National Child Research Articles

Highland Gypsy Travellers in the News: A Note on Prejudices as Reflected in Nineteenth-Century Newspapers in the Highlands

This note considers some of the reporting on Highland Gypsy Travellers by journalists writing in northern Scottish newspapers in the mid- and late-nineteenth century and illustrates the nature and extent of prejudices against this group. It shows how these prejudices were displayed even by those who advocated for Highlanders, opposed oppression and showed sympathy towards the plight of Travellers. These include Hugh Miller, writing in the Inverness Courier, John Mackie in the John o’ Groat Journal and Northern Ensign, and Thomas Mulock in the Inverness Advertiser. These writers, while rejecting the claim that there were innate differences between ‘races of men’, generally held that some peoples had fallen into a ‘degraded state’ from which it was the duty of Christians to rescue them. This was similar to the approach often taken towards colonised peoples, for example towards First Nations children in Canada. The note briefly considers two areas of legislation which had an impact in Highland Gypsy Travellers – the Vagrancy Act, extended to Scotland in 1871, and the Education Acts of the 1870s.

Violence Against Children in Sub-Saharan Africa: A Scoping Review of Literature on the Victim-Perpetrator Relationship.

Violence against children affects children in every region, nation, and community in the world. Despite a significant body of literature about the victims of such violence, there has been little empirical research, particularly in Sub-Saharan Africa, focused on perpetrators, their relationship to victims, and interventions that might alter their behavior. This scoping review sought to identify and summarize the scholarly literature on perpetrators of violence against children in Sub-Saharan Africa and their relationship with victims. Using a keyword search of academic databases, we included peer-reviewed studies published from January 2013 to June 2023 that focused on physical, sexual, or emotional violence against children in Sub-Saharan Africa and included prevalence data about victim-perpetrator relationships. Eighteen of the 42 studies that met eligibility criteria shared one or more primary data sources with other studies included in this review, most frequently using data from Violence Against Children Surveys (10), the Uganda Good Schools Project (7), and the National Child Homicide Study (3). The most common classifications of perpetrators, in order of frequency, were caregivers/family members, intimate partners, peers, teachers/school staff and strangers, and the most common settings in which research took place were schools. Wide variability in the taxonomies used to define and report frequencies for age, victim, perpetrator, and type of violence obscures our ability to form a complete picture of victim-perpetrator relationships. Research emphasis on victims of violence may lead to missed opportunities to disrupt the perpetration of violence against children through interventions that specifically target its source.

Artificial intelligence for children: UNICEF's policy guidance and beyond

AbstractThis policy review introduces the Policy Guidance on Artificial Intelligence (AI) for Children, produced by the United Nations Children's Fund (UNICEF). This Policy Guidance is the first international‐level output to boost the development of child‐centred AI and relevant policies. A main contribution of this Policy Guidance is that it outlines the foundations, requirements and specific recommendations for developing child‐centred AI and surrounding policies. The shortcomings of this Policy Guidance are also introduced, especially the insufficient gender responsiveness and age sensitivity, plus relatively low representation of the developing world. Possible suggestions for future updates of the Policy Guidance and improving policies on child‐centred AI are provided in this review, such as the inclusion of a broader age range of children during the consultation process. The coexistence of contributions and limitations of this Policy Guidance reflects the situation of development of child‐centred AI and relevant policies, which is currently immature but promising.

The Role of Nationality in Childhood Caries in Qatar.

