The state and future of pediatric research-an introductory overview : The state and future of pediatric research series.

IMPACT: This is an introduction to an article series devoted to the current state and future of pediatric research. The role of public-private partnerships, influencing factors, challenges, and recent trends in pediatric research are described, with emphasis on funding, drug and device development, physician-scientist training, and diversity. Potential solutions and advocacy opportunities are discussed.

Parental enculturation and youth mental health functioning among Filipino American families.

Filipino Americans accounted for 2.9 million (16%) of the total U.S. Asian American population. As one of the fastest growing Asian immigrant groups, it is important to examine factors that could be targeted in interventions to better aid this community. OBJECTIVES: This study provided a unique perspective into the lives of Filipino American youth by utilizing a specific measure developed to assess different areas of enculturation among their Filipino American caregivers. The primary objectives of this study were to examine the associations among parental enculturation with parenting practices and youth internalizing and externalizing behaviors using regression analyses. METHOD: This study focused on 131 Filipino American families who participated in the Filipino Family Health Initiative. RESULTS: Our hypotheses were partially supported. Interpersonal norms was positively associated with harsh/inconsistent discipline, while conservatism was positively associated with appropriate discipline and praise/incentives. Connection with homeland was negatively associated with youth behavioral symptoms, while interpersonal norms was positively associated with youth behavioral symptoms. Inconsistent with hypotheses, connection with homeland was negatively associated with appropriate discipline. CONCLUSIONS: This highlighted the need for better understanding of the cultural experiences and values of Filipino American parents when working with Filipino American children in clinical and research settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Short-term outcomes from a pilot randomized controlled trial evaluating a virtual culturally adapted parenting intervention among Filipino parents of school-age children.

BACKGROUND: Filipino youth in the United States have significant behavioral health problems, including high rates of depression and suicidal behavior. Evidence-based parenting groups promote positive parenting practices and improve child behavior, yet few have been implemented online. OBJECTIVES: This study tested the short-term effects of a culturally adapted hybrid version of the Incredible Years School Age Basic and Advance Programs when delivered online among groups of parents of Filipino children and estimated intervention effect sizes. METHOD: Forty-nine parents of children aged 8-12 years recruited from schools, clinics, community organizations, and social media were randomly assigned to intervention or a wait-list control group that received literature from the American Academy of Pediatrics' Bright Futures program. The intervention consisted of 12 weekly 2-hr sessions. Parent perceptions of child behavior, parenting practices, and parenting stress as well as child surveys of anxiety and depression symptoms using validated assessments were obtained at baseline and 3-month postintervention follow-up. RESULTS: Forty parents completed both baseline and follow-up surveys with a mean attendance of 9.35 out of 12 sessions (n = 18). Analysis of covariance comparing 3-month (pre-/postintervention) changes revealed that the program had a statistically significant positive impact on parenting practices (positive verbal discipline, praise and incentives, and clear expectations); parent perceptions of their child's internalizing symptoms; and child-reported anxiety and depression symptoms. CONCLUSIONS: Results support the feasibility and potential effectiveness of offering an online evidence-based parenting program to promote positive parenting and decrease child anxiety and depression. This multigenerational approach to mental health prevention could potentially help address the growing mental health epidemic among youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perspectives from the Society for Pediatric Research: contaminants of water and children's health: Can we do better?

Children are uniquely susceptible to the health consequences of water contamination. In this review, we summarize the existing, robust literature supporting the importance of examining specific water contaminants (i.e., lead, pesticides, nitrates, arsenic, perchlorate) and the routes of contamination in the United States and globally. We also discuss the health effects of exposure to contaminated water and significant disparities related to access to clean water. Lastly, we offer strategies for prevention and intervention-including those focused on the individual patient level-and review the current US policy framework pertaining to regulation of these toxicants. IMPACT: A key message in this article is that exposure to water contaminants have serious and long-lasting consequences on children's health. This review summarizes current existing literature and adds policy recommendations supporting clean water for children. Information from this review has two potential impacts: Guide health professionals in screening and/or treating children's health problems resulting from water contaminant exposure. Guide policy makers in using evidence-based approaches to improve water quality and clean water access.

