Marie Leiner

Psychosocial Profile of Bullies, Victims, and Bully-Victims: A Cross-Sectional Study

While adverse conditions in a child’s life do not excuse inappropriate behavior, they may cause emotional and behavioral problems that require treatment as a preventive measure to reduce the likelihood of bullying. We aimed to identify differences in the psychosocial profiles of adolescents who classified themselves as bullies, victims, or bully-victims. We performed a cross-sectional study in which data were collected between January 2009 and January 2010 from seven university-based clinics in a large metropolitan area with a predominantly Mexican-American population. We collected data on physical aggression among adolescents who self-categorized into the following groups: uninvolved, bullies, victims, and bully-victims. We determined the psychosocial profiles of the adolescents based on responses to the Youth Self Report (YSR) and parent’s responses to the Child Behavior Checklist (CBCL). A one-way analysis of variance and multivariate regression analyses were performed to compare the various components of the psychosocial profiles among the groups. Our analysis of the CBCL and the YSR assessments identified differences between the uninvolved group and one or more of the other groups. No significant differences were observed among the bully, victim, and bully-victim groups based on the CBCL. We did find significant differences among those groups based on the YSR, however. Our results suggest that emotional and behavioral problems exist among bullies, victims, and bully-victims. Therefore, treatment should not focus only on the victims of bullying; treatment is equally important for the other groups (bullies and bully-victims). Failure to adequately treat the underlying problems experienced by all three groups of individuals could allow the problems of bullying to continue.

Communicating genetic information: a difficult challenge for future pediatricians

BackgroundThe role of the pediatrician as genetic counselor is ideal because pediatricians have medical knowledge and experience with genetic disorders (e.g. Down syndrome). Moreover, pediatricians can provide comprehensive care in a medical home to patients with genetic disorders. However, changes in the curriculum of the pediatric resident are necessary to address the future challenges of effectively communicating genetic information to patients. The objective of this study was to explore these challenges and make recommendations for training to adequately prepare pediatricians for their future role as genetic counselors.MethodsThree reviewers independently searched PubMed, OVID, and Medline databases to identify articles describing the challenges of communicating genetic information to patients, published from 1960 to December 2005. After the publications were identified and reviewed, four major areas of interest were identified in order to categorize the findings.ResultsTwenty-five publications were identified during the literature search. From the review, the following categories were selected to organize the findings: (1) Inherent difficulties of communicating and comprehending genetic information; (2) Comprehension of genetic information by pediatricians; (3) Genetics training in residency programs; and (4) The effect of genetic information on the future role of pediatricians and potential legal implications.ConclusionPediatricians and residents lack essential knowledge of genetics and communication skills for effective counseling of patients. The review indicated that successful communication of genetic information involves a number of important skills and considerations. It is likely that these skills and considerations are universally required for the communication of most complex specialized medical information. In the past, communication skills have not been considered a priority. Today, these skills have become a demanding professional and even legal obligation. However, the challenges involved in communicating complex medical information cannot be successfully addressed with universal, one-size-fits-all recommendations. Residency training programs require changes to adequately prepare future pediatricians for the growing challenge of communicating genetic information. Four important skills should be considered in the training of residents to improve the communication of complex information to patients. These skills are (1) discriminating, (2) understanding, (3) simplifying, and (4) explaining information.

The emotional and behavioral problems of children exposed to poverty and/or collective violence in communities at the Mexico-United States border: A comparative study

Background. Collective violence attributed to organized crime has shown to be responsible for a considerable burden of physical and mental health morbidity among youth. Objective. To compare the emotional and behavioral problems of children exposed to early childhood poverty and/or collective violence in communities at the Mexico-United States border to children exposed to other social and health risks. Method. A cross-sectional study was carried out with individuals living in poverty at two sites at the Mexico-United States border. Individuals who responded once to the Pictorial Child Behavior Checklist (P+CBCL) in Spanish were selected randomly from clinics in a metropolitan area of El Paso, Texas, United States (poverty alone group), and Ciudad Juarez, Chihuahua, Mexico (poverty plus collective violence group). In addition, emotional and behavioral problems present in these groups were compared with available published emotional and behavioral CBCL scales of children exposed to other social and health risks. Results. Children exposed to both poverty and collective violence had higher emotional and behavioral problem scores as measured by the P+CBCL than those exposed to poverty alone. In addition, compared with children who were brain-injured, hearing impaired, or whose parents were exposed to drugs or alcohol, the poverty and collective violence group had higher levels of emotional and behavioral problems. Discussion and Conclusion. Systematic detection and treatment of children as young as 18 months exposed to trauma are necessary to diminish the mental health problems caused by the collective violence attributed to organized crime.

