Faculty Bibliography

BACKGROUND:Reporting guidelines for implementation strategies are important for transparency, measurement, and replicability. Yet, recent calls within implementation science highlight that foundational research commitments to advance minority health remain underspecified in current implementation strategy reporting guidelines. METHODS:In response, our research team sought to expand Proctor and colleagues' guidelines for reporting and specifying implementation strategies to advance minority health. We first identified and synthesized key elements for specification from relevant literature. We then applied potential supplemental reporting criteria to our Literacy Promotion for Latinos (LPL) study as a case example to iterate and refine the suggested supplemental criteria. LPL implemented text messages and streamlined access to community resources as implementation strategies to enhance uptake of Reach Out and Read, an evidence-based pediatric clinic-based literacy promotion intervention specifically among Latino families. RESULTS:Our suggested supplemental reporting criteria integrate elements of community-engagement and health disparities research foundational for advancing minority health. We offer a new category, (1) Prioritize It, to describe processes of defining and prioritizing the (a) health outcome gap of interest and (b) performance gap of the evidence-based intervention. We add criteria to Proctor and colleagues' (2) Specify It category, which outlines the description of the implementation strategies, to describe processes of implementation strategy (a) selection, (b) development, and (c) tailoring. Lastly, we suggest a new category, (3) Evaluate It, to include community-engaged evaluation processes. In our case example, we explain the team's processes and engagement of relevant community members and partners in (a) prioritizing disparities in linguistic and socio-emotional development for Latino children related to school readiness and performance gaps in Reach Out and Read for families in local clinic communities; (b) specifying the selection, development, and tailoring of implementation strategies to focus on social and structural drivers of this health disparity; and (c) facilitating community partnerships to evaluate the strategies. CONCLUSIONS:Expansion of implementation strategy criteria for reporting can help ensure commitments to advancing minority health are fulfilled. Future efforts should convene researchers and community partners to create expert consensus on the specifications required for implementation strategies for addressing drivers of disparities and advancing minority health. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov, Literacy Promotion for Latinos Study, NCT04609553, first posted October 30, 2020: https://clinicaltrials.gov/ct2/show/NCT04609553.

The neighborhood environment influences the amount of children's screen time, which in turn affects later development. Few studies have examined the potential for parent-child interventions to moderate such associations. This study examined the link between neighborhood disorder (observed and parent-reported) and infant screen time at 9 months, and whether the PlayReadVIP intervention attenuates this relation among Black/African-American and White families in Flint, MI. Three -hundred and ninety-nine families were included in analyses. Multigroup SEM path analyses indicated that observed neighborhood disorder predicted screen time for all participants (β=.19), but perceived neighborhood disorder was a significant -predictor of infant screen time only for the Control group (β=.11). Findings support the potential of early parent-child -programs to attenuate a range of risk factors for children's development.

OBJECTIVE:Little is known about patterns of anxiety and depressive symptoms (ADS) beginning in infancy, particularly in the U.S. It is also unclear how early harsh discipline predicts these symptoms over time. We aimed to describe longitudinal patterns of ADS from 18 months through 6 years of age and examine whether those patterns are associated with harsh discipline at 18 months. METHODS:We performed a secondary analysis of parent-child dyads in a study focused on early relational health and school readiness in low-income families in the U.S. We used group-based trajectory modeling to identify distinct patterns of ADS between 18 months and 6 years. Multinomial logistic regression was used to examine the relationship between harsh discipline (total, physical, and verbal) and trajectory group membership. RESULTS:We identified three ADS trajectories: low (29%), moderate (61%), and high (10%). Children who experienced more total harsh discipline were at greater risk of belonging to the moderate (relative risk ratio (RRR), 1.98; 95% CI, 1.19-3.32) and high groups (RRR, 2.76; 95% CI, 1.32-5.77) than the low group. After disaggregating harsh discipline into physical and verbal components and controlling for each other, harsh verbal discipline alone significantly predicted membership in the moderate group only (RRR, 1.62; 95% CI, 1.10-2.38). CONCLUSIONS:Approximately 10% of the sample developed persistent ADS starting in infancy with harsh discipline as a risk factor. Findings underscore the importance of addressing harsh discipline in early anticipatory guidance.

