Child Behavioral Health Research Articles

Child and adolescent behavioral health in the juvenile legal system: Inside the walls and beyond

Jason, a 15‐year‐old adolescent, was recently adjudicated and placed at the Rhode Island Training School (RITS), the state's only secure carceral facility for detained and adjudicated youth. Like many of the youth entering the facility, Jason arrived at the RITS with a complex history of trauma, substance use, and behavioral issues. As a child, his father was incarcerated and his mother struggled with substance use, leaving Jason without a consistent caregiver. His early life was marked by frequent moves between foster homes, unstable housing, and exposure to violence. This instability in his childhood led to feelings of anger and frustration, which often manifested in school through defiant behavior, truancy, and eventually, physical altercations that led to his involvement with the juvenile legal system.

Family-based mobile application needs in childhood obesity management in South Korea: a qualitative study.

It is essential to investigate the users' needs in developing user-centered, family-based applications (apps) for managing childhood obesity. This study conducted focus group interviews with ten parents, ten children, and four app developers to investigate the need to develop a family-based mobile app for childhood obesity. The interview period was from July 17 to August 30, 2023. The data were analyzed using thematic analysis. The results highlighted 31 key themes critical to family-based app development, including the need for comprehensive content promoting healthy lifestyle habits, tailored expert support, and motivational factors for app engagement, which were categorized as intrinsic, extrinsic, and social motivations and technological features. Participants also highlighted potential challenges, such as app usability issues and the need for a user-friendly interface. The pivotal role of parents in guiding and supporting their children's health behaviors was emphasized, particularly in creating a supportive environment that encourages sustained engagement with the app. These findings provide a comprehensive understanding of the needs and preferences of parents, children, and app developers in managing childhood obesity. Emphasis on integrating healthy lifestyle content, providing expert support, and incorporating motivational strategies is crucial for the app's success. Additionally, addressing potential difficulties and recognizing the pivotal role of parents are essential considerations. These insights will inform the design and development of a user-centered mobile app that supports families in managing childhood obesity.

The influence of health literacy on health outcomes and behaviors in fourth-graders in Germany

Abstract Background For the adult population, evidence suggests that a high level of subjective health literacy is associated with a number of favorable health outcomes and behaviors. However, for younger populations, particularly children, little evidence is available. This study investigates the relationship between subjective health literacy, health outcomes, and health behaviors in children. Methods We conducted a representative survey of 4th-grade students (age 8-11) in North Rhine-Westphalia, Germany, between Oct. 2022 and Feb. 2023. Subjective health literacy was measured with the HLS-Child-Q15 questionnaire. For mental and physical well-being, the KINDL-R was used. For health behaviors, we asked about the frequency of (1) brushing teeth, (2) eating fruit and (3) vegetables, (4) exercising, (5) consuming sweetened drinks, and (6) wearing a helmet when riding the bike. Regression analysis was used to determine the impact of health literacy on outcomes, controlling for a number of sociodemographic indicators (birthplace, home language, sex, age), as well as the tendency to give socially desirable responses. Health behaviors were rated on a Likert scale and where dichotomized for ordinal regression. Results n = 1085 students are included with a mean age of 9.5 years (SD=.6). 50.3% are female. While controlling for a number of variables, health literacy was a significant predictor (p<.05) for every indicator except the frequency of (1) brushing teeth, (4) exercising, and (5) consumption of sweetened drinks. For mental well-being, health literacy was the strongest predictor. Conclusions Our findings highlight the potentially enabling role of subjective health literacy regarding favorable health outcomes and health behaviors. However, because this is a study among younger children, further research is needed on the interplay of individual subjective health literacy, social contexts (e.g., parental health literacy and health behaviors), and children’s health outcomes and behaviors.

