Search Results (165)

Background/Objectives: Social isolation is a significant risk factor for child maltreatment. However, few studies have examined this relationship across multiple ecological levels, including neighborhood, family, and individual factors. This cross-sectional study operationalized social isolation using social cohesion, social support, and loneliness, and aimed to examine how their inter-relationships influence child maltreatment among Japanese mothers. Methods: Data were collected through an anonymous online survey of 330 Japanese mothers of children aged under six years, conducted April–May 2025. Structural equation modeling was employed in a two-step analytic approach. First, a confirmatory factor analysis was conducted to establish construct validity. Second, the hypothesized structural model was tested to examine the proposed pathways among social cohesion, social support, loneliness, parenting stress, and child maltreatment. Analyses were conducted using weighted least squares with mean and variance adjustment estimation. Results: Higher social cohesion was indirectly associated with reduced child maltreatment via two pathways. First, higher social cohesion was associated with lower loneliness, reduced parenting stress, and decreased child maltreatment (β = −0.063, p < 0.001). Second, higher social cohesion was associated with greater social support, reduced loneliness, lower parenting stress, and decreased child maltreatment (β = −0.043, p < 0.001). Conclusions: These findings highlight that enhancing neighborhood connectedness and alleviating maternal loneliness are key changes that may help to prevent child maltreatment. Full article

Objective: Based on the Person-Centered Approach, this study targeted parents of very preterm (VPT) infants in Neonatal Intensive Care Units (NICUs) from Italy and Portugal. The primary aim was to classify parents by identifying latent classes of perceived risks (NICU stressors) and resources (sources of social support). Potential specificities in class membership according to Country of Belonging and sociodemographic factors were also investigated. Methods: Overall, 303 parents (92 Italian; 211 Portuguese) completed a survey including sociodemographic factors, Parental-Stressor-Scale-NICU, and Multidimensional-Scale-of-Perceived-Social-Support. Data were analyzed by multigroup latent class analysis and multinomial logistic regression. Results: Three statistically valid and cross-country classes were identified and labelled as Class 1, Adjusted/Beneficial-and-Supported-System, Class 2, Stressed-and-Supported-System, and Class 3, Parental-Role-Alteration-with-Family-Supported-System. Portuguese parents were mainly grouped in Classes 1 and 2, while Italian parents were in Class 3. Men were less likely to belong to Classes 2 and 3, while older parents having another child were more likely to belong to Class 3. Conclusions: The experience of parents of VPT infants in NICUs is inherently challenging, yet identifying specific risk profiles featured by the unique nuances of stressors and sources of support while accounting for further factors (Country of Belonging, Gender, Age, Having another child) can foster the customization of interventions aimed at providing parents with the necessary resources for adjusting to this extremely demanding experience. Full article

Background/Objectives: Children of families facing unmet social needs experience higher rates of adverse outcomes compared to those not experiencing unmet social needs. This study aimed to identify factors associated with families’ unmet social needs as reported by parents or guardians at their children’s primary care visits. Methods: This cross-sectional study recruited English-speaking primary caregivers of children less than 18 years of age from the Southwestern Ohio Ambulatory Research Network (SOAR-Net) who were surveyed between January 2023 and August 2024. Surveys included the Maternal Social Support Index, Social Capital Scale, RAND Depression Screener, Children with Special Health Care Needs Screener, Medical Expenses of Children Survey, a 10-item social needs screener, and demographics. Data were analyzed with chi-square or Fisher’s exact tests, adjusted logistic regression, and ANOVA. Results: Among 1167 respondents (78% response rate), 1114 provided complete data. Primary caregivers were predominantly mothers (79.9%) or fathers (13.6%), White (72.0%) or Black (16.0%), and had an associate’s degree or less (65.1%). The mean (SD) index child’s age was 6.4 (5.3) years, and 52.4% were female. Underinsurance, positive depression screens, and poor child health were positively associated with unmet social needs. Higher scores for social support and social capital were associated with fewer social needs. Multinomial logistic regression revealed significant relationships with reporting two or more unmet social needs with the following variables: childhood underinsurance, household annual income < $50,000, positive depression screens, raising a child with a chronic health condition, and Black race/ethnicity. Conclusions: Several significant social factors were independently associated with a greater number of unmet social needs. These findings highlight the complex interplay among social factors in children’s healthcare. Future research should explore the putative longitudinal stability of these relationships. Full article