OBJECTIVES/OBJECTIVE:Given the known link between maternal and child mental health, it is likely that children whose mothers experienced more distress because of the COVID-19 pandemic were at greater risk for increased behavior problems. Yet research to date has not tested this hypothesis among families who were hit hardest by the pandemic-those with low incomes and from Black and Hispanic backgrounds. Research is also needed that focuses on young children and uses a longitudinal design. DESIGN/METHODS:We harmonized data from 4 cohorts originally designed to study pediatric parenting interventions with underresourced families in 2 US cities. We examined, first, whether maternal distress because of the pandemic was associated with change over the next 1 to 2 years in preschool-aged children's anxiety/depression and aggression, and second, whether such associations were moderated by maternal depression. RESULTS:Maternal pandemic-related distress predicted a small increase in child aggression but no change in anxiety/depression. There was no moderation by maternal depression. CONCLUSION/CONCLUSIONS:Among families at risk of the most severe health and financial hardships because of the pandemic, maternal pandemic-related distress was associated with increases in child aggression 1 to 2 years later. Maternal mental health must be made a priority in the future disasters not only in its own right but also because of possible spillover effects on young children.

OBJECTIVES/OBJECTIVE:Much research has documented disruptions to parent well-being and family functioning because of the COVID-19 pandemic in the United States, but little is known about how parents' provision of cognitive stimulation to young children has been affected. This question is of added importance for families with low incomes, who were disproportionately disadvantaged by the pandemic. The current study examined whether and how provision of cognitive stimulation at home, as measured by the parent-reported StimQ2, changed for parents with low incomes after onset of the COVID-19 pandemic. We examined scores on a total scale and subscales tapping multiple aspects of verbal responsivity and reading. DESIGN/METHODS:Data from 7 cohorts of families with low incomes across 3 US cities were de-identified and combined into a single analytic sample for secondary analysis. Cohorts ranged in timing relative to the onset of the pandemic (i.e., as early as 2015 and as late as April 2023). Each study contributed data from families assessed at multiple timepoints between birth and age 4 years. RESULTS:Total scores on the StimQ2 increased after the onset of the COVID-19 pandemic. Subscales reflecting reading stayed the same (quantity) or declined (quality), whereas subscales reflecting verbal responsivity increased. CONCLUSION/CONCLUSIONS:Relative to prepandemic levels, low-income parents' child-directed speech and responsivity increased postpandemic, but the quantity of parent-child reading was unchanged and its quality declined. Findings suggest the possibility of stability or improvement among parents with low incomes during the pandemic and opportunities for intervention.

Several reports have described increases in children's behavior problems since the onset of the COVID-19 pandemic, but few were based on prospective data or represented groups who disproportionately experienced pandemic-related hardships. This study followed low-income and racially diverse young children from 3 U.S. cities-New York, NY, Pittsburgh, PA, and Tulsa, OK-with repeated measures of child behavior between 2016 and 2023. A total of 1,124 children were included (50% female; 48% Hispanic/Latine; 30% Black; 22% White/Other race/ethnicity; aged 3-7 at pandemic onset). Results reveal different patterns of behavior change by city. In New York, children's behavior stayed the same or slightly improved following the pandemic onset, whereas it stayed the same or got slightly worse in Tulsa, and got worse in Pittsburgh. Future studies of pandemic impacts should consider regional variation.

BACKGROUND:Efficacy of health-care based Early Relational Health (ERH) parenting interventions like PlayReadVIP and Smart Beginnings, are well-established, but limited research has examined parental perceptions of impact. OBJECTIVE:To explore parents' perceptions of how PlayReadVIP and SB support their parenting, generally and during the COVID-19 pandemic. METHODS:Nested sample of low-income parents enrolled in a two-site RCT of Smart Beginnings (SB), in New York City, NY (n = 40, 93% Latino) and Pittsburgh, PA (n = 40, 80% Black) and a single-site RCT of PlayReadVIP, Supporting Parents And Raising Resilient Kids (SPARRK), in Flint, MI (n = 40, 45% Black, 38% White). Interviews were audio taped and transcribed. Transcripts were coded using an iterative process of textual analysis until thematic saturation was reached. RESULTS:Four themes emerged: (1) Caregivers valued learning new, foundational parenting practices; (2) became more child-centered; (3) felt increased self-efficacy and empowerment; and (4) identified PlayReadVIP and SB as sources of support. CONCLUSIONS:Parents valued the ERH-aligned skills and concepts they learned in PlayReadVIP and SB and viewed the programs as sources of social support. Findings can inform and strengthen pediatric primary care-based parenting programs and have implications for feasibility, acceptability, and scaling of evidence-based and layered ERH programs. CLINICAL TRIAL REGISTRATION/BACKGROUND:Clinicaltrials.gov, NCT02459327, NCT03945552 https://clinicaltrials.gov/study/NCT02459327 , https://clinicaltrials.gov/study/NCT03945552 . IMPACT/CONCLUSIONS:Qualitative study demonstrating that parents value and learn Early Relational Health (ERH) skills from health-care based preventive parenting interventions. Findings inform adaptation, engagement, and scaling. Efficacy of parenting interventions (PlayReadVIP, Smart Beginnings) are well-established, but limited research has examined parental perceptions of impact. This study explores parents' experience with these programs to better understand core components and identify areas for adaptation and refinement. This study builds on prior quantitative work to demonstrate parents' perceived impact of and value in PlayReadVIP and Smart Beginnings. Parents reported participation in these programs/models resulted in enhancements to ERH, mind-mindedness, social support, and mental health.