Inequities in child health in Luxembourg

Abstract Background In Luxembourg, despite its economic prosperity, 28.6 % of children are estimated to be at the risk of poverty. Research has shown that growing up with socioeconomic disadvantage is associated with worse physical and mental health in childhood. We explore the association of socioeconomic status with health, health behaviours and access to healthcare in Luxembourg for children up to age twelve. Methods We used data from 2014 to 2022 for 11-12 year old children from the Health Behaviour in School-aged Children (HBSC) survey as well as social security data from Luxembourg for a similar time period and children 0 to 12 years old. To assess socioeconomic status, we used information on self-perceived household wealth for the HBSC results and stratified health and health behaviours by well-off, average, or less well-off households. For the social security data, we stratified access to care indicators by equivalized household income quintiles. Results We found that physical activity levels, nutritional quality and daily routines such as eating breakfast and brushing teeth are significantly lower in children from less affluent families. For example, 61% of 11-12-year-old children from well-off families reported eating breakfast every day, but only 41% of children from less well-off families. Only 23% of 11-12 year olds from less affluent families rated their health as excellent, compared to 52% of children from affluent families. There were similarly large differences for multiple health complaints, with 63% of children from less affluent families reporting this indicator for psychosomatic problems, compared to 34% of children from affluent families. We did not find differences in the use of pre- and postnatal care visits. Conclusions Socioeconomic differences in child health, mental health and health behaviours are large, with children from poorer households being in worse physical and mental health and less likely to report positive health behaviours. Key messages • Many children in Luxembourg face socioeconomic challenges that are adversely associated with health and health behaviours. The underlying reasons require further attention to improve child health. • Children from poorer backgrounds are in significantly worse mental health than children from better off families in Luxembourg.

Are answers affected by data collection on paper or online? The case of Belgian adolescents

Abstract Background In the early 2000s, the prevalence estimations were compared in relation with the mode of data collection, i.e. paper or online. Following the widely spread routine use of connected devices, especially in adolescents, such a monitoring is of interest. Within the 2022 “Health Behaviour in school-aged children” survey in French-speaking primary and secondary schools of Belgium, those participating could choose between paper and online collection. Our objective was to compare a large set of indicators between the two modes after adjusting for the students’ characteristics. Methods After a two-stage random selection of schools and classes, 11,751 10-to-20-year-old adolescents completed the questionnaire either on paper or online. Descriptive analysis and comparisons were conducted using chi2 and multiple logistic regressions adjusted for the students’ sociodemographic characteristics that may vary according to the questionnaire mode. Results Overall, 54.9% of the questionnaires were completed online. The choice of the collection mode provided to the schools’ headteachers was associated with the adolescents’ characteristics. Those who completed the questionnaire online were more likely to be in secondary schools, in Wallonia, and of a more favourable socioeconomic profile. After adjustments, no difference in the indicators regarding health, well-being, substance use, or sleep duration was observed. Conversely, a difference was observed for screen time (internet ≥2h/weekday: 70.4% on paper vs. 72.3% online; adjusted P-value: 0.02), some food groups (daily vegetables: 51.2% vs. 58.0%; P-value<0.001) and body weight status (overweight including obesity: 16.7% vs. 14.0%; P-value<0.001). Conclusions In some circumstances such as data collection in the school setting, mixed modes are still necessary due to operational issues. While most indicators did not show a difference between online and paper collection, potential implications for others need to be further understood. Key messages • Collecting data through online or paper questionnaires does not lead to major differences in prevalence estimates. • With the rise of online surveys, further assessment is required to understand the potential declaration biases.

Digital health literacy and health behaviour of schoolchildren: A representative study in Germany

Abstract Background Health information is increasingly available and plays a crucial role in making health decisions and developing healthy behaviours. Digital health literacy (DHL) enables one to distinguish between true and false health information online. Studies have found higher health literacy to be associated with healthier behaviour. However, there is no research on child DHL and health behaviour. This study aims to investigate the relationship between DHL and selected health behaviour of schoolchildren in Germany. Methods This cross-sectional study is based on a representative sample of (N = 1448) secondary schoolchildren (aged 9-18 years) in Germany across all 16 federal states and school forms. DHL was assessed using the child and adolescent version of the Digital Health Literacy Instrument developed and pretested in this study. Selected health behaviours (eating, teeth brushing, smoking, and alcohol consumption) were measured using self-report scales. Chi-square tests were conducted to measure differences between DHL and health behaviour. Results Associations were found between DHL and all eating behaviours (fruits; vegetables and salad; whole-grain products; other animal-based products; chocolate or other sweets; sugary drinks; fast food), except for eating meat and sausages. Schoolchildren with higher levels of DHL reported more often about regular consumption of fruits and vegetables (X2 (2)=17.06, p = <.001). salads (X2 (2)=56.54 p = <.001) and whole-grain-products (X2 (2)=98.81 p = <.001). While DHL was associated with teeth brushing (X2 (2)=44.46, p = <.001), no differences were observed for smoking (X2 (2)=1.93, p=.381) and drinking alcohol within the last 30 days (X2 (2)=2.62, p=.270). Conclusions These findings indicate that most health behaviours of schoolchildren may benefit from enhancing DHL in schools. Programs should build around these topics. However, more research is needed to investigate associations between DHL and health behaviours comprehensively.

