The COVID-19 pandemic has exposed the vulnerability of many families, including grandparent kinship families, to deal with a health/economic crisis. The fear of COVID-19 plus stay-at-home orders have ...increased individuals’ psychological distress. Moreover, school closures and homeschooling further increased parenting stress among caregivers.
This study examined the relationship between material hardship and parenting stress among grandparent kinship providers, and assessed grandparents’ mental health as a potential mediator to this relationship during the COVID-19 pandemic in the United States.
Grandparent kinship providers (N = 362) that took primary care of their grandchildren participated in a cross-sectional survey via Qualtrics Panels in June 2020 in the United States.
Descriptive and bivariate analyses, binary logistic regression, and mediation analyses were conducted using STATA 15.0.
Suffering material hardship was significantly associated with higher odds of experiencing parenting stress among grandparent kinship providers, and grandparents’ mental health partially mediated this association.
Addressing material and mental health needs among grandparent kinship providers is critical to decreasing their parenting stress.
Grandparent kinship caregivers may experience increased parenting stress and mental distress during the COVID-19 pandemic. It may lead to risky parenting behaviors, such as psychological aggression, ...corporal punishment, and neglectful behaviors towards their grandchildren. This study aims to examine (1) the relationships between parenting stress, mental health, and grandparent kinship caregivers’ risky parenting practices, such as psychological aggression, corporal punishment, and neglectful behaviors towards their grandchildren during the COVID-19 pandemic, and (2) whether grandparent kinship caregivers’ mental health is a potential mediator between parenting stress and caregivers’ psychological aggression, corporal punishment, and neglectful behaviors. A cross-sectional survey among grandparent kinship caregivers (
N
= 362) was conducted in June 2020 in the United States. Descriptive analyses, negative binomial regression analyses, and mediation analyses were conducted using STATA 15.0. We found that (1) grandparent kinship caregivers’ high parenting stress and low mental health were associated with more psychological aggression, corporal punishment, and neglectful parenting behaviors during COVID-19; and (2) grandparent kinship caregivers’ mental health partially mediated the relationships between parenting stress and their psychological aggression, corporal punishment, and neglectful behaviors. Results suggest that decreasing grandparent kinship caregivers’ parenting stress and improving their mental health are important for reducing child maltreatment risk during COVID-19.
OBJECTIVES: To determine whether patients who developed delirium after cardiac surgery were at risk of functional decline.
DESIGN: Prospective cohort study.
SETTING: Two academic hospitals and a ...Veterans Affairs Medical Center.
PARTICIPANTS: One hundred ninety patients aged 60 and older undergoing elective or urgent cardiac surgery.
MEASUREMENTS: Delirium was assessed daily and was diagnosed according to the Confusion Assessment Method. Before surgery and 1 and 12 months postoperatively, patients were assessed for function using the instrumental activities of daily living (IADL) scale. Functional decline was defined as a decrease in ability to perform one IADL at follow‐up.
RESULTS: Delirium occurred in 43.1% (n=82) of the patients (mean age 73.7±6.7). Functional decline occurred in 36.3% (n=65/179) at 1 month and in 14.6% (n=26/178) at 12 months. Delirium was associated with greater risk of functional decline at 1 month (relative risk (RR)=1.9, 95% confidence interval (CI)=1.3–2.8) and tended toward greater risk at 12 months (RR=1.9, 95% CI=0.9–3.8). After adjustment for age, cognition, comorbidity, and baseline function, delirium remained significantly associated with functional decline at 1 month (adjusted RR=1.8, 95% CI=1.2–2.6) but not at 12 months (adjusted RR=1.5, 95% CI=0.6–3.3).
CONCLUSION: Delirium was independently associated with functional decline at 1 month and had a trend toward association at 12 months. These findings provide justification for intervention trials to evaluate whether delirium prevention or treatment strategies might improve postoperative functional recovery.
COVID-19 has exacerbated material hardship among grandparent-headed kinship families. Grandparent-headed kinship families receive financial assistance, which may mitigate material hardship and reduce ...child neglect risk.