Background/Objectives: Caregiver perception of child weight may be a cognitive antecedent of feeding practices, yet evidence linking misperception to feeding practices remains inconsistent. Guided by Social Cognitive Theory, this study examined whether caregiver weight perception (underestimation, overestimation, or accurate) is independently associated with feeding practices among caregivers of U.S. preschool-aged children. Methods: Primary caregivers of children aged 3–5 years (analytic n = 139) were recruited across the Midwestern United States from April 2022 to March 2023. Weight perception was classified as accurate, underestimation, or overestimation by comparing perceived with CDC BMI-for-age category. Four Comprehensive Feeding Practices Questionnaire (CFPQ) subscales were assessed: pressure to eat, restriction for health, restriction for weight control, and monitoring. Multivariable linear regression estimated associations, adjusting for child and caregiver characteristics and child BMI-for-age z-score. Results: Overall, 45.3% of caregivers accurately perceived their child’s weight, 44.6% underestimated it, and 10.1% overestimated it. In adjusted models, underestimation was independently associated with lower restriction for health (B = −0.62, 95% CI: −1.10, −0.13, p = 0.013) and lower restriction for weight control (B = −0.30, 95% CI: −0.58, −0.02, p = 0.033) relative to accurate perception. Overestimation was marginally associated with higher restriction for weight control (B = 0.53, 95% CI: 0.00, 1.07, p = 0.050). No associations were observed with pressure to eat or monitoring. Conclusions: Weight misperception was selectively associated with restrictive feeding. This identifies it as a candidate cognitive target in early obesity prevention research. Longitudinal research is needed to establish causality. Full article

Background/Objectives: Parenting stress and life satisfaction are important indicators of family well-being and parent mental health in families of children with disabilities. However, limited empirical attention has been given to how these outcomes differ among parents whose children receive adapted physical activity (APA) services within South Korea’s Developmental Rehabilitation Service system. This cross-sectional study examined subgroup differences in parenting stress and life satisfaction according to sociodemographic, disability-related, and service-utilization characteristics among parents of children receiving APA services. Methods: Data were collected from 295 parents of school-aged children with disabilities enrolled in APA services at child development centers. Welch-type tests, Welch’s ANOVA or one-way ANOVA, Pearson correlation analyses, Benjamini–Hochberg FDR adjustment, and supplementary analyses of covariance (ANCOVA) were used to examine group differences and the stability of selected associations after adjustment for prespecified covariates. Confirmatory factor analysis and gender-based measurement invariance testing were also conducted for the adapted parenting stress scale. Results: Parenting stress subdomains were positively correlated with one another (r = 0.19–0.53) and negatively correlated with life satisfaction (r = −0.28 to −0.40). Female parents reported higher social and psychological stress than male parents. Household income showed the largest association with economic stress, and significant differences were also observed according to parental age, education level, disability severity, and selected service-utilization characteristics. Some associations remained after ANCOVA adjustment, whereas others were attenuated or emerged only after adjustment. Conclusions: The findings indicate subgroup differences in parenting stress and life satisfaction among parents of children receiving APA services. Because the study used a cross-sectional, self-reported design with convenience sampling and an adapted instrument, the results should be interpreted as preliminary associative evidence rather than evidence of causal or service-specific effects. Future longitudinal, comparative, and service-level research is needed to clarify how APA service contexts relate to caregiver well-being over time. Full article

