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The study purpose was to examine the effect of emotional support on the overall mental health and stress for caregivers of children with autism spectrum disorder (ASD). A cross-sectional retrospective study using secondary data from the 2016–2019 National Survey of Children's Health was conducted using single variable and multivariable linear regression analyses. More informal emotional support sources were associated with better overall mental health (β = 0.124, SE = 0.015, p <.001) and reduced stress (β = −0.261, SE = 0.039, p <.001) for caregivers of children with ASD, controlling for covariates. The number of formal emotional support sources was not significantly associated with caregiver overall mental health or stress when controlling for covariates. Increased amounts of total emotional support sources were significantly associated with increased overall mental health (β = 0.042, SE = 0.010, p <.001) and reduced stress (β = −0.093, SE = 0.024, p <.001) for caregivers. Other factors significantly associated with caregiver outcomes included caregiver sex, caregiver marital status, caregiver education level, economic hardship, child sex, child race/ethnicity, ASD severity, and child receipt of ASD treatment. More emotional support sources, in particular informal support sources, may be a protective factor for well-being for caregivers of children with ASD. Health care providers should evaluate the impact of their formal support services on caregivers of children with ASD and advocate for increased informal and formal support resources for these caregivers. • More informal support sources was associated with lower caregiver stress. • More informal support sources was associated with better caregiver mental health. • Over 75% of caregivers reported having 2 or fewer informal support sources. • Over half of the caregivers reported having no formal support sources. [ABSTRACT FROM AUTHOR]

The Developmental Psychobiological Model of Experiential Canalization (DPMEC) proposes that conditions of poverty-related adversity influence child self-regulation through parental caregiving, stress hormones, and the child's genetics. However, empirical findings investigating these relationships with prolonged stress hormones are mixed. Further, the relationships among conditions of adversity with prolonged stress hormones have seldom been investigated in toddlers living in poverty. Guided by the DPMEC, we examined the relationships among maternal caregiving, prolonged stress, and self-regulation in toddlers living in poverty in the United States, to include examining whether toddler prolonged stress mediated relations between maternal caregiving and child self-regulation. Participants were mothers and toddlers (20 to 24 months of age) living in poverty, who provided hair samples to measure four months of average cortisol concentration to estimate prolonged stress. We used observational measures to examine maternal caregiving and indirect report to measure children's self-regulation. Findings did not support the role of toddler prolonged stress in mediating the relationship between maternal caregiving and toddler self-regulation. However, multiple linear regression models showed that higher levels of maternal emotionally supportive caregiving significantly predicted better toddler soothability (b = 0.90; p =.03; 95% CI [0.10, 1.69]; partial correlation = 0.26). This study adds partial support for the DPMEC to represent associations between maternal caregiving and toddler self-regulation for mothers and toddlers experiencing poverty. While these data come from an observational study, pediatric nurses may consider assessing maternal supportive caregiving upon reports of poor toddler soothability. • We tested toddlers' stress hormones and self-regulation responses to adversity. • The sample comprised 94 mothers and toddlers living in poverty in the United States. • Toddler stress did not mediate parental caregiving and child self-regulation. • Toddlers had better soothability if mothers were more emotionally supportive. [ABSTRACT FROM AUTHOR]

Caregivers of children with Autism Spectrum Disorder (ASD) report high levels of stress, social isolation, and poor mental health. Social and emotional support may buffer negative effects of stress for caregivers of children with ASD, however, those living in rural areas may be disadvantaged due to social isolation and increased distance from resources. This scoping review examined the literature regarding the mental health and impact of support for rural caregivers of children with ASD. Articles were limited to those available in the English language and conducted in a high income country. Articles had to include a population of rural caregivers of children with ASD and focus on caregiver mental health and/or the impact of support on caregiver mental health. Searches were conducted with Embase, PubMed, CINAHL, ERIC, and PsycINFO and 22 articles were included. Study findings indicate overall poor mental health for rural caregivers of children with ASD. Formal and informal support appear to be beneficial in decreasing stress for rural caregivers of children with ASD. However, a few studies indicated that formal support may add stress to rural caregivers. There is limited information regarding support needs and the impact of support services on the mental health of rural caregivers of children with ASD. There is a need to increase access to support resources in rural areas for caregivers of children with ASD. Healthcare professionals, including nurses, can play a fundamental role in supporting, educating, and connecting caregivers to other support services. • Urban and rural caregivers of children with ASD have high levels of stress. • Some rural caregivers reported not feeling respected by healthcare professionals. • Navigating ASD resources can be difficult and increase stress for some caregivers. • Rural caregivers felt like they were left to navigate resources on their own. • Parent-intervention programs decrease stress for caregivers. [ABSTRACT FROM AUTHOR]

