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It matters what we do: Relationships between forms of media use and life satisfaction of adolescents

Abstract Background Electronic media communication is firmly anchored in the leisure time of adolescents. Adolescents use electronic devices (ED) as a means of interpersonal communication with friends, such as text messaging, for entertainment in the form of receptive communication, such as watching movies, in the form of interactive communication, such as playing computer games, and for other purposes, such as homework. We aimed to identify how these communication forms are related to and interact on life satisfaction (LS) of girls and boys. Methods We conducted multivariable linear regression analysis with the dataset of 5,961 adolescents aged 11, 13 and 15 years, obtained from the German Health Behaviour in School-aged Children (HBSC) survey of 2013/2014. Separate statistical analyses were performed for girls and boys, including statistical interactions. We controlled for age, family affluence and family structure. Results Interpersonal communication with friends has a positive relationship with LS in boys (β = 0.12, t = 3.19, p = 0.001), but no effect in girls. Whereas other communication forms have a negative main effect on life satisfaction in girls (entertainment β = -0.1, t = -3.79, p < 0.001; gaming β = -0.09, t = -4.12, p < 0.001; using the ED for other purposes β = -0.04, t = -2.26, p = 0.024), we found no association of entertainment with LS for boys. The negative effect of gaming in boys is conditional on the level of using the ED for other purposes: the results show a reinforcing statistical interaction (β = 0.02, t = 3.24, p = 0.001). Conclusions The results demonstrate the relevance of considering the differences in associations between single forms of communication and LS for boys and girls separately. This confirms our theoretical focus on a communication-centred approach. Moreover, it is of high relevance to identify potentially enabling and harmful media communication and to understand adolescents’ perspectives on these forms of communication. Key messages • When examining associations between media use and life satisfaction among adolescents, form of communication and gender should be taken into account. • Investigating interactions of different forms of communication can help to better understand their influence on adolescents’ life satisfaction.

Schloemer T, Rocco I, Kolip P

A health promotion intervention for vulnerable schools (BeE-school): a cluster-randomized trial : Rafaela Rosário

Abstract Background Noncommunicable diseases (NCDs) share key determinants like unhealthy diet, unhealthy 24h- movement behaviour (sleep, sedentary behaviour and physical activity), leading to other risks including overweight, obesity and raised blood pressure. Although the manifest of the NCDs in childhood is rare, risk behaviours, obesity, and raised blood pressure that accelerates their development begin during childhood. The current study aims to analyze the effectiveness of the intervention program based on the promotion of health literacy and lifestyles, on children’s health literacy, lifestyles (e.g. dietary intake, 24hmovement behaviour) and overweight and obesity. Methods 478 children (6 schools) aged 6-12years old will participate in this cluster-randomized trial, having schools as the unit of randomization, assigned into intervention (239-3schools) and the control arm (239-3schools). This project is currently performing social listening (online and offline) and stakeholders’ involvement. Data collection includes sociodemographics, health literacy and infodemic resilience, dietary intake and children’s 24-h movement behaviour (e.g. accelerometry), anthropometry (e.g. weight, height and waist circumference) and blood pressure. It will occur at baseline and after the intervention (follow-up, 6 months after the beginning of the intervention). Results Expected outputs and outcomes include the 1-creation of a model for characterizing NCDs and health topics based on artificial intelligence techniques (e.g. deep learning, social network analysis methods).2- improved health literacy and infodemic resilience of children, families and teachers.3- enhanced children’s lifestyles. 4- reduce NCDs’ physical risk factors (e.g. overweight, raised blood pressure). Conclusions A feasible intervention program for school-aged children with vulnerabilities enhances tailored policies about health promotion and NCDs’ prevention, respecting the contextś singularities. Key messages • Health promotion and NCDs prevention are crucial for the well-being of our societies. • Feasible intervention programs advocates for evidence-based policies that respect local singularities.

Rosário R, Pereira B, Novais P et al.