Psychosocial profile of Mexican American youths who play aggressive video games

The effects of video games on youths have been subject to debate. Some researchers have linked video games to behavioral and emotional problems, while others have found no adverse effects. The behavioral and emotional problems experienced by some gamers may be linked to certain types of video games. We hypothesized that Mexican American youths with lower socioeconomic status and who play “aggressive” video games have more emotional and behavioral problems than those who do not play such games. We examined a total of 579 youths using the Child Behavior Checklist and analyzing the games played within the last 6 months. Youths who played aggressive video games had higher scores and more emotional and behavioral problems compared with those who did not play aggressive video games.

Smoking Status of Adolescents in 2 Countries and the Impact of the Smoking Status of Mother, Father, Grandparents, and Siblings

There is considerable agreement throughout the world that adolescent smoking preferences are influenced by parents grandparents and siblings. Learning about the influence of this modifiable family environmental factor is extremely important because prevention strategies focused on including relatives might lead to greater reductions in the incidence and prevalence of adolescent smoking than adolescent-only programs. Researchers have found that the effect of relatives on adolescent smoking preferences is variable among different cultures. However there has been little opportunity to determine if smoking preferences differ between adolescents of a similar culture and heritage who live in 2 completely different geographic environments. The US-Mexico border is a place where adolescents share similar culture and heritage but are exposed to different laws different finances and different economic resources. We recently conducted a study of adolescent smoking in the border area of El Paso TX (population: 78% Hispanic 64% Mexican) and Ciudad Juarez Chihuahua Mexico. While conducting this cross-sectional study we assessed the influence of relatives (parents grandparents and siblings) smoking preferences on adolescent smoking. (excerpt)

Is there a need to modify existing coping scales to include using electronic media for coping in young people

Children and adolescents spend an average of 7 h a day using electronic media which include television, radio, cellphones, computers, and handheld devices (1); it would be naive to think that time spent on these devices has no effects (2). Indeed, it is clear that media has an effect on all of us, especially, youth who have grown up in a world surrounded by electronic devices (3–5). Decades of study on media use indicate a profound effect on the lives, health, and well being of youth (1). In particular, findings from a large number of studies, though often subject to controversy, link media use to psychosocial (6, 7), behavioral, and health problems (8–10) in children and youth. Potential positive effects of media use have been less studied. Media entertains, teaches, is a tool for communication, and may also be used as a means to cope with stress. We propose a need for the development of a novel assessment scale that will facilitate studies of the role of electronic media as a youth coping strategy.

Assessment Disparities among Pediatric Patients: Advantages of Pictorial Descriptions

Remarkable progress in medicine has provided people with the potential for longer and healthier lives. However, health disparities (e.g., poverty, access to health care, educational inequalities, higher exposure to health risks, etc.), make individuals, families, and communities miss most of the benefits of this progress (1, 2). Pediatric populations are affected by these disparities during crucial years of development. The result is poor health or disease, which develops over short and/or long term periods (3–5). The adverse contributions of these disparities have a different effect on each individual. However, they have a powerful effect on pediatric outcomes. One of the most recognized factors associated with health disparities is the problem of poor communication with parents/caretakers. Poor communication prevents them from receiving health benefits, participating in research studies, and actively contributing to disease prevention and health care for their children (6–9). Decades of effort and research on strategies to reduce health disparities have led to inconclusive and conflicting results, and there has been little improvement in leading health indicators (10). Some interventions could have a true beneficial effect on the participants. However, it is possible that the findings have been affected by misclassification of outcomes, exposures, or health conditions due to assessment disparities (11–13).

The impact of public or private schools on smoking prevalence among adolescents in 2 countries.