Telomere length (TL), a biomarker of cellular aging, is influenced by adverse life experiences. Although depression and anxiety are associated with shorter TL in adults, the relationship in younger ages has received little attention. We examined relationships between depression and anxiety diagnoses and symptomatology and TL in adolescence, an important developmental window for early intervention. Sex differences in relationships were also examined. Wave 1 survey and TL data from the Adolescent Health and Development in Context study were analyzed (N = 995). Depression and anxiety diagnosis were parent-reported measures categorized as: current diagnosis, prior diagnosis, and never diagnosed (reference category). Depressive symptoms were measured via adolescent-report using nine items from the Center for Epidemiologic Studies-Depression scale, short form. Anxiety symptoms were measured via adolescent-report using eight items from the pediatric anxiety scale obtained from the Patient-Reported Outcomes Measurement Information System. Genomic DNA was isolated from 500 μL saliva via ethanol precipitation. Genomic DNA TL was assessed using monoplexed quantitative polymerase chain reactions. Relative T/S quantities were calculated in accordance with established procedures. Covariates included sociodemographic factors (sex, age, race/ethnicity, caregiver marital status and education level, and household income), pubertal development, and season of collection. Descriptive and multivariable linear regression analyses were conducted, including an examination of sex as a moderator in the relationships between depression, anxiety, and TL. In multivariable analysis, adolescents with a current depression diagnosis (b = −0.26, p <.05), but not a prior diagnosis (b =0.05, p >.05) had shorter TL than those who were never diagnosed; higher depressive symptom scores were associated with shorter TL (b = −0.12, p <.05). No significant associations were found between anxiety diagnosis and TL; however, higher anxiety symptom scores were associated with shorter TL (b = −0.14, p <.01). Sex did not significantly moderate any of the relationships between depression, anxiety and TL. Depression and anxiety were associated with shorter TL in this diverse community sample of adolescents and the findings highlight the potential for impaired mental health to contribute to cellular senescence as early as adolescence. Prospective research on the long-term effect of depression and anxiety occurring earlier in the life span on TL over time is needed, including examination of potential mechanisms that may accelerate or buffer the negative effects of impaired mental health on TL. • Current diagnosis of depression, but not anxiety associated with shorter TL. • Greater depressive and anxiety symptoms associated with shorter TL. • Sex did not moderate associations between depression or anxiety and TL. [ABSTRACT FROM AUTHOR]

Highlights • Reactivation of a latent virus is one indicator of immune-system dysregulation due to chronic stress exposure. • Early childhood may be a particularly important time for the biological-embedding of chronic stress. • We assessed early childhood family instability and salivary EBV DNA shedding in adolescence. • Children who moved in with grandparent or new parent/caregiver before age 5 had higher EBV DNA shedding in adolescence. • Contemporaneous family structure and SES not associated with EBV DNA shedding in adolescents. Abstract Exposure to stress is one way in which social disadvantages during childhood may alter biological and psychological systems with long-term consequences. Family social and economic conditions are critical for early childhood development and exposure to difficult family conditions may have lasting physiological effects. However, there is little research linking early childhood conditions with physiological indicators of stress and system dysregulation in adolescence. In this study, we assess how family social and economic instability that occurred in early childhood (birth to age 5) is associated with immune system dysregulation in adolescence, as indicated by DNA shedding of the Epstein-Barr virus (EBV). We utilize a biomarker of EBV obtained through saliva, a non-invasive method of collecting immune-system biomarkers, in 674 adolescents 11–17 years old. Multivariable regression results indicated that experiences of moving into a new parent/caregiver household or moving in with a grandparent during early childhood was associated with an estimated 100% increase in EBV DNA shedding among prior EBV-infected adolescents. Other measures of early childhood family instability, total number of family structure changes and economic insecurity, were marginally significant. Contemporaneous family conditions were not associated with adolescents' EBV DNA shedding. [ABSTRACT FROM AUTHOR]

