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1.
ObjectiveVictimization by violence elevates adolescents’ risk for developing internalizing and externalizing psychopathology. Recent findings suggest that disruptions in developmental processes associated with post-traumatic stress (PTS) reactions may partially account for the relationship between victimization and the subsequent development of psychopathology during adolescence. The present study tested the temporal sequencing of these associations using multi-informant measurements in a large, diverse sample of adolescents at high-risk for victimization.MethodData were collected from a multi-site consortium of prospective studies, the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Information about 833 youth’s victimization experiences (i.e., direct, indirect, familial, and non-familial violence), PTS, and affective, anxiety, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms were gathered from youth and their caregivers during biannual face-to-face interviews when youth were between the ages of 4 and 14 years, and continuously from official child protective services records.ResultsStructural equation modeling revealed that cumulative victimization contributed to elevations in youth and caregiver reported late childhood and early adolescent psychopathology. While PTS mediated the association between victimization and youth reported ADHD, ODD, CD, major depressive, and generalized anxiety symptoms during adolescence, it only mediated the association between victimization and caregiver reported affective symptoms.ConclusionsPTS reactions following childhood victimization partially accounted for escalations in psychopathology during the transition to adolescence. These findings underscore the importance of integrating trauma-informed assessment and intervention approaches with at-risk adolescents. Researchers should determine whether trauma-focused interventions sufficiently ameliorate other psychopathology among victimized adolescents or if additional interventions components are necessary.  相似文献   

2.
In the present study, witnessing in-home violence and peer relationship quality are evaluated as to their relative impact on Post Traumatic Stress (PTS) symptoms among children aged 8 to 17 investigated by child protective services (CPS) for maltreatment exposure. The sample included 2151 children from the National Survey of Child and Adolescent Well-Being II (NSCAW II). Linear growth models were estimated to assess associations between changes in PTS symptoms, witnessing in-home violence, and peer relationship quality over time. Greater frequency of witnessing in-home violence at baseline (i.e. wave 1) was associated with higher baseline PTS symptoms (β = 0.44). Increases in witnessing in-home violence frequency over time (average annual change across three years) had a strong association with increases in PTS symptoms over time (β = 0.88). Baseline peer relationship quality was associated with fewer PTS symptoms at baseline (β = −0.45). Increases in peer relationship quality over time were strongly associated with declines in PTS symptoms over time (β = −0.68). Peer relationship quality at baseline did not moderate baseline or over time associations between witnessing in-home violence and PTS symptoms. The average decline in PTS symptoms due to decreases in witnessing in-home violence and increases in peer relationship quality was 0.51 and 0.65 standard deviations respectively, over the three-year study period. Reducing chronic witnessing in-home violence and promoting the development of healthy social relationships with peers are critical for PTS symptom recovery.  相似文献   

3.
BackgroundTraumatic events experienced in childhood, particularly those that are perpetrated by someone whom the child trusts or depends upon (i.e., high betrayal traumas [HBTs], such as abuse by a parent) can lead to long-term negative consequences, including a tendency to see oneself in a negative light, low self-compassion, and posttraumatic stress disorder. Although negative psychological consequences of HBTs are well-documented in the literature, little is known surrounding the protective factors that may reduce the effects of HBTs on individuals’ functioning. The present study focused on one potential protective factor, dialectical self-beliefs, that may moderate the negative effects of HBTs experienced in childhood on self-compassion, and hence reduce posttraumatic stress (PTS).ObjectiveThe present study is aimed at determining whether dialectical self-beliefs moderate the indirect effect of HBTs on PTS via self-compassion.Participants and settingData of the present study were collected from 747 college students attending a university in the Northeast region of the United States.MethodUsing a correlational study design, the data of this study were collected from college students through an online survey.ResultsThe results of a moderated mediation analysis indicated that the hypothesized model explained 25% of the variance in PTS. After controlling for low betrayal traumas, the indirect effect of HBTs on PTS through self-compassion was moderated by dialectical self-beliefs. These findings provide support for our hypotheses and suggest that having a dialectical self-view may enhance the adjustment of individuals with a history of HBTs by reducing the negative effect of HBTs on self-compassion.  相似文献   