There were two objectives. First, to understand the variation of primary dentition caries among 4- to 8-year-old children in Qatar across nationality classified into four groups, and second, to explore whether the association persisted in the presence of socio-demographic and behavioural indicators. The study used data from the Qatar Child Oral Health Survey 2017 (QCOHS 2017). Detailed information was collected through a parental dual-language questionnaire and an oral epidemiological examination conducted by calibrated dentist examiners. Children in 20 kindergartens and 40 schools across Qatar were recruited. Data were weighted to represent the Qatar child population. Overall, 1154 children aged 4-8 years old (48.9% female, 51.1% male) participated. Qatari children made up 26.3%, Non-Qatari (N-Q) Arabic children 44.2% N-Q Indian sub-continent 16.4% and N-Q Other 13.1%. There were no significant differences by nationality for age or sex, but differences existed for kindergarten/school type and parents' highest level of education. Among behavioural indicators, Qatari and N-Q Arabic children began toothbrushing later, and more N-Q Other children brushed 2+ times a day and had made a check-up visit in the last 12 months. More Qatari children were in the highest tertial for sugar intake and drank bottled water with no fluoride. All N-Q children had a significantly lower prevalence and experience of caries. The means ratio (95% CI) for N-Q Arabic (0.78; 0.65-0.94), Indian (0.58; 0.46-0.72) and other children (0.61; 0.42-0.88) were all significant against Qatari nationality children. Multivariable models showed an attenuation of the association with caries with the means ratio for N-Q Arabic (0.92; 0.73-1.16), Indian (0.79; 0.57-1.11) and other children (0.94; 0.61-1.44) being non-significant compared to Qatari nationality children. The variables which were significantly associated with caries were parental education, toothbrushing frequency, sugar intake and check-up visiting in the last 12 months in the multivariable models. Primary dentition caries in children resident in Qatar differed by nationality. The association of primary dentition caries with nationality was markedly attenuated and non-significant in the presence of socio-demographic and behavioural variables, pointing towards the importance of these variables as the pathways to improving primary dentition caries prevalence and experience of children in Qatar.

Developing National Information Systems to Monitor COVID-19 Vaccination: A Global Observational Study.

Strong information systems are essential for safe and effective immunization programs. The COVID-19 vaccine rollout presented all immunization information systems (IIS) with challenging demands-requiring in-depth vaccine implementation data at all health system levels in real time. The system development approaches taken by countries were heterogeneous, with some countries opting to adapt existing systems and others implementing new ones. Using data reported by Member States to the World Health Organization (WHO), we aim to develop a global understanding of (1) the types of IIS used to monitor COVID-19 vaccination implemented in 2021 and (2) the approaches taken by countries to develop these systems. We conducted a descriptive analysis of data reported through a supplemental questionnaire of the WHO/United Nations Children's Emergency Fund (UNICEF) Joint Reporting Form on Immunization, collecting data for 2021 on (1) the use of and developmental approaches taken for 7 IIS functions (appointments, aggregate reporting, individual-level reporting, reminders, home-based records, safety surveillance, and stock management), and (2) modifications needed for digital health frameworks to permit COVID-19 vaccination monitoring. In total, 188 of 194 WHO Member States responded to the supplemental questionnaire, with 155 reporting on the IIS-related questions. Among those reporting, for each of the 7 IIS functions explored, greater than 85% of responding countries reported that the system was in place for COVID-19 vaccines. Among responding countries, "aggregate reporting system" was the system most frequently reported as being in place (n=116, 98.3%), while "reminder system" was the least (n=77, 89%). Among the countries reporting using a system, whether an existing system was adapted for COVID-19 vaccines or a new one was developed varied by system. Additionally, two-thirds (n=127, 67.6%) of countries reported establishing at least one new system, ranging from 72% (n=42) in high-income countries (HICs) to 62% (n=16) in low-income countries. Concurrently, 55.3% (n=104) of countries reported adapting at least one system already in place for COVID-19 vaccines, with 62% (n=36) of HICs reporting this compared to about 53% for other income groups. Of those reporting developing new systems, for each of the systems explored, more than 85% of countries reported that they intended to keep new systems specific to COVID-19 vaccines. Further, 147 of the 188 (78.2%) Member States responding to the supplemental questionnaire responded to the digital health frameworks question. Lastly, 31% (n=46) of responding countries reported needing to adapt them for COVID-19 vaccination systems. HICs had a higher percentage. Nearly all countries have adapted existing or developed new IIS to monitor COVID-19 vaccination. The approaches varied, notably by income group. Reflection is needed on how to sustain the investments made in IIS during the pandemic. Continued support for IIS is critical, given their essential role in program monitoring and performance.

