Diane Santa Maria

Contemporary research on parenting: conceptual, methodological, and translational issues.

Researchers over the last decade have documented the association between general parenting style and numerous factors related to childhood obesity (e.g., childrens eating behaviors, physical activity, and weight status). Many recent childhood obesity prevention programs are family focused and designed to modify parenting behaviors thought to contribute to childhood obesity risk. This article presents a brief consideration of conceptual, methodological, and translational issues that can inform future research on the role of parenting in childhood obesity. They include: (1) General versus domain specific parenting styles and practices; (2) the role of ethnicity and culture; (3) assessing bidirectional influences; (4) broadening assessments beyond the immediate family; (5) novel approaches to parenting measurement; and (6) designing effective interventions. Numerous directions for future research are offered.

Does parental monitoring moderate the relation between parent–child communication and pre-coital sexual behaviours among urban, minority early adolescents?

This study examined parental monitoring (PM) as a potential moderator of the relation between parent–child communication (PCC) and pre-coital sexual behaviours (PCSB) in an urban, minority, early adolescent population. Seventh-grade students (n = 1609) reported PCC, PM and PCSB. Multivariable logistic regression was conducted to assess for moderation. PM moderated the association between PCC and PCSB. Specifically, young people reporting both high PCC and high PM had the lowest odds of PCSB. Findings suggest that PCC is more protective in combination with high PM. However, young people reporting low levels of PM had an increased probability of PCSB with higher levels of PCC. No moderating effect between PCC, PM and PCSB was found by race/ethnicity or gender. However, race/ethnicity was found to moderate the effect of PCC on PCSB. This knowledge highlights the protective role of parental factors on PCSB and may inform the development of more effective parent-based adolescent sexual health interventions that address both PCC and PM.

Mental Illness and substance use problems in relation to homelessness onset

OBJECTIVES The relationships among youth (≤ 24 years) versus adult (>24 years) homelessness onset, lifetime serious mental illness, and substance use problems is not well understood. We sought to explore these associations among 394 homeless adults, 124 of whom reported youth-onset homelessness. METHODS Covariate-adjusted logistic regression analyses evaluated the associations among homelessness onset, serious mental illness, and self-reported substance use problems. RESULTS Youth-onset homelessness was associated with greater likelihood of serious mental illness and sedative problems, and a lower likelihood of cocaine problems, in adjusted analyses (p values ≤ .04). CONCLUSIONS Serious mental illness and sedative problems may characterize homeless youth who are vulnerable to adulthood homelessness, although longitudinal cohort studies are needed to explicate temporal relations between variables.

Promoting Parent-Child Sexual Health Dialogue with an Intergenerational Game: Parent and Youth Perspectives.

OBJECTIVES Sexual health discussions between parents and their preadolescent youth can delay sexual debut and increase condom and contraceptive use. However, parents frequently report being uncomfortable talking with their youth about sex, often reporting a lack of self-efficacy and skills to inform and motivate responsible decision making by youth. Intergenerational games may support parent-youth sexual health communication. The purpose of this study was to explore parent and youth perspectives on a proposed intergenerational game designed to increase effective parent-youth sexual health communication and skills training. MATERIALS AND METHODS Eight focus groups were conducted: four with parents (n=20) and four with their 11-14-year-old youth (n=19), to identify similarities and differences in perspectives on gaming context, delivery channel, content, and design (components, features, and function) that might facilitate dyadic sexual health communication. RESULTS Participants concurred that a sex education game could improve communication while being responsive to family time constraints. They affirmed the demand for an immersive story-based educational adventure game using mobile platforms and flexible communication modalities. Emergent themes informed the development of a features inventory (including educational and gaming strategies, communication components, channel, and setting) and upper-level program flow to guide future game development. CONCLUSIONS This study supports the potential of a game to be a viable medium to bring a shared dyadic sexual health educational experience to parents and youth that could engage them in a motivationally appealing way to meaningfully impact their sexual health communication and youth sexual risk behaviors.

Parental involvement in exercise and diet interventions for childhood cancer survivors: a systematic review

Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment effects and/or post-treatment behaviors. Parents are key agents influencing child diet and physical activity (PA), which are modifiable risk factors for obesity. A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken to evaluate current interventions that include diet and PA elements for CCS to determine if and to what extent parents were included, and whether parent involvement had a significant effect on behavioral outcomes or adiposity. A total of 2,386 potential articles were reviewed and 25 individual studies fulfilled inclusion criteria. Parental involvement was classified into three categories and varied across studies, although most had indirect or no parental involvement. The studies that included direct parental involvement showed positive outcomes on a variety of measures suggesting that increasing parental involvement in interventions for CCS may be one way to promote long-term lifestyle changes for pediatric cancer patients. However, additional research directly addressing parental involvement in obesity prevention and treatment among CCS is warranted.

