School of Social Sciences, Humanities, and Arts

Parent-child dyads in which the child is deaf but the parent is hearing present a unique opportunity to examine parents’ use of non-auditory cues, particularly vision and touch, to establish communicative intent. This study examines the multimodal communication patterns of hearing parents during a free play task with their hearing (N=9) or deaf (N=9) children. Specifically, we coded parents’ use of multimodal cues in the service of establishing joint attention with their children. Dyad types were compared for overall use of multimodal – auditory, visual, and tactile – attention-establishing cues, and for the overall number of successful and failed bids by a parent for a child’s attention. The relationship between multimodal behaviors on the part of the parent were tracked for whether they resulted in successful or failed initiation of joint attention. We focus our interpretation of the results on how hearing parents differentially accommodate their hearing and deaf children to engage them in joint attention. Findings can inform the development of recommendations for hearing parents of deaf children who are candidates for cochlear implantation regarding communication strategies to use prior to a child’s implantation. Moreover, these findings expand our understanding of how joint attention is established between parents and their preverbal children, regardless of children’s hearing status.

A large body of work has advanced our understanding of the neurodevelopment of cognitive control in early childhood. Such work frequently used simplistic visual stimuli, making them well-suited for event-related potentials (ERP) research. However, more naturalistic stimuli may better mirror visually rich environments where cognitive control is engaged. Here, we measured ERPs from 171 kindergartners at public schools with diverse socioeconomic characteristics during a Go/No-Go task using photographs of animals in natural scenes. Instead of the commonly reported N2 in Go/No-Go tasks with simplistic stimuli, the earlier-occurring ERP morphology was dominated by a P2. The later-occurring ERP morphology was consistent with the P3b reported in Go/No-Go tasks with simplistic stimuli. Both the P2 and P3b displayed more positive mean amplitudes for No-Go compared to Go trials. Additionally, P2 amplitudes decreased with age for No-Go stimuli whereas P3b amplitudes decreased for both Go and No-Go stimuli, indicating different developmental changes across earlier- and later-occurring neural processes. Only larger P3b mean amplitudes were associated with better task performance, suggesting that variability in later-occurring neural processes may be more closely related to individual differences in behavioral performance. These findings suggest that earlier-occurring neural indices of cognitive control may not generalize across paradigms varying in stimulus complexity, while later-occurring indices may. Furthermore, results indicate that earlier- and later-occurring ERPs exhibit distinct age-related differences and associations with behavioral performance. Furthermore, our study highlights the feasibility of conducting school-based developmental cognitive neuroscience research, facilitating the inclusion of children from diverse socioeconomic backgrounds.

Cognitive control fluctuates from moment to moment, even when the sensory and contextual demands of the task remain constant. However, traditional approaches used to measure cognitive control have largely treated such variability as noise and predominantly relied on overall performance metrics, such as accuracy and average response time. Using response time variability as an index of fluctuations in cognitive control, we examined how cognitive control consistency relates to the development of academic skills in children (N = 112) who were followed across kindergarten and first grade, an important period encompassing the transition and acclimation to formal schooling. Cognitive control consistency was assessed via response time variability in a Go/No-Go task, and math and literacy skills were assessed by the Applied Problems and Letter-Word Identification subtests of the Woodcock-Johnson III Tests of Achievement. More consistent cognitive control (indexed by lower response time variability) was associated with stronger math skills both concurrently in kindergarten and prospectively in first grade, above and beyond an accuracy-based metric (d'). In contrast, cognitive control consistency did not relate to literacy skills in kindergarten or first grade, suggesting potential domain-specificity in these relations during the early school years. Together, these findings demonstrate that consistency is an important aspect of cognitive control that uniquely contributes to math performance in early childhood.

Background: Research on transgender people's health, particularly in reproductive health, has expanded exponentially over the past decades. However, previous studies frequently highlight perceived inaccessibility and gender-exclusivity of reproductive and perinatal care for transgender people. Objective: This observational study used a cross-sectional content analysis to examine online obstetrics, labor and delivery, and pregnancy-related materials from a purposive sample of 178 online hospital resources across the United States to understand the extent to which they use gender-inclusive and gender-exclusive language, imagery, and other inclusive symbolism. Methods: Two hundred US hospitals were purposively selected from the most populous cities in each state; 22 (11%) lacking obstetrics pages were excluded, yielding 178 (89%) hospitals across all 50 states. Four coders assessed obstetrics websites (from October 2025 to December 2025) for transgender-specific resources, inclusive language, second-person language, exclusive language, inclusive imagery, and inclusive symbols or statements. Hospitals were categorized by US Census region, transgender-specific legal protections, and university or religious affiliation. Results: Across the United States, the presence of gender-inclusive elements was relatively rare, while most hospitals consistently used second-person or gender-exclusive elements. These patterns persisted across geographic regions, university affiliations, religious affiliations, and variation in state-level, transgender-specific legal protections, although hospitals in states with stronger protections and university-affiliated institutions showed somewhat higher rates of inclusive content. Importantly, even on websites that included gender-inclusive language, such content co-occurred with gender-exclusive terms, raising questions about how transgender and gender-diverse patients might interpret these mixed signals when deciding where to seek care. Conclusions: These findings underscore the need for hospitals to develop clear, service-specific standards for gender-inclusive obstetric communication and to ensure that online materials visibly and consistently signal their readiness to care for transgender and gender-diverse patients across the perinatal period.