Innovative management strategies for addressing paediatric medical staff shortages in underdeveloped cities in developing countries

BackgroundPaediatric professional scarcity and uneven distribution is acute in underdeveloped regions, exacerbated by COVID-19’s workload surge and burnout, highlighting the need for strengthened prevention and response measures.AimPropose an effective talent...

Planning policies to restrict fast food and inequalities in child weight in England: a quasi-experimental analysis.

England has one of the highest childhood obesity rates in Europe. To promote a healthier food environment in 2015, Gateshead Council in North East England introduced planning guidelines effectively banning any new fast-food outlets. Our aim was to investigate whether this policy led to any reductions in childhood overweight and obesity prevalence and the inequalities in these outcomes. We used data from the National Child Measurement Programme, the Food Standards Agency Food Hygiene Rating Scheme data, and the Office of National Statistics between 2012 and 2020. We estimated a difference-in-differences model employing propensity score matching to identify a control group. We found no significant change in population-level childhood overweight and obesity in Gateshead compared with control areas. In subgroup analysis by area-level deprivation, we found that the quintile of deprivation with the highest proportion of fast-food outlets had a statistically significant reduction of 4.8% in the prevalence of childhood overweight and obesity compared with control areas. Restricting fast-food outlets in areas with a high concentration of such outlets as part of a package of policies to reduce childhood obesity may help to reduce prevalence and inequalities in childhood overweight and obesity.

Prevalence of Bottle‐Feeding Practice and Associated Factors Among Mothers of Children Under Five in the World, 2024: Systematic Review and Meta‐Analysis

ABSTRACTBackgroundChild‐feeding practices, particularly breastfeeding, significantly impact children's health and survival. However, bottle feeding, although historically practiced, presents numerous disadvantages affecting optimal child nutrition and health. Despite World Health Organisation and The United Nations Children's Fund recommendations against bottle feeding, it remains prevalent globally, affecting roughly 59% of infants worldwide and 85% in Australia by 5 months of age.ObjectiveThis study aims to assess the prevalence and determinants of bottle feeding among mothers of children under five globally.MethodsThis systematic review and meta‐analysis adhered to the Preferred Reporting Items for Systematic Review and Meta‐Analysis guidelines. We comprehensively searched electronic databases for English‐language articles published between 2014 and 2024. The quality of studies was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were analysed in STATA version 17, including summary tables, narrative descriptions, forest plots, and statistical heterogeneity and publication bias assessment.ResultsThe pooled prevalence of bottle feeding among mothers was 57%. Subgroup analysis revealed higher prevalence in larger sample sizes (> 2151) and lower prevalence in smaller ones. Factors significantly associated with bottle feeding included mode of delivery (OR = 1.953; 95%, CI: 1.272, 2.635), child hospitalisation (OR = 1.984, CI: 1.593, 2.376), mother's occupation (OR = 1.579; CI: 1.467, 1.690), post‐natal care (OR = 2.965; CI: (1.358, 4.571), age of children (OR = 2.836; CI: 1.895, 3.777), place of residence (OR = 1.423; CI: 0.994, 1.852), and mother's education (OR = 3.366, CI: 1.949, 4.783).ConclusionEfforts to promote optimal child‐feeding practices should address the identified determinants, emphasising the importance of breastfeeding and providing support to mothers, especially those facing challenges such as cesarean delivery, child hospitalisation, and maternal employment.

The impact of trauma-informed practices on academic outcomes of First Nations children: a pilot study of culturally responsive supports in Australia

This pilot observational study examined the effectiveness of trauma-informed and culturally responsive behavior support practices on the academic outcomes of predominantly First Nations children in an Australian primary school. The research supports integrating culturally relevant ways of knowing, being and doing into prevalent pedagogical and behavior support practices. The cohort study found that the co-designed, multi-tier Trauma-informed Behaviour Support program improved students’ literacy and numeracy scores over 2 years. The findings highlight the complex relationship between behavioral difficulties and academic abilities. Changes in numeracy scores were significantly higher for students with improved teacher-reported rates of disruptive behaviors. In contrast, changes in literacy scores were equivalent between students with and without such improvements. The findings suggest that educators can improve academic outcomes by promoting cultural safety across the school and making the curriculum more flexible, engaging, and relevant. Further implications for educators, policymakers, and researchers working with First Nations students are discussed.

