Child Behavioral Health Research Articles

The development and cross-national validation of the short health literacy for school-aged children (HLSAC-5) instrument

Health literacy is an asset for and indicator of adolescents’ health and wellbeing, and should therefore be monitored and addressed across countries. This study aimed to develop and validate a shorter version of the original 10-item health literacy for school-aged children instrument in a cross-national context, using data from the health behaviour in school-aged children 2017/18 survey. The data were obtained from 25 425 adolescents (aged 13 and 15 years) from seven European countries. Determination was made of the best item combination to form a shorter version of the health literacy instrument. Thereafter, the structural validity, reliability, measurement invariance, and criterion validity of the new 5-item instrument were examined. Confirmatory factor analysis showed a good model fit to the data across countries and in the total sample, confirming the structural validity (CFI = 0.995, TLI = 0.989, SRMR = 0.011, RMSEA = 0.031). The internal consistency of the instrument was at a good level across countries (α = 0.87–0.98), indicating that the instrument provided reliable scores. Configural and metric invariance was established across genders, ages, and countries. Scalar invariance was achieved for age and gender groups, but not between countries. This indicated that the factor structure of the scale was similar, but that there were differences between the countries in health literacy levels. Regarding criterion validity, structural equation modelling showed a positive association between health literacy and self-rated health in all the participating countries. The new instrument was found to be valid and reliable for the purposes of measuring health literacy among adolescents in a cross-national context.

Intergenerational transmission of health behaviors: A population-based study in Germany

Abstract Background Intergenerational transmission has been identified for many chronic diseases and behavioral factors. Long-term prospective studies are needed that examine different generations within families and determine the expression of specific biological and psychosocial characteristics using a standardized measurement protocol. At present, there are no prospective cohort studies in Germany that have examined the association between the health behavior of parents and children. Methods The ongoing pilot study is the first phase of a population-based longitudinal study on the health behavior of the generations. A random sample of 230 community members aged 70-85 years in Germany was recruited. A face-to-face interview with standardized questionnaires was conducted to collect information on health outcomes, including lifestyle, medical, social, and psychological factors in participants’ lives. Blood and saliva samples were also collected to determine some specific biomarkers. Online questionnaires will be used for younger generations. Results Data collection for the first generation has been completed and recruitment for the second and third generations is expected to be completed by June 2023. Written informed consent has been obtained from all participants. Results from the current study will be presented at the conference. Conclusions Parental health behaviors may influence the onset of risky health behaviors in their offspring. Thus, in order to promote healthy behaviors, it is important to examine these factors to understand whether the transmission from one generation to the next is due to high-risk lifestyles, the direct transmission, or both. Key messages • This pilot study will provide information needed to design a larger population study, i.e., sample size will depend on response rates and associations between psychosocial and biological factors. • Intergenerational transmission may provide an important framework for health promoting interventions leading to healthy aging.

The effects of parental retirement on adult children's health: Evidence from China.

Using representative data from China, we examine the causal effects of parental retirement on the health of adult children. To do so, we adopt a fuzzy regression discontinuity design and exploit the mandatory retirement ages in China as cut-off points. We find no evidence that parental retirement has significant effects on the mental health, healthcare utilization, or risky health behaviors of adult children. However, paternal retirement and maternal retirement have different effects on adult children's Self-reported health (SRH). Paternal retirement has a significantly negative effect only on the SRH of sons, while maternal retirement does not induce such effects. Potential mechanisms of intergenerational transfer through which parental retirement might affect adult children's health are also explored.

COVID-19 and children's behavioral health: An overview

The paper reviews the impact of the COVID-19 pandemic on children's and adolescents’ well-being. A trauma-informed framework is employed to discuss the emerging evidence of notable changes in youth's psychological, developmental, academic, and social well-being since the start of the COVID-19 pandemic. Children and adolescents have been uniquely affected based on their age at the start of the pandemic. Despite multiple resiliency factors, COVID-19 and its ramifications have had an adverse effect on youth in general and have exacerbated preexisting racial and socioeconomic disparities. This review concludes with recommendations for child health clinicians.

