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Background and Objective: Sixty countries worldwide have banned the use of physical punishment, yet little is known about the association of physical and nonphysical forms of child discipline with child development in a global context. The objective of this study is to examine whether physical punishment and nonphysical discipline are associated with child socioemotional functioning in a global sample of families from 62 countries and whether country-level normativeness of physical punishment and nonphysical discipline moderated those associations. Methods: Data for this study are from 215,885 families in the fourth and fifth rounds of the United Nations Children's Fund Multiple Indicator Cluster Surveys. Bayesian multilevel logistic models were used to analyze the associations of physical punishment and nonphysical discipline (i.e., taking away privileges and verbal reasoning) with three different outcomes representing children's socioemotional functioning: getting along well with other children, aggression, and becoming distracted. Results: The use of physical punishment was not associated with getting along with other children, was associated with increased aggression, and was associated with increases in distraction. Taking away privileges was associated with lower levels of getting along with other children, higher levels of aggression, and higher levels of becoming distracted. Verbal reasoning (i.e., explaining why a behavior was wrong) was associated with higher levels of getting along with other children, higher levels of aggression, and higher levels of becoming distracted. Country-level normativeness moderated some of these associations but in general the direction of effects was consistent. Conclusions: Results suggest that eliminating physical punishment would benefit children across the globe and align with the United Nations Convention on the Rights of the Child, which calls for all children to be free from physical violence. More attention needs to be focused on the associations of nonphysical forms of discipline with child functioning across the globe.

In many low- and middle-income countries, young children learn a mother tongue or indigenous language at home before entering the formal education system where they will need to understand and speak a country's official language(s). Thus, assessments of children before school age, conducted in a nation's official language, may not fully reflect a child's development, underscoring the importance of test translation and adaptation. To examine differences in vocabulary development by language of assessment, we adapted and validated instruments to measure developmental outcomes, including expressive and receptive vocabulary. We assessed 505 2-to-6-year-old children in rural communities in Western Kenya with comparable vocabulary tests in three languages: Luo (the local language or mother tongue), Swahili, and English (official languages) at two time points, 5-6 weeks apart, between September 2015 and October 2016. Younger children responded to the expressive vocabulary measure exclusively in Luo (44%-59% of 2-to-4-year-olds) much more frequently than did older children (20%-21% of 5-to-6-year-olds). Baseline receptive vocabulary scores in Luo (β = 0.26, SE = 0.05, p

Parenting may be influenced by ethnicity; marginalization; education; and poverty. A critical but unexamined question is how these factors may interact to compromise or support parenting practices in ethnic minority communities. This analysis examined associations between mothers’ stimulating parenting practices and a range of child-level (age; sex; and cognitive and socio-emotional development); household-level (indigenous ethnicity; poverty; and parental education); and community-level (economic marginalization and majority indigenous population) variables among 1893 children ages 4–18 months in poor; rural communities in Mexico. We also explored modifiers of associations between living in an indigenous community and parenting. Key findings were that stimulating parenting was negatively associated with living in an indigenous community or family self-identification as indigenous (β = −4.25; SE (Standard Error) = 0.98; β = −1.58; SE = 0.83 respectively). However; living in an indigenous community was associated with significantly more stimulating parenting among indigenous families than living in a non-indigenous community (β = 2.96; SE = 1.25). Maternal education was positively associated with stimulating parenting only in indigenous communities; and household crowding was negatively associated with stimulating parenting only in non-indigenous communities. Mothers’ parenting practices were not associated with child sex; father’s residential status; education; or community marginalization. Our findings demonstrate that despite greater community marginalization; living in an indigenous community is protective for stimulating parenting practices of indigenous mothers.

We examined effects on child development of a group-based parenting support program ("Educación Inicial" - EI) when combined with Mexico's conditional cash transfer (CCT) program ("Prospera," originally 'Oportunidades" and "Progresa"). This cluster-randomized trial included 204 communities (n = 1,113 children in final sample), stratified by community indigenous status, and assigned to receive either: (T[subscript 0]) CCT only; (T[subscript 1]) CCT plus availability of EI in the community; or (T[subscript 2]) [subscript 1] plus promotion of the EI program by the CCT program. Interviews were conducted with the mother or primary caregiver of each child at baseline (2008, children 0-18 months old), and at follow-up (2012, children 3-5 years old); the intervention began after baseline and continued for all eligible households. Cognitive development was assessed with the Extended Ages and Stages Questionnaire (baseline) and the McCarthy Scales of Children's Development (follow-up); assessors were blinded to treatment. All analyses were intention to treat. There were significant effects on child development when EI received support and promotion from the CCT program (T[subscript 2] vs. T[subscript 0]: General Cognitive Index, ß = 3.90; 95% CI [0.51, 7.30], Verbal Score, ß = 4.28; 95% CI [0.51, 8.05], and Memory Score, ß = 4.14; 95% CI [0.62, 7.66]), effects equivalent to 0.26-0.29 SD. There were no significant benefits when the programs operated independently (T[subscript 1] vs. T[subscript 0]). In stratified analyses, EI showed significant effects in indigenous communities only. We found consistent results in regressions controlling for covariates, with some reductions in magnitude of differences. Our findings suggest that group-based, parenting support programs can improve child outcomes within the context of a CCT, but only when the 2 programs are integrated and mutually supportive.