Development of a Joyful Learning-Based Instructional Model in Javanese Script

Learning Javanese script is considered an outdated and boring lesson. This paradigm of boring and obsolete Javanese script lessons must be changed into a modern, interesting, and enjoyable learning experience. One way to do this is by developing a Joyful Learning-based model for Javanese language instruction. Joyful Learning is a concept of enjoyable learning. The development of a Joyful Learning-based model for Javanese language instruction is urgent and necessary because the learning model currently used by students needs to employ the principles of Joyful Learning, resulting in students feeling bored, tired, and unmotivated to learn. Additionally, Javanese language instruction is viewed as a good means to develop the character of the nation's children, as it contains values of morality and politeness. The research design used is the ADDIE Research and Development design, with the steps of analyzing, designing, developing, implementing, and evaluating. This study uniquely integrates traditional games into the Joyful Learning model. The result of the study is creating a Joyful Learning-based model for Javanese script instruction. The components of this model include the social system, reaction principles, support system, instructional and incidental impacts, and syntagmatic. The syntagmatic model of Joyful Learning-based Javanese script instruction includes an introduction, material delivery, games for writing sentences, games for reading paragraphs in Javanese script, formative assessment, and reflection. The learning model has been tested at SMPN 12 Semarang. The results of the school trial indicate that the Joyful Learning-based Javanese script instruction model is effective for learning.

Nutritional Assessment Based on Mid-upper Arm Circumference Among Tribal Preschool Children of Three Distinct Ecological Zones of India

Undernutrition among infants and children retards the physical and cognitive growth and increases susceptibility to infections and diseases. Educational attainment and productivity of children get adversely affected by undernutrition, NFHS (2019–2020) and IIPS (2021) found the prevalence of undernutrition indicators to be high among the under-five children of the nation and tribal children to be in a more vulnerable condition. Mean mid-upper arm circumference (MUAC) is a quick, simple and precise screening tool to use in large-scale community-based nutritional programme. The present study aimed to assess the prevalence of undernutrition based on MUAC among three tribes of three distinct ecological zones of India, namely Bhil Tribe (Desert ecology), Dhodia tribe (Coastal ecology) and Kinnaura tribe (Himalayan ecology). The present cross-sectional study consists of 985 tribal children (509 boys and 476 girls) belonging to the age group 0–1 through 5+ years (below six years). Z-score was computed using WHO (2006) recommended age and sex-specific cutoff points for MUAC and the prevalence of undernutrition was assessed for children of below five years of age. MUAC has been found to have significant age difference among all communities ( p < .001). Prevalence of undernutrition was found to be the highest among the Bhil tribe, the one residing in the desert ecology (41.03%) followed by Dhodia (18.06%) and Kinnaura tribe (12.16%). Among Bhil and Kinnaura children, prevalence of undernutrition was higher among the girls, while the Kinnaura boys manifested higher prevalence of undernutrition in comparison to their counterpart. Significant ( p < .01) sex difference in undernutrition prevalence was found only in case of Bhil tribe (boys: 33.33%, girls: 48.02%). The prevalence of undernutrition significantly differs among the tribes of three distinct ecological zones ( p < .001). The nutritional status of the tribal children, particularly that of the Bhil children, was unsatisfactory. To improve the nutritional wellbeing of the tribal population of the nation, studies at regular intervals focusing on the causes responsible for nutritional status are needed.

Age of Emergence of Disparities in Asthma Prevalence and Morbidity among US Children.

