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Understanding the impact of neighborhood characteristics is crucial given its multigenerational impact. However, there is low availability of validated instruments measuring neighborhood dimensions, particularly in pregnant women, and a lack of cross-country validation of neighborhood-related scales. In this study, we used data from the [masked] study to assess the conceptual and measurement equivalence of the community domains of neighborhood cohesion, intergenerational closure, and neighborhood and social disorder, testing for measurement invariance across eight low- and middle-income countries (LMICs). Following this, we examined patterns of associations with prenatal maternal stress, well-being, and depressive symptoms through the use of nomological networks. We found that the conceptual and measurement equivalence of the neighborhood domains were good across the eight LMICs, although some adjustments had to be made to improve the model fit in two of the sites. Moreover, our results suggest that, in general, higher levels of neighborhood and social disorder, and lower levels of cohesion and intergenerational closure in the community were similarly associated with adverse maternal outcomes across the included sites. The results of this study emphasize the importance of exploring the community context when assessing maternal well-being and supports the need to advocate for community-based interventions that promote safer physical and social environments within maternal programs.

Parental engagement in parenting programs is essential for good outcomes but can be challenging for many families. In low- and middle-income countries, where resources are limited and there are fewer support services, there is little research examining the factors that influence engagement. This mixed-methods study explored factors associated with parent engagement, as well as barriers and supports, in a pilot evaluation of a parenting program with 140 parents in North Macedonia, Republic of Moldova, and Romania. The relationship between various quantitative types of engagement (e.g., premature drop-out, participation) and a range of demographic, personal, and implementation factors were examined. Qualitative parent interviews explored barriers and supports to program engagement. Implementation variables (e.g., phone calls with parents, program fidelity and text messages sent to parents) were consistently positively associated with different types of engagement after controlling for other factors. Parents of boys, being a victim of intimate partner violence, more children in the household and better parental well-being were positively associated with premature drop-out whilst having a child enrolled in school was positively associated with participation. Barriers included logistical factors such as timing and lack of childcare facilities. Factors that increased engagement included facilitator skills/support, weekly text messages and phone calls and engagement strategies such as transport and childcare. The results emphasise the importance of implementation factors in increasing parent engagement in parenting programs and will help to inform the next phase of the project as well as other family-support initiatives in the three countries. The trial is registered on ClinicalTrials.gov (ID: NCT03552250).

Funder: Jacobs Foundation; doi: http://dx.doi.org/10.13039/501100003986, Funder: UBS Optimus Foundation; doi: http://dx.doi.org/10.13039/501100008391, Funder: Fondation Botnar; doi: http://dx.doi.org/10.13039/501100011318, Funder: Consuelo Zobel Alger Foundation, Funder: British Academy, Funder: Cambridge Humanities Research Grants Scheme, Funder: ESRC Impact Acceleration Account Programme, Funder: University of Edinburgh College Office for the College of Arts, Funder: Humanities and Social Sciences SFC ODA Global Challenges Internal Fund, Funder: University of Cambridge GCRF Quality Research Fund, Funder: Wolfson Professor of Criminology Discretionary Fund, Funder: British Academy Wolfson Foundation Fellowship, Maternal prenatal stress places a substantial burden on mother's mental health. Expectant mothers in low- and middle-income countries (LMICs) have thus far received less attention than mothers in high-income settings. This is particularly problematic, as a range of triggers, such as exposure to traumatic events (e.g. natural disasters, previous pregnancy losses) and adverse life circumstances (e.g. poverty, community violence), put mothers at increased risk of experiencing prenatal stress. The ten-item Perceived Stress Scale (PSS-10) is a widely recognised index of subjective experience of stress that is increasingly used in LMICs. However, evidence for its measurement equivalence across settings is lacking. This study aims to assess measurement invariance of the PSS-10 across eight LMICs and across birth parity. This research was carried out as part of the Evidence for Better Lives Study (EBLS, vrc.crim.cam.ac.uk/vrcresearch/EBLS). The PSS-10 was administered to N = 1,208 expectant mothers from Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam during the third trimester of pregnancy. Confirmatory factor analysis suggested a good model fit of a two-factor model across all sites, with items on experiences of stress loading onto a negative factor and items on perceived coping onto a positive factor. Configural and metric, but not full or partial scalar invariance, were established across all sites. Configural, metric and full scalar invariance could be established across birth parity. On average, first-time mothers reported less stress than mothers who already had children. Our findings indicate that the PSS-10 holds utility in assessing stress across a broad range of culturally diverse settings; however, caution should be taken when comparing mean stress levels across sites.

