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Pet Dogs and Children’s Health: Opportunities for Chronic Disease Prevention?

Authors:
  • Bassett Medical Center,Cooperstown,NY

Abstract and Figures

Introduction: Positive associations between having a pet dog and adult health outcomes have been documented; however, little evidence exists regarding the benefits of pet dogs for young children. This study investigates the hypothesis that pet dogs are positively associated with healthy weight and mental health among children. Methods: This cross-sectional study accrued a consecutive sample of children over 18 months in a pediatric primary care setting. The study enrolled 643 children (mean age, 6.7 years); 96% were white, 45% were female, 56% were privately insured, and 58% had pet dogs in the home. Before an annual visit, parents of children aged 4 to 10 years completed the DartScreen, a comprehensive Web-based health risk screener administered using an electronic tablet. The screener domains were child body mass index (BMI), physical activity, screen time, mental health, and pet-related questions. Results: Children with and children without pet dogs did not differ in BMI (P = .80), screen time of 2 hours or less (P = 0.99), or physical activity (P = .07). A lower percentage of children with dogs (12%) met the clinical cut-off value of Screen for Child Anxiety and Related Disorders (SCARED-5) of 3 or more, compared with children without dogs (21%, P = .002). The mean SCARED-5 score was lower among children with dogs (1.13) compared with children without dogs (1.40; P = .01). This relationship was retained in multivariate analysis after controlling for several covariates. Conclusions: Having a pet dog in the home was associated with a decreased probability of childhood anxiety. Future studies need to establish whether this relationship is causal and, if so, how pet dogs alleviate childhood anxiety.
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PREVENTING CHRONIC DISEASE
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY
Volume 12, E205 NOVEMBER 2015
ORIGINAL RESEARCH
Pet Dogs and Children’s Health:
Opportunities for Chronic Disease
Prevention?
AnneM.Gadomski,MD,MPH; MelissaB.Scribani,MPH; NicoleKrupa;
PaulJenkins,PhD; ZsoltNagykaldi,PhD; ArdisL.Olson,MD
Suggested citation for this article:
Gadomski AM, Scribani MB,
Krupa N, Jenkins P, Nagykaldi Z, Olson AL. Pet Dogs and
Children’s Health: Opportunities for Chronic Disease Prevention?
Prev Chronic Dis 2015;12:150204. DOI: http://dx.doi.org/
10.5888/pcd12.150204.
PEER REVIEWED
Abstract
Introduction
Positive associations between having a pet dog and adult health
outcomes have been documented; however, little evidence exists
regarding the benefits of pet dogs for young children. This study
investigates the hypothesis that pet dogs are positively associated
with healthy weight and mental health among children.
Methods
This cross-sectional study accrued a consecutive sample of chil-
dren over 18 months in a pediatric primary care setting. The study
enrolled 643 children (mean age, 6.7 years); 96% were white, 45%
were female, 56% were privately insured, and 58% had pet dogs in
the home. Before an annual visit, parents of children aged 4 to 10
years completed the DartScreen, a comprehensive Web-based
health risk screener administered using an electronic tablet. The
screener domains were child body mass index (BMI), physical
activity, screen time, mental health, and pet-related questions.
Results
Children with and children without pet dogs did not differ in BMI
(
P
= .80), screen time of 2 hours or less (
P
= 0.99), or physical
activity (
P
= .07). A lower percentage of children with dogs (12%)
met the clinical cut-off value of Screen for Child Anxiety and Re-
lated Disorders (SCARED-5) of 3 or more, compared with chil-
dren without dogs (21%,
P
= .002). The mean SCARED-5 score
was lower among children with dogs (1.13) compared with chil-
dren without dogs (1.40;
P
= .01). This relationship was retained
in multivariate analysis after controlling for several covariates.
Conclusions
Having a pet dog in the home was associated with a decreased
probability of childhood anxiety. Future studies need to establish
whether this relationship is causal and, if so, how pet dogs allevi-
ate childhood anxiety.
Introduction
Childhood mental illness and obesity are significant public health
problems in the United States (1,2). Because both conditions start
in childhood, preventive and early intervention approaches are
needed. Pet dogs have been linked with varied physical and men-
tal health benefits for adults (3,4), benefits that are promoted by
the US Public Health Service (USPHS) (Figure 1). Although dog
ownership may improve adult physical activity, body weight, and
mental health (5,6), less is known about the relationship between
pet dogs and children’s health. In Australia and the United King-
dom, dog ownership was associated with increased accelerometer-
measured physical activity among children aged 5 to 12 years
(7–9) and a lower likelihood of overweight or obesity among chil-
dren aged 5 to 6 years (10). In those countries, promoting walking
and active play with a dog is an effective strategy to increase chil-
dren’s physical activity. Such studies have not been done in the
United States, so more evidence is needed to support this as a US
strategy.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health
and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0204.htm • Centers for Disease Control and Prevention 1
Figure 1. US Public Health Service flyer, “Pets Promote Health,” describing
benefits of pet ownership.
