilitate the implementation and delivery of evidence-based information to populations that are not easily reached with other intervention modalities. The program can be easily scaled up for delivery as an early preventive intervention and may represent a less expensive option for service delivery. Trial Registration: anzctr.org.au Identifier: ACTRN12618000117213.

The long-term impact of the Communist Revolution on social stratification in contemporary China.

The Chinese Communist Revolution that culminated in the 1949 founding of the People's Republic of China fundamentally transformed class relations in China. With data from a nationally representative, longitudinal survey between 2010 and 2016, this study documents the long-term impact of the Communist Revolution on the social stratification order in today's China, more than 6 decades after the revolution. True to its stated ideological missions, the revolution resulted in promoting the social status of children of the peasant, worker, and revolutionary cadre classes and disadvantaging those who were from privileged classes at the time of the revolution. Although there was a tendency toward "reversion" mitigating the revolution's effects in the third generation toward the grandparents' generation in social status, the overall impact of reversion was small. The revolution effects were most pronounced for the birth cohorts immediately following the revolution, attenuating for recently born cohorts.

The Association of Grandparent Care with Childhood Overweight and Obesity in Chinese American Families.

BACKGROUND: Grandparents are often the caretakers of children in Chinese American families. Studies have shown that Chinese grandparents underestimate the weight of their grandchildren and associate food with increased height and strength. This study examines the association of grandparental care with weight status in Chinese American children and adolescents. METHODS: This is a cross-sectional study of 12,029 Chinese American pediatric patients ages 2-19 at a community health center in New York City in 2015. Grandparental care was defined as child care provided by at least one grandparent. Multivariable logistic regression was conducted to assess for association between having a grandparent caretaker and weight status in the age groups 2-5, 6-11, and 12-19 while adjusting for sex, place of birth, neighborhood poverty, and two-parent households. RESULTS: Approximately 12% of Chinese American children in this population had a grandparent caretaker. Children and adolescents with grandparent caretakers are more likely to be overweight than their counterparts with no grandparent caretakers at ages 6-11 (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.23-1.79) and ages 12-19 (OR: 1.54; 95% CI: 1.18-2.02). No association was found between grandparental care and overweight in ages 2-5 nor with obesity in any age group. CONCLUSIONS: Grandparental care is associated with the weight of school-age children and adolescents. Targeted education on appropriate nutrition for the child's age is needed for grandparents who take care of children.

"It Has Changed": Understanding Change in a Parenting Program in South Africa.

BACKGROUND: Poor parenting that leads to child maltreatment during adolescence presents a major public health burden. Research from high-income countries indicates that evidence-based parenting program interventions can reduce child maltreatment. Much less is known, however, about how beneficiaries of these programs experience this process of change. Understanding the process that brings about change in child maltreatment practices is essential to understanding intervention mechanisms of change. This is particularly important given the current scale-up of parenting programs across low- and middle-income countries. OBJECTIVES: This study aimed to provide insight into how caregivers and adolescents attending a parenting program in South Africa perceived changes associated with abuse reduction. METHODS: Semi-structured interviews were conducted with caregivers and adolescents (n = 42) after the intervention, as well as observations of sessions (n = 9) and focus group discussions (n = 240 people). Participants were adolescents between the ages of 10-18 and their primary caregiver residing in peri-urban and rural program clusters in the Eastern Cape Province of South Africa. Data were coded in Atlas.ti, and thematic content analysis was conducted. FINDINGS: Based on participant perceptions, the Sinovuyo Teen parenting program workshops catalyzed change into practice by creating an environment that was conducive to learning alternatives. It did so through prioritizing a process of mutual respect, openness, and being valued by others, giving legitimacy to a respectful reciprocity and new ways of spending time together that enabled caregivers and teenagers to shift and normalize more positive behaviors. This in turn led to reductions in physical and verbal abuse. CONCLUSIONS: This study's findings may be of use to policymakers and practitioners who need to understand how parenting programs support parents and teenagers in increasing positive parenting approaches and changing potentially harmful practices. It additionally highlights the importance of assessing the experiences of both parents and teenagers attending such programs.

Avós cuidadores e suas funções: uma revisão integrativa da literatura / Grandparents caregivers and their functions: an integrative literature review

Este estudo teve como objetivo investigar as produções científicas sobre o tema avós, publicadas no período de 2005 a 2015. Realizou-se uma busca de estudos nacionais nas bases de dados SciELO e PePSIC, por meio dos descritores: avós e grandparents e do termo de busca: grandmother. Foram recuperados 139 artigos científicos. Selecionou-se 14 estudos, os quais integraram a amostrafinal desta revisão integrativa. Os resultados foram divididos em duas categorias:avóscuidadores dos netos e a influência dos avós nas práticas de amamentação. Constatou-se que os avós são figuras importantes no suporte emocional, apoio, carinho e afeto tanto para seus filhos como para os netos. Essas figuras são importantes fontes de apoio no contexto da gravidez na adolescência, de netos com deficiência e do aleitamento materno. Conclui-se a necessidade de elaboração de políticas públicas que abordem questões referentes à saúde física e mental dos avós.(AU)

This study aimed to investigate the scientific literature on grandparents' subject, published from 2005 to 2015. The search was conducted on national databases SciELO and PePSIC using the search term grandparents; grandmother. 139 scientific articles were recovered and 14 studies were selected for the final sample of the present integrative review. The results were divided into two categories: grandparents who take care of grandchildren; and the influence of grandmothers on breastfeeding practices. Grandparents were found to be important figures in emotional care, support, and affection both for their children and for their grandchildren. These figures are important sources of support in the context of teenage pregnancy, grandchildren with disabilities and breastfeeding. The conclusion is that there is a need for development of public policies that address issues related to grandparents' physical and mental health.(AU)

Child Directed Interaction Training for young children in kinship care: A pilot study.