Conditional cash transfer programs (CCTs) have shown mixed effects on child development outcomes in the context of poverty. Direct parenting support integrated with CCTs may improve the effectiveness of CCTs for children's development, and benefits could occur via improvements in parenting practices or the home environment. Here, we use data from a randomized effectiveness trial to examine the pathways connecting parenting support and child development. The parenting program ("EI: Educación Inicial") was implemented at scale among beneficiaries of "Prospera" (a CCT, previously "Oportunidades" and "Progresa"). Participants included children between the ages of 3 and 5 years old (n = 1,362) from 91 rural communities in three Mexican states. Communities were stratified by indigenous classification and randomized to one of three arms: (T[subscript 0]) Comparison group (CCT benefits only); (T[subscript 1]) CCT benefits plus availability of "EI" in the community; or (T[subscript 2]) CCT benefits plus promotion and encouragement by the CCT program to participate in "EI." Findings were that participation in the T[subscript 2] arm of the study was associated with a 13% increase in the number of play activities that parents engaged in with their children, particularly shared storybook reading and singing. Parents in T[subscript 2] showed nearly two times greater odds of reading daily to their children. In mediation analyses, the amount of play activities and shared book reading explained up to 32% of the effects of the "EI" parenting program on child development outcomes. In this study, collaboration and integration of two social programs was critical for program impact, which occurred through pathways relating to parental engagement in reading and play.

Background and Objectives Pediatricians face numerous challenges in providing care for children with special health care needs (CSHCN). Few studies have described health care resources available to support pediatricians to care for CSHCN. This study investigated available resources to care for CSHCN and factors associated with having a greater proportion of CSHCN in practice. Methods We conducted a statewide survey of active members of the American Academy of Pediatrics in California to study pediatric subspecialty care access, community and office resources and practice barriers. We performed a logistic regression model on having an 'above average proportion' of CSHCN in practice, adjusting for demographics, practice type (rural vs. suburban/urban) and medical resources, care satisfaction, and ease of subspecialty access. Results Our response rate was 50.2% (n = 1290); 75% of respondents reported providing some primary care services, with many primary care pediatricians caring for a high proportion of CSHCN. Pediatricians reported an average of 28% CSHCN in their practices. Rural pediatricians lacked subspecialty access (10-59% reporting no access to the various subspecialties). Factors relating to higher CSHCN in practice included being in academic medical centers and satisfaction in caring for CSHCN. Conclusions Pediatricians report lack of access to mental health services, care coordination and case management. Academic medical centers and higher physician satisfaction in care delivery for CSHCN are associated with more CSHCN in practice. Promoting ways to support pediatricians, such as practice collaboration with behavioral specialists, may be necessary to encourage primary care pediatricians to provide medical homes for CSHCN., Author(s): Megumi J. Okumura [sup.1] [sup.2] [sup.3] , Heather A. Knauer [sup.1] [sup.4] , Kris E. Calvin [sup.5] , John I. Takayama [sup.1] Author Affiliations: (Aff1) 0000 0001 2297 6811, [...]

Children with special health care needs (CSHCN) are at risk for school failure when their health needs are not met. Current studies have identified a strong connection between school success and health. This study attempted to determine (a) how schools meet the direct service health needs of children and (b) who provides those services. The study used the following two methods: (a) analysis of administrative data from the California Basic Educational Data System and (b) a cross-sectional online survey of 446 practicing California school nurses. Only 43% of California's school districts employ school nurses. Unlicensed school personnel with a variety of unregulated training provide school health services. There is a lack of identification of CSHCN, and communication barriers impair the ability to deliver care. Study results indicate that California invests minimally in school health services.