Children may interact with dogs in other ways that may benefit
them. From a mental health standpoint, children aged 7 to 8 often
ranked pets higher than humans as providers of comfort and self-
esteem and as confidants (11,12). Animal-assisted therapy (AAT)
with dogs affects children’s mental health and developmental dis-
orders by reducing anxiety and arousal or enhancing attachment
(13). Because dogs follow human communicative cues, they may
be particularly effective agents for children’s emotional develop-
ment (14). Despite the evidence for the therapeutic effects of AAT
for certain childhood conditions, little evidence is available for
primary care providers to use when counseling parents regarding
the benefits of pet dogs for young children.
Promoting children’s behavioral and emotional competence is an
effective strategy to prevent mental, emotional, and behavioral dis-
orders during adulthood (15). If exposure to pet dogs during child-
hood is inversely related to mental health problems, positive
child-–-dog interactions could prevent the evolution of these prob-
lems into full-fledged disorders during adolescence or later life.
Studies support this possibility (Figure 2). Our study investigated
the hypothesis that pet dogs are positively associated with healthy
weight and mental health among children.
Figure 2. Model for how pet dogs may influence the physical and mental
health of children aged 4 to 10 years. The model summarizes study findings
regarding how pet dogs promote children’s behavioral and emotional
development, mental health (3,4, 11–13,30), and physical activity (6–10,26).
Methods
This cross-sectional study was conducted at a general pediatric
clinic in an academic medical center at the hub of a not-for-profit
rural health network in Upstate New York. From July 2012
through December 2013, we consecutively recruited parents of
children, aged 4 to 10 years who came to clinic for their annual
check-ups. Over the 18 months, we consecutively enrolled 643
children who were 96% white, 45% female, and 56% privately in-
sured. One child per family was eligible; ill or developmentally
disabled children were excluded. Before the doctor’s check-up the
parent completed the DartScreen, a comprehensive Web-based
child health screener using an electronic tablet (16,17) . A re-
search assistant entered the age, sex, height, and weight measured
by the nurse.
The DartScreen includes questions about somatic and mental
health concerns, nutrition, physical activity, screen time, general
health, anxiety, parental depression, and whether or not the child
has emotional difficulties or difficulties with attention, behavior,
or getting along with others (17). A pet module added to the end
of the DartScreen was automatically triggered by a question about
having pets in the home: “Do you live with a pet in your home?”
If the parent selected “yes,” the screener branched to the kind of
pet. If dog was selected, the screener branched to more detailed
PREVENTING CHRONIC DISEASE VOLUME 12, E205
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
2 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
questions about the dog, including duration of exposure to the pet
dog in the child’s lifetime and time spent being physically active
with the dog. If the family had more than one dog, the parent was
prompted to think of the dog that the child spent the most time
with. The Flesch-Kincaid Reading Ease score for the pet module
was 91 and the grade level was 3.
Mental health measures were 4 widely used and validated assess-
ment tools used for screening but not for formal diagnosis.
DartScreen automatically coded responses and calculated scores
for the validated scales it contains. All parents completed the
SCARED-5, a 5-item scale adapted from the Screen for Child
Anxiety and Related Disorders, a screening tool for childhood
anxiety disorders validated in both psychiatric (18) and primary
care settings (19,20). The abbreviated SCARED-5 has shown psy-
chometrics similar to the full 41-item SCARED screening tool,
which measures general anxiety, separation anxiety, social phobia,
school phobia, and physical symptoms of anxiety. In addition to
analyzing the mean SCARED-5 score, the proportion of children
meeting the SCARED-5 clinical score threshold of 3 or more was
also analyzed.
For children with reported emotional, attention, or behavioral dif-
ficulties, the screener branched to the Strengths and Difficulties
Questionnaire (SDQ) Impact Supplement (21) and, if responses
were positive, to the Pediatric Symptom Checklist (22).The SDQ
inquires whether the child has difficulties in 4 areas (emotion, con-
centration, behavior, and getting along with others) and whether
such difficulties interfere with home life, friendships, classroom
learning, and leisure activities. SDQ questions are scored at 3
levels (0, not at all or a little; 1, a medium amount; 2, a great deal)
to yield an impairment score of 0 to 10 for unlikely, possible, or
probable mental disorder the higher the score, the more prob-
able a mental disorder (21). The PSC-17, adapted from the Pediat-
ric Symptom Checklist (PSC), assesses psychosocial problems
among children and youths aged 6 to 16 years (23). PSC-17 has
been validated against structured psychiatric interviews, and in-
cludes subscales for internalizing, externalizing, and attention con-
ditions; however, it is less accurate for anxiety disorders (23).
