Individual factors, neighborhood social context and asthma at age 5 years.

OBJECTIVE: Childhood asthma is a major public health problem and its development is multifactorial. We examined whether neighborhood cohesion and disorder were associated with caregiver-report of asthma at age 5 years. METHODS: This study is a secondary data analysis of the 2011-2012 United States National Survey of Children's Health. Data were available for 4680 children, age 5 years old born at term or preterm with birthweight >2500 g. Neighborhood disorder and cohesion were assessed based on caregivers' responses to validated questionnaires. Child asthma diagnosis was reported by the caregiver. Multivariable logistic regression was used to examine the relationship between these neighborhood factors and caregiver-report of child asthma, while accounting for individual level covariates. RESULTS: Approximately two-thirds of the 4680 children were White and lived in households with income >400% of federal poverty line. Asthma was present in 399 (9%) children. Child female sex was associated with reduced risk of caregiver-reported asthma while non-Hispanic Black race and having smokers in the household were independently associated with increased risk in multivariable models. In these models, neighborhood disorder was significantly associated with asthma (adjusted Odds Ratio [aOR] 1.70, 95% Confidence Interval [CI] 1.04-2.78), while neighborhood cohesion was not (aOR 0.93, 95% CI 0.51-1.68). CONCLUSION: Even after adjustment for several individual level factors, neighborhood disorder was associated with caregiver-report of asthma in this nationally representative sample of 5-year-old children. Further research is needed to better understand how risk factors at different levels of the socio-ecological framework may interact to affect childhood asthma development.

Overstimulated Consumers or Next-Generation Learners? Parent Tensions About Child Mobile Technology Use.

PURPOSE: Mobile technology is ubiquitous, but its impact on family life has not been thoroughly addressed in the scientific literature or in clinical practice guidelines. We aimed to understand parents' views regarding mobile technology use by young children, aged 0 to 8 years, including perceived benefits, concerns, and effects on family interactions, with the goal of informing pediatric guidelines. METHODS: We conducted 35 in-depth, semistructured group and individual interviews with English-speaking caregivers of diverse ethnic backgrounds, educational levels, and employment statuses. After thematic saturation, results were validated through expert triangulation and member checking. RESULTS: Participants included 22 mothers, 9 fathers, and 4 grandmothers; 31.4% were single parents, 42.9% were of nonwhite race or ethnicity, and 40.0% completed high school or less. Participants consistently expressed a high degree of tension regarding their child's mobile technology use, from which several themes emerged: (1) effects on the child-fear of missing out on educational benefits vs concerns about negative effects on thinking and imagination; (2) locus of control-wanting to use digital devices in beneficial ways vs feeling that rapidly evolving technologies are beyond their control (a tension more common in low-income caregivers); and (3) family stress-the necessity of device use in stressed families (eg, to control a child's behavior or as an inexpensive learning/entertainment tool) vs its displacement of family time. CONCLUSIONS: Caregivers of young children describe many novel concepts regarding use of mobile technology, raising issues not addressed by current anticipatory guidance. Guidance may be more effectively implemented if it takes into account parents' uncertainties, locus of control, and functional uses of mobile devices in families.

The art of empathy: Teaching empathy through art.

BACKGROUND: The instruction of empathy is challenging. Although several studies have addressed how art-based education can foster empathy, there is a need for more evidence showing its impact and students' perceptions, especially in graduate education. APPROACH: We designed and implemented a virtual art-based curriculum focused on fostering empathy-The Art of Empathy. This novel curriculum used diverse art-based education methodologies to promote meticulous and collaborative observation and reflection, building on constructivism. Thirty-six interns at the Brigham and Women's Hospital were invited to participate in the curriculum, while 34 served as control. EVALUATION: We used mixed methods to explore interns' perceptions of the curriculum and assess its impact on their empathy. We used two quantitative instruments with known psychometric characteristics: the Toronto Empathy Questionnaire (TEQ) and the Jefferson Scale of Physicians Empathy (JSPE), which were distributed in a survey and completed by 31/99 (31.3%). We collected qualitative data from four interns using semi-structured interviews. Thematic analysis showed how The Art of Empathy promoted interns' reflections and actions toward empathy. This was partially supported by the quantitative data that showed significantly higher scores on the 'Compassionate Care' subscale of the JSPE (p = 0.039) when compared with interns in the control group. The thematic analysis showed that interns appreciated the curriculum and valued its benefits while highlighting the limitations of the virtual delivery approach. IMPLICATIONS: Our curriculum was well received by interns and showed the potential of art-based methodology to promote empathic capacities in graduate students.