A quasi-experimental effectiveness evaluation of the 'Incredible Years Toddler' parenting programme on children's development aged 5: A study protocol.

Child behavioural and mental health problems have become a public health crisis. The consequences of poor mental health in childhood have large economic costs and consequences for the individual, their families, and for society. Early intervention through parenting programmes can reduce the onset of poor mental health in childhood, hence evaluating the effectiveness of parenting programmes is critical. The 'Incredible Years Toddler' parent programme is an education and training intervention designed to enhance the social and emotional wellbeing of children aged 1-3 years. Whilst previous studies show Incredible Years Toddler to provide promising effects on child outcomes in the short term, the research samples have lacked ethnic diversity and representation from socioeconomically deprived families. This quasi-experimental study is registered on ISRCTN (ISRCTN49991769). We will investigate the effectiveness of Incredible Years Toddler being delivered in three neighbourhoods in inner city Bradford, England. These neighbourhoods contain a socially and ethnically diverse population with 84% living in the poorest decile for England and Wales. Parents with a child aged 1-3 years old who are enrolled in Born in Bradford's Better Start interventional family cohort study are eligible for this study. Intervention participants will be matched to a demographically comparable control group using propensity score matching. This study will use retrospective and prospective data from participants who attended Incredible Years groups between September 2018 and April 2024. The required minimum sample is n = 1336 (ratio 1:3) to detect a small effect (odds = 1.5, d = .20) on the Early Years Foundation Stage profile total score at age 5; a measure of early child development that is routinely collected by teachers. We will also establish whether these effects are moderated by child age at entry to intervention, programme delivery mode, socioeconomic status, and ethnicity. We will also estimate the cost of the intervention and conduct a cost-consequence analysis.

Stair poster media as an effort to improve the dental health behavior of elementary school children

The prevalence rate of dental caries has experienced an increasing trend from year to year, so that the condition of dental and oral health problems in Indonesia is still worrying, especially for elementary school children. The high number of dental health problems is caused by many factors, one of which is the low level of dental health maintenance behavior. Promotive and preventive measures are needed to prevent dental and oral health problems, namely by providing dental and oral health education. Poster media is a medium or prop/tool that can be used to convey messages from communicators to the audience. Staircase poster media is a development of general poster media, this media is designed for the sequence/stages of maintaining dental health which are attached to the school steps. Objective: This research is to analyze the effectiveness of stair poster media in improving the dental health behavior of elementary school children. Method: This research used a non-equivalent control group quasi-experimental design. The research sample was 125 people taken using purposive sampling technique. The intervention group was given dental health education using posters, while the control group was given dental health education using filpchart. Data were tested using Wilcoxon test analysis, namely a pre-post design, while to compare the means of the treatment and control groups, the Mann Whitney test was used. Results: The results of the test of differences in knowledge, attitudes and actions of brushing teeth show that the p-value between the intervention group and the control group is 0.000 (p <0.05), meaning that there is a difference between the values of knowledge, attitudes and actions of brushing teeth after dental health education with children's poster media. steps and dental health education with filpchart. Conclusion: dental health education using stair poster media is more effective in increasing the knowledge, attitudes and actions of brushing teeth in elementary school children compared to dental health education using flipcharts Keywords: Stair poster, media, dental health, behavior

Association between maternal pre-pregnancy body mass index and offspring’s outcomes at 9 to 15 years of age