Fathers are globally recognized as influential figures in children’s development, yet the specific mechanisms linking paternal beliefs to preschoolers’ social adjustment remain insufficiently explored. This study examined the sequential mediation effects of father involvement and the father–child relationship on the link between paternal progressive beliefs and children’s social adjustment (indexed by social competence and problem behaviors). A stratified random sample of 1862 Chinese mother–father dyads (3724 individual participants) was recruited. Structural equation modeling showed that the following: (1) Fathers’ progressive beliefs had a direct positive association with children’s social competence, and a small but significant direct positive link to children’s anger–aggression behaviors; (2) The associations between the fathers’ beliefs and children’s social adjustment were indirectly explained by a sequential mediation process: beliefs were associated with greater father involvement, which, in turn, connected to fostered closeness or increased father–child conflict, ultimately leading to more positive adjustments through closeness, or to more negative adjustments via conflict. This study also uncovered discrepancies between mothers’ and fathers’ perceptions of the fathering process. Notably, due to the lack of parallel measures of maternal constructs, these findings reflect paternal contributions within the family system rather than unique effects. These findings were discussed within the transitional context of culturally specific Chinese fathering. This study extends the traditional “parenting beliefs–practices–outcomes” framework to include the parent–child relationship, highlighting the importance of targeting fathers’ effective relationship-building practices in family programs. Full article

Sentiment expressions related to child maltreatment (CM) in public discourse are influenced by demographic, economic, and cultural factors and individual characteristics. Using 188,429 geotagged CM-related tweets during 2018–2022, we explored public sentiment expression about CM across the contiguous U.S. We applied multiscale geographically weighted regression (MGWR) to examine how contextual factors relate to the percentage of CM-related tweets with negative sentiment at the county level, revealing the spatial heterogeneity and varying geographic scales of these associations. Counties with higher male-to-female ratios and lower education levels tended to express negative sentiment in CM-related tweets, with consistent patterns observed nationwide. Five factors exhibited spatially varying associations by U.S. region, with higher levels of negative sentiment in the following contexts: a lower percentage of residents living in group quarters or a higher percentage of same-sex couples (Eastern and Central); fewer households lacking broadband access (Central); a higher percentage of single-parent households (New England and Southern Mississippi River); and areas where professionals are mandated to report CM (Great Lakes and Southern Appalachian Mountains). This study provides critical insights for policymakers to adjust policies, educators to design focused interventions, and the public to raise CM awareness. The methodology also provides a valuable framework for investigating public discourse on other social issues. Full article

Background/Objectives: Social development in children is a significant aspect that supports appropriate behavior in the community, and parents, as the main caregivers, play a central role in developing social skills in children. However, caregivers experiencing mental health problems—such as depression, anxiety, and stress—may find it challenging to provide a nurturing rearing environment. This one-year follow-up study examined whether the baseline mental health of caregivers was associated with social skills in children 1 year later in an urban Indonesian context. Methods: A one-year follow-up study was conducted in an urban area of Indonesia in 2023–2024, inviting all nine kindergartens in the area to participate. Caregivers completed the demographic questionnaire and the Depression, Anxiety, Stress Scale (DASS-21), while teachers assessed social skills in children using the Social Skills Scale (SSS). Linear mixed-effects models with random intercepts for kindergarten were estimated to account for clustering. Results: Finally, a total of 270 parent–child dyads were included. After adjusting for baseline social skills and covariates, higher levels of baseline caregiver depression (B = −0.15, p < 0.001), anxiety (B = −0.22, p < 0.001), and stress (B = −0.27, p < 0.001) were associated with lower social skills in children in the follow-up. Conclusions: Even subclinical variations in caregiver mental health problems may be meaningfully associated with social development in children over time. The findings highlight mental health in caregivers as a potentially important factor associated with early social development in an urban setting of Indonesia. Full article