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The National Association for Children's Behavioral Health is holding its NACBH 2024 Emerging Best Practices Conference: Cultivating Tomorrow's Excellence Dec. 4–6 in St. Pete Beach, Florida. For more information, visit https://nacbh.memberclicks.net/emerging‐best‐practices‐conference.

Parental awareness and dental health behavior of children with congenital heart disease, with diabetes mellitus, or undergoing anti-cancer treatment, compared to healthy children

IntroductionChildren with chronic diseases tend to experience a considerably higher burden of oral disease compared to their healthy peers. Low awareness of the impact of systemic diseases on oral health, lack of motivation, and discomfort may render the maintenance of good oral hygiene challenging. We conducted a study of four groups of parents: of children with congenital heart disease (CHD), with diabetes mellitus type 1 (DM), and undergoing anti-cancer treatment (ACT); and a control group of healthy children (C). We aimed to compare between the groups, parental attitudes and knowledge of their children's oral health, and their reports of their children's dental habits.MethodsParents who arrived with their children for routine check-ups at three main clinics: cardiology, endocrinology, and hematology-oncology were asked to respond to a questionnaire regarding their children's oral and dental health.ResultsA total of 287 questionnaires were collected from 76 parents of children with CHD, 100 parents of children with DM, 50 parents of children undergoing ACT, and 61 parents who comprised group C. Compared to the CHD and DM groups, the ACT group demonstrated significantly more awareness of the importance of maintaining oral and dental health following diagnosis of their children's medical condition. Mothers’ education was found to correlate with dental health knowledge. Most children in the DM and C groups had previous dental examinations, compared to only half in the CHD and ACT groups. A higher proportion of the children in the C than the other groups brushed teeth twice daily. The groups were similar in their consumption of sugary drinks, and of sweets and snacks. The children's specialist physicians were the main source of information on oral health, especially in the ACT group.ConclusionsAlthough most of the parents reported awareness to the oral health aspects of their children's disease, only part of them reported that their children visited dentists, and brushed their teeth twice daily. For the parents of children with CHD, DM, and ACT, their children's treating specialists were the primary source of information regarding oral health. This highlights the importance of clear and continuous communication between pediatric specialists and dentists.

Early Childhood Education and Care Attendance and Its Association With Outdoor Play, Screen Time and Sleep Duration of Young Children: Findings From the CHAT Trial in Australia.

Effects of attending early childhood education and care (ECEC) on health behaviours of young children remain unclear. This study aimed to investigate whether ECEC attendance was associated with outdoor play, screen time, sleep duration and family demographics of children aged 2 and 3 years. Secondary analysis was conducted using data extracted from two linked trials conducted in Australia, 2017-2020. Telephone surveys were conducted with participating mothers for data collection. Multiple logistic and linear regression models were built to investigate the associations of ECEC attendance with outdoor play, screen time, sleep duration and family demographics among young children. At ages 2 and 3 years, 797 and 537 mothers completed surveys, respectively. Of respondents, 65% and 72% of children attended ECEC, respectively. Children who attended ECEC had 17 min (95% CI 3.8-30.5) and 28 min (95% CI 14.1-41.9) more daily outdoor playtime and had 13 min (95% CI 4.0-21.5) and 19 min (95% CI 6.4-30.7) less daily screen time at home at 2 and 3 years, respectively. Although ECEC attendance was not associated with sleep duration, children who attended ECEC were more likely to meet all three recommendations (outdoor play, screen time and sleep) with adjusted odds ratio (AOR) 1.84 (95% CI 1.24-2.72) at age 2 and AOR 2.34 (95% CI 1.28-4.28) at age 3. Mothers who were employed, first-time mothers, spoke English at home or had a high household income were more likely to use ECEC services. ECEC services may hold promise to influence outdoor play and screen time among young children. Children from lower socio-demographic background had a lower rate of ECEC attendance. Future health promotion programmes for young children need to also consider children who do not attend ECEC.