© 2022 Elsevier Ltd. All rights reserved., Rationale: The associations between the number of COVID-19 cases/deaths and subsequent uptake of protective behaviors may reflect cognitive and behavioral responses to threat-relevant information. Objective: Applying protection motivation theory (PMT), this study explored whether the number of total COVID-19 cases/deaths and general anxiety were associated with cross-situational handwashing adherence and whether these associations were mediated by PMT-specific self-regulatory cognitions (threat appraisal: perceived vulnerability, perceived illness severity; coping appraisal: self-efficacy, response efficacy, response costs). Method: The study (#NCT04367337) was conducted in March-September 2020 among 1256 adults residing in 14 countries. Self-reports on baseline general anxiety levels, handwashing adherence across 12 situations, and PMT-related constructs were collected using an online survey at two points in time, four weeks apart. Values of COVID-19 cases and deaths were retrieved twice for each country (one week prior to the individual data collection). Results: Across countries and time, levels of adherence to handwashing guidelines were high. Path analysis indicated that smaller numbers of COVID-19 cases/deaths (Time 0; T0) were related to stronger self-efficacy (T1), which in turn was associated with higher handwashing adherence (T3). Lower general anxiety (T1) was related to better adherence (T3), with this effect mediated by higher response efficacy (T1, T3) and lower response cost (T3). However, higher general anxiety (T1) was related to better adherence via higher illness severity (T1, T3). General anxiety was unrelated to COVID-19 indicators. Conclusions: We found a complex pattern of associations between the numbers of COVID-19 cases/deaths, general anxiety, PMT variables, and handwashing adherence at the early stages of the pandemic. Higher general anxiety may enable threat appraisal (perceived illness severity), but it may hinder coping appraisal (response efficacy and response costs). The indicators of the trajectory of the pandemic (i.e., the smaller number of COVID-19 cases) may be indirectly associated with higher handwashing adherence via stronger self-efficacy.

© The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Behavioral Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/ licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited., Background: Patterns of protective health behaviors, such as handwashing and sanitizing during the COVID-19 pandemic, may be predicted by macro-level variables, such as regulations specified by public health policies. Health behavior patterns may also be predicted by micro-level variables, such as self-regulatory cognitions specified by health behavior models, including the Health Action Process Approach (HAPA). Purpose: This study explored whether strictness of containment and health policies was related to handwashing adherence and whether such associations were mediated by HAPA-specified self-regulatory cognitions. Methods: The study (NCT04367337) was conducted among 1,256 adults from Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Self-report data on cross-situational handwashing adherence were collected using an online survey at two time points, 4 weeks apart. Values of the index of strictness of containment and health policies, obtained from the Oxford COVID-19 Government Response Tracker database, were retrieved twice for each country (1 week prior to individual data collection). Results: Across countries and time, levels of handwashing adherence and strictness of policies were high. Path analysis indicated that stricter containment and health policies were indirectly related to lower handwashing adherence via lower self-efficacy and self-monitoring. Less strict policies were indirectly related to higher handwashing adherence via higher self-efficacy and self-monitoring. Conclusions: When policies are less strict, exposure to the SARS-CoV-2 virus might be higher, triggering more self-regulation and, consequently, more handwashing adherence. Very strict policies may need to be accompanied by enhanced information dissemination or psychosocial interventions to ensure appropriate levels of self-regulation., The study was supported by grant number 2020/01/0/HS6/00059 from the National Science Centre, Poland, awarded to Aleksandra Luszczynska

