Abstract We extend the conceptualization of the social and health burdens of household water insecurity on children beyond the traditional narrow lens of microbiological pathogens and diarrhea. The global burden of disease associated with water insecurity has traditionally focused on diarrheal disease as the most significant driver of infant and child mortality. However, there are many other pathways through which children experience adverse health and social consequences from inadequate or unsafe household water. We synthesize evidence of a broad range of health impacts, affecting children from infancy to late adolescence, across four domains: exposure to unsafe water; interruptions to growth and development through poor nutrition and hydration; negative social effects such as school absenteeism and interpersonal violence; and other non‐communicable health issues such as mental health, injuries, and reproductive health. The growing burden and urgency of these issues is implicated by forecasted increases in climate‐ and conflict‐induced water scarcity, human displacement, and environmental contamination in the decades ahead. This article is categorized under: Engineering Water > Water, Health, and Sanitation Human Water > Rights to Water
Steven Jay Rhue, Giulia Torrico, Chioma Amuzie et al.
Background Children are increasingly exposed to stressors related to urbanization, climate instability, and biodiversity loss, which may contribute to poor well-being. School-based outdoor education has shown potential to support both well-being and learning, but robust evidence from randomized trials remains scarce. Science education outdoors, by engaging students with local biodiversity, may enhance scientific observation skills while contributing to public health goals such as stress reduction and connection to nature. Methods This cluster randomized controlled trial (cRCT) will compare outdoor versus classroom-based science instruction among 5th- and 6th-grade students in primary schools in the greater Montreal area (Québec, Canada). Forty classes (≈1,000 students) will be recruited across two waves (2025–2026). Teachers will be randomized (1:1) to teach life science content either outdoors (intervention) or indoors (comparator) for 2 h per week over 5 weeks. The primary outcome is students’ scientific observation skills, assessed through structured interviews and a validated observation framework. Secondary outcomes include eco-anxiety, perceived stress, connection to nature, and basic psychological needs satisfaction measured with standardized questionnaires. Analyses will use mixed-effects regression models to account for clustering at the class and school levels. Discussion This study will implement a cluster randomized controlled design to examine the effects of outdoor education on students’ science learning, stress, eco-anxiety, and psychosocial factors. By embedding the intervention in the regular science curriculum, the trial aims to generate ecologically valid evidence relevant to both education and public health sectors. Despite the relatively short intervention duration, the study is designed to inform intersectoral initiatives addressing health-promoting school environments and to generate evidence regarding the role of nature-based learning in urban settings. Clinical trial registration ClinicalTrials.gov , identifier NCT07147634.
Jean‐Philippe Ayotte‐Beaudet, Gabriela Quintela Do Carmo, Patrice Potvin et al.
Parents with immigration backgrounds face the dual challenges of maintaining their heritage culture while supporting their children’s adaptation to the mainstream culture. Although previous studies stressed both acculturation and enculturation, these two processes can compete and even conflict, leading to the important question for parents: Does parental enculturation influence children’s peer relationships and emotional functioning? This study examines the associations between parental enculturation and the social and emotional adaptation of Asian American youth by focusing on peer relationship difficulties and emotional symptoms. Participants included 75 Asian American parents of children aged 4 to 17, who completed measures of parental enculturation (Vancouver Index of Acculturation) and child emotional and social outcomes (Strengths and Difficulties Questionnaire). Correlational and regression analyses were conducted to explore whether higher parental enculturation predicts greater peer and emotional difficulties in children. Results indicated that parental enculturation was not significantly associated with children’s emotional symptoms but was negatively associated with peer relationship difficulties. Overall, the results suggest that parental enculturation may be differentially associated with specific domains of youth adaptation, with a stronger link to peer functioning than to emotional symptoms in this sample. Future studies should consider the multidimensional and context-sensitive nature of enculturation when understanding cultural influence and supporting immigrant-youth.
BACKGROUND AND OBJECTIVES: The outbreak of coronavirus disease 2019 has changed American society in ways that are difficult to capture in a timely manner. With this study, we take advantage of daily survey data collected before and after the crisis started to investigate the hypothesis that the crisis has worsened parents’ and children’s psychological well-being. We also examine the extent of crisis-related hardships and evaluate the hypothesis that the accumulation of hardships will be associated with parent and child psychological well-being. METHODS: Daily survey data were collected between February 20 and April 27, 2020, from hourly service workers with a young child (aged 2–7) in a large US city (N = 8222 person-days from 645 individuals). A subsample completed a one-time survey about the effects of the crisis fielded between March 23 and April 26 (subsample n = 561). RESULTS: Ordered probit models revealed that the frequency of parent-reported daily negative mood increased significantly since the start of the crisis. Many families have experienced hardships during the crisis, including job loss, income loss, caregiving burden, and illness. Both parents’ and children’s well-being in the postcrisis period was strongly associated with the number of crisis-related hardships that the family experienced. CONCLUSIONS: Consistent with our hypotheses, in families that have experienced multiple hardships related to the coronavirus disease 2019 crisis, both parents’ and children’s mental health is worse. As the crisis continues to unfold, pediatricians should screen for mental health, with particular attention to children whose families are especially vulnerable to economic and disease aspects of the crisis.