Because a parent’s mental health can affect reporting about the
child (24), the DartScreen included the 2-item Patient Health
Questionnaire (PHQ-2), which has a sensitivity of 79% and spe-
cificity of 86% for any depressive disorder (25). We used the
PHQ-2, a commonly used screening test for depression, as a brief
measure of parental depressive symptoms. To be at risk for de-
pression, the parent had to have a score of 3 or higher out of a pos-
sible 6, a cut point that has been validated.
Potential confounders
Research on human–animal interactions requires controlling for
potential covariates such as age, sex, socioeconomic status (SES),
and race/ethnicity, which may account for the differences between
pet owners and nonowners (9,12,26). Families who own pets may
differ from families who do not have pets by several factors that
can also influence a child’s health (26). Among a set of 17 SES in-
dicators, a community's poverty rate was ranked as the leading
measure of socioeconomic environment that is a social determin-
ant of health (27). Family income is also significantly related to
adolescent mental health, accounting for 28% of the prevalence of
DSM IV disorders among adolescents (2). Therefore, we investig-
ated 2 SES proxies: 1) the type of health insurance the child had,
and 2) the percentage of the population living below the 2013
poverty level in the child’s residence zip code (28). In our catch-
ment area, this latter indicator ranges from 4% to 61%. Type of
health insurance (none, Medicaid, Child Health Plus [New York
State Children's Health Insurance Program], or commercial insur-
ance) was not related to the dependent variables. However,
poverty level (percentage of population under the poverty
threshold by zip code) was related to SDQ impact and PSC-17, so
it was used to adjust multivariate analyses.
Sample size
Using the proportion of overweight or obese children in Australia
aged 5 to 6 years who owned a dog (19.8%) and did not own a dog
(25.2%) (10), we estimated that the proportion of overweight US
children among those with dogs versus those without would be
20% and 25% respectively. Assuming a 1-tailed
α
of .05, a sample
of 311 subjects in both of these groups (622 subjects total)
provided a power of .80 for the test of the null hypothesis of no
difference in proportions. Our target sample size was 650, and our
effective sample size was 643 after excluding cases with incom-
plete data or duplicates.
Statistical methods
At the conclusion of data collection, data were de-identified be-
fore analysis. Univariate comparisons of BMI classes, screen time
(dichotomized as ≤2 hours/d vs >2 hours/d), physical activity,
SDQ impairment, PSC-17, SCARED-5, and the child’s history of
mental disorder were made between the pet dog group and the no
pet dog group. Because the distribution of SCARED-5 skewed to
the right, this variable was transformed to square-root values be-
fore analyses. Mean values and 95% confidence intervals were
then back-transformed to display in tables.
Using SAS 9.3 (SAS Institute), continuous variables, such as age,
BMI z-score, total SCARED-5 score and total PSC-17 score, were
PREVENTING CHRONIC DISEASE VOLUME 12, E205
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0204.htm • Centers for Disease Control and Prevention 3
compared between groups by using the
t
test. Categorical vari-
ables, such as BMI classification, parent PHQ-2 positivity,
SCARED-5 score of 3 or greater, 3-level SDQ impairment, and
the child’s history of mental disorder were compared between the
pet dog group and the no pet dog group by using the χ
2
test.
Multivariate analyses were carried out using multiple linear re-
gression for composite outcomes (SCARED-5 and total PSC-17),
and using logistic regression for dichotomous outcomes for
SCARED-5 (≥ 3 vs < 3) and SDQ impairment (SDQ ≥2 vs <2). In
these multivariate models, we controlled for the child’s sex, the
child’s age, the parent PHQ positivity, and percentage of popula-
tion under the poverty threshold in the child’s zip code.
To further delineate the relationship between specific anxiety ele-
ments and dog ownership, we analyzed the 5 screener items of the
SCARED-5. The scores for each item were compared between the
pet dog group and no pet dog group by using the
t
test.
We also conducted subanalyses to assess the relationship between
anxiety and other mental health measures. Specifically, the distri-
bution of 3-level SDQ impairment of function was compared
between children with SCARED-5 of 3 or greater and children
with SCARED-5 of less than 3 by using χ
2
. The 4-item internaliz-
ing subscale of the PSC-17 was also dichotomized at the cut point
and compared with SCARED-5 ≥ 3 by using χ
2
.
The Bassett Hospital Institutional Review Committee approved
this study on March 19, 2012, and reviews it annually for the life
of the study.
Results
Among the 643 enrolled children, 470 (73%) had a pet, 133 (21%)
had no pets, and 40 (6%) were missing all pet data and were as-
signed to the no-pet-dog group. Among the 470 with pets, 4 were
missing data about the type of pet; 3 of these were assigned to the
group with pet dogs because they had answered screener ques-
tions specific to a pet dog. The remaining subject was assigned as
having no pet dog. In the final analysis, 370 (57.5%) children with
a pet dog were compared with 273 (42.5%) with no pet dog.