Peer reviewed: True, Funder: fondation botnar; FundRef: https://doi.org/10.13039/501100011318, Funder: British Academy/Wolfson Foundation, OBJECTIVE: ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and fetal development; however, there has been almost no research examining their impact during pregnancy. We aimed to address this gap. METHOD: We used data (n = 1,204) from a longitudinal birth cohort study spanning eight countries to address this gap. RESULTS: ADHD symptoms in the third trimester of pregnancy were associated with lower social support from family (b = -0.16, p = .031), friends (b = -0.16, p = .024), and significant others (b = -0.09, p = .001); higher stress (b = 0.34, p < .001) and depressive symptoms (b = 0.31, p < .001), and increased likelihood of an unwanted pregnancy (b = 0.30, p = .009). Significant associations with tobacco use (b = 0.36, p = .023) and premature birth (b = 0.35, p = .007) did not survive correction for multiple comparisons and there were no significant associations with alcohol use, low birth weight, or unplanned pregnancy. CONCLUSION: Results suggest that women with ADHD symptoms could benefit from earlier, more regular screening for mental health difficulties and greater mental health support during pregnancy.

© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data., Background: The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier). Methods: The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports. Results: Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence. Conclusions: To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic., The study was supported by grant number 2020/01/0/HS6/00059 from the National Science Centre, Poland.

Aims This paper explores the number and characterization of latent classes of adverse childhood experiences across the Evidence for Better Lives Study cohort and investigates how the various typologies link to prenatal substance use (i.e., smoking, alcohol, and illicit drugs) and poor infant outcomes (i.e., infant prematurity and low birth weight). Participants and setting A total of 1,189 mother-infant dyads residing in eight diverse low- and middle-income countries (LMICs) were recruited. Methods Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions with distal outcomes were performed. Results The LCA identified three high-risk classes and one low-risk class, namely: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Overall, across all latent classes, there were low probabilities of prenatal substance use and poor infant outcomes. However, pairwise comparisons between classes indicate that class 1 and 3 had higher probabilities of prenatal illicit drug use compared to class 4. Additionally, class 2 had higher probability of low birth weight compared to the three remaining classes. Conclusion The results further our understanding of the dynamic and multifaceted nature of ACEs. More research grounded on LMICs is warranted with more attention to various parameters of risk exposure (i.e., severity, duration, chronicity).

Background: The COVID-19 pandemic has affected people’s engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. Associations between the pandemic’s trajectory and engagement in the protective behavior of handwashing are unclear. This study investigated whether adherence to the World Health Organization’s (WHO) handwashing guidelines is associated with (i) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, (ii) recent cases (country-level COVID-19 morbidity/mortality in the 14 days prior to data collection), (iii) increases/acceleration in recent cases (country-level COVID-19 morbidity/mortality in the previous 14 days minus cases recorded 14-28 days earlier), and (iv) stringency of the national containment-and-health policies (in the 7 days prior to data collection).Methods: The observational study (#NCT04367337) enrolled 6,064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on cross-situational handwashing adherence were collected via an online survey (March–July 2020). Individual data were matched with the WHO daily reports of COVID-19 and indices of containment-and-health policies. Country-level human development index and sociodemographic variables were controlled.Results: Multilevel regression models indicated that as the total cases of COVID-19 morbidity and mortality grew higher, handwashing adherence decreased. As increases in recent cases of COVID-19 morbidity and mortality occurred, handwashing adherence increased. Higher levels of containment-and-health policy index were associated with lower handwashing.Conclusions: Research investigating protective behaviors should account for indicators of fluctuations of COVID-19 morbidity/mortality, besides accounting for time since the beginning of the pandemic.Trial Registration: Clinical Trials.Gov, #NCT04367337, first registration date: 29/04/2020

BACKGROUND: Because there is high variability among European countries in prevalence levels of various alcohol consumption measures, the informational value of adolescent's alcohol consumption indicators is uncertain. The present study aimed to examine information capacity and measurement invariance of different alcohol consumption indicators in adolescents from countries of the former Soviet (Eastern) Bloc in Central and Eastern Europe (CEE). METHODS: Data were collected in 16 CEE countries, as part of the 2013/2014 wave of the Health Behavior in School-aged Children study. Data from adolescents (age 15) who reported having consumed alcohol at least once in their lifetime were analyzed. Four binary items selected for analysis measured the presence or absence of alcohol consumption in the last 30 days, lifetime drunkenness, weekly drinking frequency, and binge drinking on a typical occasion. Multiple group confirmatory factor analysis and item response theory analysis were used to examine the data. RESULTS: In most of the included countries, alcohol consumption in the last 30 days and lifetime drunkenness were indicative at lower severity levels, while binge drinking and weekly drinking frequency were informative at higher levels of alcohol use severity. A low proportion of the estimated intercepts and factor loadings were noninvariant, which indicated approximate cross-national invariance of these indicators. CONCLUSIONS: Adolescent alcohol consumption indicators are informative for different severity levels and enable cross-nationally invariant measurement. However, different indicators suggested the presence of diverging drinking cultures in the CEE regions, with the highest discrimination capacity at the lower and higher ends of the continuum of alcohol use severity.