Perceptions of Asthma and Exercise, and Associations With Weight Status and Asthma Morbidity in Urban Children.

BACKGROUND: Given the high prevalence of asthma and obesity in minority children, there is a need to identify targets for intervention to decrease the impact of these conditions on children's functioning in this high-risk group. OBJECTIVE: To examine in urban children with persistent asthma, 1) differences in asthma indicators (eg, FEV1% predicted) by weight status, and by ethnic group/weight status, 2) caregivers' fears about their child's asthma by weight status, and by ethnic group/weight status, and 3) the proportion of children who qualified for exercise-induced bronchospasm (EIB) via exercise challenge test among those whose caregivers endorse exercise as a trigger for asthma. METHODS: In this sample of urban children (aged 7-9; N = 147), subjective measures included child/caregiver daily report of asthma symptoms and caregiver fears about their child's asthma. Objective lung function was measured twice daily via handheld spirometer and EIB was confirmed via exercise challenge test. RESULTS: In the overall sample, a greater proportion of normal-weight children reported asthma symptoms compared to overweight/obese children. Caregiver fears about asthma were more prevalent among Latino caregivers. Non-Latino White children whose caregivers were afraid their child may die when having asthma reported more days with asthma symptoms. Very few children had confirmed EIB compared to the proportion of caregivers who endorsed exercise as a dangerous trigger for asthma. CONCLUSIONS: Caregiver fear about asthma and misperceptions of exercise as a dangerous trigger for asthma should be addressed during health care visits with families of children with asthma and interventions including urban children with asthma.

Parent Perspectives on Their Mobile Technology Use: The Excitement and Exhaustion of Parenting While Connected.

OBJECTIVE: Parent use of mobile devices (e.g., smartphones, tablets) while around their young children may be associated with fewer or more negative parent-child interactions, but parent perspectives regarding this issue have not been explored. We aimed to understand parent views regarding their mobile device use to identify actionable targets of potential intervention. METHOD: We conducted 35 in-depth semi-structured group and individual interviews with English-speaking caregivers of children 0 to 8 years old, purposively sampled from diverse ethnic backgrounds, educational levels, and employment statuses. Following thematic saturation, results were validated through expert triangulation and member checking. RESULTS: Participants included 22 mothers, 9 fathers, and 4 grandmothers; 31% were single parents, 43% nonwhite race/ethnicity, and 40% completed high school or less. Participants consistently expressed a high degree of internal tension regarding their own mobile technology use, which centered around 3 themes relevant to intervention planning: (1) Cognitive tensions (multitasking between work and children, leading to information/role overload), (2) emotional tensions (stress-inducing and reducing effects), and (3) tensions around the parent-child dyad (disrupting family routines vs serving as a tool to keep the peace). CONCLUSION: Caregivers of young children describe many internal conflicts regarding their use of mobile technology, which may be windows for intervention. Helping caregivers understand such emotional and cognitive responses may help them balance family time with technology-based demands.

Maternal Report of Advice Received for Infant Care.

BACKGROUND: Advice has been associated with increased adherence to recommended infant care practices, and may represent a modifiable factor to promote infant health. METHODS: A stratified, 2-stage, clustered design, with oversampling of black and Hispanic mothers, was used to survey a nationally representative sample of 1031 mothers of infants aged 2 to 6 months. Survey questions assessed advice received from doctors, birth hospital nurses, family, and media regarding immunization, breastfeeding, sleep position, sleep location, and pacifier use. Weighted frequencies of no advice and advice consistent with recommendations were calculated to obtain prevalence estimates. Multivariable logistic regression analyses were performed to assess factors associated with receipt of recommendation consistent advice. RESULTS: Although doctors were the most prevalent source of reported advice, ∼20% of mothers reported no doctor advice for breastfeeding or sleep position, and more than 50% reported no advice regarding sleep location or pacifier use. Reported advice from nurses was generally similar to doctors. The prevalence of any advice from family or media was 20% to 56% for nearly all care practices, and advice given was often inconsistent with recommendations. The only factors that were consistently associated with receipt of recommendation consistent advice were race/ethnicity and parity; black and Hispanic mothers and first-time mothers were more likely to report recommendation consistent advice. CONCLUSIONS: Mothers commonly report receiving either no advice or recommendation inconsistent advice from each of the 4 sources we studied. By identifying care practices with low prevalence of recommendation consistent advice from potentially important advisors, our findings highlight opportunities for future intervention.