Early-life exposures may precipitate asthma, but their contribution to disparities in asthma is less clear. To elucidate racial, ethnic, and socioeconomic status (SES) disparities in the age trajectory of asthma burden among US children. We analyzed three datasets: (1) 2016-2021 National Children's Health Survey (NCHS) (n=223,551); (2) 2015-2017 Child Asthma Call-Back Survey (ACBS) (n=4,289); and (3) 2018-2019 National Inpatient Sample (NIS) (n=23,713 children with asthma). We examined cumulative asthma prevalence by individual-year of age and children's race and ethnicity or SES (NCHS); mean age at asthma diagnosis by race and ethnicity and SES, unadjusted and adjusted for confounders (ACBS); and asthma hospitalization rates overall and per child with asthma by individual year of age and race and ethnicity (NIS). Among White children, cumulative asthma prevalence rises gradually through childhood, to 6.6% at age 5 and 16.1% by age 17. Prevalence rises more sharply in early childhood among Black children, reaching 17.6% at age 5 (RR 2.6;95%CI 1.9,3.8), but plateaus after age 9, with a consequent decline in Black-White relative disparities into adolescence. Disparities according to SES follow a similar trajectory, emerging early and subsequently narrowing. Similarly, Black, Hispanic and low-income children with asthma are diagnosed at an earlier age than White (or high-income) children. The asthma hospitalization rate rises in the first years of life among all children, but most rapidly among Black children, with a peak absolute Black-White gap at age 4; the relative gap remains wide throughout childhood and peaks at age 10. However, per child with asthma, relative disparities in White-Black hospitalizations rise through age 15. Disparities in asthma prevalence emerge in early childhood and then narrow, suggesting that reducing early-life adverse environmental exposures may be key to asthma prevention. Policies to improve the social determinants of health during gestation and childhood, e.g. environmental equity and family income support, are needed.

Is there an association between psychological distress during early adulthood and later trajectories of physical activity during adulthood? Longitudinal data from two cohort studies

BackgroundOur aim was to analyse the prospective association between psychological distress during early adulthood and physical activity trajectories between early and middle adulthood.MethodsWe used data from the 1958 National Child...

Childhood psychosocial adjustment and midlife obesity, diabetes and hypertension: prospective study from two birth cohorts.

Understanding how childhood psychosocial adjustment (CPA) influences later life health outcomes is crucial for developing interventions to mitigate the long-term risk of cardiometabolic diseases (CMDs). To investigate the association between CPA and incident CMDs in mid-life, and the mediating roles of educational attainment, smoking habits and depression during young adulthood. A prospective cohort study utilised data from the 1958 National Child Development Study (NCDS; 1958-2013) and the 1970 British Cohort Study (BCS70; 1970-2018), encompassing 22 012 participants assessed for CPA in childhood, who were subsequently evaluated for educational attainment, smoking habits and depression in young adulthood, followed by assessments for CMDs in mid-life. CPA was assessed using the Bristol Social Adjustment Guides in the NCDS and the Rutter Child Behaviour Scale in the BCS70, with higher scores indicating poorer psychosocial adjustment. The primary outcomes were the mid-life incidences of hypertension, diabetes and obesity. Compared with children in the lowest tertile for CPA scores, those in the middle tertile had an adjusted odds ratio for hypertension of 0.98 (95% CI 0.90-1.06), whereas those in the highest tertile had an odds ratio of 1.17 (95% CI 1.08-1.26). For diabetes, the corresponding odds ratios (95% CI) were 1.15 (0.98-1.35) and 1.39 (1.19-1.62). For obesity, the corresponding odds ratios (95% CI) were 1.08 (1.00-1.16) and 1.18 (1.09-1.27). These associations were partially mediated by educational attainment (2.4-13.9%) and depression during young adulthood (2.5-14.9%). Poorer CPA is correlated with the development of hypertension, diabetes and obesity in mid-life. Interventions aimed at improving CPA may help in reducing the burden of these diseases in later life.