This study aims to examine (1) the association between material hardship and child neglect risk; and (2) whether financial assistance moderates this association in a sample of kinship grandparent-headed families during COVID-19.
Cross-sectional survey data were collected from a convenience sample of grandparent-headed kinship families (not necessarily child welfare involved) (N = 362) in the United States via Qualtrics Panels online survey.
Descriptive, bivariate, and negative binomial regression were conducted using STATA 15.0.
Experiencing material hardship was found to be associated with an increased risk of child neglect, and receiving financial assistance was associated with a decreased risk of child neglect in the full sample and a subsample with household income > $30,000. Receiving financial assistance buffered the negative effect of material hardship on child neglect risk across analytic samples, and receiving SNAP was a significant moderator in the full sample. Among families with a household income ≤ $30,000, receiving SNAP and foster care payments was associated with a decreased risk of child neglect, while receiving TANF and unemployment insurance was associated with an increased risk of child neglect. Among families with household income > $30,000, only receiving SNAP was associated with a decreased risk of child neglect.
This study suggests the potential importance of providing concrete financial assistance, particularly SNAP and foster care payments, to grandparent-headed kinship families in efforts to decrease child neglect risk during COVID-19.
Women with previous gestational diabetes are at high risk of developing Type 2 diabetes. The National Diabetes Prevention Program (NDPP) is a widely disseminated lifestyle intervention to prevent ...Type 2 diabetes. Although NDPP programs are open to adults of any age, participants are usually older adults. Effectiveness among younger women with previous gestational diabetes is largely unknown.
The NDPP was delivered by lifestyle coaches in a large network of Federally Qualified Health Centers. Reach, retention, physical activity, and weight loss outcomes were compared between women aged <40 years with previous gestational diabetes and all other participants. Data were collected from 2013 to 2019 and analyzed in 2022.
Among 2,865 enrollees who agreed to start the yearlong NDPP, 63.3% were Latinx, 18.8% were non-Latinx Black, and 16.4% were non-Latinx White. Younger women with previous gestational diabetes represented <4% (n=107) of participants. There was no significant difference in the frequency of attending ≥1 NDPP session between these women and all other participants (37.4% vs 44.6%; p=0.146). However, among those attending ≥1 session (n=1,265), younger women with previous gestational diabetes attended more (11.27 ± 1.27 vs 8.50 ± 0.22 sessions, p=0.021) and had greater weight loss (3.04% ± 0.59 vs. 1.49% ± 0.11, p=0.010) in covariate-adjusted models than other participants.
Diverse younger women with previous gestational diabetes attending the NDPP had one third greater attendance and twice as much weight loss as other NDPP participants but represented a much smaller proportion of enrollees. Thus, the NDPP appears to be a beneficial but underutilized resource for this high-risk population.
•Three latent classes of material hardship were identified: Class 1 low overall hardship with high medical hardship, class 2 moderate overall hardship with high utility hardship, and class 3 severe ...overall hardship.•Factors, including race, household income, labor force status, years of care, and financial assistance status, were associated with class membership.•Class 2 was significantly associated with grandchildren’s physical health.
COVID-19 has increased economic hardship for many families, including custodial grandparent-headed families. We aim to examine latent classes of material hardship among custodial grandparent-headed families, to assess predictors associated with identified classes, and to investigate associations with grandchildren’s physical and mental health outcomes during COVID-19. A cross-sectional survey was administered via Qualtrics Panels in June 2020. The sample comprised of 362 grandparents. Latent class analysis and multinomial and binary logistic regression were conducted. Three latent classes of material hardship were identified: Class 1 low overall hardship with high medical hardship, class 2 moderate overall hardship with high utility hardship, and class 3 severe overall hardship. Factors, including race, household income, labor force status, years of care, and financial assistance status, were associated with class membership. Class 2 was significantly associated with grandchildren’s physical health. Our findings suggest that material hardship is heterogeneous among custodial grandparents during COVID-19, and children in households experiencing utility hardship have a higher risk for poorer physical health outcomes. Results highlight the need to meet grandparents’ material needs and call for future research to examine possible mechanisms that explain the link between material hardship and grandchildren’s outcomes.
