Kenneth R. Ginsburg

The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds

Play is essential to development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth. Play also offers an ideal opportunity for parents to engage fully with their children. Despite the benefits derived from play for both children and parents, time for free play has been markedly reduced for some children. This report addresses a variety of factors that have reduced play, including a hurried lifestyle, changes in family structure, and increased attention to academics and enrichment activities at the expense of recess or free child-centered play. This report offers guidelines on how pediatricians can advocate for children by helping families, school systems, and communities consider how best to ensure that play is protected as they seek the balance in children’s lives to create the optimal developmental milieu.

The protective effects of good parenting on adolescents.

Purpose of review To explore recent developments in the literature regarding parenting practices and adolescent development, with a focus on parenting style, parental monitoring, communication, and supervision. Recent findings There have been significant recent advances in the study of the relationship between parenting and adolescent development. Several recent intervention studies with a parenting component demonstrated immediate and long-term protective effects on adolescent risk behavior. Parent-child connectedness and authoritative parenting style are protective for teens. Parental monitoring has a protective effect on many adolescent risk behaviors in both middle-class populations and poor urban environments and has been shown both to moderate the effect of peer influence and to persist into late adolescence. Whereas unsupervised time, exposure to sexual possibility situations, and out-of-home care increase sexual behavior, improved parent-child communication reduces sexual risk behaviors. Summary Recent scholarship demonstrates the significant, enduring, and protective influence of positive parenting practices on adolescent development. In particular, parental monitoring, open parent-child communication, supervision, and high quality of the parent-child relationship deter involvement in high-risk behavior. Authoritative parenting generally leads to the best outcomes for teens. Clinicians should find opportunities to discuss evidence-based parenting practices with families. Future research should focus on the development and long-term evaluation of effective parenting interventions.

The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bond: Focus on Children in Poverty

Play is essential to the social, emotional, cognitive, and physical well-being of children beginning in early childhood. It is a natural tool for children to develop resiliency as they learn to cooperate, overcome challenges, and negotiate with others. Play also allows children to be creative. It provides time for parents to be fully engaged with their children, to bond with their children, and to see the world from the perspective of their child. However, children who live in poverty often face socioeconomic obstacles that impede their rights to have playtime, thus affecting their healthy social-emotional development. For children who are underresourced to reach their highest potential, it is essential that parents, educators, and pediatricians recognize the importance of lifelong benefits that children gain from play.

The reason and rhyme of qualitative research: why, when, and how to use qualitative methods in the study of adolescent health.

Many of the life experiences, understandings, and beliefs that place young people’s health at risk are difficult to quantify, yet adolescent health providers must assess and evaluate them. Qualitative research offers tools to examine these powerful forces at work in young lives. It looks beyond diagnostic outcomes to explore context and motivation, the “how” and the “why” of adolescent health risk behaviors. Although qualitative methods are relatively new to medical and public health research, clinicians use qualitative techniques every day: observing, actively interviewing, receptively listening, evaluating narratives, integrating data from diverse sources while recognizing inherent biases, and analyzing the information in a flexible and critical manner. This intuitive use of qualitative techniques informs clinicians how to vary their interactions subtly to best meet the differing needs of their patients. This “art of medicine” combined with biomedical science allows clinicians to move beyond medical problem solving and become healers. The goal of all research is to enhance a knowledge base. By furthering clinicians’ understanding of human factors that influence adolescent health, including social context and the patient perspective, qualitative research (1–4) enhances the type of knowledge that allows us to more effectively prevent unhealthy behaviors and, ultimately, to heal disease.

Parents' perceptions of factors that affect successful diabetes management for their children

Objective. To learn which factors parents perceive to be most influential in determining successful type 1 diabetes management. Methods. A 4-stage mixed qualitative-quantitative method that consists of a series of focus groups, a survey, and in-depth interviews was used to ensure that parents generated, prioritized, and explained their own ideas. In each stage, parents offered a new level of insight into their perception of how children achieve good metabolic control while living as normal a life as possible. The survey responses were divided into statistically different ranks, and the Kruskal-Wallis test was used to compare the results between subgroups. Results. A total of 149 parents participated in the formative qualitative phases, 799 families (66%) responded to the parent-generated survey, and 67 explanatory interviews were conducted. The families who responded to the survey had children of varied ages (mean: 11.9 years; SD: 4.44) and diabetes control (mean hemoglobin A1c: 8.22%; SD: 1.65); 84.1% of respondents were white, 12.3% were black, and 89% were privately insured. The 30 survey items were statistically discriminated into 8 ranks. The items cover a wide range of categories, including concrete ways of achieving better control, families’ or children’s traits that affect coping ability, actions of the health care team that support versus undermine families’ efforts, and the availability of community supports. No clear pattern emerged regarding 1 category that parents perceived to matter most. Conclusions. Clinicians can affect many of the factors that parents perceive to make a difference in whether they can successfully raise a resilient child in good diabetes control. Future research needs to determine whether health care teams that address the concerns that parents raised in this study are more effective in guiding children to cope well with diabetes, to incorporate healthier lifestyles, and ultimately to achieve better metabolic control.

Depression screening in adolescents with somatic complaints presenting to the emergency department

STUDY OBJECTIVE To determine the frequency of documented depression screening for adolescents presenting with somatic chief complaints to a pediatric emergency department. METHODS We conducted a retrospective chart review of 408 consecutive patients aged 11 to 17 years who presented to the ED with a chief complaint of chest pain, abdominal pain, headache, weakness/fatigue, dizziness/fainting, or hyperventilation. RESULTS Documentation of depression screening was noted in 4.2% of cases (17 of 408). For patients charts listing both a somatic chief complaint and a similar nonspecific discharge diagnosis, the documentation rate for depression screening rose to 7.5%. No change in screening documentation was noted for chronically ill patients. We did detect a significant difference in screening frequency between black adolescents and adolescents of all other races (P = .021). CONCLUSION Our findings demonstrate an extremely low frequency of documentation of depression screening in adolescents with somatic complaints presenting to the ED. Documentation of screening in black patients was still low but was performed at a significantly higher rate. These results indicate a need for education on the adolescent at risk for depression and suicide in the acute care setting.