Confronting our failures: Tensions in remedying systemic discrimination in Canada

This article examines the complexities of providing remedies for systemic discrimination in light of evolving understandings of equality and justice. Despite constitutional and statutory protections affirming the right to live free from discrimination, there remains a significant gap between recognizing systemic discrimination and implementing effective remedies. The 2021 case of Canada (Attorney General) v. First Nations Child and Family Caring Society of Canada serves as a focal point to highlight the shortcomings of the current remedial framework, which often prioritizes corrective over transformative justice, reflecting a formal rather than substantive approach to equality. In this case, the Canadian Human Rights Tribunal found that Canada’s inequitable funding of First Nations child welfare services was discriminatory on the grounds of race and national or ethnic origin. It ordered Canada to compensate every child impacted, while simultaneously imposing systemic remedies such as reforming federal funding policies. By exploring the Tribunal’s decision to uphold both individual and systemic remedies, the paper argues for a more integrated approach that moves beyond the dichotomy of individual versus systemic discrimination. It advocates for co-designed remedies informed by the perspectives of affected communities, calling for a shift in how systemic discrimination is addressed within Canada’s legal framework.

Routine Immunization Status and Factors Associated with Immunization Coverage among Children Aged 12-23 Months in Tanzania.

Immunization has saved millions of lives globally from vaccine-preventable diseases. Childhood immunization is an effective public health strategy for decreasing morbidity and mortality among children in developing countries. Tanzania has one of the highest rates of coverage of routine child immunization among sub-Saharan African countries. However, obstacles to universal immunization still exist, particularly in rural areas of the country. Assessing routine immunization coverage is essential to inform vaccine policies and program implementation. This study aimed to assess routine immunization status and factors associated with its coverage among children aged 12-23 months. We conducted a cross-sectional, quantitative household survey in 31 regions with caretakers of children in Tanzania, where a total of 4,560 households were visited. Nationally, 85.5% of children aged 12-23 months had completed the full recommended course of vaccines. Overall, 14.5% of children aged 12-23 months did not complete routine immunization schedules in 2019. We found that factors associated with immunization coverage included having one to six family members, higher household wealth, the family's head engaging in subsistence farming, caretakers' age, children's age, educational level, children with clinic cards, and children receiving the diphtheria, pertussis, tetanus-3 vaccine. The country is about to reach the vaccination coverage target set by the WHO and the United Nations Children Fund. Improving existing vaccination coverage and optimizing the use of recommended interventions are required. We strongly advise using the periodic micro-planning tool and satellite image technology, particularly in areas where immunization coverage is less than 80%.

Cheating the evidence to get to best interest and the presumption of unfitness

AbstractThis article explores our national reactive child protection model which has focused on removing poor people from poor families and has resulted in conflating poverty with neglect. Significant issues of class and race are implicated given dramatic systemic racial and ethnic disparities and questions must be asked whether current practices have done more harm than good. In reviewing this landscape this article is descriptive and prescriptive and calls for adopting proactive public health‐oriented policies which support children and families in their homes and a culture of due process and fairness in juvenile and family court hearings involving children and their families. Dependency or abuse and neglect cases involve state intervention. These are not disputes between private parties where the sole focus is the best interest of the child regarding which guardian to be placed with. Cheating the Evidence warns against diluting the constitutional requirement of proving the lack of parental unfitness by clear and convincing evidence by making comparative judgments about placement which are based on often subjective assessments on best interests of the child which are resource based. Given that high percentage of cases involving allegations of neglect versus inflicted abuse these concerns are of paramount importance. There is a need for more rigor in fact‐finding and adherence to constitutionally required burdens of proof. Due process and fairness are best‐served by supporting client‐directed advocacy and greater transparency, including presumptively opening up the doors to closed juvenile and family court hearings as recommended by the National Council of Juvenile and Family Court Judges in 2005. Opening the doors is not a binary or either or proposition‐ we can preclude dissemination of records of youth, and protect confidentiality as a growing number of states have done. Transparency includes more than raising the level of practice of lawyers and judges‐ it includes encouraging systemic accountability from child serving agencies and educating the public about the complexities which are related to the birth or cradle to prison pipeline.

Well-Being and Healthcare Inequality on Bulon-Don Island in Southern Thailand-Results of a Pre-Intervention Field Survey.