INTRODUCTION: State and local jurisdictions in the United States are increasingly adopting flavored tobacco sales restrictions (FTSRs) to mitigate tobacco initiation and use. Policy implementation is highly understudied yet can impact policy effectiveness. This review examines existing literature on state and local FTSR policy design and implementation in the United States. METHODS: We systematically searched for PubMed articles published by December 31, 2024 which were: original research articles in English focused on a US state or local FTSR that reported at least one policy implementation outcome measure. We excluded articles that were systematic reviews or reported on federal or non-FTSR policy. Guided by policy and implementation science frameworks, we developed a data extraction template to report: policy design elements, study characteristics, and implementation measures (ie, inputs, activities, outcomes). RESULTS: Of 1595 articles identified, 30 were retained for review. Most evaluated local FTSRs, and eight evaluated a statewide policy. Pre-post test and cross-sectional study designs were the most common. Frequently reported implementation outcomes were acceptability, appropriateness, feasibility, and fidelity/compliance. Studies with pre-post test designs and comparison groups showed significantly increased fidelity/compliance (ie, reduced availability of restricted products) in FTSR jurisdictions. A majority (56.7%) detailed an implementation input for infrastructure (eg, resources) or activity (eg, outreach). Few described enforcement-related mechanisms. CONCLUSIONS: Key gaps exist in policy implementation articles on state and local FTSRs in the United States, including infrequent reporting of enforcement agencies and penalties which may impact implementation. Additional mixed-methods research is needed to compare FTSR implementation across jurisdictions with varying policy designs. IMPLICATIONS: Results contribute to our understanding of FTSR policy design, evaluation, and areas needed for intervention to strengthen implementation. Strategies to support compliance include guidance and criteria to identify targeted products for retailers and enforcement agents. Research gaps include a lack of information on penalty structures and data from enforcement agents or on violations, which are missed opportunities to evaluate components that can impact implementation and effectiveness.

China has undergone rapid economic changes in recent years, yet little is known about how children in China understand the social status hierarchies around them. The present study addressed this gap by examining whether Chinese children held essentialist beliefs about two social status categories: residency, an important but understudied status-related category in China, and socioeconomic status (SES). We also examined whether children's beliefs about these categories varied with their age or their own social status background (residency, subjective SES). Chinese 5- to 9-year-old children (47 female) who held residency in a prestigious megacity (N = 50) or less prestigious non-megacities (N = 50) completed two tasks that measured whether they viewed residency and SES as biologically based or causally informative, two dimensions of essentialism. Results suggested that children viewed residency but not SES as biologically based, though this decreased with age. Children from megacities with higher subjective SES were more likely to view residency as causally informative with age, suggesting children with higher social status are more likely to essentialize this status-related category. Children's beliefs about SES did not vary with their social-status background. These findings suggest that the developmental trajectory of Chinese children's essentialist beliefs about social status vary across status-related categories, dimensions of essentialism, and their own social-status background.

Research on transgender health has expanded significantly within the past decade, yet the topic of transmasculine pregnancy remains underexplored. In this article, we extend the Gender Minority Stress Theory (GMST) to examine how psychosocial stressors faced by transmasculine individuals during pregnancy might influence gestational outcomes through key psychobiological pathways, including the HPA axis, immune, and cardiovascular systems. Specifically, we propose an adapted model that incorporates both proximal (e.g. internalized transphobia, concealment) and distal (e.g. discrimination, institutional exclusion) stressors specific to transmasculine pregnancy by synthesizing evidence that these psychosocial stressors are not only consequential for the mental and physical health of the pregnant person but may also have downstream effects on pregnancy outcomes. We also highlight certain personal and social psychosocial resilience resources that might buffer the impact of stressors on adverse outcomes. This model helps to identify novel pathways for intervention to promote the wellness of both the child and the transmasculine parent.