4.
Few longitudinal studies have analyzed how violence exposure (e.g. child maltreatment, witnessing community violence) influence both externalizing and Post-Traumatic Stress (PTS) symptoms among children in foster care. Data from three waves of the National Survey of Child and Adolescent Well-Being (1999–2007) (NSCAW; National Data Archive on Child Abuse and Neglect, 2002) were analyzed to investigate the change trajectories of both externalizing and PTS symptomatology among children with a substantiated report of child maltreatment by Child Protective Services (CPS) between October 1999 and December 2000. This study uses data collected at three time points: baseline and approximately 18 (Wave 3) and 36 (Wave 4) months post-baseline. The Child Behavior Checklist (CBCL) scale measured externalizing symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model with a sample of n = 280 maltreated youth between the ages of 8 and 15 following home removal. Findings revealed that initial levels of externalizing and PTS symptomatology were both significantly and positively related and co-develop over time. Externalizing symptom severity remained in the borderline range during the first two years in out-of-home care. Both direct and indirect forms of interpersonal violence exposure were associated with initial level of externalizing symptom and PTS symptom severity, respectively. Taken together, our results suggest an underlying process that links early violence exposure to the co-development and cumulative impact of PTS on externalizing behavior above and beyond experiences of maltreatment. We conclude by discussing the key points of intervention that result from a more nuanced understanding of the longitudinal relationship between PTS and externalizing symptoms and the effect of complex trauma on growth in these symptoms over time.  相似文献   

5.
Research Findings: Child care delivery practices promoting continuous, primary caregiver–child relationships (relationship-focused child care) were evaluated for 223 preschool-age children (45% African American, 55% Latino) attending child care centers serving low-income children. Both relationship-focused and non-relationship-focused centers were accredited by the National Association for the Education of Young Children. Children in relationship-focused programs received more sensitive, involved, and affectionate caregiving and were more engaged with their caregivers than children in comparison centers, but some differences were greater for African American children. Outcomes associated with relationship-focused care included greater parent-reported child compliance and closer parent–caregiver relations, but no consistent benefits for cognitive school readiness, receptive language, or child behavior problems were found. Follow-up assessments were completed 1 year later for 119 children who remained in their programs. Social and cognitive outcomes improved over time, but some changes were moderated by child race/ethnicity and center type. Over time, parents reported greater child compliance and caregivers reported better parent–caregiver relationships in relationship-focused programs. Practice or Policy: Some social benefits of continuous, primary caregivers were found, but children's cognitive competencies improved with sustained attendance at these accredited programs regardless of the relationship-focused practices.  相似文献   

6.
BackgroundAlthough prior research has indicated that sexual behavior problems (SBPs) are present among maltreated and non-maltreated children, risk factors for SBPs remain understudied. Further, few studies have examined multiple forms of trauma such as exposure to community violence and several likely important familial and environmental factors have yet to be investigated in the context of SBPs. The use of a more comprehensive ecological model of child, trauma-related, family, and environmental risk factors may help to further delineate the factors that contribute to the development of SBPs.ObjectiveThe aim of the current study was to build upon previous research by utilizing an ecological model that includes child, trauma-related, caregiver and familial, and environmental factors as potential predictors of SBPs.Participants and SettingThe present study was conducted with 1,112 8-year-old children (51.6% female; 48.9% Black) and their primary caregivers from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study.ResultsSeveral child, caregiver, and familial factors, as well as sexual and physical abuse demonstrated bivariate associations with SBPs. A number of these factors remained significant in a regression model, such as child’s living arrangement, child’s aggressive behaviors and posttraumatic stress symptoms (PTSS), sexual and physical abuse, caregiver’s psychological difficulties, and children’s perceptions of family health.ConclusionsThe findings highlight the role of select child, trauma-related, caregiver and familial, and environmental factors in the context of SBPs and also demonstrate the need to examine multiple levels of children’s environments when investigating SBPs.  相似文献   