Primary Access to Vehicles Increases Risky Teen Driving Behaviors and Crashes: National Perspective

OBJECTIVE: The goal was to explore teen driver vehicle access and its association with risky driving behaviors and crashes. METHODS: A nationally representative, school-based survey of 2167 ninth-, 10th-, and 11th-graders examined patterns of vehicle access (primary access [ie, the teen is the main driver of the vehicle] versus shared access) and associated driving exposure, risky driving behaviors, and sociodemographic factors. RESULTS: Seventy percent of drivers reported having primary access to vehicles. They were more likely to be white, to be in 11th grade, to attend schools with higher socioeconomic levels, to have mostly A/B grades, to have a job, to drive a pickup truck, and to drive more hours per week but were not more or less likely to consume alcohol or to wear seat belts while driving. Compared with drivers with shared access, drivers with primary access reported more than twice the crash risk (risk ratio [RR]: 2.05 [95% confidence interval [CI]: 1.41–2.99]) and higher likelihoods of using cellular telephones while driving (RR: 1.23 [95% CI: 1.12–1.35]) and speeding ≥10 mph above the posted limit (RR: 1.24 [95% CI: 1.11–1.40]). CONCLUSIONS: Primary access of novice teen drivers to vehicles is highly prevalent in the United States. This practice is a dangerous norm, because primary access is associated with risky driving behaviors. Healthcare providers and schools should consider counseling parents to discourage giving novice teen drivers primary access to vehicles. In communities where teens require primary access (eg, due to limited public transportation options), greater efforts should be made to promote safe behaviors.

Unlicensed Teenaged Drivers: Who Are They, and How Do They Behave When They Are Behind the Wheel?

OBJECTIVE. The objective of this study was to determine the prevalence and associated risk factors for unlicensed driving among 9th- through 11th-graders. METHODS. A nationally representative school-based survey of 5665 9th-, 10th-, and 11th-graders ascertained whether students engaged in unlicensed driving and determined associated driving behaviors, risk behaviors, and demographic factors. Unlicensed driving, defined as not having any type of license and “driving on [ones] own” as opposed to learning to drive, or not driving yet was ascertained. RESULTS. One (4.2%) in 25 US 9th- through 11th-graders reported that they drove at least 1 hour/week without a license. Unlicensed drivers were more likely to identify as being black or Hispanic, to live in rural or central city districts, and to report lower grades in school. No relationship was found between license status and reported crashes; however, unlicensed teenaged drivers were less likely to report seat belt use, more likely to report driving while under the influence of alcohol or drugs, and more likely to report more trips without a purpose. One fourth (28%) of them had taken a drivers education class, and one half (50%) reported parents as most helpful in learning to drive. Two thirds (66%) of the unlicensed drivers reported most often using a vehicle that others usually drive. CONCLUSIONS. Considering the high burden of teen crashes, it is important to reach and deliver effective anticipatory guidance to unlicensed teenaged drivers who are at high risk for unsafe driving practices. Parents and drivers education instructors have contact with many of these unlicensed drivers. Clinicians, particularly those in rural and central city districts, should discuss unlicensed driving starting before the legal age of driving while screening for other health risk behaviors. Additional research is needed for better understanding of barriers to licensing among the teen population of licensing age.

Important health provider characteristics: the perspective of urban ninth graders.

ABSTRACT. Clinicians caring for adolescents may be better positioned to provide health care when equipped with an understanding of adolescents’ preferences regarding provider characteristics. The purpose of this study is to obtain a manageable framework of adolescents’ concerns about health care providers. A series of qualitative and quantitative data-collection methods were used to elicit and organize ideas about health care providers from ninth-grade students in Philadelphia. A 5-point Likert survey, based on ideas generated and prioritized in earlier qualitative stages, was administered in school. Exploratory and confirmatory factor analysis was used to uncover latent factors. A total of 2602 students returned usable surveys. A confirmatory factor analysis model including four latent factors (patient’s interpersonal relationship with provider, concern for physical safety, concern for emotional safety, and provider counseling ability) explained 51.6% of the model variability. Urban ninth graders want providers with whom they can develop strong relationships, feel emotionally and physically safe, and turn to for counseling. Communication with adolescent-aged patients should be a standard component of health care training and should promote provider sensitivity to adolescent fears and needs in the health care setting.

Teen perceptions of good drivers and safe drivers: implications for reaching adolescents

Objective: To understand definitions of the phrases “good driver” and “safe driver” among teen pre-drivers and early drivers in order to appropriately tailor messages about driving safety. Design: Qualitative study using freelisting, an anthropological research technique, to explore nuances in the ways that teens define a good driver and a safe driver Setting: Classes in six high schools each in a different state in the USA. Subjects: 193 adolescent pre-drivers and early drivers, aged 15–17. Main outcome measures: Meaning of the phrase good driver and safe driver was identified for subgroups of adolescents. Results: Teen pre-drivers and early drivers define a good driver and a safe driver as one who is cautious, alert, responsible, does not speed, obeys the law, uses seatbelts, and concentrates. There are subtle and potentially important differences in the way that subgroups define a good driver and a safe driver. Conclusions: Injury prevention experts need to attend closely to the implicit meanings that teens attach to everyday terms. Freelisting is a method that identifies perceptions about the meaning of health communication messages and suggests differences in meaning among subgroups.