Black-White disparities in physiological stress during adolescence are increasingly evident but remain incompletely understood. We examine the role of real-time perceptions of safety in the context of everyday routines to gain insight into the sources of observed adolescent racial differences in chronic stress as measured by hair cortisol concentration (HCC). We combined social survey, ecological momentary assessment (EMA), and hair cortisol data on 690 Black and White youth ages 11–17 from wave 1 of the Adolescent Health and Development in Context (AHDC) study to investigate racial differences in physiological stress. Individual-level, reliability-adjusted measures of perceived unsafety outside the home were drawn from a week-long smartphone-based EMA and tested for association with hair cortisol concentration. We observed a statistically significant interaction (p <.05) between race and perceptions of unsafety. For Black youth, perceived unsafety was associated with higher HCC (p <.05). We observed no evidence of an association between perceptions of safety and expected HCC for White youth. For youth who perceive their out-of-home activity locations to be consistently safe, the racial difference in expected HCC was not statistically significant. At the high end of perceived unsafety, however, Black-White differences in HCC were pronounced (0.75 standard deviations at the 95th percentile on perceived unsafety; p <.001). These findings call attention to the role of everyday perceptions of safety across non-home routine activity contexts in explaining race differences in chronic stress as assessed by hair cortisol concentrations. Future research may benefit from data on in situ experiences to capture disparities in psychological and physiological stress. • Black adolescents have substantially higher levels of hair cortisol concentration than White adolescents. • Real-time perceived unsafety is positively associated with hair cortisol concentration for Black youth, but not White youth. • At high levels of average perceived unsafety, racial differences in hair cortisol concentration are pronounced. • At low levels of perceived unsafety, we observe no statistically significant racial difference in hair cortisol. [ABSTRACT FROM AUTHOR]

Background Adolescent females have a higher prevalence of depression in comparison to their male peers – a disparity that has been increasing over the past decade. Depression is of concern as it is associated with chronic disease and to immune dysregulation, which may be one mechanism linking depression to future pathology. This study examined the extent to which sex moderated the association between depressive symptoms and immune dysregulation during adolescence using Epstein-Barr virus (EBV) reactivation, a biomarker of cellular immune response, as a model. Methods A representative community sample of 259 female and 279 male adolescents aged 11–17 years who were EBV IgG positive were examined. Trained interviewers collected the data during two home visits, one week apart. Depressive symptoms were measured at the first visit using the 9 item short-form of the Center for Epidemiologic Studies-Depression scale. EBV biomarkers were collected via saliva at the second visit and included a qualitative measure of EBV viral capsid antigen immunoglobulin G to assess prior EBV infection and a quantitative measure of EBV DNA to assess the number of viral copies shed in the saliva. Results In multivariable logistic regression analyses, increasing depressive symptoms were significantly associated with salivary shedding of EBV DNA for adolescent females only (logit = 0.66, se = 0.30, p < 0.05), and the interaction between sex and depressive symptoms on salivary shedding of EBV DNA was statistically significant (logit = − 1.19, se = 0.42, p < 0.01). Sensitivity analyses were conducted in which sex was examined as a moderator in the relationship between depressive symptoms and salivary EBV DNA quantitative copies via Tobit regression; results were consistent with the presented findings. Conclusions Depressive symptoms are associated with EBV reactivation among EBV positive female adolescents, but not males. Future research is needed to examine EBV reactivation in female adolescents as a mechanism linking depression to future chronic disease and the role of sex hormones in explaining sex differences in the relationship between depressive symptoms and EBV reactivation. [ABSTRACT FROM AUTHOR]