Mothers most often completed the screener (80% mother, 16%
father, 4% other). A total of 20 parents scored positively on the
PHQ-2 (3.2%), and 14 (2.2%) parents reported family issues they
wished to discuss with the provider during the visit. We observed
no significant difference in parental PHQ-2 between those with
and those without a pet dog (Table 1).
We found no difference between children with and children
without a pet dog in BMI (
P
= .80) or screen time of 2 hours or
more (
P
= .99) (Table 1). We also found no difference for physic-
al activity (
P
= .07). Among families with pet dogs, BMI
z
-score
was not associated with the parent’s reported time that the child
was physically active with the dog (
P
= .15).
Twenty-six children (7.6%) who had pet dogs had a history of a
mental disorder, and 15 (7.0%) children with a mental disorder
history did not have a pet dog (
P
= .76). The mean PSC-17 score
for children with a pet dog was 11.6 versus 12.0 for children
without a pet dog (
P
= .65) (Table 1).
Ninety-nine children (15.7%) had a SCARED-5 score of 3 or
higher. The mean age for children with a positive SCARED-5
score (6.71 years) was virtually identical to those with a negative
SCARED-5 score (6.70 years) (
P
= .95). Girls had higher mean
SCARED-5 scores than did boys; however, there was no differ-
ence in percentage scoring SCARED-5 ≥ 3. In univariate analyses,
the mean SCARED-5 score was significantly lower among chil-
dren with a pet dog (1.13 untransformed, 0.65 transformed) com-
pared with children without a dog (1.40 untransformed, 0.89 trans-
formed,
P
= .02) (Table 1). Duration of pet dog exposure (years) in
the child’s lifetime was not correlated with the SCARED-5 score
(
r
= - 0.087,
P
= .10). Table 2 displays the results for each com-
ponent of SCARED-5 stratified by pet dog or no pet dog. Signific-
ant differences between groups were found for the separation anxi-
ety component (“My child is afraid to be alone in the house”) and
social anxiety component (“My child is shy”) favoring pet owner-
ship.
Among children with a SCARED-5 score of 3 or higher, 18.6%
had an SDQ Impairment score of 2 or higher compared with only
5.5% with an SDQ score of 2 or higher among those with a
SCARED-5 score lower than 3 (
P
< .001). This finding suggests
that the child’s anxiety score was associated with functional
impairment. For children with a SCARED-5 score of 3 or higher,
12.5% scored positively on the internalizing subscale of the PSC-
17. In contrast, only 1.6% of children who scored lower than 3 on
SCARED-5 scored positively on this subscale.
The significant association between pet dog versus no pet dog
groups and SCARED-5 score was maintained in a linear regres-
sion model controlling for poverty level, parent PHQ positivity,
age, and sex (Table 3). This finding was also true in the logistic re-
gression model for children meeting the SCARED-5 score point of
3 or higher. The predicted probability of a SCARED-5 score of 3
or higher was 0.20 for children without pet dogs compared with
0.11 for children with pet dogs. A pet dog in the home was associ-
ated with a 9% decreased probability of a SCARED-5 score of ≥ 3
or higher.
PREVENTING CHRONIC DISEASE VOLUME 12, E205
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
4 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
Discussion
Our study results suggest that children who have a pet dog in the
home have a lower anxiety screening score than children who do
not. A greater percentage (21%) of children without pet dogs than
children with pet dogs (12%) had a SCARED-5 score of 3 or
higher, a point at which further assessment is indicated to dia-
gnose anxiety. The anxiety scores in our study were higher for
girls than boys as were the social and separation anxiety subfactor
distribution. These findings are consistent with those documented
in a predominantly white primary care sample of slightly older
children (8–12 y) (19). Whereas that study showed no variation
with demographic factors, our study found and controlled for an
association between SCARED score and poverty level. Despite
controlling for age, sex, poverty level, and parent PHQ positivity
in our multivariate models, the association between having a pet
dog in the home and a lower child anxiety score remained signific-
ant. However we observed no difference in body weight, screen
time, or physical activity between children with and children
without pet dogs in the home.
Because anxiety disorders often start in childhood, often persist in-
to adulthood, and have the longest delays for treatment (eg, age
20–23 y for social and separation anxiety disorders) , addressing
subthreshold conditions in primary care settings during childhood
is a reasonable target for preventive interventions (2,11,20,21).
Our study findings are more relevant to a discussion of sub-
threshold conditions than of disorders, because this study was of a
primary care population as opposed to a population of children
with diagnosed mental disorders or a clinically referred popula-
tion. Only 18% of children who met the SCARED-5 cutoff also
met SDQ criteria for probable mental disorder, whereas 82% of
children who met the SCARED-5 cutoff did not meet SDQ criter-
ia. This finding is consistent with the relatively high rates of the
different types of anxiety among children, including subthreshold
anxiety symptoms (2).