The aim of this study was to explore the construction of breastfeeding in public, as depicted in the stories and the opinions of women participating in discussions on public forums. There were 8 discussion forums selected, from which 769 messages were subjected to a narrative analysis further informed by recurrent themes identified in the literature and across messages. The emerging narratives were grouped based on their valence, and three broader categories of themes were formed, highlighting the predominant tone towards breastfeeding in public. The three broader themes, ‘public restraint of breast(feeding) as acknowledgement of the cultural status-quo’, ‘permission within boundaries’ and ‘breast(feeding) as a human right’, depict various meanings and experiences associated with public breastfeeding. People seeing breasts as mainly a cultural symbol of sexuality were more against public breastfeeding and more in favour of covering up or striving to discretion. Those arguing that breastfeeding is no more than exercising a fundamental right and pleading for breast as a primary maternal symbol were more in favour of breastfeeding in public. Aiming to understand personal and social perspectives on public breastfeeding is informative for understanding cultural differences in breastfeeding rates but also for designing effective interventions to promote it.

Background:Child mental health problems continue to be a major global concern, especially in low- and middle-income countries (LMICs).Parenting interventions have been shown to be effective for reducing child behavior problems in high-income countries, with emerging evidence supporting similar effects in LMICs. However, there remain substantial barriers to scaling up evidence-based interventions due to limited human and financial resources in such countries. Methods:This protocol is for a multi-center cluster randomized factorial trial of an evidence-based parenting intervention, Parenting for Lifelong Health for Young Children, for families with children ages two to nine years with subclinical levels of behavior problems in three Southeastern European countries, Republic of Moldova, North Macedonia, and Romania (8 conditions, 48 clusters, 864 families,108 per condition). The trial will test three intervention components: length (5 vs. 10 sessions), engagement (basic vs. enhanced package), and fidelity (on-demand vs. structured supervision). Primary outcomes are child aggressive behavior, dysfunctional parenting, and positive parenting. Analyses will examine the main effect and cost-effectiveness of each component, as well as potential interaction effects between components, in order to identify the most optimal combination of program components. Discussion:This study is the first factorial experiment of a parenting program in LMICs. Findings will inform the subsequent testing of the optimized program in a multisite randomized controlled trial in 2021. Trial registration:NCT03865485registered in ClinicalTrials.gov on March 5, 2019.

