Leslie A. McClure

Background: Pediatric pedestrian injury is a major public health concern. Children’s perceived abilities correlate with behavior across many pediatric behavioral health contexts, but this association is untested regarding pedestrian safety. Objective: If children’s perceptions relate to behavior in pedestrian settings, there are implications for targeted intervention. We evaluated associations between parent and child perceptions of children’s street-crossing ability with actual abilities within a virtual reality (VR) pedestrian platform. Methods: As part of a larger clinical trial, 497 children aged 7–8 years participated in baseline pedestrian skill assessments and subsequent virtual reality training sessions. Training terminated when children achieved adult competency. Outcomes included baseline unsafe crossings and number of visits to reach adult competency. Baseline perceptions of children’s ability were assessed via parent and child self-report. Linear regression models were completed for each outcome, with parent perception, child perception, child age, and child sex as predictors. Results: The first linear regression demonstrated significant associations between baseline unsafe crossings and both parent perception of real-world crossings (β=-0.10771, p <.05) and child age (β=-0.18288, p <.01). A second linear regression examining the number of training visits required to achieve adult competency also identified significant associations between parent perception of real-world crossings (β=-0.13499, p <.01) and child age (β=-0.13927, p <.01). Conclusions: Parents’ perceptions of children’s abilities are significantly associated with children’s pedestrian skills, whereas children’s own perceptions show less consistent and non‑significant associations. Prioritizing youth voices alongside educating parents about pedestrian safety risks may offer complementary and effective strategies to support children to become safe, active pedestrians. Clinical Trial Registration: The trial was registered at ClinicalTrials.gov, Identifier NCT02948400.

Background: Nonpharmacological strategies are first‐line treatments for behavioral symptoms, the most distressful aspect of dementia care. Few caregivers have knowledge of or access to effective strategies. We tested the effects of WeCareAdvisor, a web app to help caregivers problem‐solve and identify nonpharmacological strategies to manage behaviors. Participants/Setting: Two hundred and sixty‐two community‐living caregivers of people with dementia. Methods: Prospective two‐group randomized trial comparing immediate app users ( N = 131) to 3‐month delayed app users (controls, N = 131). Interviewers masked to participant allocation conducted baseline, 1‐(check‐in), and 3‐month (main endpoint) interviews. Using the DICE approach, immediate users answered brief questions to describe targeted behaviors and investigate contributors from which the app creates “Prescriptions” detailing strategies that caregivers evaluate if effective. Educational materials were also available. Three primary outcomes (caregiver distress, confidence managing behaviors, behavioral frequency by severity) and seven pre‐specified secondary (number, frequency, severity of behaviors, functional dependence and caregiver‐associated upset, wellbeing, and communications) outcomes were examined. Results: Caregivers were 63.8 (SD = 10.6) years old, mostly female (82%), spouses (65%), with some college (93%); 83% were White, 10% Black, 3% Asian, or other/multi‐racial group (3.9%). Most (87%) lived with people with dementia who averaged 75.1 (SD = 10.5) years, were primarily male (57%) and White (82%), with moderate–severe dementia (62%) and averaged 6.4 (SD = 2.8) behaviors. There were no treatment differences between groups in behavioral symptoms, or caregiver distress and confidence at 3 months. However, the difference in caregiver distress between immediate versus delayed user groups was apparent over time by 3 months (Bonferroni corrected p for interaction between time and intervention = 0.012). In secondary analyses, by 3 months, immediate users versus controls, reported fewer behaviors ( p = 0.02), less functional dependence ( p = 0.05) and associated caregiver upset ( p = 0.005), and improved caregiver wellbeing ( p < 0.001). Conclusions: WeCareAdvisor use was associated with significant and clinically meaningful improvements in caregiver distress and wellbeing, although differences in frequency/severity of behaviors were not significant. Trial Registration: NCT05012410; https://clinicaltrials.gov/study/NCT05012410 . Initial registration date: 08/12/2021