Children living in an area distant from or associated with barriers to travelling to health service centres usually experience health and well-being disparities. This is a survey of child health and well-being on Bulon-Don Island, located 22 kms. from the southern mainland of Thailand, to gather essential background data before activating responses from local service provider agencies. Demographic data, physical and crude psychological health, harm to health, and living conditions of Bulon-Don children aged 1-14 years were studied and compared with the results of the corresponding national child health survey. Descriptive statistics were used for the statistical analysis of significance (p < 0.05). A total of 21 male and 41 female children (N = 62) participated in the survey after obtaining consents from parents or care providers. The islanders are Indigenous people who use their own languages and have traditional beliefs. Comparing with the children of the national survey, most children aged <5 years were found to have significantly lower height and weight according to their age (p = 0.044 and p = 0.043, respectively), whereas those aged >5 years had a similar nutritional status. In addition, there is a lack of facilities for healthy living. However, the mean total psychological and ethical standards scores were significantly higher in the 1-5 and 6-9-year-old children. Disparity of socio-political status, cultural beliefs and practices, socioeconomic basis, and geographic distance from the mainland were the social determinants and barriers of low health service accessibility for the islander children. Comprehensive child health and well-being evaluation in an enclave of isolation like this is mandatory before an integrated intervention carried out by the local healthcare and living facilities providers is implemented.

Mapping the Fetal Alcohol Spectrum Disorder Continuum of Care Across the Military Health System.

Although a leading cause of developmental disability in the United States, many individuals with fetal alcohol spectrum disorders (FASDs) do not receive a timely diagnosis, are misdiagnosed, or are never diagnosed. Prevention, diagnosis, and clinical management of FASD have not been previously studied in the U.S. Military Health System (MHS), where nearly 1 million of the nation's children receive health care. To address this gap, we undertook an environmental scan of the clinical guidelines, services, programs, educational resources, and policies within the MHS pertaining to alcohol use (AU), AU disorder (AUD), prenatal alcohol exposure, and FASD. From March to June 2023, we undertook an environmental scan of MHS clinical guidelines, services, programs, educational resources, and policies that address AU, AUD, prenatal alcohol exposure, and FASD. We identified multiple resources that attended to AU and AUD before and during pregnancy in the MHS. However, despite numerous resources for other neurodevelopmental disorders, we did not find any MHS-specific resources that address diagnosis and management of FASD. Findings suggest opportunities to raise awareness, educate providers, and improve guidelines, policies, and practices in the MHS.

Network Analysis to Visualize Qualitative Results: Example From a Qualitative Content Analysis of The National Child Abuse Hotline.

Data visualization, such as figures created through network analysis, may be one way to present more complete information from qualitative analysis. Segments of qualitatively coded data can be treated as objects in network analysis, thus creating visual representations of the code frequency (i.e., nodes) and the co-occurrence (i.e., edges). By sharing an example of network analysis applied to qualitative data, and then comparing our process with other applications, our goal is to help other researchers reflect on how this approach may support their interpretation and visualization of qualitative data. A total of 265 de-identified transcripts between help-seekers and National Child Abuse Hotline crisis counselors were included in the network analysis. Post-conversation surveys, including help-seekers' perceptions of the conversations, were also included in the analysis. Qualitative content analysis was conducted, which was quantified as the presence or absence of each code within a transcript. Then, we divided the dataset based on help-seekers' perceptions. Individuals who responded that they "Yes/Maybe" felt more hopeful after the conversation were in the "hopeful" dataset, while those who answered "No" were in the "unhopeful" dataset. This information was imported to UCINET to create co-occurrence matrices. Gephi was used to visualize the network. Overall, code co-occurrence networks in hopeful conversations were denser. Furthermore, the average degree was higher in these hopeful conversations, suggesting more codes were consistently present. Codes in hopeful conversations included information, counselor support, and problem-solving. Conversely, non-hopeful conversations focused on information. Overall, network analysis revealed patterns that were not evident through traditional qualitative analysis.