The relationships between resilience and child health behaviors in a national dataset.

Resilience mechanisms at the individual, family, and environmental levels may improve health outcomes despite potentially harmful stress exposure partly through the practice of positive health behaviors. We performed a secondary analysis of 2016-2021 National Survey of Children's Health data to assess the relationships between three resilience domains - child, family, neighborhood - and six health behaviors using multiple regression models adjusted for the other resilience domain(s) and potential confounders. Analysis revealed significant associations between each resilience domain and multiple health behaviors in a total weighted analytic sample of 70,156,540 children. For each outcome, the odds of better health behaviors were highest with high resilience in all possible domains. For example, among children ages 0-5 years, the adjusted odds of having "good quality" vs. "poor quality" sleep for those with "high" resilience in all domains were 2.21 times higher (95% CI 1.78, 2.63) than for those with "low" resilience in all domains. This line of research may help to inform the design of resilience and health behavior promotion interventions by targeting multiple socio-ecological domains of influence to improve health and development outcomes in children exposed to experiences or sources of potential stress. This study assessed the associations between three socio-ecological resilience domains (child, family, and neighborhood) and six child and family health behaviors in a national dataset. Resilience exists within multiple socio-ecological levels and supports healthy functioning despite experiencing stress. Studies in adults and limited pediatric sub-populations show associations between resilience and health behaviors, which in turn influence numerous health outcomes. Resilience at three levels of socio-ecological levels was found to be associated with the performance of multiple child and family health behaviors in a nationally representative general pediatric population. These findings have important implications for child and family health promotion efforts.

Association between snack intake behaviors of children and neighboring women: A population-based cross-sectional analysis with spatial regionalization

BackgroundAccumulated evidence indicates that neighborhood environments affect children's health behaviors. However, measuring neighborhood environments remains challenging because there exist strengths and weaknesses both in objective and perceived environment measures. Drawing on a recent conceptual model of how environment, perception, and behavior interact, we hypothesized that neighbors' behavioral similarities indicate the combined influence of physical and social environmental opportunities on specific behaviors. We then examined how these similarities (i.e. the behavioral tendencies of children's adult neighbors) relate to children's obesogenic dietary behaviors. MethodsWe used data for 2275 women and 821 elementary schoolchildren from a 2012–2013 population-based survey in greater Tokyo, Japan. Snack intake was defined as the total consumption of various types of snacks, estimated using a validated self-administered diet history questionnaire. Spatial regionalization, a type of spatial clustering, was used to empirically identify segments that could effectively differentiate regional variation in women's snack intake behaviors. We conducted multiple regression analysis to assess the cross-sectional association between children's snack intake and the mean snack intake of neighborhood women, adjusting for mother's intake. ResultsA 1-g increase in the mean snack intake of neighborhood women was associated with a 0.23-g (95% confidence interval: 0.00–0.45) increase in children's intake, while a 1-g increase in mother's intake was associated with a 0.34-g (95% confidence interval: 0.26–0.41) increase in children's intake. DiscussionThe results suggest that the out-of-home physical and social neighborhood environments may have non-ignorable associations with children's dietary behaviors by offering behavioral opportunities in addition to maternal influence.

A qualitative exploration of the COVID-19 pandemic on health and nutrition behaviours during the first 1000 days in Sri Lanka.

This study sought to understand reported impacts of the COVID-19 pandemic on maternal and child health and nutrition behaviours during the first 1000 days of life. This qualitative and participatory substudy was embedded within mixed methods formative research conducted during 2020-2022 across two urban, three rural and one estate sector site in Sri Lanka. Semi-structured interviews among caregivers of children aged 6-23 months (n = 34), influencers of caregivers, such as health workers (n = 37), leaders (n = 10) and pregnant women (n = 20) were conducted. Participatory workshops (n = 14) triangulated interview findings. Interview data were analyzed to identify salient themes using Dedoose. Numerical data from voting conducted in workshops were summed and triangulated with interview data. Findings suggest that the COVID-19 pandemic and imposed restrictions shaped maternal and child health and nutrition behaviours through a complex interplay of factors. Imposed restrictions and changes to the food system contributed to temporary unemployment for wage workers and reduced purchasing power to maintain food security for vulnerable households. While deciding whether to seek care, fears of infection prevented usual care-seeking decisions. Also, reduced incomes and disrupted public transportation made transport to health care facilities for antenatal care services difficult. Once women reached facilities, medical services and quality of care were negatively impacted. Implementing expanded community-based services during home visits focused on the first 1000 days and beyond was one effective strategy to maintain maternal and child health and nutrition during the early pandemic in Sri Lanka.

