Faculty Bibliography

BACKGROUND:Children's social-emotional development and mental well-being are critical to adult mental health. However, little is known about the mechanisms or factors that contribute to poor child mental health in low- and middle-income countries. Given the lack of child mental health research to guide interventions or social-emotional learning programs and policy planning, the present study aimed to address these knowledge gaps by examining the psychopathology mechanism involved in the development of childhood mental health problems. METHODS:This cross-sectional study recruited parents (N = 393) whose children attended preschool to primary classes in the Arghakhanchi district of Nepal. Data were gathered through parent interviews. Structural Equation Modeling was used to examine the pathways of the mediational mechanism that examined the influence of parental well-being on parenting and children's mental health outcomes. RESULTS:Approximately 22% of the parents were at risk for moderate to severe mental health problems (anxiety: 24%, depression:19%). Parental mental health problems were higher in families who reported food insecurity, among female parents, less educated parents, and those who perceived themselves on a lower social ladder. Parental mental health, social support, and perceived class were associated with parent-child conflict. Greater parent-child conflict was associated with decreased social competence and increased anger, anxiety, and depression in children. CONCLUSION/CONCLUSIONS:The results partially support the mediational model that Nepali parents' well-being (especially in mental health symptoms, social support, and perception of family's social class domains) is associated with less optimal parenting and, in turn, greater child mental health problems and lower social competence. This study provides new evidence of cross-cultural consistency in child psychopathology and guides the development of evidence-based programs to prevent and promote mental health among Nepali children and families.

Efforts to bolster the school readiness of Latine children from low-income and immigrant homes have focused on fostering parent engagement in children's education. In assessing parent engagement, most measures center school-based activities in alignment with middle class, European American dominant norms, missing the multiple ways that Latine families engage with their children to support their educational experiences and development. Additionally, studies of predictors of Latine parent engagement have mainly focused on parent demographic and linguistic factors, limiting our understanding of how to support parent engagement equitably. Using a measure of parent engagement sensitive to culturally contextualized behaviors of Latine families, this study describes the ways Latine parents living in historically disinvested neighborhoods in New York City engage in their children's learning at home and in school during a nationally charged anti-immigrant, anti-Latine sociopolitical climate. We also examine whether immigration enforcement threat and parent health are associated with Latine family engagement in home and school-based activities. Data come from a larger study conducted with Latine parents (n=103; 42% immigrant) of pre-K children. Descriptive results indicate that despite a charged sociopolitical context, levels of engagement in children's education and development across multiple domains were comparable with mean levels established by the developers. Findings from regression analyses demonstrated that above and beyond demographic, linguistic and financial factors, immigration enforcement threat and parent health were associated with aspects of family engagement in young children's learning among Latine families in low-income communities. Implications for policy and practice are discussed.

BACKGROUND/UNASSIGNED:The burden of pediatric mental disorders in low-and middle-income countries (LMICs) is tremendous, but solutions for addressing the burden remain limited. Although digital solutions have potential to improve prevention services, such solutions have not been systematically tested in these countries. OBJECTIVE/UNASSIGNED:This study explores the use of a digital parenting intervention tool designed for pediatric behavioral health, known as the Pediatric-Behavioral Health Digital Tool, in a preventive service model for low resource communities. We study the feasibility of implementing this new digital health service model and preliminary estimate the potential impacts on parenting and child social emotional outcomes when the program is implemented in faith-based organizations in Uganda. The Pediatric-Behavioral Health Digital Tool is a preventive intervention designed to be implemented by trained community-health-workers to facilitate caregivers' access to the preventive mental health service in community for their young children. The tool is based on the screening, brief intervention, and referral to treatment prevention service model for promoting pediatric behavioral and mental health. METHODS/UNASSIGNED:The evaluation study was designed using a pre-post assessment design. The content in Pediatric-Behavioral Health Digital Tool was co-designed with local expert and iteratively adapted based on parents and caregivers as well as community-health-workers and experts who were invited to provide their feedback and suggestions for improvements in content, functions, and delivery model through a series of focus groups and workshops. This pilot evaluation focuses on the pre-post changes of the intervention families (91 families) and 10 community-health-workers. RESULTS/UNASSIGNED:We found high acceptability, appropriateness, and usefulness of the program based on the intervention families' community-health-workers' report. Intervention parents felt safe in using the digital toolkit. Parents felt comfortable for the CHWs asked them personal questions. In estimating the impacts, we found some expected findings on parenting and child social emotional health. Specifically, we found intervention parents become more mindful in their parenting (d=1.61, p=.049), and felt more effective in discipline their child's misbehavior (d=1.29, p=.003) after they receive the intervention. For children, we found improvement on children's social emotional outcomes, measured by decreased parent-child conflict (d=-1.08, p=.002) and increased child emotional regulation skills (d=1.0, p=.049) after their parents receive the intervention. CONCLUSIONS/UNASSIGNED:Our Pediatric-Behavioral Health Digital Tool has potential to provide a cost-effective service solution to provide preventive mental health care in communities to promote child social-emotional and mental wellbeing in low-resource settings.