Pet dogs could reduce childhood anxiety, particularly social and
separation anxiety, by various mechanisms (Figure 2). A pet dog
can stimulate conversation, an ice-breaking effect that can allevi-
ate social anxiety via a social catalyst effect (12). Companionship
with a pet can alleviate separation anxiety and strengthen attach-
ment (13). Social interaction of humans and dogs may also lead to
increased oxytocin levels in both the human and the dog (29). In-
teracting with a friendly dog also reduces cortisol levels most
likely through oxytocin release, which attenuates physiologic re-
sponses to stress (29). These hormonal effects may underlie the
observed emotional and behavioral benefits of AAT and pet dogs.
The advantage of this study is that it used a real-world setting for
data collection, adapted a tablet for in-clinic data collection, and
enabled a more comprehensive analysis of the relationship
between pet dogs and children’s mental health symptoms while
adjusting for several covariates. The study was of children being
seen for preventive care, a far larger and more inclusive group of
children than those in prior human–animal interaction studies,
which focused on children with mental and developmental dis-
orders.
Because this was a cross-sectional study of associations, a correla-
tional study, no cause or effect can be inferred. It may be that less
anxious children have pet dogs or pet dogs make children less
anxious. To make such inferences, a quasi-experimental design is
required in which families who acquire a pet dog are followed lon-
gitudinally with a comparison group. Although AAT lends itself to
randomized controlled trial design, routine pet exposure does not;
however, children spend more time with pets at home than they
would with AAT animals. This study does not answer whether pet
dogs have direct effects on children’s mental health or whether
other factors associated with acquisition of a pet dog benefit their
mental health.
This study was limited by parental report. However, parental con-
cerns about emotional and behavioral problems, if carefully eli-
cited, can detect mental health problems among children age 4
years or older (30). Furthermore, in primary care settings, moder-
ate to high concordance between parents’ and children’s reported
anxiety scores have been documented (19,20). Given the homo-
geneity of this study population (96% white), this study requires
replication in settings that have more racially and ethnically di-
verse populations (20).
The USPHS currently promotes pet dogs for improving adult
physical and mental health (Figure 1). However, more evidence is
needed before promoting interactions between pet dogs and chil-
dren. Yet, pet dog ownership was associated with a 9% reduction
in the probability of a SCARED-5 score of 3 or higher. If this
were an effect size, it could provide significant prevention on a
population level, assuming a broad reach but only if the relation-
ship is found to be causal. However, a prospective study is re-
quired to establish the magnitude of the potential effect as well as
causality. Future research should establish the direction of causal-
ity, the specificity and magnitude of the effect, and its potential
long-term impact on anxiety.
Acknowledgments
This study was funded by Grant No. 1 RO3 NR013873-01 (PI
Anne M. Gadomski) from the National Institute of Nursing Re-
PREVENTING CHRONIC DISEASE VOLUME 12, E205
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0204.htm • Centers for Disease Control and Prevention 5
search, Eunice Kennedy Shriver National Institute of Child Health
and Human Development and the Mars-WALTHAM Centre for
Pet Nutrition, a division of Mars, Incorporated.
Author Information
Corresponding Author: Anne M. Gadomski MD, MPH, Research
Institute, Bassett Medical Center, One Atwell Road, Cooperstown,
NY 13326. | Telephone: 607-547 3066. Email:
anne.gadomski@bassett.org.
Author Affiliations: Melissa B. Scribani, Nicole Krupa, Paul
Jenkins, Research Institute, Bassett Medical Center, Cooperstown,
New York; Zsolt Nagykaldi, University of Oklahoma Health
Sciences Center, Oklahoma City, Oklahoma; Ardis L. Olson MD,
Dartmouth Medical School, Lebanon, New Hampshire.
