Children and Parental Barriers to Active Commuting to School: A Comparison Study

The main objectives of this study were: to compare the barriers to active commuting to and from school (ACS) between children and their parents separately for children and adolescents; and to analyze the association between ACS and the children’s and parents’ barriers. A total of 401 child–parent pairs, from Granada, Jaén, Toledo and Valencia, self-reported, separately, their mode of commuting to school and work, respectively, and the children’s barriers to ACS. T-tests and chi-square tests were used to analyze the differences by age for continuous and categorical variables, respectively. Binary logistic regressions were performed to study the association between ACS barriers of children and parents and ACS. Both children and adolescents perceived higher physical and motivational barriers and social support barriers towards ACS than their parents (all p < 0.05). Additionally, the parents perceived higher distance, traffic safety, convenience, built environment, crime-related safety and weather as barriers towards ACS, than their children (all p < 0.05). Moreover, a higher perception of barriers was related to lower ACS. The results of our study showed the necessity of attenuating the perceptions of children and their parents in order to increase ACS. This is relevant to develop interventions in the specific contexts of each barrier and involving both populations.

Parental Barriers in Seeking Mental Health Services for Attention Deficit Hyperactivity Disorder in Children: Systematic Review

Objective: Many children at risk for negative outcomes related to untreated attention deficit hyperactivity disorder (ADHD) do not receive necessary mental healthcare. Parents’ mental health-seeking behavior is important in the early identification of ADHD and preventing comorbidities with ADHD. Parents may experience some barriers that may delay or stop parents from seeking mental healthcare for their children. Method: This systematic review summarized existing evidence of parents’ barriers to seeking mental healthcare for their children at risk of ADHD. Results: This review included 21 studies that address different parental barriers under the three levels of the social-ecological model, including individual, interpersonal, and community levels. Conclusion: Raising parents’ awareness of the process of seeking mental healthcare has the potential to help identify children at risk for ADHD earlier. Developing psychoeducational intervention that improves parents’ seeking behavior and reduces barriers toward seeking mental healthcare is needed.

Predictors of Parental Barriers to Reduce Excessive Child’s Screen Time Among Parents of Children Under Five Years of Age in Selangor: A Cross-Sectional Study (Preprint)

BACKGROUND Globally, there is an increasing prevalence of excessive screen time exposure among young children, including Malaysia. Parents are advised to limit this exposure but there are barriers for many of them to follow this recommendation. To date, there is a lack of studies on the factors that cause these parental barriers. OBJECTIVE This study aimed to determine the parental barrier towards the reduction of excessive child’s screen time and its predictors among parents of children under five years old in Petaling District, Selangor. METHODS A cross-sectional study was conducted from April 2019 to June 2020 among 789 parent-child dyads attending child health clinics in Petaling District, Selangor. Validated self-administered questionnaires were used to capture information on sociodemographic factors, parental influences, child-related factors, environmental factors, and parental barriers. Stratified sampling with probability proportionate to size was employed. Data were analysed with IBM SPSS version 25. Descriptive analysis and bivariate analysis were performed before multiple linear regression was used to identify the predictors of parental barriers. RESULTS The overall mean score of parental barriers was 3.51 ± 0.83, indicating that the average numbers of barriers experienced by parents were more than three. The multivariate analysis showed that the predictors of parental barriers included monthly household income (adjusted β: -0.031, 95% CI: -0.048 to -0.015), parents who worked in public sectors (adjusted β: 0.178, 95% CI: 0.063 to 0.292), positive parental attitude on screens (adjusted β: 0.684, 95% CI: 0.576 to 0.793), parents’ low self-efficacy to influence child’s physical activity (adjusted β: -0.318, 95% CI: -0.432 to -0.204), and child’s screen time (adjusted β: 0.042, 95% CI: 0.024 to 0.061). CONCLUSIONS The strongest predictor of the parental barriers to reduce excessive child’s screen time was the positive parental attitude on screen time. Thus, future intervention strategies should aim to foster correct parental attitudes towards screen time activities among young children.