Efforts to bolster the school readiness of Latinx children from low-income homes in the United States have focused on fostering parent engagement in children"™s education. Measurement of parent engagement in early childhood however, has been critiqued for having too narrow a focus on school-based involvement and missing other aspects of Latinx parent engagement. Using a recently developed culturally sensitive assessment of Latinx parent engagement, we test for associations between dimensions of Latinx parent engagement in learning and indicators of school readiness in a diverse sample of Latinx families (n = 114). We find significant associations between multiple dimensions of Latinx parent engagement and indicators of child school readiness. In addition to promoting parent-teacher connections, efforts to support Latinx school readiness equitably are encouraged to attend to various culturally relevant aspects of Latinx parent engagement in early childhood. In particular, investing in programing that supports parents"™ well-being and capacity for home-based engagement in learning may be a promising way to support the school readiness of Latinx children living in historically disinvested neighborhoods.

BACKGROUND:Psychotic-like experiences (PLEs) and adverse life events (ALEs) are highly prevalent in sub-Saharan Africa where gendered practices are also common. There is, however, a paucity of data on how the relationship between PLEs and life adversities is influenced by gender. The current study addressed this gap. METHOD/METHODS:Data were collected from 1886 school-based young people (1174 females) in Ghana, West Africa using a cross-sectional survey methodology and analyzed using Chi-square, independent t-test, Pearson correlation, and multivariate regression. RESULTS:The results showed that victimization experiences, school stress and having a family member with mental illness were significantly associated with PLEs in both males and females. In contrast, substance misuse and experiences of head trauma correlated significantly with PLEs in females only. CONCLUSION/CONCLUSIONS:Life adversities constitute major risk factors for PLEs among school-based young people in Ghana, who could benefit from gender neutral and gender-sensitive intervention programming to remediate the effects of life adversities on PLEs.

PURPOSE/OBJECTIVE:Cancer deaths in low- and middle-income countries (LMICs) will nearly double by 2040. Available evidence-based interventions (EBIs) for cancer prevention and early detection can reduce cancer-related mortality, yet there is a lack of evidence on effectively scaling these EBIs in LMIC settings. METHODS:We conducted a scoping review to identify published literature from six databases between 2012 and 2022 that described efforts for scaling cancer prevention and early detection EBIs in LMICs. Included studies met one of two definitions of scale-up: (1) deliberate efforts to increase the impact of effective intervention to benefit more people or (2) an intervention shown to be efficacious on a small scale expanded under real-world conditions to reach a greater proportion of eligible population. Study characteristics, including EBIs, implementation strategies, and outcomes used, were summarized using frameworks from the field of implementation science. RESULTS:This search yielded 3,076 abstracts, with 24 studies eligible for inclusion. Included studies focused on a number of cancer sites including cervical (67%), breast (13%), breast and cervical (13%), liver (4%), and colon (4%). Commonly reported scale-up strategies included developing stakeholder inter-relationships, training and education, and changing infrastructure. Barriers to scale-up were reported at individual, health facility, and community levels. Few studies reported applying conceptual frameworks to guide strategy selection and evaluation. CONCLUSION/CONCLUSIONS:Although there were relatively few published reports, this scoping review offers insight into the approaches used by LMICs to scale up cancer EBIs, including common strategies and barriers. More importantly, it illustrates the urgent need to fill gaps in research to guide best practices for bringing the implementation of cancer EBIs to scale in LMICs.

PURPOSE/OBJECTIVE:Disruptive behavioral disorders (DBDs) are common among children/adolescents in sub-Saharan Africa. A 16-week manualized multiple family group (MFG) intervention called Amaka Amasanyufu designed to reduce DBDs among school-going children/adolescents in low-resource communities in Uganda was efficacious in reducing symptoms of poor mental health relative to usual care in the short-term (4 months post-intervention-initiation). We examined whether intervention effects are sustained 6 months postintervention. METHODS:We used longitudinal data from 636 children positive for DBDs: (1) Control condition, 10 schools, n = 243; (2) MFG delivered via parent peers (MFG-PP), eight schools, n = 194 and; (3) MFG delivered via community healthcare workers (MFG-CHW), eight schools, n = 199 from the SMART Africa-Uganda study (2016-2022). All participants were blinded. We estimated three-level linear mixed-effects models and pairwise comparisons at 6 months postintervention and time-within-group effects to evaluate the impact on Oppositional Defiant Disorder (ODD), impaired functioning, depressive symptoms, and self-concept. RESULTS:At 6 months postintervention, children in MFG-PP and MFG-CHW groups had significantly lower means for ODD (mean difference [MD] = -1.08 and -1.35) impaired functioning (MD = -1.19 and -1.16), and depressive symptoms (MD = -1.06 and -0.83), than controls and higher means for self-concept (MD = 3.81 and 5.14). Most outcomes improved at 6 months compared to baseline. There were no differences between the two intervention groups. DISCUSSION/CONCLUSIONS:The Amaka Amasanyufu intervention had sustained effects in reducing ODD, impaired functioning, and depressive symptoms and improving self-concept relative to usual care at 6 months postintervention. Our findings strengthen the evidence that the intervention effectively reduces DBDs and impaired functioning among young people in resource-limited settings and was sustained over time.