OBJECTIVE:Supporting early relational health (ERH) positively affects lifelong health. We investigated perspectives of low-income parents of preterm children regarding child factors and parenting behaviors (defined as responsive parenting, structure/routines, and warm parent-child relationship) associated with ERH and factors associated with these behaviors. METHODS:We conducted in-depth, semi-structured interviews with low-income parents of children born preterm between Neonatal Intensive Care Unit (NICU) discharge and age 3 years. We examined perceptions of ERH and used the PRECEDE framework to identify predisposing, enabling, and reinforcing factors affecting parenting behaviors associated with ERH. We developed codes and themes iteratively using a deductive qualitative approach. RESULTS:We interviewed 22 parents of children born 24 to 34 weeks' gestation at 1 to 35 months corrected age. Regarding perspectives on ERH, parents shared that the NICU hospitalization heightens attention to children after discharge and that they feel an intense, sometimes overwhelming, bond with children born preterm. Parents both make accommodations for their preterm children and treat them the same as children born full term. Medical vulnerability affects how they spend time with their children. Regarding predisposing, enabling, and reinforcing factors of parenting behaviors associated with ERH, parents noted that developmental professionals can support relationships, that perceptions of preterm birth affect parents' relationships with their children, and that prior experience parenting preterm and full-term children affects confidence and knowledge of how to form relationships. CONCLUSION/CONCLUSIONS:Adaptation of existing ERH interventions should incorporate ways that NICU hospitalization and views of prematurity inform low-income parents' perceptions and use of parenting behaviors associated with ERH.

INTRODUCTION/BACKGROUND:Parenting self-efficacy (PSE) is correlated with positive parenting and child outcomes, but may be reduced in stressful settings. Community factors affecting PSE are not well understood. The community of Flint, Michigan, endured significant stressors, including the Flint Water Crisis (FWC), and disproportionate effects of the COVID-19 pandemic. This study examines how these superimposed stressors affect PSE in families in Flint. METHODS:This study was a secondary, cross-sectional analysis of 291 infants and caregivers. Baseline surveys included sociodemographics, stress, and PSE. Primary predictors were FWC and COVID-19 distress. Primary outcome was PSE. Bivariate analyses were used to examine the association between FWC and COVID-19 distress with PSE, and multiple linear regression to control for sociodemographics. RESULTS:Both increased COVID-19 distress and FWC distress had significant inverse association with PSE in bivariate analyses, and predicted PSE (COVID-19 distress, β -.18, p <.01, and FWC distress, β -.18, p <.05) in multiple linear regression. A significant interaction was found between FWC distress and COVID-19 distress. Simple slope analyses indicated that COVID-19 distress predicted reduced PSE only for high FWC-distress group (β -.22, p <.01). DISCUSSION/CONCLUSIONS:Results show COVID-19 distress and FWC distress both had independent negative associations with PSE, but FWC distress moderated the effect of COVID-19 distress on PSE, indicating that families more affected by previous stressors were more vulnerable to the effects of COVID-19 distress, while those less affected were resilient to subsequent stressors. Future interventions should target disinvestment, prevent community stressors, and support exposed families.

OBJECTIVES/OBJECTIVE:To examine the effects of PlayReadVIP, a pediatric primary care intervention promoting early relational health, on child behaviors. STUDY DESIGN/METHODS:A factorial randomized controlled trial enrolled mother-child dyads postpartum. PlayReadVIP was delivered in two phases: birth to 3 years (PlayReadVIP 0-3) and 3 to 5 years (PlayReadVIP 3-5). At enrollment, dyads were assigned to PlayReadVIP 0-3 or control. At age 3, dyads were re-randomized to PlayReadVIP 3-5 or control. Analyses included dyads with a second randomization and complete data on the mediators and child outcomes. In PlayReadVIP, dyads attended one-on-one sessions with a parent coach, in which they received child development information, learning materials, and real-time, strengths-based feedback on brief video recordings of parent-child interactions. Cognitive stimulation and harsh discipline were reported by mothers. Child behaviors were assessed using the Behavior Assessment System for Children, Second Edition. RESULTS:grade. No significant indirect effects through harsh discipline were found. CONCLUSIONS:PlayReadVIP leads to sustained but small improvements in child behaviors by enhancing maternal cognitive stimulation, emphasizing the potential of early intervention in pediatric primary care for promoting child mental health in disadvantaged populations.