ObjectiveMaternal pre-pregnancy underweight, overweight and obesity might increase the risk for worse short- and long-term outcome in the offspring. There is a need for further study into the relationship between maternal pre-pregnancy body mass index (BMI) and the combined outcome of physical development, state of health and social behavior in children. Question: Is maternal pre-pregnancy BMI associated with the child outcome in terms of physical development, state of health and social behavior (school and leisure time behavior) at the age of 9 to 15 years?MethodsIn the population-based birth cohort study Survey of Neonates in Pomerania (SNIP) children at the age 9–15 years and their families were re-examined by questionnaire-based follow-up. 5725 mother–child pairs were invited to SNiP-follow-up. This analysis is based on the recall fraction of 24.1% (n = 1379). Based on the maternal pre-pregnancy BMI (ppBMI), 4 groups were formed: underweight (ppBMI < 19 kg/m2, n = 117), normal weight (ppBMI 19–24.99 kg/m2, n = 913, reference), overweight (ppBMI 25–30 kg). /m2, n = 237) and obesity (ppBMI > 30 kg/m2, n = 109).ResultsIn the multiple regression model, the BMI-z-score for children of mothers in the underweight group was −0.50 lower, and 0.50/1.07 higher in the overweight/obese group (p < 0.001) compared to reference at median age of 12 years. No differences were found in children of underweight mothers with regard to social behavior (interaction with friends and family), school and sports performance (coded from “very good” to “poor”), other leisure activities (watching television, using mobile phones, gaming), and health (occurrence of illnesses) compared to children of normal weight mothers. In contrast, maternal pre-pregnancy overweight and obesity were associated with lower school and sports performance, and higher screen time (smart phone, gaming, television) compared to children of normal weight mothers.ConclusionMaternal pre-pregnancy overweight and obesity but not underweight was negatively associated with school performance and leisure time behavior in the offspring at 9–15 years of age.

Perceived Susceptibility and Responses to Ill-health Risks among Children of the Street in Addis Ababa, Ethiopia

Abstract This study identifies perceptions about susceptibility and responses to health risks among children of the street in Addis Ababa, Ethiopia. Using a qualitative approach, data were collected through in-depth interviews from 22 purposely selected street children. In addition to the field notes, audio was recorded, transcribed and translated into English. After coding the responses, themes and sub-themes were identified, followed by interpretations of responses. The findings showed that children of the street perceive to be highly susceptible for health risks such as HIV/AIDS, skin diseases, malaria, accidental injuries, lung cancer, and ‘Corella’. Whereas most of the health risks have been associated generally with the living situations of the children, engagement in risky behaviors such as unsafe sexual practices, addictions to drugs and other harmful substances, and sharing of sharp materials have also been reported to increase their vulnerability. The extent to which they perceive to be susceptible, the type of disease and its perceived cause were found to influence the preventive health behavior of the street children. The high risk perception among street children opened the way for individual and collective efforts of maintaining health and wellbeing which in turn facilitates interventions aimed at reintegrating street children into the society.

Parenting stress and autistic children's emotional problems relate to family-school partnerships and parent mental health.

Dimensions of family-school partnerships, including parent-teacher relationship quality and family educational involvement, are associated with positive outcomes for youth. Family-school partnerships are important for autistic youth, who may particularly benefit from cross-setting supports. Coordinated family-school partnerships may help maximize child outcomes. This study investigated the extent to which child behavioral and physical health (emotional, behavioral, and medical problems) and parent mental health (parenting stress, parent mental health history, and parent depressive symptoms) were associated with parent-teacher relationship quality and family involvement in a sample of 68 families of school-aged autistic children. Families were recruited through invitation letters disseminated at local early intervention and early childhood programs. Children in the sample were primarily boys, primarily White, and approximately 8 years old. Results suggest that (a) child emotional problems and parenting stress were negatively associated with parent-teacher relationship quality (large effects) and (b) parent history of mental health problems was negatively associated with family involvement (large effect). Intervention recommendations and future research directions are discussed. For example, it would be helpful for future research to include the perspectives of ethnically diverse samples when examining family-school partnerships among families with autistic children. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Transforming Child Health and Family Well-being.

Challenges to child health that pre-dated COVID-19, such as rising rates of child mental health issues, instability in the early care and education system, and food insecurity, accelerated during the pandemic. The health and well-being of children and families have been uniquely and disproportionately impacted. Children are paying the price as our strained child behavioral health, child welfare, and early care and education systems reach breaking points. The solutions that children and families need to recover stronger will require a whole-child and whole-family approach to health that addresses their physical, behavioral, and social needs. The articles in this edition of the NCMJ describe the scope of the challenges facing children and families in North Carolina and approaches to improving their health and well-being in priority areas including behavioral health, child welfare, early care and education, and nutrition.