To test the feasibility and effectiveness of a Web-based lifestyle intervention based on the Diabetes Prevention Program modified for women with recent gestational diabetes mellitus to reduce ...postpartum weight retention.
We randomly allocated 75 women with recent gestational diabetes mellitus to either a Web-based lifestyle program (Balance after Baby) delivered over the first postpartum year or to a control group. Primary outcomes were change in body weight at 12 months from 1) first postpartum measured weight; and 2) self-reported prepregnancy weight.
There were no significant differences in baseline characteristics between groups including age, body mass index, race, and income status. Women assigned to the Balance after Baby program (n=36, three lost to follow-up) lost a mean of 2.8 kg (95% confidence interval -4.8 to -0.7) from 6 weeks to 12 months postpartum, whereas the control group (n=39, one lost to follow-up) gained a mean of 0.5 kg (-1.4 to +2.4) (P=.022). Women in the intervention were closer to prepregnancy weight at 12 months postpartum (mean change -0.7 kg; -3.5 to +2.2) compared with women in the control arm (+4.0 kg; +1.3 to +6.8) (P=.035).
A Web-based lifestyle modification program for women with recent gestational diabetes mellitus decreased postpartum weight retention.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT01158131.
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Understanding variability in conceptions of dementia in multiethnic populations is important to improve care and guide research. The objectives of this study were to describe caregiver conceptions of ...dementia using a previously developed typology and to examine the correlates of conceptions of dementia in a multiethnic sample. This is a cross‐sectional study conducted in Boston and the San Francisco Bay area. Participants were a convenience sample of 92 family dementia caregivers from four ethnic/racial groups: African‐American, Anglo European‐American, Asian‐American, and Latino. In‐depth, qualitative interviews explored the caregivers' ideas about the nature and cause of dementia (i.e., explanatory models). Explanatory models of caregivers were categorized as biomedical, folk, or mixed (folk/biomedical). Quantitative analyses examined the association between ethnicity and other caregiver characteristics, and explanatory model type. Overall, 54% of caregivers, including 41% of Anglo European Americans, held explanatory models that combined folk and biomedical elements (i.e., mixed models). For example, many families attributed Alzheimer's disease and related dementias to psychosocial stress or normal aging. Ethnicity, lower education, and sex were associated with explanatory model type in bivariate analyses. In multiple logistic regression analysis, minority caregivers (P<.02) and those with less formal education (P<.02) were more likely to hold mixed or folk models of dementia. Although minority and nonminority caregivers often incorporated folk models into their understanding of dementia, this was more common in minority caregivers and those with less formal education. Further research on cross‐ethnic differences in a larger, more‐representative sample is needed.
This study aims to examine the (a) prevalence of adverse childhood experiences (ACEs) among children in kinship care; (b) relationships between the number and type of ACEs and children’s ...internalizing and externalizing problems; and (c) moderating role of kinship caregivers’ mental health on the relationships between ACEs and children’s internalizing and externalizing problems. A sample of children in kinship care (N = 224) obtained from the National Survey of Child and Adolescent Well-Being II was used. Ordinary least squares regression models were conducted. Results indicated that neglect followed by parental substance abuse were found to be the most prevalent of the ACEs. Child neglect, sexual and emotional abuse, and parental substance abuse were significantly associated with child internalizing problems, whereas sexual and emotional abuse were significantly associated with child externalizing problems. The total number of ACEs and experiencing three or more ACEs were significantly associated with child externalizing problems. Kinship caregivers’ mental health significantly moderated the relationships between neglect, sexual abuse, and child internalizing problems. Caregiver’s mental health also moderated the relationships between emotional and sexual abuse, neglect, and children’s externalizing problems. Findings suggest the importance of addressing ACEs and the need for mental health services to both kinship caregivers and children in kinship care.
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