7.
This study explored differences in caregiver–child interactions following children's information‐seeking questions. Naturalistic speech from thirty‐seven 4‐year‐olds and their caregivers was used to explore children's information‐seeking questions, the caregiver's response, and children's subsequent follow‐up. Half of the families were low‐socioeconomic status (SES) and the other half were mid‐SES. Although children across socioeconomic groups asked a similar proportion of questions, mid‐SES caregivers offered significantly more explanatory responses to causal questions as well as more noncircular explanations than low‐SES caregivers. No differences were found in children's follow‐up to responses given to fact‐based questions; however, after hearing unsatisfactory responses to causal questions, mid‐SES children were significantly more likely to provide their own explanation. Such variability in caregiver–child interaction may have implications for subsequent learning.  相似文献   

8.
Head Start teachers and their aides (n = 24) were assigned to either the experimental or active control treatment in this preliminary investigation on the effects of Child Teacher Relationship Training (CTRT) on 52 disadvantaged preschool children identified with behavioral problems. CTRT is based on the principles and procedures of Child Parent Relationship Therapy (CPRT), a structured, time‐limited approach that trains young children's caregivers to be active participants in an early mental health delivery system. Analysis of pre‐ to mid‐ to posttest findings revealed that, compared to the active control, CTRT demonstrated a large treatment effect on reducing children's externalized behavior problems; furthermore, the between‐group difference over time was statistically significant. The statistical, practical, and clinical significance of findings provide preliminary support for CTRT as a developmentally responsive school‐based intervention for at‐risk preschool children exhibiting clinical levels of behavioral problems. © 2010 Wiley Periodicals, Inc.  相似文献   

9.
Social contexts shape the development of attention; however, little is known about joint attention beyond infancy. This study employed behavioral and eye-tracking measurements to investigate cultural variations in how caregivers direct 3- to 4-year-old children's attention and subsequent changes in children's attention to objects and contextual backgrounds in the United States (predominantly non-Hispanic Whites) and Japan (N = 60 mother-child dyads, 29 girls, 31 boys). The findings revealed that caregivers directed children's attention to culturally sensitive information, and significant cross-cultural differences in attention emerged after caregiver–child interaction, with Japanese children shifting their attention to the backgrounds. Results provide new insights into the role of social interaction and cultural diversity in the development of attention.  相似文献   

10.
In this study of the multiple determinants of professional caregiving, 237 caregivers (age range: 18–56 years) from 64 Dutch child care centers were extensively observed during their interactions with the children (0–4 years) in their usual care group. The choice of potential determinants of the caregiving quality was guided by Belsky's [Belsky, J. (1984). The determinants of parenting: A process model. Child Development, 55, 83–96] model of the determinants of parenting. Consistent with Belsky's model, quality of caregiving was found to be multiply determined by characteristics of the caregiver, the children and the caregiving context. More specifically, lower-quality care was provided by younger caregivers, to younger children, and by caregivers reporting higher physical occupational workloads. The differences between the participating child care centers proved to explain more variance in the quality of professional caregiving than the differences between the individual caregivers.  相似文献   

11.
ObjectivesIn light of the current U.S. family separation crisis, there is growing attention to Childhood Traumatic Separation, defined here as a significant traumatic stress reaction to a familial separation that the child experiences as traumatic. When living in a family setting, Childhood Traumatic Separation may interfere with the child's relationships with the current caregiver(s). Effective treatments for Childhood Traumatic Grief can be modified to address Childhood Traumatic Separation. This article describes current applications of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Childhood Traumatic Separation.MethodsUsing two composite clinical cases, TF-CBT applications for Childhood Traumatic Separation are described. These include: (1) implementing the safety component first; (2) tailoring coping skills to address the uncertainty of Childhood Traumatic Separation; (3) integrating past traumas into trauma narration and processing of the traumatic familial separation; (4) providing Childhood Traumatic Separation-focused components to address challenges of committing to new relationships while retaining connections to the separated parent; and (5) addressing role changes.ResultsThese modifications have been implemented for many youth with Childhood Traumatic Separation and have anecdotally resulted in positive outcomes. Research is needed to document their effectiveness.ConclusionsThe above practical strategies can be incorporated into TF-CBT to effectively treat children with Traumatic Separation.Practical implicationsPractical strategies include starting with safety strategies; tailoring skills components to address the ongoing uncertainty of traumatic separation; integrating past traumas into trauma narration and processing of traumatic separation; providing traumatic separation-focused components to balance the challenges of committing to new relationships with retaining connections to the separation parent; and addressing role changes. Through these strategies therapists can successfully apply TF-CBT for Childhood Traumatic Separation.  相似文献   