157 Association Between Structural Racism and Acuity of Illness at Initial Presentation in Pediatric Patients with Solid Tumors

OBJECTIVES/GOALS: Racial/ethnic minoritized children experience poorer cancer outcomes, which may be driven by structural racism. We apply an index that combines segregation and neighborhood vulnerability to a pediatric oncology population and assesses its association with acuity of illness at initial presentation. METHODS/STUDY POPULATION: A retrospective analysis will be performed in a cohort of pediatric patients diagnosed with solid tumors at Children’s Healthcare of Atlanta (CHOA) from 2010-2018 (N=1149). The sample will be linked to a structural racism index (SRI) that has been established in our prior work. We abstract data from medical records to quantify initial acuity of illness based on the need for ICU-level resources. Differences in sociodemographic characteristics will be analyzed by the SRI, using chi-squared, Student t-tests, and ANOVA where appropriate. Logistic regression models will be used to assess the association of the SRI with acuity of illness. RESULTS/ANTICIPATED RESULTS: We anticipate that relevant sociodemographic characteristics (e.g., race/ethnicity, insurance status) differ by the SRI. The CHOA Cancer Registry includes a racially and ethnically diverse group of patients: 63% of the cohort is White, 30% is Black,10% are Other, and 15% are Hispanic/Latino. Furthermore, we anticipate that pediatric patients with solid tumors living in counties with greater levels of structural racism as measured by the SRI experience an increased acuity of illness at initial presentation. DISCUSSION/SIGNIFICANCE: By applying a novel index quantifying structural racism, we will provide new information about the structural barriers patients and families face prior to a pediatric cancer diagnosis. This work will allow us to identify areas for potential interventions in this vulnerable young patient population.

Cathcart A, Castellino S, Sohn H et al.

Inequalities in adverse birth outcomes and survival in early childhood: birth cohort in South Korea

Abstract Background Adverse birth outcomes (ABOs) are considered the most common factor of deaths in early childhood. Inequalities in child mortality occur due to interactions between intrinsic and socio-environmental factors related to socioeconomic disadvantage. There are, however, few studies investigating the impact of ABOs on mortality in terms of parental SEP. Methods Using the Under-5 Infant Birth-Death Cohort Data in Korea, a pooled retrospective birth cohort of all children born in 2012-2014 was built (N = 1,356,584). We analyzed neonatal, post-neonatal, and childhood mortality by ABOs and with the interaction of parental SEP using the Cox proportional hazard regression model for survival analyses. We further stratified the analysis both by parental SEP and child age. Multiple logistic regression was performed to confirm the social inequalities in ABO itself. Results After adjusting for covariates, children born with ABOs presented higher risk of mortality for all periods. For post-neonatal period, lower maternal education showed significant interaction effect with LBW (HR = 0.57; 95% CI = [0.39-0.85]), PTB (HR = 0.53; 95% CI = [0.33-0.86]), LBW & PTB ([HR = 0.67; 95% CI = [0.54-0.83]) while lower paternal education (HR = 0.67; 95% CI = [0.54-0.82]) and maternal unemployment (HR = 0.80; 95% CI = [0.63-0.99]) showed significance for babies with LBW & PTB. However, stratification analyses suggested that the impact of ABOs on mortality was greater for children born to lower parental SEP in neonatal period. Meanwhile apparent social inequalities in ABOs were suggested from regression analyses. Conclusions We confirmed social inequalities in the incidence of ABOs as well as mortalities from ABOs. However, the difference in mortality between babies with and without ABOs was greater for advantaged children. Policies to reduce the mortality of children with ABOs as well as those of healthy children among socioeconomically disadvantaged families are required. Key messages • Social inequalities in mortality from ABOs were apparent especially in the neonatal period while the incidence of ABOs itself was greater among children from disadvantaged families. • Disadvantaged children are more likely to die not only from ABOs but also from other socio-environmental determinants, especially in the post-neonatal period than their counterparts.

Jo M, Chung H

Disentangling the multigenerational transmissions of socioeconomic disadvantages and mental health problems by gender and across lineages: Findings from the Stockholm Birth Cohort Multigenerational Study

Introduction There is a paucity of research examining the patterning of socioeconomic disadvantages and mental health problems across multiple generations. The significance of research on multigenerational processes is based on a concern with if and how (dis)advantages are generated and sustained across generations, and how socioeconomic, mental health, and gender inequalities evolve over a longer period of time. Objectives The current study therefore aimed to investigate the interconnected transmissions of socioeconomic disadvantages and mental health problems from grandparents to grandchildren through the parents, as well as the extent to which these transmissions differ according to lineage (i.e., through matrilineal/patrilineal descent) and grandchild gender. Methods Drawing on the Stockholm Birth Cohort Multigenerational Study, the sample included 21,416 unique lineages by grandchild gender centered around cohort members born in 1953 (parental generation) as well as their children (grandchild generation) and their parents (grandparental generation). Based on local and national register data, socioeconomic disadvantages were operationalized as low income, and mental health problems as psychiatric disorders. A series of path models based on structural equation modelling were applied to estimate the associations between low income and psychiatric disorders across generations and for each lineage-G2 gender combination. Results We found a multigenerational transmission of low income through the patriline to grandchildren. Psychiatric disorders were transmitted through both the patriline and matriline, but only to grandsons. The patriline-grandson transmission of psychiatric disorders was partially operated via low income of the fathers. Furthermore, grandparents’ psychiatric disorders influenced their children’s and grandchildren’s income. Conclusions We conclude that there is evidence of transmissions of socioeconomic disadvantages and mental health problems across three generations, although these transmissions differ by lineage and grandchild gender. Our findings further highlight that grandparents’ mental health problems could cast a long shadow on their children’s and grandchildren’s socioeconomic outcomes, and that socioeconomic disadvantages in the intermediate generation may play an important role for the multigenerational transmission of mental health problems. Disclosure of Interest None Declared