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the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
6 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
Wren FJ, Berg EA, Heiden LA, Kinnamon CJ, Ohlson LA,
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the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0204.htm • Centers for Disease Control and Prevention 7
Tables
Table 1. Summary Statistics for Children’s (N = 643) Health Indicators and Results of Bivariate Tests for Effects of a Pet Dog in the
Home
Indicator n
a
Sample
Pet Dog in Home
(n = 370)
No Pet Dog in home
(n = 273)
P
Value
b
Female, % 643 45.1 45.1 45.1 .98
Age, mean (95% CI) 643 6.72 (6.55– 6.88) 6.72 (6.50– 6.94) 6.71 (6.46, 6.96) .94
Poverty level, mean (95% CI)
c
643 0.15 (0.14–0.15) 0.15 (0.14– 0.16) 0.15 (0.14– 0.15) .23
Positive on Parent PHQ, % 617 3.2 3.3 3.1 .87
Child history of mental health diagnosis, % 594 7.2 7.5 6.9 .76
PSC-17 score, mean (95% CI)
d
177 11.75 (10.80–
12.70)
11.55 (10.14– 12.96) 11.99 (10.73– 13.25) .65
Screen time ≤2 h/d, % 630 54.9 54.9 54.9 .99
BMI
z
-score, mean (95% CI) 640 0.54 (0.46– 0.63) 0.53 (0.42– 0.65) 0.56 (0.43– 0.68) .80
BMI
e
, %
Normal 423 66.1 65.8 66.5
.80Overweight 108 16.9 17.7 15.8
Obese 109 17.0 16.6 17.7
SCARED-5 score, mean (95% CI)
Mean SCARED-5 (untransformed [raw data]) 630 1.24 (1.14– 1.35) 1.13 (1.00– 1.26) 1.40 (1.23– 1.58) .01
Mean SCARED-5 (transformed) 630 0.74 (0.65– 0.84) 0.65 (0.54– 0.77) 0.89 (0.73– 1.06) .02
SCARED-5 score ≥3, % 630 15.7 12.0 21.0 .002
SDQ impact scores, %
Normal (SDQ = 0) 551 87.7 89.0 85.9
.33Borderline (SDQ = 1) 29 4.6 4.7 4.6
Abnormal (SDQ ≥2) 48 7.6 6.3 9.5
Abbreviations: BMI, body mass index; CI, confidence interval; PHQ, PSC, Pediatric Symptom Checklist; SCARED, Screen for Child Anxiety and Related Disorders;
SDQ, Strengths and Difficulties Questionnaire Impact Supplement.
a
The number for covariates. These numbers do not equal 643 in cases where data were missing for the given covariate.
b
P
value is for having a dog versus not having a dog.
c
Percentage of population below the poverty level in NY by zip code.
d
The screener branched to the Pediatric Symptom Checklist if the SDQ Impact Supplement was positive. Therefore not all children were screened with the PSC.
e
We used the CDC definitions for the 3 child BMI classes (normal, overweight, obese): overweight = BMI ≥85th percentile and <95th percentile for children of the
same age and sex; obesity = BMI ≥95th percentile for children of the same age and sex).
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8 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
Table 2. Screen for Child Anxiety and Related Disorders (SCARED-5) Component Questions Comparing Children With a Pet Dog with
Children Without A Pet Dog
Question Pet Dog in Home, Mean No Pet Dog in Home, Mean
P
Value
My child gets really frightened for no reason at all. 0.14 0.20 .07
My child is afraid to be alone in the house. 0.31 0.42 .02
People tell me that my child worries too much. 0.13 0.14 .99
My child is scared to go to school. 0.07 0.06 .64
My child is shy. 0.49 0.60 .01
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PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
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the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
www.cdc.gov/pcd/issues/2015/15_0204.htm • Centers for Disease Control and Prevention 9
Table 3. Multivariate Regression Showing Relationship Between Having a Pet Dog in the Home and Child Body Mass Index
Z
-Score
and Child Mental Health Indicators, Adjusted for Poverty Level, Parent PHQ Positivity, Age, And Sex
Variable
β
Coefficient
a
SE 95% CI
P
Value
Child BMI
z
score 0.01 0.09 −0.16 to 0.19 .87
SCARED-5 −0.27 0.11 −0.49 to 0.06 .01
PSC-17 score −0.70 0.89 −2.46 to 1.06 .43
Variable Odds Ratio
b
SE 95% CI
P
Value
SCARED-5 score ≥3 0.49 0.23 0.31 to 0.77 .002
SDQ score ≥2 0.63 0.30 0.35 to 1.15 .13
Abbreviations: BMI, body mass index; CI, confidence interval; PSC-17, Pediatric Symptom Checklist-17; SCARED-5, Screen for Child Anxiety and Related Disorders-
5; SDQ, Strengths and Difficulties Questionnaire.
a
Linear regression results are shown for BMI z score, SCARED-5 score, and PSC-17 score.
b
Logistic regression result is shown for the binary outcomes of SCARED-5 score. <3 vs ≥3. and SDQ score, <2 vs ≥2 .
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PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY NOVEMBER 2015
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the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
10 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2015/15_0204.htm
... Several potential pathways through which pets may facilitate child development have been suggested. For example, pet attachment can improve a child's social-cognitive and social-emotional development, and psychosocial health [27][28][29]. Positive attitudes and affiliative interactions with pets may enhance well-being [30]. Owning pets may provide children with opportunities to control their emotions [23]. ...
... However, a prospective study has suggested that a strong bond with a dog results in less time spent with others [39]. Other studies have shown no evidence of an impact of family dog ownership on social developmental outcomes among children aged 4-10 years [29], and on social functioning and psychosocial health of adolescents [40]. The significantly reduced risk of developmental delay in the personal-social domain was found only among "always" dog owners in the current study; this indicates that the duration of time lived with a dog may be important. ...