12.
BackgroundInvestigations have found mothers’ adverse childhood experiences (ACEs) confer an intergenerational risk to their children's outcomes. However, mechanisms underlying this transmission have only been partially explained by maternal mental health. Adult attachment insecurity has been shown to mediate the association of ACEs and mental health outcomes, yet an extension of this research to children's behavioral problems has not been examined.ObjectiveTo examine the cascade from maternal ACEs to risk for child behavioral problems at five years of age, via mothers’ attachment insecurity and mental health.Participants and settingParticipants in the current study were 1994 mother-child dyads from a prospective longitudinal cohort collected from January 2011 to October 2014.MethodsMothers retrospectively reported their ACEs when children were 36 months of age. When children were 60 months of age, mothers completed measures of their attachment style, depression and anxiety symptoms, and their children's behavior problems.ResultsPath analysis demonstrated maternal ACEs were associated with children's internalizing problems indirectly via maternal attachment avoidance, attachment anxiety, and depression symptoms, but not directly (β = .05, 95% CI [−.001, .10]). Maternal ACEs indirectly predicted children's externalizing problems via maternal attachment avoidance, attachment anxiety, and depression. A direct effect was also observed from maternal ACEs to child externalizing problems (β = .06, 95% CI [.01, .11]).ConclusionsMaternal ACEs influenced children's risk for poor behavioral outcomes via direct and indirect intermediary pathways. Addressing maternal insecure attachment style and depression symptoms as intervention targets for mothers with histories of ACEs may help to mitigate the intergenerational transmission of risk.  相似文献   

13.
BackgroundUnderstanding different longitudinal patterns of traumatic stress reactions in children exposed to intimate partner violence (IPV) can promote early identification of at-risk children.ObjectiveOur study aims to explore trajectories of traumatic stress reactions following childhood IPV exposure, and their relation with parental traumatic stress and child emotional security in the interparental subsystem.Participants and SettingThe sample comprised 303 children (age 3–10, M = 6.20) from families referred to institutions for IPV. Data were collected at home.MethodsThree waves of parent-reported questionnaire data were analyzed using latent class growth analysis and linear regression.ResultsFive trajectories were identified: ‘resilient’, ‘moderate stable’, ‘struggling’, ‘improving’, and ‘elevated adjusting’. Only the ‘struggling’ trajectory had dysfunctional symptom levels at the final wave. Higher parental traumatic stress predicted ‘improving’ trajectory membership (β = 0.17, p = .033), whereas lower parental traumatic stress (β = −0.20, p = .003) and child emotional insecurity (β = −0.45, p = < .001) predicted ‘resilient’ trajectory membership. Higher child emotional insecurity predicted membership in trajectories with higher initial traumatic stress (improving: β = 0.26, p < .001; struggling: β = 0.31, p < .001; elevated adjusting: β = 0.27, p < .001). Child emotional security did not buffer the effect of parental traumatic stress on likelihood of dysfunctional trajectory membership (β = 0.04, p =.380).ConclusionsChildren exposed to IPV show different trajectories of traumatic stress reactions, partly corresponding to trajectories identified in other populations. Child emotional security and parental traumatic stress predict trajectory membership.  相似文献   