Associations of Warzone Veteran and Intimate Partner PTSD Symptoms with Child Depression, Anxiety, Hyperactivity, and Conduct Problems

Warzone deployment increases risk for posttraumatic stress disorder symptoms (PTSS), including among service members who have children. Parental PTSS are associated with child depression, anxiety, hyperactivity, and conduct problems, yet few studies of child behavioral health outcomes in military populations have accounted for PTSS in both warzone veterans and their partners. Fewer still incorporate non-clinically-recruited samples of nationally dispersed warzone veterans and their families. The current research examines whether children whose parent(s) have higher levels of PTSS exhibit more behavioral health symptoms. One hundred and thirty-three Iraq and Afghanistan War veterans and their cohabitating partners completed clinical interviews and self-report questionnaires. Higher intimate partner PTSS, more extensive child exposure to stressful life events, and being an adolescent were significantly associated with child depression after adjusting for warzone veteran PTSS, demographics, and recent warzone veteran absence from the household. Greater child exposure to stressful life events was also associated with child conduct problems. Treatment of PTSD symptoms experienced by warzone veterans’ intimate partners, and preventative interventions aimed at helping the children of warzone veterans cope with stress, may ultimately yield positive benefits for the behavioral health of children in military families.

Health Practices, Nutrition, and Other Aspects of Lifestyles of Children Less Than 18 Years during COVID-19 Pandemic in Egypt: Role of Mothers

BACKGROUND: COVID-19 is a public health crisis of worldwide fear which under strategies of isolation, alterations to lifestyle behaviors were typically inevitable. These included extreme changes in hygiene practices, dietary habits, and physical activity. AIM: The present study aimed to assess how mothers managed their children at home during COVID-19 lockdown as regards health practices such as, hand washing, eating behaviors, and their daily lifestyles such as physical activity, screen time, and sleep. METHODS: Mothers of children aged &lt;18 years were enrolled in the study. Online survey was conducted through Google form May 17, 2020, to the June 01, 2020. A specific questionnaire was prepared to fulfill the objective of the study. RESULTS: Mothers of 83.6% of children succeeded in establishing a good behavior of hand washing using soap and water when their hands are visibly dirty versus 62.8% doing the same when their hands are not visibly dirty. Father’s occupation could have significant association with hand washing. During lockdown, 74.4% of mothers stopped buying prepared foods from outside and 88% of them were keen to prepare healthy meals for their children, dietary supplements were used by 41.6% of participant mothers; meanwhile, the percentage was 38.8% by their children. Mothers succeeded in limiting screen time of their children (43.2%), and 32% of them succeeded in setting a specific time for going bed. CONCLUSION: COVID-19 pandemic has brought intense changes to health behaviors of children regarding hand washing, eating habits, sleep, and physical activity.

Resources used and trusted regarding child health information by culturally and linguistically diverse communities in Australia: An online cross-sectional survey