This study's aim was to examine the joint influence of self-reported weight and body weight dissatisfaction on weight control strategies and physical and psychological complaints. A number of 5404 Romanian adolescents, aged between 13 and 15 years (50.6% girls) participated in a larger study assessing health risk behaviors and attitudes in youth. Participants were asked to fill in their weight and height (in order to calculate the BMI). Questions regarding body weight dissatisfaction, unhealthy weight control and physical and psychological health complaints were also addressed. We used logistic regressions to test the associations between BMI, body weight dissatisfaction, unhealthy weight control behaviors, and health complaints. The proportion of adolescents who reported being too fat was 21% with 10% of normal weight boys and 20% of normal weight girls adolescents being dissatisfied with their body weight. The most common health complaints reported by adolescents were headaches (23.3%), sleep problems (16.7%) and feeling low (32%). There were significant interactions between BMI and body weight dissatisfaction in predicting unhealthy weight control and physical and psychological symptoms. Non-overweight adolescents who perceived themselves as being too fat were more likely to engage in unhealthy weight control behaviors and more likely to report both physical and psychological symptoms compared to their overweight or those who considered themselves as being too thin. The present study suggests that the use of unhealthy weight control methods is not uncommon among adolescents who believe they are too fat but who have BMIs within the normal range. Interventions informed by research should aim to address boy weight concerns and to equip adolescents with skills in order to critically appraise body weight ideals., El objetivo de este estudio fue examinar la influencia común del índice de masa corporal (IMC) e insatisfacción con el peso corporal en las estrategias del control de peso y quejas físicas y psicológicas. Un total de 5404 adolescentes rumanos a la edad de entre 13 y 15 años (50.6% chicas) participaron en un estudio más grande que examinaba las conductas y actitudes de riesgo de salud en los jóvenes. Los participantes tenían que dar su peso y altura (para calcular el IMC). También respondieron a las preguntas sobre su insatisfacción con el peso corporal, control de peso insalubre y quejas sobre molestias de salud física y psicológica. Hemos usado la regresión logística para examinar la relación entre el IMC, la insatisfacción con el peso corporal, el control de peso insalubre y las molestias de salud. 21% de adolescentes autoevaluaron que padecen sobrepeso, con 10% de adolescentes de peso normal insatisfechos con su peso corporal. Las molestias de salud más frecuentes reportadas por los adolescentes fueron dolor de cabeza (23.3%), problemas con el sueño (16.7%) y mal humor (32%). Hubo una interacción significativa entre el IMC y la insatisfacción con el tamaño corporal para predecir el control de peso insalubre y síntomas físicos y psicológicos. Los adolescentes sin sobrepeso pero insatisfechos con su cuerpo mostraban más tendencias a las conductas de control de peso insalubre y reportaban tanto síntomas físicos como psicológicos en comparación con sus compañeros con el sobrepeso o aquellos más satisfechos con su cuerpo. El presente estudio sugiere que el uso de métodos del control de peso insalubre no es poco común entre los adolescentes con niveles altos de insatisfacción, y que tienen el IMC dentro de lo normal. Las intervenciones deberían tratar de abordar las preocupaciones sobre el peso corporal y proporcionar a los adolescentes habilidades para valorar críticamente ideales de peso corporal.

Introduction and hypothesis Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25% to 51%. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI). A European research consortium is investigating an innovative system based on information and communication technology for the conservative treatment of women with SUI. When introducing a new intervention, implementation barriers arise and need to be identified. Therefore, we investigated healthcare providers’ experience with and attitude towards innovative care options. Methods We performed an online survey to assess (1) the characteristics and practice of healthcare providers, (2) current protocols for SUI, (3) current use of biofeedback, and (4) knowledge about serious gaming. The survey was sent to members of professional societies in Europe (EUGA), UK (BSUG) and The Netherlands (DPFS). Results Of 341 questionnaires analyzed (response rate between 18% and 30%), 64% of the respondents had access to a protocol for the treatment of SUI, and 31% used biofeedback when treating patients with SUI. However, 92% considered that biofeedback has a clear or probable added value, and 97% of those who did not use biofeedback would change their practice if research evidence supported its use. Finally, 89% of respondents indicated that they had no experience of serious gaming, but 92% considered that it could be useful. Conclusions Although inexperienced, European urogynecologists and physical therapists welcome innovative treatment options for the conservative treatment of SUI such as portable wireless biofeedback and serious gaming. Scientific evidence is considered a prerequisite to incorporate such innovations into clinical practice., published version, peerReviewed

BACKGROUND: Evidence for the effectiveness of serious games (SGs) and their various features is inconsistent in the motor rehabilitation field, which makes evidence based development of SGs a rare practice. OBJECTIVE: To investigate the effectiveness of SGs in motor rehabilitation for upper limb and movement/balance and to test the potential moderating role of SGs features like feedback, activities, characters and background. METHODS: We ran a meta-analysis including 61 studies reporting randomized controlled trials (RCTs), controlled trials (CTs) or case series designs in which at least one intervention for motor rehabilitation included the use of SGs as standalone or in combination. RESULTS: There was an overall moderate effect of SGs on motor indices, d = 0.59, [95% CI, 0.48, 0.71], p