14.
The present study was conducted to better understand the influence of the child–perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrator's status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice.  相似文献   

15.
Learning about emotions is an important part of children's social and communicative development. How does children's emotion-related vocabulary emerge over development? How may emotion-related information in caregiver input support learning of emotion labels and other emotion-related words? This investigation examined language production and input among English-speaking toddlers (16–30 months) using two datasets: Wordbank (N = 5520; 36% female, 38% male, and 26% unknown gender; 1% Asian, 4% Black, 2% Hispanic, 40% White, 2% others, and 50% unknown ethnicity; collected in North America; dates of data collection unknown) and Child Language Data Exchange System (N = 587; 46% female, 44% male, 9% unknown gender, all unknown ethnicity; collected in North America and the UK; data collection dates, were available between 1962 and 2009). First, we show that toddlers develop the vocabulary to express increasingly wide ranges of emotional information during the first 2 years of life. Computational measures of word valence showed that emotion labels are embedded in a rich network of words with related valence. Second, we show that caregivers leverage these semantic connections in ways that may scaffold children's learning of emotion and mental state labels. This research suggests that young children use the dynamics of language input to construct emotion word meanings, and provides new techniques for defining the quality of infant-directed speech.  相似文献   

16.
BackgroundIt is estimated that more than half of children living in households where intimate partner violence (IPV) occurs are also exposed to animal cruelty (AC). Although prior research links bonds with pets with higher levels of socioemotional competence among school-age children, exposure to AC may negate the protective effects of pet ownership and/or exacerbate the potentially deleterious effect of IPV on children’s mental health.ObjectiveThe current study evaluates whether and to what extent the associations between exposure to IPV and several indicators of children’s mental health vary as a function of children’s positive engagement with pets and exposure to AC.Participants and SettingParticipants included 204 children (aged 7–12 years; 47% female; 57% Latinx) and their maternal caregiver who were recruited from domestic violence agencies in a western U.S. state.MethodMultiple moderation analysis evaluated whether the association between children’s exposure to IPV and internalizing and posttraumatic stress symptoms vary as a function of children’s positive engagement with pets and exposure to AC.ResultsAnalyses revealed several moderation effects for positive engagement with pets (e.g., internalizing problems: [b = −.15, t(195) = −2.66, p = .008]; posttraumatic stress symptoms: [b = −.13, t(195) = −2.24, p = .026]), whereas exposure to AC only moderated the association between IPV and anxious/depressed symptoms (b = .32, t(195) = −2.41, p = .017).ConclusionsThese findings highlight the potential protective effects of positive engagement with pets and importance of screening for exposure to AC when engaging in trauma-informed work with children exposed to IPV.  相似文献   

17.
This study investigates the reliability and validity of the Child Care Ecology Inventory (CCEI), a measure of the quality of family child care in the social domain. The CCEI focuses on research-based environmental features and caregiving practices for promoting positive social development in preschool-age children. A total of 198 family child care homes in the Northwest USA participated. Good scale reliabilities were found for the measures of the environment (Enrichment and Organization) and for caregivers’ practices (Monitoring, Positive Attention, Promoting Social Skills, and Teaching Rules) and interrater reliability was adequate for research purposes. The CCEI was associated with other commonly used measures of child care quality that assessed similar environmental and caregiving constructs. Linear regression models were run to determine the features of family child care quality that were concurrently associated with observed child behavior. The child–caregiver ratio, Environment Organization, and caregivers’ Teaching Rules were negatively associated with children's problem behavior (noncompliance and aggression). Caregivers’ provision of Planned Activities/Routines and Positive Attention were associated with positive child behavior. Results indicate that different aspects of quality are related to different aspects of children's social interactions and behaviors.  相似文献   