Background: A paediatric cancer diagnosis is a profound stressor for the entire family system. Although coping strategies are well-studied, their link to the quality of the parent–child attachment relationship remains less explored. In this study, we investigated whether dyadic attachment dynamics—specifically closeness and conflict between parent and child—are associated with the use of adaptive or maladaptive coping strategies in caregivers of children undergoing active treatment for oncohaematological diseases. Methods: We conducted a multicentre, cross-sectional study across three Italian paediatric oncohaematology centres. A total of 165 caregivers of 91 paediatric patients aged 3–17 years completed self-report measures assessing parent–child relationship quality (Child–Parent Relationship Scale-CPRS), coping strategies (COPE-NVI), perceived social support (MSPSS), and resilience (RS-14). We tested whether the quality of the parent–child attachment relationship is associated with caregivers’ coping strategies. We hypothesised that Attachment Closeness would be associated with adaptive coping (Positive Attitude, Social Support, Problem Orientation), whereas Attachment Conflict would be associated with maladaptive coping (Avoidance). We conducted multiple linear regression models, adjusted for key covariates and with robust standard errors clustered at the family level, to test these hypotheses. Results: Higher levels of emotional closeness (CPRS) were significantly associated with greater use of adaptive coping strategies, specifically Positive Attitude (β = 0.20, p = 0.049) and Problem Orientation (β = 0.26, p = 0.002), even after controlling for sociodemographic factors, social support, and resilience. Conversely, higher levels of relational conflict were significantly associated with greater use of the maladaptive Avoidance strategy (β = 0.14, p = 0.015). The hypothesis linking closeness to Social Support seeking was not supported. Conclusions: The findings suggest that the parent–child attachment relationship is a significant correlate of caregiver coping strategies in caregivers of children with cancer. Interventions aimed at supporting the caregiver–child dyad by fostering emotional closeness and reducing conflict may promote more adaptive parental coping mechanisms, thereby enhancing family resilience and psychological adjustment throughout the treatment journey. Full article

Background/Objectives: The characterization of varying levels of parental engagement is important for increasing understanding of how to tailor and maximize the effectiveness of parent-based eHealth interventions. In this study, we aimed to determine if parental engagement in the WeChat group of a parent-based eHealth intervention affected preschoolers’ physical activity, diet, or sleep. Methods: We utilized baseline, post-test (12 weeks after baseline), and follow-up (12 weeks after post-test measurement) data from the intervention group in a parent-based eHealth intervention concerning children aged from three to six years, designed as a single-blinded randomized controlled trial with two parallel arms to explore the intervention’s influence on preschoolers’ physical activity, diet, and sleep. The parents in the intervention group were categorized into two groups: (1) The actively engaged group (53 parent–child dyads), defined as parents who actively posted and commented on modules at least once a week, either in the WeChat groups or through private messages with the researchers. (2) The lurker group (67 parent–child dyads), defined as parents who only responded to the weekly self-assessment messages and who, aside from this, showed no interaction within WeChat groups and did not privately message the researchers. Preschoolers’ physical activity was measured using ActiGraph wGT3X-BT, while their dietary behaviors and sleep were measured using parent-reported questionnaires. Generalized Estimating Equations using group and time as main effects and adjusted demographic information for covariates were computed to examine the effects of parental engagement in the eHealth intervention on preschoolers’ physical activity, diet, and sleep. Results: At post-test, higher levels of parental engagement were significantly associated with a marked increase in preschoolers’ moderate-to-vigorous and vigorous physical activity, alongside a notable reduction in weekend screen time. Furthermore, active parental engagement was linked to greater decreases in satiety responsiveness, desire to drink, and food fussiness compared to the ‘lurker’ group. However, no significant associations were observed between the level of parental engagement and preschoolers’ sleep-related outcomes. Conclusions: Further research with larger sample sizes and longer durations is needed to better investigate the potential of social media in parent-based interventions for promoting healthy lifestyles in children. Full article