BackgroundParents’ play a proactive role in seeking health information to ensure optimal growth and development for their children. To date, very little is known about the differences between information seeking behaviour for child health and engagement with resources between culturally and linguistically diverse (CALD) and non-CALD parents. ObjectiveTo investigate the differences in resources used and trusted for information related to child health behaviours and engagement with online features among CALD and non-CALD respondents in Australia. MethodsAn analysis of a theory informed online cross-sectional survey was conducted using data from 122 CALD and 399 non-CALD parents who had a child younger than 24 months or were currently pregnant in Australia. Descriptive statistics and chi-squared were used to compare the differences, and logistic regression models were used to identify factors associated with using health resources. ResultsThe most trusted sources for information reported by respondents were health professionals (76.2 %), websites run by health professionals (59.5 %), and government websites (53.2 %). Social media was significantly more trusted as a source of information for child health behaviours among CALD respondents than non-CALD respondents (odds ratio (OR) 1.92, P = 0.01). In contrast, booklets/ pamphlets and friends were significantly more trusted by non-CALD parents than for CALD parents (OR 0.54, P = 0.02). General search engines were used very frequently among CALD respondents for child health information (39.3 % vs 24.1 %, p = 0.013). Overall, the most common features respondents enjoyed on websites were images (81 %), videos (40.1 %), and discussion forums (39.9 %). CALD respondents significantly favoured videos (p = 0.003) while non-CALD respondents preferred obtaining information through attachments (p < 0.001). ConclusionsDespite parents’ reporting health professionals, websites run by health professionals, and government websites as trustworthy, general search engines and social media were still the most frequently used information source for parents with young children. Credible resources parents deem as trustworthy should take into account effective and engaging means of disseminating information that are accessible to both CALD and non-CALD communities.

THE RELATIONSHIP BETWEEN KNOWLEDGE AND PRODUCTION HEALTH BEHAVIOR IN ELEMENTARY SCHOOL CHILDREN IN BLABAK 1, KEDIRI REGENCY

Introduction: The transition from childhood to adolescence or puberty is a time when hormonal development can affect the physical and psychological development of an early adolescence. The change can be a traumatic experience, if there is no early preparation. Knowledge is very necessary and can be a major factor in shaping one's actions or behavior, because at this time the importance of knowledge about adolescent physical changes, because at this time there is a lot of pressure with physical, biological changes and pressure on environmental changes, while elementary school children are still rarely exposed to reproductive health knowledge. The purpose of this study was to analyze the relationship between reproductive health knowledge and behavior in elementary school children. The method used is observational analytics with a sample number of 75 musing total sampling smapling techniques, analysis tests used using chi squere. The results showed that the low knowledge of respondents with poor reproductive health behavior was around 26.7%. High knowledge of respondents with good reproductive health behavior is around 21.3%. Poor reproductive health behavior with low knowledge is 18.7%, while for good reproductive health behavior with good knowledge is around 33.3%. The results of the chi-square test obtained a value of p = 0.001, it can be interpreted that H0 is rejected and Ha is accepted, there is a relationship between knowledge and reproductive health behavior in children of SD Blabak 1. Conclusion: There is a relationship between knowledge and reproductive behavior in elementary school children 1 Blabak Kediri.

Effects of School-Based Health-Promoting Activities on Children's Health: A Pragmatic Real-World Study.

More insight into the health effects of scaled-up school-based interventions in real-world settings is vital to sustainably integrate health in all schools. This study investigated the effectiveness of the scaled-up Healthy Primary School of the Future (HPSF) initiative in real-world school contexts on children's health (behaviours). From 2019 to 2022, eleven Dutch primary schools implemented HPSF-related activities. In 315 children from study years four to six (aged 7-11 years) from these schools, anthropometric measurements were performed, and questionnaires assessing the children's dietary behaviours and physical activity were administered. COVID-19 greatly limited the implementation of HPSF-related activities. Therefore, the results were compared between schools categorised as medium implementers and schools categorised as low implementers. After correction for baseline, waist circumference in the medium implementer group was significantly higher at one-year follow-up (B = 1.089, p = 0.003) and two-year follow-up (B = 1.665, p < 0.001) compared with waist circumference in the low implementer group. No significant effects were observed for other outcomes. This study showed hardly any effects of the scaled-up HPSF initiative, mainly due to the limited implementation caused by COVID-19. More research investigating the real-world effectiveness of HPSF and comparable programmes is greatly encouraged to advance the field of school-based health promotion.