The immune system plays a critical role in the prevention of infectious and chronic disease. We investigate associations between exposure to neighborhood immigrant concentration across the transition from adolescence to adulthood and immune function among Latino young adults, including moderation by nativity. Data from the National Longitudinal Study of Adolescent Health (1994–2008) were analyzed. Immune function was measured via Epstein–Barr virus (EBV) antibody levels (higher levels indicate impaired immune function) among EBV-positive Latino adults ( N =1130). Results indicated the averaged individual exposure to immigrant concentration (mean % of foreign-born residents in the census tract across waves 1–4) was associated with immune function for foreign-born Latinos only ( b =−0.37, P <0.05). For waves of exposure, only the cumulative measure of living in an immigrant enclave (census tracts with ≥40% foreign-born residents) across all waves was associated with immune function and only for foreign-born Latinos ( b =−0.22, P <0.05). Research on the mechanisms through which neighborhood immigrant concentration confers salubrious physiological outcomes for foreign-born Latinos is needed. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To examine the longitudinal associations between exposure to violence with a weapon during the past year among adolescents and hypertension during adulthood, including the extent to which adult cardiovascular risk factors mediated the association. Methods: Secondary analysis of the National Longitudinal Study of Adolescent Health, 1994–2008. The sample included 3555 male and 4416 female participants who were aged 11–17 years at wave 1 (1994–1995). Participants were categorized as hypertensive if they had a mean systolic blood pressure of 140 mm Hg or higher or a mean diastolic pressure of 90 mm Hg or higher at wave 4 (2008). Witnessed violence with a weapon was defined as having seen a shooting or stabbing during the year before wave 1, whereas victim of violence with a weapon was defined as having been shot, cut, or stabbed or had a gun or knife drawn on them during the year before wave 1. Potential mediators of adult cardiovascular risk (wave 4) included body mass index, daily smoking, alcohol abuse, and depression. Results: Males who witnessed violence and females who were victims of violence in the year before wave 1 had an increased odds of hypertension at wave 4 compared with their unexposed peers (adjusted odds ratio, 1.45; 95% confidence interval, 1.003–2.10 and adjusted odds ratio, 1.72; 95% confidence interval, 1.04–2.84, respectively). The hypothesized adult cardiovascular risk mediators did not significantly attenuate the associations for either the male or female samples. Conclusions: Interventions addressing prior violence exposure are needed to promote adult cardiovascular health. [Copyright &y& Elsevier]

Children with Cerebral Palsy (CP) commonly experience unpleasant symptoms such as pain, anger, and sadness. The purpose of this quasi-experimental study, guided by the Theory of Unpleasant Symptoms (TOUS), was to examine the practicality and impact of delivering Reiki Therapy (RT) in homes over an 8-week intervention phase to children with CP. Thirteen pediatric participants were recruited, ranging in age from 5 to 16 years. Reiki Therapy was administered by a Level 3 Reiki Therapist in the home for 8 consecutive weeks. Parents completed on-line questionnaires addressing their children's unpleasant symptoms. Hair cortisol was measured as an indicator of stress. Nearly all study procedures were completed by the participants, indicating that the methods are feasible for a larger study. Reiki Therapy significantly decreased pain while lying down (3.09 vs. 2.00; p =.002) but not while sitting (2.55 vs. 2.09; p =.40). Anger symptoms showed a trend towards improvement in the participants. These preliminary findings demonstrate that Reiki is a therapeutic modality worthy of further investigation in the CP pediatric population. • Home-based Reiki Therapy was well tolerated in children with Cerebral Palsy. • RT was well-received and associated with a decrease in some measures of pain with a trend toward improvement in other symptoms. • Further studies are needed to evaluate RT in populations of children with Cerebral Palsy and other chronic conditions. [ABSTRACT FROM AUTHOR]

PURPOSE: To examine racial-ethnic differences in Epstein-Barr virus (EBV) antibody levels among U.S. children and adolescents. Elevated titers among seropositive youth can indicate viral reactivation-an indirect measure of impaired cell-mediated immunity. METHODS: Data from the 2003-2010 National Health and Nutrition Examination Survey were analyzed using multivariable linear regression accounting for the complex survey design and potential confounders. The sample comprised 4663 black-African American, Mexican American, and white youth aged 6-17 years who were EBV seropositive. RESULTS: EBV antibody levels were significantly higher for black-African American youth compared with their white peers (b = 0.343, P < .0001). Gender-stratified models were consistent with the total sample except differences in EBV antibody levels were greater between black-African American and white males (b = 0.525, P < .0001) than between black-African American and white females (b = 0.169, P = .0185). Differences in EBV antibody levels between Mexican American and white youth were only marginally significant in the total and the gender-stratified samples. CONCLUSIONS: Black-white differences in EBV antibody levels were found suggesting EBV reactivation and potential disparities in immune function among minority youth. Research on multilevel factors contributing to the disparities is needed, including potential health implications over the life course for minority youth. [ABSTRACT FROM AUTHOR]