Many of the factors that increase the prevalence of smoking among adolescents are independent of the geographic area in which they live. Other factors depend exclusively on geographic area or environment and are sustained by economic, social, and cultural norms that prevail in the adolescent’s city, region, or country of residence. Such factors include among others tobacco retail sales to minors, legal policies, cultural beliefs and attitudes, and type of school. Studies have shown that school environments, teacher attitudes regarding smoking, and attendance at public versus private schools have a definite effect on smoking preferences of adolescents. However, further study has revealed unexpected differences: the impact of the school environment may not be the same across national borders. Such may be the case with attendance at public versus private schools on the United States-Mexico border. Available information indicates that in the United States, the prevalence of smoking is higher among adolescents attending private schools, whereas in Mexico, the prevalence of smoking is higher among adolescents attending public schools. These reported differences were found among adolescents who belonged to different ethnic and cultural backgrounds, living in different environments, and they were measured at different times. Rarely do we have the opportunity to measure, at the same time, smoking preferences in adolescents from similar cultures living in 2 completelydifferent environments in a developed versus a developing country. At the United States-Mexico border, adolescents exposed to different laws and economic resources share similar cultures and heritage. In the US border area of El Paso, TX (population: 78% Hispanic, 64% Mexican), and Ciudad Juarez, Chihuahua, Mexico, we observed, as part of a cross-sectional study of nonsmoker adolescents, differences in the smoking behaviors of adolescents attending private versus public schools. A sample of US (1437, mean age = 14.0 years, SD = 1.5) and Mexican (2477, mean age = 14.5 years, SD = 1.4) adolescents living in the United States-Mexico border area and representative of different socioeconomic and geographic areas participated in a questionnairebased survey that included attendance at public or private schools and a 7-level variable scale to measure adolescents’ progress toward regular smoking. The term nonsmoker was used for persons who had never smoked a cigarette and never tried or experimented with smoking. All other adolescents were considered to have been smokers. Logistic regression analysis was used to calculate prevalence odds ratios (ORs) to identify the effect of school attendance on smoking behaviors. US adolescents who attended private schools had a nonsignificant 10% decrease in the odds of smoking compared to those who attended public schools (Table 1). After adjustment for age and gender, this OR was significant. For Mexican adolescents who attended private schools, there was a 50% decrease in the odds of smoking compared to their counterparts who attended public schools. After the adjustment for age and gender, the OR remained highly significant. The results of our study strongly suggest that, on the United StatesMexico border, adolescent smoking status on the Mexico side concurs with findings in previous studies, in that a lower prevalence of smoking was found in private schools. On the US side, smoking status did not concur with the pattern found in other US cities, where the prevalence of smoking was higher in private schools. Further research is needed to determine school environmental factors related to school attendance patterns that cause this difference and whether school attendance patterns can be a risk factor for smoking independent of cultural and ethnic backgrounds.

Mental and Emotional Health of Children Exposed to News Media of Threats and Acts of Terrorism: The Cumulative and Pervasive Effects

Viewing extreme violence and terrorism, either directly by witnessing acts or indirectly by watching them in the media, affects children’s mental and emotional health (1), and some children are at a higher risk for negative effects than others. Indirect exposure to terrorism acts and threats through the media affects the mental health of children, in both short- and long-term ways that differ completely from the effects in adults. Children’s vulnerability, immaturity, and developmental state change their perspective, and the tools used to confront these issues do not affect each child equally. Additionally, emotional problems might not surface immediately; instead, they can remain latent until they surface eventually. How and when this occurs depends mostly on additive effects generated by the environment in which the child develops and additional disparities in which the child confronts. The Federal Bureau of Investigation (FBI) defines terrorism as “the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives” (2). Direct or indirect exposure to terrorism violence provokes a state of terror in the general public through the use of calculated acts of violence, which includes murder, mutilation, and explosions that affect innocent people, often including children. Even though the events might no longer be in the news, the psychological scars and trauma caused by viewing the horrifying images and by the memories are pervasive and do not heal easily (3). The natural tendency of adults to try to forget about the problems and move on with their lives often results in underestimating the importance and effect of the exposure on the emotional and psychosocial problems of children. The negative effect of exposure to violence in the media on children has been extensively discussed for years, with many controversial and conflicting results and conclusions. While some have found highly negative effects (4–6), others have denied any possible effects from media exposure (7, 8). Nevertheless, the existing evidence about the effects of media exposure to terrorism and violence acts among children should not be underestimated or dismissed. The point of discussion here is to consider the need to support strategies that reduce the effects of unsupervised viewing of terrorism acts and threats presented by the media. While stopping the media presentation of this violence might not be possible, there is much room to consider strategies that can reduce and help to better understand the effects of violence on the emotional health of children at home, in school, and in health sector. The media itself can also help by increasing the attention given to these strategies.

Comparison of methods for teaching developmental milestones to pediatric residents

BackgroundInteractive media are effective tools in teaching and allow for self-directed study, which develops skills for life-long learning among health professionals. With this type of study, the learner can review material at his/her own pace and target areas that require emphasis. Pediatric residents require an accurate understanding of developmental milestones in children of various ages and their normal variations. The best representation of developmental milestones requires video recordings of children demonstrating appropriate skills. However, such recordings are not always available, so printed materials are most often used. In this realm, a computer-based interactive learning tool using animated cartoons gives flexibility for presentation using drawings. We compared pediatric residents’ knowledge of developmental milestones in neonates to 5-year-olds before and after study with either an interactive DVD or paper-based materials.MethodsA team of physicians and educational specialists in Texas Tech University Health Sciences Center produced an interactive DVD containing animated cartoons and questions. Residents were divided into an intervention group that used the DVD and a control group that used traditional paper-based materials. Each group’s improvement [or increase] in knowledge was measured.ResultsCompared with the 17 residents in the control group, the 37 in the intervention group tended to acquire more knowledge about developmental milestones. The mean scores at T1, T2, and T3 doubled from the initial scores in the intervention group, while no difference was observed in the control group.ConclusionAn interactive educational DVD can be an effective supplement to improve residents’ knowledge of developmental milestones.