Development and Acceptability of Provider Training to Increase Treatment Engagement of Parents in Their Children's Behavioral Health Care Need.

BACKGROUND: Disruptive, Impulse-Control, and Conduct disorders (DIC) affect 5 million children in the United States and often require comprehensive and long-term behavioral health care for which sustained parental involvement is essential. Our research team is developing an intervention to improve parental engagement in the behavioral health care of their children with DIC. The intervention, which will be a modification of an evidence-based shared decision-making intervention called DECIDE, will include a parent component and a provider component. AIM: To determine the acceptability of the provider component of the modified DECIDE intervention. METHODS: The provider intervention is an asynchronous self-paced online training program made up of five modules: introduction, shared decision-making, perspective-taking, attributional errors, and being a responsive provider. The training was piloted with 41 providers in two public child and adolescent treatment programs. Following completion of the training, semi-structured interviews were conducted with the providers to assess the acceptability of the training. The interviews were analyzed with conventional content analysis. RESULTS: The provider training was well received by providers, and many had made practice changes based on what they had learned. Several offered recommendations for improvement, most notably the need to tailor the training based on provider role, discipline, and level of expertise. CONCLUSIONS: The feedback given by providers will be used to refine future iterations of the provider training component of the modified DECIDE intervention. Psychiatric nurses and other clinicians may draw from strategies incorporated in the training program to improve parent engagement in the treatment of children with DIC.

Caregiver, community health worker, and dentist feedback on a behavioral intervention for caregivers of children with severe early childhood caries.

Severe early childhood caries (S-ECC) is a common disease within marginalized pediatric populations. S-ECC is often treated under general anesthesia to facilitate extensive treatment in young children, but treatment does not address etiology of an infectious disease that is rooted in health behaviors. Without behavior changes related to toothbrushing and sugar consumption, many children experience recurrent disease and some require subsequent surgeries. To improve post-surgery oral health, we developed PROTECT (Preventing Recurrent Operations Targeting Early Childhood Caries Treatment), a community health worker (CHW)-delivered behavioral intervention for caregivers that focuses on children's oral health behaviors. The purpose of this study was to use qualitative research methods to receive feedback on the planned protocol for a pilot study of PROTECT, a six-month intervention initiated at the time of a child's surgery to treat severe early childhood caries. Study participants included caregivers of children presenting for surgery [n = 12], CHWs [n = 8] and dentists [n = 8] in a series of audio-video recorded semi-structured interviews. Five coders used Braun and Clarke's six-phase framework for data analysis. Participant feedback on the pilot study protocol yielded the following themes: (1) right time, population, and type of support; (2) flexible intervention delivery and content; (3) inclusion of other social determinants of health; and (4) cultural considerations. Implementing a behavioral intervention for caregivers in the immediate time during a child's surgery for treating dental caries was widely deemed important and timely in order to affect post-surgical behavioral and clinical outcomes. Flexibility in content, timing, and communication were all named as facilitators to participant engagement and study retention. Caregivers and CHWs emphasized the relevance of addressing other social determinants of health. CHWs emphasized the importance of training in becoming aware of culture and practicing with understanding and humility, given the influence on health beliefs, behaviors, and family dynamics. Cultural considerations in intervention delivery were deemed an important factor for participant retention and engagement. Participant feedback led to critical modifications of the pilot study protocol, specifically in intervention content and CHW-led delivery.