... First, this study assessed family dog ownership status at several points within a very small age range. There appears to be no long-term behavioral benefit from acquiring a pet dog, as child behavior only improved when the child first acquired the dog [29,39]. Studies with more time points and a wider age range are needed to elucidate the impact of the timing of pet acquisition and duration of the time spent with dogs. ...
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... We also specifically defined past pet ownership as previously sharing the same residence as one of the aforementioned animals prior to participation, excluding current pets. These animals were chosen based on their local prevalence and existing literature reports of the relationship of ownership of these pets on human physical activity, mental health and atopic conditions 4,10,16,22,26,27 . All other participants were considered non-pet owners. ...
... Thirdly, our findings also support pet-assisted therapies for hospital inpatients, palliative care patients, psychiatric patients and nursing home residents. There is a growing body of supportive evidence for animal-assisted therapy 10,67,68 as a form of social support 69 to improve mental health 70 , which has clinical implications in cognitive function 71,72 , mental disabilities and developmental disorders 10,73 . Pet therapy has also been shown to significantly reduce self-reported stress and anxiety levels 43 . ...
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Although existing literature increasingly suggests a positive influence of pet ownership on human physical activity levels, results from many European, American, and Japanese studies have been inconsistent. How pet ownership impacts mental health and atopy is likewise controversial and whether distinct demographic subgroups experience differential effects is unclear. This cross-sectional study surveyed participants (n = 823) via a self-administered online questionnaire. Comparisons of outcomes between pet owners and non-pet owners with subgroup analyses were performed within a propensity score-matched subset (n = 566) of respondents. There were no differences in physical activity levels or mental health scores between pet owners and non-pet owners. In subgroup analyses, compared to non-pet owners, main pet caregivers reported 14.1 (95% CI 2.79–25.3) and 19.0 (95% CI 4.70–33.3) more minutes per week of moderate- and vigorous-intensity physical activity respectively and higher SF-36 emotional well-being (β = 2.7, 95% CI 0.100–5.32) and energy scores (β = 3.8, 95% CI 0.410–7.27). Age was a significant effect modifier of the association between pet ownership and emotional well-being, energy and social functioning scores, with greater scores above the ages of 39, 35 and 39 years old respectively (interaction p = 0.043, 0.044, 0.042). Finally, pet acquisition was associated with worsening of allergic rhinitis, while pet ownership cessation was associated with improvement of allergic rhinitis and eczema symptoms. To our knowledge, this is the first study addressing the public health impact of pet ownership in Southeast Asia and its findings add contextual nuance to suggest potential benefits derived from pet ownership.
... Test-retest reliability was most frequently evaluated using intraclass 178, 179, 184, 187-190, 192-194, 196, 197, 201, 202, 206 175,177,184,189,191,192,194,196,198,200,202,204,207,213 176, 178-180, 188, 190, 193, 197, 199, 201, 203, 206, 208- 175-177, 180, 181, 184, 186, 187, 190, 192-194, 197, 198, 200-203, 206, 209 179,185,188,189,191,195,196,199,204,205,208,211,216,218 177, 178, 181, 183, 190-194, 196, 199, 202-204, 206, 207, 209 ...
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To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit. A mixed methods design was used. English-speaking parents were recruited from 3 primary care systems (urban MD and rural NY and VT) when they presented for a well-child visit with a child 4 to 10 years of age. Parents completed an electronic previsit screen, which included somatic concerns, health risks, and 4 mental health tools (SCARED5, PHQ-2, SDQ Impact, and PSC-17). Parents completed an exit survey, and a subset were interviewed. All primary care providers (PCPs) were interviewed. A total of 120 parents and 16 PCPs participated. The exit surveys showed that nearly 90% of parents agreed or strongly agreed that the screener was easy to use and maintained confidentiality. During interviews, parents noted that the screener helped with recall, validated concerns, reframed issues they thought might not be appropriate for primary care, and raised new questions. PCPs thought that the screener enabled them to normalize sensitive issues, and it permitted them to simultaneously focus and be comprehensive during the visit. Parents and PCPs agreed that the screener helped guide discussion, promoted in-depth exchange, and increased efficiency. Findings were consistent across quantitative and qualitative methods and between parents and PCPs. A comprehensive electronic previsit screening tool is an acceptable and practical strategy to facilitate well-child visits. It may help with problem identification as well as with setting agendas, engaging the family, and balancing attention between somatic and psychosocial concerns.