Li B, Almquist Y, Liu C et al.

LGG-11. COGNITIVE, ACADEMIC, AND QUALITY OF LIFE OUTCOMES IN SURVIVORS OF PEDIATRIC LOW-GRADE GLIOMA: CHALLENGING THE ‘BENIGN TUMOR’ PERCEPTION

Abstract High survival rates in pediatric low-grade gliomas (pLGG) may overshadow potentially significant long-term toxicities and functional impact. Chemo-radiation sequelae are well documented, in contrast to those who undergo surgical resection or observation alone. We performed a retrospective cohort study from 2000-2015, assessing cognitive, academic, and quality of life (QoL) impact on 45 eligible pLGG survivors aged 0-16 years at diagnosis, at a median 7.4 years post-treatment. A multidisciplinary panel oversaw proxy questionnaires for young children (<7 years), proxy and self-reported for adolescents (8-15 years) and self-reported for young adults (>15 years). Data included demographics; tumor and treatment; early school (young child) progress; academic and occupation achievement (adolescents and young adults); health; and lifestyle issues. The incidence of abnormalities in the domains studied were compared to published population statistics. 16% of survivors underwent observation alone, and 84% surgery (58% complete resection). 57% of survivors experienced cognitive deficits. Young children (50%) and adolescents (42%) had low cognitive functioning scores, correlating with poor academic (p < 0.01) and standardised school educational tests’ performance. 42% of mainstream school attendees required learning support; 33% examination assistance; 50% completed secondary education and 22% a tertiary degree, but had attention (young child and adolescent), and memory (young adult) issues. 65.9% of survivors had at least one neurological concern, highest in adolescents (70%). Language deficits (42.9%), pain, fatigue, and hearing loss (28.6 %) in young children; and vision/sleep difficulties (35%); fatigue (30%) and mobility (25%) in adolescents were reported. Young adults suffered headaches (47.1%) and fatigue (29.4%). Young children (57%) suffered more emotional disturbance than adolescents (16%). Anxiety (23%) and depression (14%) reflected poor QoL on Emotion Thermometer scales in all survivors. These findings challenge the ‘benign’ label of pLGG and highlights the importance of close psychosocial surveillance in helping survivors achieve their best emotional and educational potential.

LGG-05. IMAGING-BASED DEEP LEARNING FOR EVENT-FREE SURVIVAL PREDICTION IN PATIENTS WITH PEDIATRIC LOW-GRADE GLIOMA

Abstract Pediatric low-grade gliomas (pLGGs) have heterogeneous outcomes, making individualized clinical decision-making challenging. Imaging-based biomarkers for progression and/or recurrence may better risk-stratify pLGG patients and guide management. We developed and externally validated a deep learning (DL) algorithm to predict event-free survival (EFS) in pLGG using multi-institutional databases. We collected linked, T2-weighted diagnostic Magnetic Resonance Images (MRI) and clinical data for patients with WHO grade 1-2 pLGG (diagnosed from 1991-2017) from the Children’s Brain Tumor Network (CBTN, n=176, median follow-up: 3.7 years, IQR=2-6.8 years) for model development and internal validation, and Boston Children’s Hospital (BCH, n=219, median follow-up: 8.8 years, IQR=4-13.4 years) for external validation. Leveraging a self-supervised learning approach, we trained a DL Unet model for tumor segmentation and used it for extracting image features. We combined 12 DL-imaging features with three clinical variables (age, sex, and surgical resection status (gross total/subtotal/no resection) and trained a Deep Cox Mixtures(DCM) model for survival analysis. We externally validated the performance of three models: clinical, DL-imaging, and combined DL-imaging and clinical. The combined DL-imaging and clinical model outperformed the clinical alone and DL-imaging alone models for prediction of 3-year EFS (time-dependent AUC: 0.85, 0.73, 0.53, respectively) with improved calibration (Integrated Brier Score: 0.08, 0.13, 0.15, respectively). Using the combined DL-imaging and clinical model output, patients were divided into low and high-risk groups based on mean event probability (3-year EFS 53% vs 86%, p=0.02). Variables associated with poor EFS were imaging score, lower age, and lack of gross total resection. In conclusion, deep learning-derived, MRI-based imaging features may improve prediction of event-free survival and risk stratification for patients with pLGG.