Adverse childhood experiences, child behavioral health needs, and family characteristics associated with the presence of a firearm in the home: a survey of parents in Chicago

BackgroundFirearm violence is the leading cause of pediatric mortality in the USA. The presence of a firearm in the home poses an immense risk to children with increased rates of suicide and unintentional injury by firearm. Recent literature has not explored child ACEs and child behavioral health needs with the presence of a firearm in the home. The objective of this study was to explore an association between these factors, parent health, family experience with firearm violence, and demographics, and the presence of a firearm in the home.ResultsOverall, 382 of 1,436 (weighted to 22.0%) responding parents reported the presence of a firearm in the home. In an adjusted model, the odds ratio of firearm presence increased incrementally with a child’s increasing exposure to ACEs. Compared to a child in the household exposed to no ACEs, a child in the household exposed to two or more ACEs was associated with a 5.16 times higher odds of firearm presence in the home (95% confidence interval (CI) 2.92–9.10). Similarly, a child in the household who had used behavioral health services was associated with a 2.10 times higher odds of firearm presence in the home (95% CI 1.35–3.26), compared to a child in the household who had not. Presence of firearm in the home was also associated with higher household income, younger parent age (under 35 years), and male parent gender.ConclusionsChicago parents have higher odds of reporting the presence of a firearm in the home when living in a household with a child exposed to ACEs and with behavioral health needs. These findings could inform future public health interventions and targeted safe storage messaging to prevent pediatric firearm injury in the home.

Social determinants associated with psychological distress in children and adolescents during and after the first COVID-19-related lockdown in France: results from the CONFEADO study

BackgroundThis study aimed to analyze the parental socio-demographic characteristics of children and adolescents aged 9 to 18 years old, as well as the living and housing conditions associated with the psychological distress in these two sub-populations during and after France’s first national COVID-19-related lockdown in spring 2020.MethodsWe used data from the cross-sectional, observational, web-based study CONFEADO, which collected data on children and adolescents’ living and housing conditions and socio-demographic characteristics as well as those of their parents. It also collected data on children’s and adolescents’ health behaviors and psychological distress. We assessed psychological distress using the 10-item Children and Adolescents Psychological Distress Scale (CAPDS-10), and performed a multinomial logistic regression.ResultsA total of 2882 children and adolescents were included in the present study. Factors associated with moderate psychological distress included being a female, parental financial difficulties, a lack of a private living space at home for the child/adolescent, and the following child health behaviors: no leisure or recreational activities with adults in the household, doing less than one hour of school homework a day, and not going outside during the lockdown. Severe psychological distress was associated with the parent’s occupation (especially essential frontline workers), a lack of a private living space at home for the child/adolescent, and the following child health behaviors: spending over 5 h a day on social media, doing less than one hour of school homework a day, and no leisure or recreational activities with adults in the household.ConclusionsThis study emphasizes the impact of housing and living conditions, as well as parents’ socio-economic characteristics on children’s health behaviors and psychological needs during the first COVID-19-related lockdown in France. Our results suggest that health policies implemented during future pandemics should consider these structural social determinants to prevent severe psychological distress in children and adolescents.

Early Counseling to Improve Oral Health Behavior in Children with Major Congenital Heart Defects: A Randomized Controlled Trial

Maintaining optimal oral health behavior in children with a congenital heart defect (CHD) is important in managing the risk for caries development and infective endocarditis. The aim of this study was to evaluate the impact of an early and repeat oral health promotion intervention (OHPI) among children with major CHD. Randomized controlled trial including 72 out of 91 children born in Finland April 1, 2017–October 31, 2020 with (a) major CHD potentially included in the criteria of endocarditis prophylaxis or (b) any CHD with surgical repair combined with a chromosomal syndrome. A parallel passive control (C) group of 87 healthy children were recruited at birth. CHD children were randomized 1:1 to intervention (CHD-I) and control (CHD-C) groups. The OHPI included counseling by motivational interviewing, home delivered toothpaste and toothbrushes, and written information, and was provided at baseline, 6, 12, and 18 months of age to CHD-I group. The primary outcome measure at 24 months was child’s oral health behavior (toothbrushing, sugar intake, and dental care contact). The secondary outcome measures were parents’ awareness of the importance of oral health behavior, and oral health behavior as a predictor for child behavior. At 24 months, toothbrushing was performed twice a day in 20/27 (74%) among CHD-I, in 13/30 (43%) among CHD-C (CHD-I vs. CHD-C p = 0.03), and in 37/50 (74%) among healthy comparisons (CHD-C vs. C p = 0.01). Electric toothbrush use was 12/27 (44%) in CHD-I, 5/30 (17%) in CHD-C (CHD-I vs. CHD-C p = 0.04), and 7/50 (14%) in healthy comparison (CHD-C vs. C p = 0.76) children. Among CHD-I, toothbrushing and use of electric toothbrush improved between 12 months and 24 months. Sugar drink intake was more common among CHD-C (CHD-C vs. C p = 0.02), but comparable to CHD-I children. Parental toothbrushing predicted child toothbrushing twice a day. There were no statistical group differences in dental care contact. Children with CHD are at risk for poor oral health behavior. This could be improved with early and repeat oral health promotion parental counseling.