Anna Gassman‐Pines, Elizabeth Ananat, John Fitz-Henley
Attention-deficit/hyperactivity disorder (ADHD) is America’s most common childhood disorder. Although an ADHD diagnosis can bring positives, recent research uncovers potential negatives associated with diagnosis. This study examines understudied racial-ethnic heterogeneity in the relationships between an early elementary school ADHD diagnosis—with or without medication treatment—and children’s future perceived self-competence, teacher-rated school behaviors, and parent-rated educational expectations. Findings are consistent with the notion that diagnosis can trigger racialized patterns of stigma. That is, relative to undiagnosed matches of the same social class and regardless of medication use, diagnosed Black children demonstrate worse teacher-rated school behaviors, diagnosed White children report poorer perceived self-competence, and parents of diagnosed Hispanic children report poorer educational expectations. Racialized patterns of stigma might amplify the consequences of negative-ability stereotyping on Black children, academic pressure on White children, and mental health stigma on Hispanic children. Findings also highlight the challenges of identification posed by differential unobserved selection into diagnosis.
Participatory learning and action cycles with women’s groups have been recommended by the WHO to promote maternal and newborn health, but few studies have tested its feasibility and acceptability in mobile health (mHealth) interventions among mothers of toddlers. This was a mixed-method feasibility assessment of an 8-week WhatsApp-based maternal support group for mothers of toddlers (12–18 months of age) enrolled in a birth cohort study in Southern Brazil. Daily messages and weekly activities were sent by moderators to promote maternal–child outcomes: child nutrition, child sleep, nurturing care, and maternal psychosocial well-being (assessed pre- and post-intervention via self-reported questionnaire). The implementation and engagement of the mothers in the program were assessed by message extraction. Acceptability was evaluated through in-depth interviews (n = 5) and open-ended surveys (n = 10). 1481 messages were exchanged in 3 WhatsApp groups (n = 30 mothers). Mothers were most active on weekdays (68.6% of messages sent on Tuesdays and 72.6% on Thursdays), afternoons (2:00–4:00pm), and evenings (9:00–11:00 pm). Engagement was higher at weeks 1–4. Mothers enjoyed and considered topics relevant. Group interaction was perceived as low, which influenced their participation. The prevalence of depression symptoms decreased from pre- to post-intervention (9% to 5%; P = .04). A moderated mobile-based support group for mothers of toddlers was feasible. mHealth services to promote maternal support are a promising strategy to improve maternal–child outcomes, but engagement and use of the service remains a challenge. Program managers should work with community members to identify ways to support engagement and participation throughout the intervention.
Angela C. B. Trude, Rafaela Costa Martins, Thaís Martins‐Silva et al.
Abstract The absence of violence against children is a fundamental children’s right and a major milestone of civilized society. Similarly, reports on incidences of violence by children and youth, including severe cases with devastating consequences, speak to the need that the trauma of exposure to violence in childhood needs to be addressed. While violence and its risk factors are generally understood, what is less clear are the essential protective factors, how we can identify those as early as possible, and how we can use them to prevent and address the trauma of violence exposure in children and youth. In this report, I review pathways of child and youth violence through the lens of social-emotional development as a central protective factor. Negative emotions of frustration and anger can underlie violence and aggression. Kind emotions, such as caring and our ability to connect with others emotionally, can serve as social-emotional protective factors. A brief review of the central social-emotional processes and their development is provided, including the human capacity to feel with others and express empathy, be emotionally aware and care about the effects of one’s own actions on others, and be able to regulate the self and their emotions. Given the negative widespread and long-term impact of exposure to violence, I describe research-informed attempts to prevent violence exposure across development. Taking a humanistic, strength-based perspective, the focus is on social-emotional protective factors to address violence and nurture mental health in every child. I conclude with recommendations for practice and policy.
Abstract Background Nurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children’s and caregivers’ cortisol levels, and meta-analyzed the results. Methods In January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies – randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children’s morning and evening cortisol levels, as well as change across the day. Results A total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: − 0.14 to 0.16; I2: 47.5%), and for caregivers it was 0.04 (95%CI: − 0.22 to 0.30; I2: 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found. Conclusion Existing evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.
Rafaela Costa Martins, Cauane Blumenberg, Luciana Tovo‐Rodrigues et al.
BACKGROUND: Growth trajectories during the first 1,000 days from conception to 2 years influence human capital, predicting intelligence, skills and health in adults. SUMMARY: This review describes current evidence on the impacts of adverse pregnancy outcomes such as low birth weight, preterm birth, small for gestational age, and infant nutrition on long-term neurodevelopment and summarizes interventions that have proven to be effective in improving child development and further impact human capital. To date, no globally standardized measurements of child development in low-medium-income countries exist, and comparisons among studies using different developmental scales are challenging. In the perinatal period, birth weight, gestational age at delivery and elevated placental blood flow resistance have been identified as the main risk factors for global neurological delay, poor neurosensory development and cerebral palsy. Although these adverse neurological outcomes have decreased in developed settings, it is still a problem in low-resource populations. Nutritional deficiencies are the main drivers of developmental impairment, notably iron, iodine and folate deficiencies, and environmental stressors during pregnancy such as air pollution, exposure to chemicals, substance abuse, smoking, and maternal/parental psychiatric disorders can affect the developing brain. Interventions aiming to improve maternal macro- and micronutrient status, delayed cord clamping, exclusive breastfeeding and nurturing care have demonstrated to be effective strategies to prevent perinatal complications known to affect child development.
Doris González‐Fernández, Tricia S. Williams, Tyler Vaivada et al.
Background: (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic. Methods: This comparative case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions. Findings: Families' limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability. Interpretation: Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon. Funding: NIH/NICHD.
Gabriela Buccini, Muriel Bauermann Gubert, Poliana de Araújo Palmeira et al.