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Animal-assisted therapy (AAT) has been practiced for many years and there is now increasing interest in demonstrating its efficacy through research. To date, no known quantitative review of AAT studies has been published; our study sought to fill this gap. We conducted a comprehensive search of articles reporting on AAT in which we reviewed 250 studies, 49 of which met our inclusion criteria and were submitted to meta-analytic procedures. Overall, AAT was associated with moderate effect sizes in improving outcomes in four areas: Autism-spectrum symptoms, medical difficulties, behavioral problems, and emotional well-being. Contrary to expectations, characteristics of participants and studies did not produce differential outcomes. AAT shows promise as an additive to established interventions and future research should investigate the conditions under which AAT can be most helpful.
Article
Objective: To replicate and extend work on the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED), a child and parent self-report instrument used to screen for children with anxiety disorders. Method: The 41-item version of the SCARED was administered to a new sample of 190 outpatient children and adolescents and 166 parents. The internal consistency, discriminant, and convergent validity were assessed. In addition, using discriminant function analysis, a briefer version of the SCARED was developed. Results: Using item analyses and factor analyses on the 41-item version, 5 factors were obtained: panic/somatic, generalized anxiety, separation anxiety, social phobia, and school phobia. In general, the total score and each of the 5 factors for both the child and parent SCARED demonstrated good internal consistency and discriminant validity (both between anxiety and depressive and disruptive disorders and within anxiety disorders). A reduced version of the SCARED yielded 5 items and showed similar psychometrics to the full SCARED. Conclusions: In a new sample, the authors replicated their initial psychometric findings that the SCARED is a reliable and valid instrument to screen for childhood anxiety disorders in clinical settings. Furthermore, pending future research, the 5-item SCARED appears to be a promising brief screening inventory for anxiety disorders in epidemiological studies.
Article
Community epidemiological data on the prevalence and correlates of adolescent mental disorders are needed for policy planning purposes. Only limited data of this sort are available. To present estimates of 12-month and 30-day prevalence, persistence (12-month prevalence among lifetime cases and 30-day prevalence among 12-month cases), and sociodemographic correlates of commonly occurring DSM-IV disorders among adolescents in the National Comorbidity Survey Replication Adolescent Supplement. The National Comorbidity Survey Replication Adolescent Supplement is a US national survey of DSM-IV anxiety, mood, behavior, and substance disorders among US adolescents based on face-to-face interviews in the homes of respondents with supplemental parent questionnaires. Dual-frame household and school samples of US adolescents. A total of 10,148 adolescents aged 13 to 17 years (interviews) and 1 parent of each adolescent (questionnaires). The DSM-IV disorders assessed with the World Health Organization Composite International Diagnostic Interview and validated with blinded clinical interviews based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Good concordance (area under the receiver operating characteristic curve ≥0.80) was found between Composite International Diagnostic Interview and Schedule for Affective Disorders and Schizophrenia for School-Age Children diagnoses. The prevalence estimates of any DSM-IV disorder are 40.3% at 12 months (79.5% of lifetime cases) and 23.4% at 30 days (57.9% of 12-month cases). Anxiety disorders are the most common class of disorders, followed by behavior, mood, and substance disorders. Although relative disorder prevalence is quite stable over time, 30-day to 12-month prevalence ratios are higher for anxiety and behavior disorders than mood or substance disorders, suggesting that the former are more chronic than the latter. The 30-day to 12-month prevalence ratios are generally lower than the 12-month to lifetime ratios, suggesting that disorder persistence is due more to episode recurrence than to chronicity. Sociodemographic correlates are largely consistent with previous studies. Among US adolescents, DSM-IV disorders are highly prevalent and persistent. Persistence is higher for adolescents than among adults and appears to be due more to recurrence than chronicity of child-adolescent onset disorders.
Article
The aim of this study was to examine the influence of maternal health status (MHS) on the relationship between child health conditions and child health status (CHS). The study sample included 38 207 children aged 5 to 17 years in the 2001 to 2008 National Health Interview Surveys whose mothers were the survey respondent for the child and herself. Information was collected about CHS, MHS, diagnosed child health conditions, and sociodemographic characteristics. Responses to a question on general health status were used to rate CHS and MHS as "better" (excellent/very good health) or "worse" (good/fair/poor health). The percentage of children with worse CHS, adjusted for sociodemographic characteristics, was estimated using logistic regression. Adjusting for child and family sociodemographic characteristics had a negligible effect on the association between CHS and a 4-level variable that classified children by both MHS and child health conditions. The adjusted percentage of children with worse CHS was higher among children whose mothers had worse MHS compared with children whose mothers had better MHS. Moreover, among children whose mothers had worse MHS, there was a weak relationship between child health conditions and worse CHS. Among children whose mothers had better MHS, there was a strong relationship between child health conditions and worse CHS. Because mother-reported CHS is used widely in epidemiological studies as a measure of a child's actual state of health, it is important to consider how maternal characteristics may influence a mother's report of a child's status. In particular, CHS reported by mothers with worse health status merits further investigation.