California's Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Be Better social marketing campaign: mothers' fruit and vegetable consumption and facilitation of children's healthy behaviours.

Evaluation of California Department of Public Health's three-year social marketing campaign (Be Better) to encourage healthy eating and water consumption among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) California mothers. Andreasen's social marketing framework was used to outline the development and evaluation of the campaign. Quantitative, pre-post cross-sectional study with three cohorts nested within survey years. Generalised estimating equation modeling was used to obtain population estimates of campaign reach and changes in mothers' fruit and vegetable (FV) consumption and facilitative actions towards their children's health behaviours. CalFresh Healthy Living (California's SNAP-Ed). Three separate cohorts of SNAP mothers were surveyed (pre, post) between 2016 and 2018 inclusive. A total of 2229 mothers (ages 18-59) self-identified as White, Latina, African American or Asian/Pacific Islander participated. Approximately 82 percent of surveyed mothers were aware of the campaign as assessed by measures of recall and recognition. Ad awareness was positively associated with mothers' FV consumption (R2 = 0·45), with the proportion of FV on plates and with behaviours that facilitate children's FV consumption and limit unhealthy snacks and sugary drinks (βs ranged from 0·1 to 0·7). The campaign successfully reached 82 percent of surveyed mothers. Positive associations between California's Be Better campaign and targeted health behaviours were observed, although the associations varied by year and media channel (i.e. television, radio, billboards and digital). Most associations between ad awareness and outcomes were noted in years two and three of the campaign, suggesting that more than 1 year of campaign exposure was necessary for associations to emerge.

The Impact of Smartphone and Social Media Use on Adolescent Sleep Quality and Mental Health during the COVID-19 Pandemic

Objective. Social media (SM) has gained almost ubiquitous use in society and especially among adolescents; however, there has been rising concern over its negative consequences, including the effects on child behavioral health, such as sleep and internalizing symptoms. Research elucidating the impacts of SM use on young people should be conducted to inform healthier SM usage. This study seeks to understand how SM use and use of phones around bedtime associates with worse sleep quality, depression, and anxiety among youth during the peak of the COVID-19 pandemic and social distancing. Methods. This project uses archival data collected in fall 2020 through school-based surveys to adolescents in a rural school district in Michigan. There were a total of 200 participants (91.7% response rate) of which 180 adolescents (12-15 years old, 40.0% male, 55.6% female, 3.9% nonbinary) were included in the analysis based on their SM use, the majority of whom identified as white (91.7%). Results. Linear regression analyses indicated that higher self-reported SM use was associated with poorer sleep quality and greater depression ( p &lt; 0.05 ). Sleep quality mediated the association between SM use and depression ( p &lt; 0.05 ). Furthermore, youth who brought their smartphones to bed with them had poorer sleep quality than those without phones ( p &lt; 0.05 ). SM use was not associated with anxiety after controlling for age and gender. Conclusions. SM use is associated with higher rates of adolescent depression; however, sleep appears to mediate the relationship. The impacts of bringing a smartphone to bed and self-reported SM use on adolescent mental health may be better predicted via sleep disruption even during a widescale event such as COVID-19.