Correction: Policy threats to maternal and child nutrition: putting the unborn child at a lifelong disadvantage.

Following publication of this article the authors noticed that affiliations were incorrectly assigned. The original article has now been updated so that the author "Joyce R. Javier" is associated with the "Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Department of Pediatrics, Division of General Pediatrics, Los Angeles, CA, USA", and the author "Vivek Balasubramaniam" is associated with the "Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, USA". This has been corrected in both the PDF and HTML versions of the article.

Voices of the Filipino Community Describing the Importance of Family in Understanding Adolescent Behavioral Health Needs.

Filipinos are a large, yet invisible, minority at high risk for adolescent behavioral health problems. Limited research describes the family as offering a source of positive support for some Filipino youths and yet for some it is also a source of stress and isolation, leading to struggles with adolescent depression and suicidal behavior. This article describes a qualitative study that investigates the role of family when understanding behavioral health needs among Filipino adolescents. Findings highlight the importance of addressing family cohesion when designing interventions aimed at improving the well-being of Filipino youth.

Prevention of Filipino Youth Behavioral Health Disparities: Identifying Barriers and Facilitators to Participating in "Incredible Years," an Evidence-Based Parenting Intervention, Los Angeles, California, 2012.

INTRODUCTION: Evidence-based interventions for training parents are proven to prevent onset and escalation of childhood mental health problems. However, participation in such programs is low, especially among hard-to-reach, underserved populations such as Filipino Americans. Filipinos, the largest Asian subgroup in California, have significant behavioral health disparities compared with non-Hispanic whites and other Asian subgroups. The purpose of this study was to learn about Filipinos' barriers and facilitators to participating in "Incredible Years" (IY), a parenting program. METHODS: We conducted 4 focus groups in Los Angeles, California, in 2012; the groups consisted of 20 Filipino parents of children aged 6 to 12 years who recently completed the IY parenting program, which was offered as a prevention workshop. Three reviewers, including two co-authors (A.S., J.J.) and a research assistant used content analysis to independently code the interview transcripts and extract subthemes. Grounded theory analytic methods were used to analyze interview transcripts. RESULTS: Parents' perceived benefits of participation in IY were learning more effective parenting techniques, networking with other parents, improved spousal relationships, and improvements in their children's behavior. Parents' most common motivating factor for enrollment in IY was to improve their parenting skills and their relationships with their children. The most common barriers to participation were being uncomfortable sharing problems with others and the fear of being stigmatized by others judging their parenting skills. Participants said that parent testimonials would be the most effective way to promote IY. Many recommended outreach at schools, pediatricians' offices, and churches. CONCLUSION: Increasing Filipino American parent enrollment in IY in culturally relevant ways will reduce the incidence of mental health disorders among children in this growing population.

Community Advocacy in Pediatric Practice: Perspectives from the Field.

Pediatrics is a specialty that is grounded in advocacy, possibly more than any other field of medicine. Infants, children, and adolescents depend on others to cover their basic needs including food, shelter, and education and rely on proxy voices to speak out on their behalf. In this article, we describe the importance of community advocacy in pediatrics, best practices for training pediatricians in community advocacy, and case studies to highlight trainee experiences and demonstrate how community advocacy and community-based participatory research can be incorporated in the career of a pediatrician.

Infants with Congenital Adrenal Hyperplasia Exhibit Thalamic Discrepancies in Early Brain Structure.