Addressing Firearm Safety Counseling: Integration of a Multidisciplinary Workshop in a Pediatric Residency Program

ABSTRACT Background Firearm-related injuries are the second leading cause of death among US children. Given this, firearm injury prevention should be a key aspect of pediatric anticipatory guidance. Objective We assessed the impact of a firearm safety counseling workshop on pediatric resident knowledge, self-efficacy, and self-reported practice patterns. Methods Sixty of 80 residents (75%) participated in a 2-hour multimodal workshop, including video, didactics with experts, and role-play scenarios. Participants were invited to complete pre-workshop, immediate post-workshop, and 3- and 6-month post-workshop self-reported questionnaires evaluating knowledge, comfort, perceived barriers, and reported practice patterns. Data comparing pre- and 6-month post-workshop practice patterns were analyzed via Fischer's exact test. Remaining statistical analysis utilized a one-sided, unpaired Mann–Whitney U test. A binomial exact proportions test was used for open-ended responses. Results After the workshop, the percentage of participants with perceived concern regarding parental barriers decreased significantly (24% to 7%, P = .001). Participants 6 months post-workshop were 5.14 times more likely to counsel their patients on firearms during more than 75% of their well visits than prior to the intervention (P = .010). Participants reported greater comfort asking patients about firearms, with mean Likert scores increasing from 3.81 pre to 4.33 post (P = .022), which was similar to 3-month (4.39, P = .06) and 6-month evaluations (4.54, P = .003). Conclusions Education on firearm safety counseling improved pediatric resident comfort level in discussing the topic. This impact persisted 6 months after the workshop, implying a sustained change in attitudes and behaviors.

Providers’ Perceptions of Parental Human Papillomavirus Vaccine Hesitancy: Cross-Sectional Study (Preprint)

BACKGROUND Human papillomavirus (HPV) vaccine hesitancy among parents contributes to low vaccination coverage in adolescents. To improve health care provider communication and vaccine recommendation practices with hesitant parents, it is important to understand how providers perceive parental HPV vaccine hesitancy. OBJECTIVE This study aimed to characterize perceived reasons for parental HPV vaccine hesitancy and identify factors associated with perceived parental hesitancy among providers at community-based pediatric clinics. METHODS In 2018, providers in 23 community-based pediatric clinics in Tennessee were invited to complete a Web-based baseline survey as part of a larger quality improvement study focused on HPV vaccine uptake. These survey data were used for a cross-sectional, secondary data analysis. Scale scores ranging from 0 to 100 were calculated for provider self-efficacy (confidence in ability to recommend HPV vaccine), provider outcome expectations (expectations that recommendation will influence parents’ decisions), and perceived parental HPV vaccine hesitancy. Provider confidence in HPV vaccine safety and effectiveness were categorized as high versus low. Clinic-level exposures examined were clinic size and rural-urban location. Descriptive analyses were used to characterize perceived parental barriers by provider type. Mixed-effects linear regression models were fit taking one exposure variable at a time, whereas controlling for provider type, age, gender, and race to identify provider- and clinic-level factors associated with perceived parental barriers to HPV vaccination. RESULTS Of the 187 providers located in the 23 clinics, 137 completed the survey. The majority of physician providers were white and female, with a higher percentage of females among nurse practitioners (NPs) and physician assistants (PAs). The most common parental barriers to HPV vaccination perceived by providers were concerns about HPV vaccine safety (88%), child being too young (78%), low risk of HPV infection for child through sexual activity (70%), and mistrust in vaccines (59%). In adjusted mixed models, perceived parental HPV vaccine hesitancy was significantly associated with several provider-level factors: self-efficacy (P=.001), outcome expectations (P<.001), and confidence in HPV vaccine safety (P=.009). No significant associations were observed between perceived parental HPV vaccine hesitancy and clinic-level factors clinic size nor location. CONCLUSIONS Researchers developing provider-focused interventions to reduce parental HPV vaccine hesitancy should consider addressing providers’ self-efficacy, outcome expectations, and confidence in HPV vaccine safety to help providers communicate more effectively with HPV vaccine hesitant parents.

Parental Reports of Lunch-Packing Behaviours Lack Accuracy: Reported Barriers and Facilitators to Packing School Lunches

Purpose: Parents influence the foods their children consume and often provide proxy reports of this intake. One way parents exert this influence is by providing home-packed lunches. This study compared parental reports of foods packed in children’s lunches with what was actually packed and identified parental barriers and facilitators to packing lunches. Methods: Grade 3 and 4 student–parent dyads (n = 321) in 19 elementary schools in Ontario participated. Parental reports and actual packed lunch contents were collected via self-administered surveys and direct observation, respectively. Parental barriers and facilitators were obtained through open and closed survey questions. Results: Median portions packed were significantly higher for sugar-sweetened beverages and snacks and significantly lower for fruits, fruit juice, vegetables, milk/alternatives, and meat/alternatives than parents reported. Packing a healthy lunch was “important/very important/of the utmost importance” for 95.9% of respondents, and 97.5% perceived their nutrition knowledge as “adequate/good/very good”. Barriers to packing a lunch included: child’s food preferences, time, finances, allergy policies, and food safety. Nutrition resources, observing other children’s lunches, child’s input, and planning ahead were identified as facilitators. Conclusions: Strategies to improve packed lunches should move beyond parental nutrition knowledge and importance of lunch packing to address parental barriers and facilitators.