The remote Objective Structured Clinical Examination (OSCE) is a cornerstone of medical education, enabling structured and objective assessment of clinical skills, communication, and patient-centered care. However, its widespread adoption has introduced challenges related to cost-effectiveness and efficient use of rater resources. Traditional double scoring (DS) ensures reliability but is labor-intensive and costly, especially in large-scale assessments. To address these challenges, this study introduces Targeted Double Scoring (TDS), a novel methodology that selectively applies DS to specific score ranges, particularly those near the pass/fail threshold. The study was conducted using data from a pilot remote OSCE administered to 550 clinical medicine undergraduates in China. The OSCE consisted of three stations: Clinical Reasoning (CR), Physical Examination (PE), and Fundamental Skills (FS). Each station was scored remotely by two raters, with a cut-off score of 60 out of 100. The TDS methodology was modeled based on the OSCE's DS design and fitted with scoring data. A decision-theoretic approach identified optimal Critical Score Ranges (CSRs) for targeted double scoring, balancing reliability and cost-effectiveness. The findings show that TDS significantly reduces rater workload and costs while maintaining high reliability and fairness. For instance, TDS achieved up to 70% cost savings compared to traditional DS under certain configurations. The study also highlights the flexibility of TDS, which can be tailored to different OSCE designs and scoring rubrics. These results have broad implications for medical education, especially in resource-constrained settings where optimizing assessment efficiency is critical. This study provides a practical solution to the cost-related challenges of remote OSCEs and offers a framework for adopting TDS in assessments. By focusing raters on critical score ranges, TDS maintains rigorous and fair evaluations without overburdening faculty or exceeding budgets. Future research should explore TDS scalability and its integration with emerging technologies like artificial intelligence to enhance efficiency and reliability.

Objectives: To determine the association between parent-reported problem behaviors and objectively measured response inhibition in children with sleep-disordered breathing (SDB). Understanding this concordance could facilitate better clinical decision-making, as parent reports often guide treatment decisions despite unclear relationships with objective behavioral measures. Methods: This prospective observational study was conducted at a tertiary care pediatric otolaryngology clinic from 1/1/24-12/1/2024. Children aged 5-11 years with SDB symptoms were included, while those with clinically significant psychiatric or neurologic disorders were excluded. Parent-reported problem behaviors were measured using the Behavior Rating Inventory of Executive Function (BRIEF), with the inhibit T-score as the primary predictor. The primary outcome was performance on the Flanker Test of Inhibitory Control and Attention, which measures response suppression to irrelevant stimuli while maintaining attention to target stimuli. Relationships between BRIEF scores and Flanker Test performance were assessed using Pearson correlation and linear regression, adjusting for sociodemographic factors. Results: Among 84 participants (mean age: 93 months [95% CI, 89-98], 56% male), parent-reported inhibitory problems showed a small but statistically significant correlation with response inhibition performance (r = -0.23, p = 0.04) in unadjusted analyses. This relationship was attenuated after adjusting for demographic and socioeconomic factors. Other behavioral domains showed weaker associations. Adjusted R ² values ranged 0.14-0.16, indicating parent reports explained minimal variance in objective scores. Conclusion: Parent-reported behavioral problems showed limited concordance with objective measures of response inhibition in children with SDB. Treatment decisions for pediatric SDB should not rely solely on parent-reported behavioral symptoms, highlighting the need for integrating objective assessments when feasible. Level of Evidence: 3.

Insufficient physical activity is a widespread health concern, necessitating the broad implementation of evidence-based behavior change interventions. Such evidence commonly derives from randomized controlled trials, but questions arise about who is willing to enroll and actively engage in such trials. This study investigated factors predicting engagement and retention in an online physical activity intervention for inactive parent-child dyads. Participants were recruited from the general Finnish population and assigned to either an intervention or wait-list control group. The intervention consisted of online materials, SMS prompts, and four online sessions. Partial least squares regression models were used to analyze autonomous motivation, parent and child gender, parental education, employment status, and recruitment source as predictors of intervention retention and engagement. Results showed that intervention retention was predicted by higher autonomous motivation, being a mother, social media recruitment, and university education. Session attendance was higher for autonomously motivated parents, fathers, parents of daughters, and university-educated parents. These findings highlight the importance of autonomous motivation and demographic factors in intervention engagement. However, the higher engagement of already motivated participants demonstrates challenges for reaching and intervening on those who might benefit most from such programs. Future research should explore strategies to engage and retain less motivated individuals and investigate reasons behind non-compliance to improve the effectiveness of physical activity interventions for inactive families.