In high-density urban environments, outdoor kindergarten spaces are vital for children’s cognitive and social development, yet their design within constrained urban greenery poses a significant challenge. This study investigated how these environments support development through autonomous play. Conducted as a case study in three Beijing kindergartens, it employed a framework analyzing ten environmental elements across four dimensions: terrain space (e.g., open space, slopes), game facilities (fixed and movable), loose materials, and natural elements (water, plants). Behavioral observations were used to examine associations between these elements and children’s play behaviors. The findings suggest that diverse, naturalized, and adaptable combinations of elements may best foster autonomous play. While functional play was predominant, our analysis identified that a core combination of rigid fixtures, shielded places, and loose materials appears to optimally support this play type, which is primarily linked to solitary play. By strategically supplementing this core with elements like moving fixtures and loose objects, the environment can further encourage constructive, dramatic, and exploratory play—forms that show stronger associations with cooperative group play. This reveals a potential pathway through which sequenced environmental provisioning might scaffold the progression from individual to social play, thereby fostering socio-cognitive growth. Consequently, the study proposes three exploratory design principles: the differentiated allocation of elements to target specific play behaviors, deliberate naturalization of the setting, and incorporating dynamic adjustability for flexibility. These hypothesis-generating strategies aim to inform the design of kindergarten outdoor spaces, offering practical guidance for creating more sustainable and child-inclusive urban communities, though their generalizability requires further cross-context validation. Full article

Objective: The aim of this study was to investigate the association between dental caries and multidimensional poverty in Colombia using data from the National Oral Health Survey (ENSAB IV, Spanish acronym). Methods: A cross-sectional analytical study was conducted using data from 20,534 individuals in six regions of the country. Dental caries was assessed using the ICDAS system, and multidimensional poverty was measured using a proxy Multidimensional Poverty Index (MPI) adapted from the method adjusted for Colombia. Descriptive analyses and bivariate comparisons were carried out, and Poisson regression models adjusted for sociodemographic variables were applied. Results: Households containing at least one member with caries had a higher incidence (59.9%) and intensity (46.7%) of multidimensional poverty compared to those without caries (52.6% and 45.6%, respectively). Significant associations were identified between caries and deprivation in education (low educational attainment: RR = 1.27), child labor (RR = 1.16), unemployment (RR = 1.04), lack of health insurance (RR = 1.09), and inadequate housing conditions (RR = 1.19). The model that analyzed the presence of caries in a household and multidimensional poverty, when controlled for housing conditions, confirmed a positive association between the MPI and the presence of caries (IRR = 1.08; 95% CI: 1.050–1.107; p-value < 0.001). A female head of household and rural residence were also identified as variables associated with the presence of caries in a household. Conclusions: The presence of a household member with dental caries is significantly associated with multidimensional poverty in Colombia. This study highlights the need to consider oral health as a sensitive indicator of structural inequality and proposes its inclusion in social progress metrics. The findings support the design of comprehensive public health strategies that address the social determinants of oral health, especially in vulnerable populations. Full article

Ultra-processed foods (UPFs) have become a dominant component of contemporary food environments worldwide. Their consumption is socially patterned, with higher intakes frequently observed among children from socioeconomically disadvantage families, highlighting a critical dimension of dietary inequality. International migration is another major social determinant of familial diet; however, few studies have examined how migration-related characteristics is associated with children’s UPF consumption in Portugal. This study assessed the association between migration-related characteristics, namely parental nationality and whether the child had always lived in Portugal, and UPF consumption among young children. Cross-sectional analysis of data from the prospective ScreenHealth cohort (5.6 ± 1.0-year-old children; n = 682; 52.1% male) included information on migration status, dietary intake, and covariates (age, parental education). Children with two foreign parents or who had not always lived in Portugal showed higher odds of consuming several UPF items. These associations were only partially attenuated after adjustment for socioeconomic indicators like parental education. Findings are descriptive and should be interpreted with caution, particularly given the small sample sizes of some immigrant subgroups and the cross-sectional design, but they provide novel insights into early-life dietary patterns and highlight population groups that may be differentially exposed to UPF-rich food environments during early childhood. Full article