Research investigating the role of maladaptive emotion regulation on food intake has exclusively focused on food intake in a forced consumption situation. In contrast, the present study examined the effect of negative emotions (fear, negative affect) and emotion regulation strategies (suppression, reappraisal) on food intake in a non-forced, free eating setting where participants (N = 165) could choose whether and how much they ate. This free (ad libitum) eating approach enabled, for the first time, the testing of 1) whether eating (yes/no) is used as a secondary emotion regulation strategy and 2) whether the amount of food intake differed, depending on the emotion regulation strategy. In order to produce a more ecologically valid design, emotion regulation strategy manipulation was realized while exposing participants to emotion-induction procedures. To induce an initial negative emotional state, a movie clip was presented without emotion regulation instruction. The instructions to regulate emotions (suppression, reappraisal, no emotion regulation instruction) then preceded a second clip. The results show that whereas about two-thirds of the control (no emotion regulation instruction) and suppression groups began to eat, only one-third of the reappraisal group did. However, when reappraisers began to eat, they ate as much as participants in the suppression and control groups. Accordingly, the results suggest that when people are confronted with a negative event, eating is used as a secondary coping strategy when the enacted emotion regulation is ineffective. Conversely, an adaptive emotion regulation such as reappraisal decreases the likelihood of eating in the first place, even when emotion regulation is employed during rather than before the unfolding of the negative event. Consequently, the way we deal with negative emotions might be more relevant for explaining emotional eating than the distress itself.

The prevalence of child emotional and behavioral problems is an international problem but is higher in low- and middle-income countries (LMIC) where there are often less mental health supports for families. Parenting programs can be an effective means of prevention, but must be low-cost, scalable, and suitable for the local context. The RISE project aims to systematically adapt, implement, and evaluate a low-cost parenting program for preventing/reducing child mental health problems in three middle-income countries in Southeastern Europe. This small pre-post pilot study is informed by the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework and tested the feasibility of the intervention, the implementation, and evaluation procedures: Phase 1 of the three-phase Multiphase Optimization Strategy (MOST) for program adaptation. Local facilitators delivered the Parenting for Lifelong Health (PLH) for Young Children program to parents of children aged 2-9 in North Macedonia, the Republic of Moldova and Romania in 2018. Parents completed assessments pre- and post-program. Results demonstrated positive pre-post change for participating families (N = 140) on various outcomes including child externalizing and internalizing symptoms and parenting behavior, in all three countries, all in the expected direction. Program participation was associated with positive outcomes in participating families. Based on the experiences of this pilot study, we outline the practical implications for the successful implementation of parenting programs in the three countries that will inform our next study phases, factorial experiment, and RCT.El predominio de los problemas emocionales y conductuales de los niños es un problema internacional, pero es mayor en los países de ingresos bajos y medios donde generalmente hay menos asistencia para la salud mental de las familias. Los programas de crianza pueden ser un medio de prevención eficaz, pero deben ser de bajo costo, escalables y adecuados para el contexto local. El proyecto RISE tiene como finalidad adaptar, implementar y evaluar sistemáticamente un programa de crianza de bajo costo para prevenir o reducir los problemas de salud mental infantil en tres países de ingresos medios del Sudeste de Europa. Este pequeño estudio piloto previo y posterior está fundamentado por el marco de Alcance, Eficacia, Adopción, Implementación y Mantenimiento (RE-AIM, por sus siglas en inglés) y evaluó la viabilidad de los procedimientos de intervención, de implementación y de evaluación: Fase 1 de la Estrategia de Optimización Multifase (MOST) de tres fases para la adaptación del programa. Un grupo de moderadores locales impartió el programa Crianza para la Salud Durante Toda la Vida (Parenting for Lifelong Health, PLH) para Niños Pequeños a padres de niños de entre 2 y 9 años en Macedonia del Norte, República de Moldavia, y Rumania en 2018. Los padres completaron evaluaciones antes y después del programa. Los resultados demostraron cambios positivos después del programa para las familias participantes (N = 140) en varias respuestas, entre ellas, los síntomas de exteriorización y de interiorización de los niños y la conducta de crianza, en los tres países, todos en la dirección esperada. La participación en el programa estuvo asociada con resultados positivos en las familias participantes. Sobre la base de las experiencias de este estudio piloto, describimos las consecuencias prácticas para la implementación satisfactoria de los programas de crianza en los tres países que servirán como base para las fases de nuestro próximo estudio, del experimento factorial y del ensayo controlado aleatorizado.