INTRODUCTION: Patients with classical congenital adrenal hyperplasia (CAH) have prenatal and postnatal hormonal imbalances. To characterize the ontogeny of reported brain and behavior changes in older children with CAH, we aimed to study the brain structure in infants with CAH compared to healthy controls. METHODS: We performed neuroimaging in 16 infants with classical CAH due to 21-hydroxylase deficiency (8 males, gestational age 38.2 ± 1.7 weeks, post-conceptional age [PCA] 42.2 ± 3.0 weeks) and 14 control infants (9 males, gestational age 38.5 ± 1.8 weeks, PCA 42.5 ± 2.4 weeks) utilizing 3-Tesla magnetic resonance imaging. Regional brain volumes were adjusted for PCA and sex, along with an additional adjustment for total brain volume (TBV), for group comparisons by regression analyses (mean, 95% confidence interval [CI]). The degree to which each brain region was differentiated between CAH and control infants was examined by relaimpo analyses, adjusting for all other brain regions, PCA, and sex. RESULTS: Infants with CAH had significantly smaller thalamic volumes (8,606 mm3, 95% CI [8,209, 9,002]) compared to age-matched control infants (9,215 mm3, 95% CI [8,783, 9,647]; ß = -609; p = 0.02) which remained smaller after further adjustment for TBV. Upon further adjustment for TBV, the temporal lobe was larger in infants with CAH (66,817 mm3, CI [65,957, 67,677]) compared to controls (65,616 mm3, CI [64,680, 66,551]; ß = 1,202, p = 0.03). The brain regions most differentiated between CAH versus controls were the thalamus (22%) and parietal lobe (10%). CONCLUSIONS: Infants with CAH exhibit smaller thalamic regions from early life, suggesting a prenatal influence on brain development in CAH. Thalamic emergence at 8-14 weeks makes the region particularly vulnerable to changes in the intrauterine environment, with potential implications for later maturing brain regions. These changes may take time to manifest, meriting longitudinal study through adolescence in CAH.

Health Equity and Enrollment in Preventive Parenting Programs: A Qualitative Study of Filipino Parents.

This qualitative study identified the parent health beliefs and normative beliefs related to child behavioral and mental health problems and examined the benefits and barriers of enrolling in an evidence-based parenting intervention among Filipino parents of school-aged children. A secondary aim was to also use the results to inform the development of a theory-based video intervention to increase enrollment in parenting interventions. Semi-structured interviews were conducted with fifteen parents who had or had not participated in the Incredible Years® parenting program, an evidence-based parenting intervention. Interviews were recorded and transcribed verbatim. Using a "Coding Consensus, Co-occurrence, and Comparison" methodology, emergent themes were mapped into a matrix against a priori-coded health belief model (HBM) and Theory of Planned Behavior (TPB) constructs. Parents believed that perceived susceptibility could be influenced by including knowledge of health disparities affecting Filipino youth in the U.S. Perceived severity was related to behavioral and mental health concerns about school, family dynamics, bullying and parent coping strategies. Perceived benefits included strengthening parent-child relationships, creating support systems, and learning positive parenting skills. Perceived barriers included logistics, stigma, and the perception of the relevance of the program, cultural factors such as generational differences about parenting, and family issues. Social norms and subjective norms related to parent participation were also discussed. Applying the HBM and TPB to enrollment in parenting interventions may explain low enrollment rates. Future interventions need to target perceived susceptibility to future behavioral health problems, barriers, and benefits to enrollment, and influence subjective and social norms.

Evaluating an Evidence-Based Parenting Intervention Among Filipino Parents: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Filipino Americans underuse mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse, and teen pregnancies, whereas adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years Basic Parent Training Program (IY) improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. OBJECTIVE: The aims of this study are to describe the design and rationale of a randomized controlled trial evaluating the effects of the web-based IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and describe the impact of COVID-19 on our study protocols. METHODS: This study uses a randomized controlled 2-arm individually randomized group treatment pretest-posttest design for 180 parent-child dyads. Individuals are eligible if they are ≥18 years, live in California, and have at least one Filipino child aged 8-12 years. Consenting participants are randomly allocated to receive either the 12-week IY parenting intervention (intervention arm) or American Academy of Pediatrics' Bright Future handouts and placed on a waitlist to receive IY posttrial (waitlist control arm). Primary outcomes include the Parent Practices Interview and the Parenting Stress Index. Secondary outcomes will be measured using the Child Behavior Checklist (completed by parent) and will include child internalizing and externalizing behaviors and total problems. Data are collected at baseline and 3- and 6-month follow-ups. RESULTS: Changes made to the protocol owing to COVID-19 include administration of surveys remotely and implementation of the intervention on the web. The pandemic has provided an opportunity to evaluate the effectiveness of a web-based version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed by December 2022. CONCLUSIONS: Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors in healthy but high-risk populations such as Filipino families. It will also uplift cultural narratives and add to the evidence base for web-based parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk racial and ethnic minority communities. TRIAL REGISTRATION: ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21867.