A study on emotionally engaging toothbrush design for children: An empirical approach based on child psychology and cognitive development

This study investigates the emotional engagement of children aged 3–12 with toothbrush color design from a psychological perspective, focusing on three distinct age groups: 3–5 years, 6–8 years, and 9–12 years. While previous research has primarily concentrated on the physical attributes of toothbrushes, this study employs a mixed-methods approach that combines quantitative surveys with qualitative interviews and observations, to analyze children's emotional responses and preferences for various toothbrush designs across different age groups. The findings reveal significant age-related differences in emotional engagement; younger children tend to prefer bright colors and playful shapes, whereas older children prioritize functionality. Additionally tactile experience and interactivity are found to play crucial roles in enhancing children's enjoyment and motivation for toothbrushing. Furthermore, the study explores the relationship between toothbrush design and children's oral health behavior, proposing an emotionally engaging toothbrush design framework that considers children's psychological needs across different age groups. This framework offers practical guidelines for designers to create toothbrushes that enhance children's brushing experience and contribute to their oral health. The study highlights the importance of emotional engagement in designing for children and offers new insights into creating user-centered products that cater to children's developmental needs, with implications for promoting children's oral health through emotionally engaging design.

The Impact of School-Based Caries Prevention Programs on DMFT Scores and Oral Health Behaviors in School Children

Oral health promotion is recognized as one of the fundamental components of health-promoting schools. However, few studies have demonstrated the efficacy of supportive school environments for school children’s Oral health. This systematic review evaluates the impact of school-based caries prevention programs on DMFT scores and Oral health behaviours in school children. Objective: To evaluate the impact of school-based caries prevention programs on DMFT Scores and Oral Health Behaviors in school children. Methods: Databases like PubMed, Google Scholar, Cochrane Library, Springer, and Science Direct were searched from January 2009 to February 2024. Prisma guidelines were followed; 1, 950 studies were identified on the first search, titles, and abstracts of 500 papers were screened, 500 full-text papers were screened for eligibility, and 25 studies meeting the inclusion criteria were evaluated, relevant information was extracted, and a systematic review was conducted. Twenty-five studies were included in the systematic review. Results: These results indicate the significant role of SCPP among school-going children. Children with school-based caries prevention programs compared to those with no school-based caries prevention programs showed improved DMFT scores, reduced caries increment, healthy oral health behaviours, consistent Oral health hygienic habits, frequent use of flossing, fluoride toothpaste and mouth rinsing, and increased caries prevention knowledge. Conclusions: It was concluded that based on the pooled results, school-based caries prevention programs provide better, easily accessible, and sustainable caries prevention activities to school children to improve DMFT scores and Oral health behaviours.

Outcomes that Matter to Youth and Families in Behavioral Health Services.

Patient-centered outcomes research helps youth and families using behavioral health services make informed decisions about treatments to help them achieve the outcomes most important to them. However, there are few efforts to identify the outcomes valued by youth and families systematically. This project aimed to support the development of behavioral health services that deliver outcomes valued by families by identifying the outcomes that youth and young adults with behavioral health needs and caregivers say matter most to them. We engaged 34 youth and young adults (YYA) with behavioral health needs, alongside 42 caregivers from six U.S. regions, in two rounds of one-hour virtual focus groups. The initial round involved participants identifying what they hoped to gain from using behavioral health services for personal, familial, and parental or child well-being and the attributes of positive service experiences. We coded responses using qualitative analytical software, culminating in synthesized reports. Subsequently, the second round entailed participants' review and refinement of initial findings. Across sessions, each group reported the top three outcomes deemed most important for children, YYA, parents, families, and their service experiences. YYA identified being understood by others, improving their interpersonal relationships, and feeling heard as the highest priority behavioral health service outcomes. Caregivers of children and youth with behavioral health needs identified having accessible services that meet their needs, having providers that collaborate effectively with parents and other service systems, and experiencing consistent and continuous behavioral health care for their child as the most important behavioral health service outcomes. Both YYA with behavioral health needs and caregivers of children and youth prioritized gaining the necessary knowledge, resources, and tools to support their or their child's behavioral health. Additionally, both participant groups emphasized the importance of effective communication with providers, within their families, and with peers. Minimizing judgment and stigma from society, providers, and other professionals also emerged as a critical outcome for these groups. It is essential for research and policy development to focus on and cater to the outcomes that are important and valued by YYA and their families to maximize family engagement in care.

Influences of Maternal Nutrition and Lifestyle Factors on Early Childhood Oral Health: A Systematic Review of Mechanisms and Intervention Strategies.