Neighborhood factors, encompassing social, built, and natural environments, may explain geographic differences in the impact of COVID-19 pandemic on populations. Data from pre-existing national, population-based cohorts could be leveraged to better understand how pre-existing conditions (both individual and neighborhood) contribute to risk factor development and disease progression. We catalogued spatial and neighborhood data in the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), comprising 14 diverse US cohorts (>50,000 participants). The C4R sample is generally spatially and socially representative of the overall nation, with C4R’s calculated spatial coverage representing 28% of US land area and 52% of the total US population. However, C4R (vs. non C4R) areas were more urban, wealthy, with more foreign-born residents, and less car-dependent with lower proportion employed and green. Twelve cohorts collected neighborhood characteristics – most commonly social environment data on neighborhood socioeconomic status– based on participants’ addresses. The most common built environment measures were related to food access, followed by other destination-based measures such as walkability. Natural environment data were available in the fewest cohorts, with emphasis on air quality or greenspace. This work provides clarity on available neighborhood and spatial data and facilitates future harmonization of data from C4R cohorts. Ultimately, this may enable future longitudinal and comparative analyses of neighborhood influences on COVID-19.

While neighborhood socioeconomic status (NSES) significantly impacts health outcomes, its measurement often assumes that the social and economic mechanisms that drive NSES operate similarly across the urban–rural continuum. This study aimed to develop a census-tract-level NSES measure that accounts for differences across community type and assesses its measurement invariance. Using data from 71,908 census tracts in the contiguous United States, we employed exploratory and confirmatory factor analyses to derive a one-factor NSES construct consisting of five variables: percent below the poverty line, households receiving public assistance, population unemployed, households without cars, and population with less than a high school education. Measurement invariance analysis revealed that while the overall NSES structure is consistent across urban and rural community types, factor loadings varied significantly. The percentage of the population living below poverty was the most reflective indicator across all community types, while other indicators, such as car access and unemployment, exhibited context-specific variability. These findings highlight the importance of incorporating urbanicity into NSES measures in health disparity research and to improve the effectiveness of public health interventions.

Studies have indicated that cadmium (Cd) exposure is associated with neurotoxicity. However, data linking Cd exposure to cognitive impairment are sparse. We aimed to investigate the association between urinary Cd concentration and cognitive impairment in US adults. The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is an ongoing population-based prospective cohort study that enrolled 30,239 Black and White US adults aged 45 years or older at baseline (2003-2007). In a randomly selected subcohort of REGARDS participants who were free of cognitive impairment or stroke at baseline, certain trace element concentrations, including urinary creatinine-corrected Cd, were measured using biospecimens collected and stored at baseline. During an average of 10 years of follow-up, global cognitive impairment was assessed annually using the Six-Item Screener, and domain-based cognitive impairment, including verbal learning, memory, and executive function, was evaluated every other year using the Enhanced Cognitive Battery. Multivariable-adjusted logistic regression models were used to examine the association between urinary Cd concentration and the odds of global or domain-based cognitive impairment. A total of 2,172 participants (mean age: 64.1 ± 9.0 years; female: 54.8%; Black participants: 38.7%) with available data on urinary Cd concentration, including 195 cases of global cognitive impairment and 53 cases of domain-based cognitive impairment, were included in the analyses. While there was no association between Cd and cognitive impairment in the full sample, there was a significant positive association of urinary Cd concentration with global cognitive impairment among White but not Black participants. The odds of cognitive impairment for White participants in the high urinary Cd concentration group (≥median) were doubled compared with those in the low urinary Cd group (odds ratio 2.07, 95% CI 1.18-3.64). Sex, age, region, smoking pack-years, alcohol consumption, and other related metals did not materially modify the associations of interest. Findings from this prospective cohort study suggest that urinary Cd concentrations are associated with global cognitive impairment among White but not Black individuals. Further studies with repeatedly measured Cd exposure, larger sample sizes, and longer duration are needed to confirm our findings and explore the potential explanations for the observed racial discrepancy, such as the impact of smoking.