358 Using autism symptom profiles at intervention baseline to predict social cognitive outcomes

OBJECTIVES/GOALS: 1) Investigate the utility of pragmatic communication profiles in a sample of children with autism at baseline to predict response to treatment in a randomized clinical trial (RCT) of oxytocin augmentation and social cognitive skills training at week 12. 2) Determine if levels of anxiety or hyperactivity moderate child outcome performance. METHODS/STUDY POPULATION: 40 children (37M, 3F), aged 8-11(M=9.25, SD=1.10), with confirmed autism spectrum disorder (ASD), enrolled in an RCT(NCT02918864) were evaluated at baseline on: an assessment of ASD (Autism Diagnosis Observation Schedule, ADOS-2), a task of perspective taking, Theory of Mind ToM, (Reading the Mind from the Eyes Task), pragmatic communication (Pragmatic Rating Scale-School Aged; PRS-SA), IQ (WAIS_I, WISC-V) and anxiety and hyperactivity (Behavior Assessment Scales for Children-3; BASC-3). A Tobii T60 XL was used for eye-tracking visual patterns and attention during the RMET. The PRS-SA was coded by trained, reliable clinicians. Parent ratings indicated over half of the participants’ had At Risk levels or higher on anxiety and hyperactivity on the BASC-3. Week 12 measures included all but the PRS-SA and ADOS-2. RESULTS/ANTICIPATED RESULTS: Baseline preliminary analysis indicated the participants spent more time looking at words (.41ms) than eye images on the RMET(.15ms, p DISCUSSION/SIGNIFICANCE: Findings at baseline suggest pragmatic communication skills are more related to ToM than gaze and attention on the RMET. This relationship will be further investigated over the time of the trial. Mental health indicators need to be considered further in this population. Child profiles at baseline may inform appropriate triage and treatment targets.

Dillon E

MDB-11. AN ONLINE CALCULATOR USING MACHINE LEARNING FOR PREDICTION OF SURVIVAL IN PEDIATRIC PATIENTS WITH MEDULLOBLASTOMA

Abstract OBJECTIVE Medulloblastoma is the most common malignant intracranial tumor affecting the pediatric population. Despite advancements in multimodal treatment over the past 2 decades yielding a >75% 5-year survival rate, children who survive often have substantial neurological and cognitive sequelae. The authors aimed to identify risk factors and develop a clinically friendly online calculator for prognostic estimation in pediatric medulloblastoma patients. METHODS Pediatric patients with a histopathologically confirmed medulloblastoma were extracted from the Surveillance Epidemiology and End Results database (2000-2019) and split into training and validation cohorts in an 80:20 ratio. The Cox proportional hazards model was used to identify the univariate and multivariate survival predictors. Subsequently, a calculator with those factors was developed to predict 2-, 5-, and 10-year overall survival as well as median survival months for pediatric medulloblastoma patients. The performance of the calculator was determined by discrimination, calibration, and decision curve analysis (DCA). RESULTS A total of 1,739 pediatric patients with medulloblastoma met the prespecified inclusion criteria. Fourteen variables, including age, sex, race, ethnicity, median household income, county attribute, laterality, histology, anatomical location, tumor grade, tumor size, surgery status, radiotherapy, and chemotherapy, were included in the calculator (https://spine.shinyapps.io/Peds_medullo/). The concordance index was 0.757 in the training cohort and 0.762 in the validation cohort, denoting clinically useful predictive accuracy. Good agreement between the predicted and observed outcomes was demonstrated by the calibration plots. The DCA curves indicated that the developed model has a good clinical prognostic benefit for pediatric medulloblastoma patients. CONCLUSION An easy-to-use prognostic calculator for a large cohort of pediatric patients with medulloblastoma was established. Future efforts should focus on improving granularity of population-based registries and externally validating the proposed calculator.