Preparing Student Nurses as Parent-based Adolescent Sexual Health Educators: Results of a Pilot Study

OBJECTIVES While health promotion and patient education are central to the scope of practice of professional nurses, they often feel ill-equipped to assume the role of sexual health educator and lack adequate knowledge and skills to effectively engage parents in adolescent sexual and reproductive health efforts. DESIGN AND SAMPLE Employing a mixed-methods study consisting of both pre- and post-test survey and exit interviews, a pilot study was conducted to assess the impact of implementing a parent-based adolescent sexual health intervention on baccalaureate nursing student outcomes (N = 31). RESULTS We found statistically significant improvements in student outcome expectancies of parenting strategies, barriers to sexual health communication, self-efficacy, and sexual health counseling experience. Using thematic content analysis of exit interview content, emerging themes were (1) need for increased sexual and reproductive health (SRH) preparation, (2) wanting greater experience and opportunity for involvement in nursing research, and (3) educational gaps in family-focused community public health. CONCLUSIONS Incorporating adolescent sexual health education into public health nursing clinical training can prepare nurses as parent-based adolescent sexual health educators, a core competency for nurses working with families in communities and across all health care delivery settings.

Relations between mental health diagnoses, mental health treatment, and substance use in homeless youth

BACKGROUND Youth experiencing homelessness have elevated rates of mental illness and substance use compared to the general population. However, the extent to which underlying mental health issues may contribute to substance use as a way to manage symptoms and whether mental health treatment may reduce risk for substance use is unclear. This paper investigated these relations in a community sample of homeless youth. METHODS Youth ages 13-24 (N=416) were interviewed as part of a community count and survey of homeless youth in Houston, Texas. A path analysis examined relations among lifetime diagnoses of ADHD, bipolar disorder, and depression; past-month marijuana, alcohol, and synthetic marijuana use, and hypothesized mediators of past-year mental health treatment and perceived unmet need for treatment. RESULTS Rates of prior mental disorder diagnoses were high, with extensive comorbidity across the three diagnoses (n=114, 27.3% had all three diagnoses). Relations varied by diagnoses and substances. ADHD was positively related to current marijuana use (β=0.55 (0.16), p<0.001), a relation that mental health treatment did not mediate. Depression was positively related to synthetic marijuana use through unmet need (β=0.25 (0.09), p=0.004) and to alcohol use through unmet need (β=0.20 (0.10), p=0.04) CONCLUSIONS: This study provides new information about relations between prior mental health diagnoses and substance use in homeless youth. Findings support the need to consider prior mental disorder diagnoses in relation to current substance use and to assess for whether youth perceive they have unmet needs for mental health treatment.

Nurses on the Front Lines: Improving Adolescent Sexual and Reproductive Health Across Health Care Settings

The girl-child is hindered from achieving her full potential in life due to an “unknown burden”. The unknown unexpected burden comprises people, poverty, pregnancy, diseases, illiteracy and maltreatment. The purpose of the paper is to examine if the girl-child could be empowered to live an improved qualitative life through a school social work intervention and connecting the people who will support the girl-child. Are there problems in the life of a girl-child that prevent her from maximizing her educational opportunities? The intervention was conducted in two schools in Akinyele Local Government Area, Oyo State, Nigeria. All students (638) who attended the intervention workshop constituted the sample for the study. Data was collected through questionnaires administered after a presentation of the “unknown burden” of the girl-child to the entire school population. Data collected were analysed through frequency counts and percentages. Findings showed that the majority of the girls were aware of their burden, even though they do not know how to deal with it. In conclusion, the intervention was successful at giving the girl-child a forum to air her burden and help her to identify sources of support. Recommendations made included the establishment of the position of school social workers and the empowerment of the girl-child to be self-determined to succeed at school. Keywords: empowerment, connecting people, school social work, girl-child, intervention, unknown burden

Parenting and Homeless: Profiles of Young Adult Mothers and Fathers in Unstable Housing Situations

Young adults who are pregnant or parents are a vulnerable subgroup of the homeless population, yet there is limited research about their specific service needs. To fill this gap, we used data from a survey of homeless and unstably housed young adults, ages 18–24, collected over 4 weeks in Houston, Texas, to examine the characteristics, risk factors, and protective factors of homeless parents (n = 109) compared to other homeless young adults (n = 243), then differences between mothers (n = 61) and fathers (n = 48). Unique risk and protective profiles for homeless parents were identified, as well as differences between mothers and fathers. Implications for service delivery targeted to the unique needs of young adult homeless mothers and fathers are discussed.

Exploring parental factors related to weight management in survivors of childhood central nervous system tumors.

Childhood central nervous system tumor survivors (CCNSTS) are at risk for adverse health issues. Little research has been conducted to explore the role of parental factors in weight management to mitigate adverse health outcomes. We conducted 9 group interviews (n = 20) with CCNSTS, their parents, and health care providers to ascertain parental factors that may influence weight management practices in CCNSTS. Three main themes were identified: parenting style, parent–child connectedness, and food and physical activity (PA) environment. Although most parents adopted an authoritative parenting style related to diet and PA practices, some adopted a permissive parenting style. Participants expressed high levels of connection that may hinder the development of peer relationships and described the food and PA environments that promote or hinder weight management through parental modeling of healthy eating and PA and access to healthy food and activities. Weight management interventions for CCNSTS may experience greater benefit from using a family-focused approach, promoting positive food and PA environments, parental modeling of healthy eating and exercise, and partnering with youth to adopt weight management behaviors.