• Adolescent hair cortisol levels were not significantly associated with depressive symptoms in the linear model. • Adolescent hair cortisol levels at the low and high end of the sample distribution were associated with increased depressive symptoms. • Significant sex differences in the curvilinear relationship between hair cortisol levels and depressive symptoms were not found. As the prevalence of depression is increasing among youth in the U.S., research on the utility of biomarkers in predicting depressive symptomatology is burgeoning. Hair cortisol may be a useful biomarker as it is a retrospective and longer-term measure of the mean cortisol level. However, studies have yet to examine the relationships between hair cortisol and depressive symptoms in samples of youth, and findings with adult samples are mixed. This study examined hair cortisol as a predictor of depressive symptoms, including the potential for nonlinear relationships. A representative community sample of 432 adolescents aged 11 to 17 years was examined. Depressive symptoms were measured using a 9-item short-form of the Center for Epidemiologic Studies-Depression scale. Hair was cut from the posterior vertex region of the scalp using thinning shears. Hair was washed, minced, ground and assayed with Salimetrics® Cortisol Enzyme Immunoassay Kit. Hair cortisol levels were logged for statistical analysis. In multivariable regression analysis, no significant linear relationship was found in model 1 between hair cortisol and depressive symptoms (b= -0.036, se = 0.02, p = 0.13). In model 2, a marginally significant linear association (b= -0.044, se = 0.02, p-value = 0.06) and a significant curvilinear relationship (b = 0.039, se = 0.01, p-value = 0.005) were found between hair cortisol and depressive symptoms. The results were graphed depicting a u-shaped curve such that hair cortisol levels on the lower and higher end of the distribution predicted depressive symptoms. The findings highlight the need to consider investigation of nonlinear associations between cortisol and depressive symptoms. Longitudinal mechanistic research is needed to elucidate the causal relationships between hypothalamic-pituitary-adrenal axis dysregulation and depressive symptoms as well as a better understanding of the biological mechanisms through which cortisol may contribute to depressive symptoms and psychopathology. [ABSTRACT FROM AUTHOR]

Background: A first step to advance stress science research in young children is understanding the relationship between chronic stress in a mother and chronic stress in her child. One non-invasive measure of chronic stress is hair cortisol. However, little is known about strategies for hair sampling in mother-toddler dyads living in low-income homes in the U.S. To address prior limitations, the purpose of this study was to understand the feasibility of sampling hair for cortisol analysis in mother-toddler dyads living in low-income homes in the U.S. We examined feasibility related to participation, eligibility, and gathering an adequate hair sample weight.Methods: We approached 142 low-income, racially diverse, urban-dwelling mothers who were participating in an ongoing longitudinal birth cohort study for informed consent to cut approximately 150 hairs from the posterior vertex of their scalp and their toddlers' (20-24 months) scalp. We demonstrated the process of sampling hair with a hairstyling doll during home visits to the mother and toddler using rounded-end thinning shears.Results: Overall, 94 of 142 mother-toddler dyads (66 %) participated in hair sampling. The most common reason for participation refusal was related to hairstyle. All but three hair samples were of adequate weight for cortisol extraction.Discussion: The findings from this study can help researchers address sampling feasibility concerns in hair for cortisol analysis research in mother-toddler dyads living in low-income homes in the U.S. [ABSTRACT FROM AUTHOR]

Aims: Homeless mothers with young children in their care contend with high rates of substance use and low self-efficacy. However, a limited number of studies have examined these outcomes associated with housing and supportive services.Design: Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline.Settings: The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city.Participants: The study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care.Measurements: We measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale.Findings: Overall, mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only.Conclusions: Substance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered. [ABSTRACT FROM AUTHOR]

• Exposure to police-related deaths is associated with negative health among black people • This study examined biological consequences of exposure for urban black youth • Black boys exposed to a police-related death have higher average nightly cortisol • No effect of police-related deaths on physiological stress levels of other youth • Potential negative health consequences for black boys exposed to police-related deaths Emerging evidence indicates that exposure to police-related deaths is associated with negative health and wellbeing outcomes among black people. Yet, no study to date has directly examined the biological consequences of exposure to police-related deaths for urban black youth. We employ unique data from the 2014-16 Adolescent Health and Development in Context (AHDC) study – a representative sample of youth ages 11 to 17 residing in the Columbus, OH area. A subsample of participants contributed nightly saliva samples for cortisol for up to six days, providing an opportunity to link recent exposures to police-related deaths within the residential county to physiological stress outcomes during the study period (N = 585). We examine the effect of exposure to a recent police-related death in the same county on the physiological stress (nightly cortisol) levels of black youth. We find evidence of elevated average levels of nightly cortisol (by 46%) for black boys exposed to a police-related death of a black victim in the 30 days prior to the subject's cortisol collection. We find no evidence of police-related death effects on the physiological stress levels of black girls or white youth. These analyses indicate that police-related deaths influence the biological functioning of black boys, with potential negative consequences for health. We consider the implications of exposure to lethal police violence among black boys for understanding racial disparities in health more broadly. [ABSTRACT FROM AUTHOR]