This systematic review and meta-analysis examined the impact of maternal nutrition and lifestyle factors on early childhood oral health. The review focused on the effects of maternal vitamin D levels and smoking during pregnancy on children's dental health outcomes. A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science, yielding 23 that were included for analysis. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The effect estimates were pooled through a random effect model. All analyses were carried out using the R program. Most studies in our systematic review showed a significant association between maternal vitamin D and smoking during pregnancy and childhood dental health outcomes. Meta-analysis revealed a significant association between maternal vitamin D levels and children's dental health (OR = 1.30, 95% CI: 0.49 to 3.45, p < 0.001). Maternal smoking during pregnancy was strongly linked to an increased risk of childhood dental caries (OR = 0.3290, 95% CI: 0.2089-0.4491, p < 0.0001). These findings underscore the crucial role of maternal health behaviors in shaping children's oral health trajectories. This study emphasizes the need for integrated public health interventions promoting healthier maternal behaviors and early preventive dental care.

Do Children's Health Behaviors Buffer the Impact of Cumulative Environmental Stress on Emerging Cardiometabolic Risk?

Previous studies have found that exposure to childhood environmental stress is associated with cardiometabolic risk. However, it is not known whether individual health behaviors disrupt this relationship. This study prospectively evaluated the relationship between cumulative environmental stress in a low-income sample and cardiometabolic risk in middle childhood and examined whether child health behaviors attenuated this relationship. In a cohort of children (n=338; 57% Hispanic children; 25% Black children), environmental stressors (family and neighborhood factors representing disadvantage/deprivation) and child health behaviors (accelerometry measured physical activity; parent-reported screen time and diet recalls) were measured over 5 time points beginning when children were aged 2 to 4 years and ending when they were aged 7 to 11 years. Children's cardiometabolic risk factors (body mass index, blood pressure, triglyceride/high-density lipoprotein ratio, glucose, hemoglobin A1c, C-reactive protein) were measured at 7 to 11 years. Emerging cardiometabolic risk was defined as having ≥1 elevations that exceeded clinical thresholds. In adjusted path analyses, greater cumulative environmental stress was associated with higher likelihood of emerging cardiometabolic risk in middle childhood (P<0.001). Higher levels of moderate to vigorous physical activity and fewer sedentary minutes attenuated the positive relationship between stress and cardiometabolic risk (P<0.05). Children with >2 hours of average daily screen time had a higher likelihood of elevated cardiometabolic risk (P<0.01), but screen time did not moderate the stress-cardiometabolic risk relationship. Dietary intake was not related to cardiometabolic risk. Interventions that promote moderate to vigorous physical activity and limit sedentary behavior may have particular importance for the cardiometabolic health of children exposed to high levels of cumulative environmental stress.

Preliminary Effectiveness of a One-Week Summer Day Camp for Improving Children's Health Behaviors and Psychosocial Well-Being Outcomes.

Summer day camp offers children opportunities to grow knowledge and skills, be physically active, and have fun. Compared to healthy children, at-risk children (i.e., overweight, or with obesity and chronic health conditions) typically display less optimal health behaviors and psychosocial well-being, especially during summer months. This study examined the preliminary effectiveness of an American-Diabetes-Association-sponsored summer day camp at improving children's health behaviors (i.e., physical activity, screen time, diet, sleep) and psychosocial well-being outcomes (i.e., quality of life [QoL], enjoyment, weight-related self-efficacy). The sample consisted of 39 participants, including 19 boys and 20 girls, with majority being overweight (n = 4 or 10%) or with obesity (n = 26 or 67%), who attended the day camp for one week. Significant improvements were observed in screen time, quality of life, and physical function. The results further showed significant time by gender interaction effect for overall QoL (p < 0.05, ηp2 = 0.15), physical health (a dimension of QoL; p < 0.05, ηp2 = 0.18), and significant time by household income for the psychosocial health (another dimension of QoL), favoring boys and those from higher income families. The findings indicate a positive preliminary effectiveness of the summer camp at reducing children's screen time and improving their QoL, especially in boys and those from higher-income families. Future research should focus on health disparities and expansion of this camp for the potential of longer-term and more robust effects related to wellness, nutrition literacy, physical activity promotion, and obesity prevention.