Background/Objectives: Parental health literacy is linked to child health outcomes, but the evidence relies mainly on parent proxy reports. This study examined the association between parental health literacy and proxy-reported mental health outcomes in children aged 6–10 years and assessed whether these associations reflect general reporting patterns. Methods: This study is a secondary analysis of data derived from a population-based cross-sectional survey conducted in South Tyrol, Italy, including proxy data from 3183 children aged 6–10 years. Parental health literacy was categorized as inadequate, problematic, adequate, or missing/insufficient. The outcomes included emotional and behavioral difficulties, psychosomatic complaints, and perceived social support. Linear regression models were estimated for each outcome, adjusted for children’s age, gender, parental age, education, family affluence, migration background, residential setting, and questionnaire language. Selective missingness and insufficient completion of parental health literacy data were examined using logistic regression analysis. Sensitivity analyses were used to adjust the mental health models for social support. Results: Higher parental health literacy was associated with lower emotional and behavioral difficulties (B = −1.40, 95% confidence interval [CI] −1.79 to −1.01), higher psychosomatic complaint scores (B = 0.61, 95% CI 0.40 to 0.081), and higher perceived social support (B = 0.14, 95% CI 0.02 to 0.26). The effect sizes were small. Missing or insufficient parental health literacy data showed social patterns by parental education and age, whereas no systematic predictors of early disengagement were observed among parents who partially completed the health literacy instrument. Sensitivity analyses attenuated but did not eliminate the associations between parental health literacy and child mental health outcomes. Conclusions: Parental health literacy is associated with proxy-reported psychosocial outcomes in children aged 6–10 years. The consistency of the effects across outcomes suggests that parental health literacy may influence how parents report child functioning, underscoring the importance of considering informant characteristics in proxy-based research. Full article

Background: Parental perceptions represent a crucial and underexplored dimension in evaluating the psychological adjustment and health-related quality of life (HRQoL) of children with growth hormone deficiency (GHD). This study aimed to: i. assess the psychological adjustment and HRQoL of children with GHD and to examine the psychological impact of six months of recombinant GH (rec-GH) therapy, based on parental reports; ii. compare the results obtained in parents of children with GHD with those of parents of children with familial short stature (FSS) and parents of children with normal stature (NS). Methods: Parents of 10 children with GHD, of 15 children with FSS, and of 17 children with NS completed the Child Behaviour Checklist for Children (CBCL) and the Quality of Life in Short Stature Youth (QoLISSY) questionnaires. For the GHD subgroup, assessments were repeated after six months of rec-GH treatment. Results: Parents reported a comparable overall behavioural functioning across the three subgroups, with a trend toward greater emotional difficulties in the GHD subgroup—particularly in the withdrawal/depression subscale of CBCL. After 6 months of rec-GH therapy, CBCL scores suggested a partial normalization of emotional functioning according to the parents of children with GHD. However, conduct problems remained more pronounced compared to the NS and FSS subgroups. As far as HRQoL is concerned, there were no significant differences between the parents of the GHD and FSS subgroups in the QoLISSY; however, both subgroups reported a markedly lower QoL than parents of children with NS across Physical, Social, Emotional, Future, Effect, and Total domains. Following a six-month rec-GH treatment, the GHD subgroup continued to exhibit lower physical QoL scores despite an improved height velocity, suggesting that the six-month rec-GH therapy did not fully mitigate the perceived physical limitations. Conclusions: This study provides an integrative evaluation of the psychosocial adjustment and HRQoL in children with GHD, FSS, and NS, emphasising the value of parent-reported outcomes. Full article