This pilot study used a randomized controlled trial design to examine the feasibility and explore initial outcomes of a twice weekly, 8-session Child Directed Interaction Training (CDIT) program for children living in kinship care. Participants included 14 grandmothers and great-grandmothers with their 2- to 7-year-old children randomized either to CDIT or a waitlist control condition. Training was delivered at a local, community library with high fidelity to the training protocol. There was no attrition in either condition. After training, kinship caregivers in the CDIT condition demonstrated more positive relationships with their children during behavioral observation. The caregivers in the CDIT condition also reported clinically and statistically significant decreases in parenting stress and caregiver depression, as well as fewer externalizing child behavior problems than waitlist controls. Parent daily report measures indicated significant changes in disciplining that included greater use of limit-setting and less use of critical verbal force. Results appeared stable at 3-month follow-up. Changes in child internalizing behaviors and caregiver use of non-critical verbal force were not seen until 3-month follow-up. Results of this pilot study suggest both the feasibility of conducting full scale randomized clinical trials of CDIT in the community and the promise of this approach for providing effective parent training for kinship caregivers.

Development and Evaluation of an Information Booklet for Grandparents of Children With Cancer.

The needs of grandparents of children with cancer are often overlooked. This study evaluated a new educational resource (booklet) targeted toward grandparents of children with cancer. A multidisciplinary committee developed a printed booklet targeting grandparents' information needs identified in a previous study. Seventy-nine grandparents of children with cancer (63% grandmothers, Mage = 66.04, SD = 7.0 years) read and evaluated the booklet. Quantitative responses were analyzed with SPSS, and qualitative responses were thematically coded using QSR NVivo 10. Grandparents' responses to the resource were positive, with 92% finding the booklet "informative" (n = 73), "useful" (84%, n = 66), and "very relevant" (50%, n = 39). Qualitative responses reflected an appreciation for the booklet's readability, informative content, and quotes from grandparent experiences. The developed booklet was highly acceptable to grandparents of children with cancer and addressed their need for reassurance and guidance on obtaining further support. This study demonstrates the feasibility of developing and evaluating a targeted resource to meet grandparent's identified information needs.

Grandparent Education Through Simulation-Diabetes.

PURPOSE: The purpose of this study was to explore the feasibility of using human patient simulation (HPS) to teach type 1 diabetes (T1DM) management to grandparents of grandchildren with T1DM. METHODS: Thirty grandparents (11 male, 19 female) of young grandchildren (aged 12 and under) with T1DM were recruited from an urban medical center. Experimental group (n = 14) grandparents received hands-on visual T1DM management education using an HPS intervention, and control group (n = 16) grandparents received similar education using a non-HPS intervention. FINDINGS: This study demonstrated the feasibility of recruiting and retaining grandparents into a clinical trial using HPS to teach T1DM management. Post intervention, all grandparent scores for T1DM knowledge, confidence, and fear showed significant improvement from time 1 to time 2, with HPS group grandparent scores showing consistently larger improvement. CONCLUSIONS: The consistency of larger HPS-taught grandparent score improvement is suggestive of a benefit for the HPS teaching method. Early multimethod Certified Diabetes Educator (CDE)-provided T1DM education is an important point of entry for inducting grandparent members onto the grandchild's diabetes care team.

What motivates maternal and child nutrition peer educators? Experiences of fathers and grandmothers in western Kenya.

BACKGROUND: Peer-led dialogue groups (i.e., support or self-help groups) are a widely used community-based strategy to improve maternal and child health and nutrition. However, the experiences and motivation of peer educators who facilitate these groups are not well documented. OBJECTIVE: We implemented eight father and ten grandmother peer dialogue groups in western Kenya to promote and support recommended maternal dietary and infant and young child feeding practices and sought to understand factors that influenced peer educator motivation. METHODS: After four months of implementation, we conducted 17 in-depth interviews with peer educators as part of a process evaluation to understand their experiences as group facilitators as well as their motivation. We analyzed the interview transcripts thematically and then organized them by level: individual, family, peer dialogue group, organization, and community. RESULTS: Father and grandmother peer educators reported being motivated by multiple factors at the individual, family, dialogue group, and community levels, including increased knowledge, improved communication with their wives or daughters-in-law, increased respect and appreciation from their families, group members' positive changes in behavior, and increased recognition within their communities. This analysis also identified several organization-level factors that contributed to peer educator motivation, including clearly articulated responsibilities for peer educators; strong and consistent supportive supervision; opportunities for social support among peer educators; and working within the existing health system structure. CONCLUSION: Peer educator motivation affects performance and retention, which makes understanding and responding to their motivation essential for the successful implementation, sustainability, and scalability of community-based, peer-led nutrition interventions.