There are increasing numbers of children with special health care needs (CSHCN) who require various levels of care each school day. The purpose of this study was to examine the role of public schools in supporting CSHCN through in-depth key informant interviews. For this qualitative study, the authors interviewed 17 key informants to identify key themes, provide recommendations, and generate hypotheses for further statewide survey of school nurse services. Key informants identified successful strategies and challenges that public schools face in meeting the needs of all CSHCN. Although schools are well intentioned, there is wide variation in the ability of schools to meet the needs of CSHCN. Increased funding, monitoring of school health services, integration of services, and interagency collaboration are strategies that could improve the delivery of health services to CSHCN in schools.

Objective: This study examined whether fathers' prebirth pregnancy intentions were associated with fathers' involvement with his child 15 months later. Method: Propensity score matching was used to assess the effects of fathers' pregnancy intentions (self-reported before the birth of the child) on three measures of father involvement (residency with child, engagement in caregiving activities, and engagement in social cognitive play) in a large sample of young, diverse, and low-income fathers (N = 2,008). Results: In this sample matched on sociodemographic and interpersonal factors, fathers reporting an intended pregnancy had significantly higher levels of social and cognitive play with their child, compared to fathers reporting an unintended pregnancy. However, intentions were not significantly associated with fathers' residency with child or caregiving activities. Conclusion: Results suggest that fathers' pregnancy intentions are predictive of certain types of father involvement and emphasize the importance of controlling for factors associated with both fathers' intentions and involvement. [ABSTRACT FROM AUTHOR]

We examined effects on child development of a group-based parenting support program (Education Initial - El) when combined with Mexico's conditional cash transfer (CCT) program (Prospera, originally Oportunidades and Progreso). This cluster-randomized trial included 204 communities (n = 1,113 children in final sample), stratified by community indigenous status, and assigned to receive either: (T0) CCT only; (T1) CCT plus availability of El in the community; or (T2) T1 plus promotion of the El program by the CCT program. Interviews were conducted with the mother or primary caregiver of each child at baseline (2008, children 0-18 months old), and at follow-up (2012, children 3-5 years old); the intervention began after baseline and continued for all eligible households. Cognitive development was assessed with the Extended Ages and Stages Questionnaire (baseline) and the McCarthy Scales of Children's Development (follow-up); assessors were blinded to treatment. All analyses were intention to treat. There were significant effects on child development when El received support and promotion from the CCT program (T2 vs. T0: General Cognitive Index, β = 3.90; 95% Cl [0.51, 7.30], Verbal Score, β = 4.28; 95% Cl [0.51, 8.05], and Memory Score, β = 4.14; 95% Cl [0.62, 7.66]), effects equivalent to 0.26-0.29 SD. There were no significant benefits when the programs operated independently (T1 vs. T0). In stratified analyses, El showed significant effects in indigenous communities only. We found consistent results in regressions controlling for covariates, with some reductions in magnitude of differences. Our findings suggest that group-based, parenting support programs can improve child outcomes within the context of a CCT, but only when the 2 programs are integrated and mutually supportive. [ABSTRACT FROM AUTHOR]

Background: Patients with Marfan syndrome (MFS) are at a high risk of type B dissection (TBAD). Aortic growth and elongation have been suggested as risk factors for TBAD. Vascular deformation mapping (VDM) is an image analysis technique for mapping 3D aortic growth on rouine computed tomography angiography (CTA) scans. We aimed to use VDM to examine the value of aortic growth rate in the descending thoracic aorta (DescAo), among other imaging biomarkers, to identify the factors associated with risk of TBAD in MFS., Methods and Results: CTA scans spanning 2004-2023 from adult MFS patients with native DescAo were analyzed by VDM. Other measurements included multi-level thoracoabdominal aortic diameters and the length of the DescAo by centerline analysis.Among the 105 MFS patients analyzed, 63.8% were male, with median age of 40 years (range 18-73) and a median surveillance interval of 5.3 years (range 2.0-18.3). During surveillance, 12 (11.4%) patients developed TBAD. Patients with TBAD had higher radial growth rate (0.63 vs. 0.23 mm/year; p < 0.001) and elongation rate (2.4 vs. 0.5 mm/year; p < 0.001), on univariate and multivariable analysis, but pre-dissection descending aortic diameter was not significantly different. Predictors of growth rate included younger age, higher baseline maximal diameter of the DescAo, smoking history and warfarin use., Conclusions: Radial growth and elongation rates of the DescAo were independent predictors of TBAD occurrence in MFS. TBAD often occurred in at non-aneurysmal diameters (<4.0 cm). These findings emphasize the role of growth over absolute diameter in risk stratification for TBAD in MFS.