18.
BackgroundForensic interviewers are at a heightened risk for secondary traumatic stress (STS) due to their frequent interactions with victims of child maltreatment (Bonach & Heckert, 2012). To date, however, few studies have examined the negative effects of this work on interviewers’ social and emotional well-being.ObjectiveThe present study seeks to explore the effect of STS on the relationships of forensic interviewers, including those with friends, family, and their respective children.Participants and settingData are derived from a sample of 367 forensic interviewers (FIs) recruited from across the United States.MethodsThe current study used a cross-sectional research design to obtain qualitative and quantitative data from an online survey of certified forensic interviewers.ResultsPersonal-level predictors of STS included interviewers’ sex (β = 0.11, p = 0.02), trauma history (β = 0.13, p = 0.004), and frequency of socializing with family members outside of work (β = -0.12, p = 0.01). Work-related predictors included the frequency of direct (β = 0.10, p = 0.04) and indirect exposures to graphic details of child maltreatment (β = 0.09, p = 0.05), burnout (β = 0.58, p = 0.000), and years of experience investigating crimes against children (β = 0.10, p = 0.03). Factors such as parental status and external social support were not significantly associated with STS in the qualitative analysis.ConclusionsForensic interviewers experience both positive and negative effects of exposure to crimes against children, with work-related factors being particularly impactful on the potential for STS.  相似文献   

19.
ObjectiveTo evaluate the social and emotional adjustment of 219 children in families with varying levels of intimate partner violence (IPV) using a model of risk and protection. To explore factors that differentiate children with poor adjustment from those with resilience.MethodologyMothers who experienced IPV in the past year and their children ages 6–12 were interviewed. Standardized measures assessed family violence, parenting, family functioning, maternal mental health, and children's adjustment and beliefs.ResultsUsing cluster analysis, all cases with valid data on the Child Behavior Checklist, Child Depression Inventory, General Self-Worth and Social Self-Competence measures were described by four profiles of children's adjustment: Severe Adjustment Problems (24%); children who were Struggling (45%); those with Depression Only (11%); and Resilient (20%) with high competence and low adjustment problems. Multinomial logistic regression analyses showed children in the Severe Problems cluster witnessed more family violence and had mothers higher in depression and trauma symptoms than other children. Resilient and Struggling children had mothers with better parenting, more family strengths and no past violent partner. Parents of children with Severe Problems were lacking these attributes. The Depressed profile children witnessed less violence but had greater fears and worries about mother's safety.ConclusionFactors related to the child, to the mother and to the family distinguish different profiles of adjustment for children exposed to IPV who are living in the community. Resilient children have less violence exposure, fewer fears and worries, and mothers with better mental health and parenting skills, suggesting avenues for intervention with this population.Practice implicationsFindings suggest that child adjustment is largely influenced by parent functioning. Thus, services should be targeted at both the child and the parent. Clinical interventions shaped to the unique needs of the child might also be tested with this population.  相似文献   

20.
BackgroundAbusive head trauma (AHT) is a preventable form of child abuse.ObjectiveThis project used a mixed method design to assess the feasibility of the Calm Baby Gently educational baby book intervention for promoting safe practices related to infant crying in an effort to prevent AHT.Participants and settingThree pediatric practices participated between June 2016 and January 2018, including 1045 caregivers who attended their infant’s 2-month well-child visit.MethodsPediatric providers gave the educational baby book to caregivers at the 1-month well-child visit. Caregivers completed a survey at the 2-month well-child visit on their use and satisfaction with the book and responses to infant crying. Thematic analysis of qualitative feedback was performed. Responses to infant crying were compared quantitatively between caregivers who had and had not read the book.ResultsOf the 819 caregivers (78%) who received the book, 92% (754) read it, and 51% (421) had another caregiver read it. Caregivers considered the book approachable, understandable, validating, and helpful for improving knowledge and skills related to infant crying. The book was rated more helpful by caregivers of younger age, male gender, and non-white race. Controlling for age, gender, and race, caregivers who read the book were more confident (p = 0.033) and had more knowledge on how to respond appropriately to infant crying (p = 0.019) than caregivers who had not read it.ConclusionsCalm Baby Gently is a feasible and well-received AHT prevention program. Randomized controlled trials are needed to better understand its impact on knowledge, behavior, and AHT rates.  相似文献   

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