Saudi Cultural Missions Theses & Dissertations
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Item Restricted Determinants of Traumatic Dental Injuries Among Adolescents in England A secondary analysis of the Children’s Dental Health Survey 2013(University College London, 2024-09) Asiri, Ali; Tsakos, Georgios; Blokland, AlexBackground: Adolescents are particularly vulnerable to traumatic dental injuries (TDI), which have a higher global prevalence in this age group. This study aimed to explore the associations between various demographic, clinical, behavioral, and socioeconomic risk factors with TDI among 12- and 15-year-old adolescents in England. Methods: This is a cross-sectional study and secondary data analysis of the Children’s Dental Health Survey 2013 (CDHS2013), using a nationally representative sample. A total of 2,126 adolescents were included after excluding cases with missing data (differences between the analytical sample and those with missing data were negligible). The analysis employed appropriate survey weights and examined demographic (age, sex, ethnicity), clinical (positive overjet, dental caries), behavioral (smoking, alcohol drinking), and socioeconomic factors (free school meals (FSM) eligibility , area deprivation, rural/urban classification) using multivariable logistic regression to model associations with TDI. Results: The overall prevalence of TDI in the sample was 10.98%. In the fully adjusted model, male adolescents were more likely to experience TDI compared to females (OR=0.64, 95% CI= 0.43-0.95). Adolescents who had never consumed alcohol had 37% lower odds of developing TDI (OR=0.63, 95% CI= 0.42-0.94). All other demographic and behavioral risk factors, as well as clinical and socioeconomic factors were not significantly associated with TDI. Conclusions: The study identified two key risk factors for TDI: being male and alcohol consumption. These findings highlight the importance of emphasizing on these risk factors while planning for preventive interventions and public health campaigns on TDI. Future research should adopt longitudinal designs to better assess the temporal relationship between these risk factors and TDI and include a broader range of variables for a more comprehensive understanding of TDI etiology.25 0Item Restricted The Association Between Head and Neck Injuries Requiring Medical Attention and Behavioural Problems Among 7- and 14-Year-Old Adolescents Living in the United Kingdom A Secondary Data Analysis of the UK Millennium Cohort Study (MCS)(University College London, 2024-09) AlRugaibah, Norah; Blokland, Alex; Sifaki, MariaBackground: Injuries are major public health problems that affect children’s lives. Behavioural problems have been linked to increased risk of injury incidence. However, few studies discussed the association between externalising and internalising behavioural problems and head and neck injuries among children and adolescents. Aim: This study aims to examine the association between head and neck injuries requiring medical attention and behavioural problems among 7- and 14-year-old youth living in the UK. Methods: A secondary analysis of data from the Millennium Cohort Study (MCS) was conducted using the fourth and sixth sweeps when the participants were 7 and 14 years old. The outcome indicated whether the child had sustained any head and neck injuries since the last survey. Behavioural problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales of externalising and internalising behaviour. In the analysis both scales were dichotomised (10% highest scores) to discern those experiencing severe difficulties. Demographic, family, and socioeconomic factors were used as covariates. Weighted analysis using regression modelling was used to examine the associations between behavioural problems and head and neck injuries. Results: The prevalence of head and neck injuries for 7- and 14-year-olds were 9.35% and 6.23% respectively. Externalising behavioural problems at age 7 were reported for just under 10% of the children, and nearly 9% were reported to experience Internalising problems. At age 14, over 10% of the sample presented with externalising behavioural problems, and nearly 8% with Internalising behaviours. Children aged 7 years who presented with externalising difficulties had a significantly higher risk of head and neck injuries in the crude model (OR=1.41, 95%CI: 1.02–1.93). However, this association became non-significant after controlling for child characteristics. In the crude model, there was no difference in head and neck injury odds between children with internalising behavioural problems and their peers at age 7 (OR=1.00, 95%CI: 0.67–1.48). The association remained non-significant after subsequent adjustments. For 14-year-olds, those who with externalising problems appeared to have higher odds of head and neck injuries compared to their peers, although not statistically significant in the crude model (OR=1.25, 95%CI: 0.79–1.98) or after adjustments (final model: OR=1.27, 96%CI: 0.80 – 2.02). There was no difference between children aged 14 experiencing internalising difficulties and their peers in the crude model (OR=0.69, 95%CI: 0.35–1.36) or after adjustments (final model: OR=0.69, 96%CI: 0.36 – 1.32). Conclusion: This study indicated that children aged 7 with externalising behavioural problems were at higher risk for head and neck injuries. However, after adjusting for confounding factors, this association became non-significant. In early adolescence (age 14), such injuries were not significantly associated with externalising difficulties. Internalising problems showed no significant association with head and neck injuries in either age group.13 0Item Restricted The Knowledge of Autism Spectrum Disorder Among Male and Female Public Education Teachers in Jeddah, Saudi Arabia.(Nottingham Trent University, 0024-07) Alobaidi, Batool; Dillon, GayleThis study investigated teachers' knowledge of autism spectrum disorder (ASD) in Jeddah, Saudi Arabia, and examined what factors influenced the knowledge that teachers had. In Saudi Arabia, ASD is common but often diagnosed late (Hayat et al., 2019). This highlights the need to assess teachers' ASD knowledge, as they are well-positioned to notice signs of ASD. Understanding teachers' awareness can guide targeted training programs, improving early detection and support for students with ASD. Participants included 197 male and female teachers from public schools who completed the Autism Spectrum Knowledge Scale-General Population (ASKSG, 2019) and the Knowledge about Childhood Autism among Health Workers (KCAHW, 2008) scale. The findings revealed that participants demonstrated an average level of knowledge across both scales, scoring below average on the ASKSG but above average on the KCAHW, suggesting a potential gap in understanding ASD. Teachers with prior contact with individuals with ASD spectrum exhibited significantly higher ASD knowledge compared to those without such exposure, underscoring the impact of firsthand experience. Contrary to expectations, no significant differences in ASD knowledge were found based on gender, teaching experience, or school level taught between all educational levels, be it primary, secondary, or high school. The results aligned with previous regional studies (Alharbi et al.,2021; Otaif et al.,2019) documenting weak to moderate ASD knowledge among Saudi Arabian educators. Due to the findings from previous studies in Saudi Arabia until this study, which find that teachers' ASD knowledge has not improved, the study accentuates the pressing need for intensified and reinvigorated ASD training initiatives tailored to teachers, emphasising immersive, experiential learning modalities. By addressing the identified knowledge gaps and recognized limitations, further research efforts can help to provide a comprehensive understanding of teachers' knowledge of ASD. These studies will help to develop comprehensive and tailored programs to provide teachers with the knowledge needed to support children with ASD best.6 0Item Restricted Reducing Type 1 Childhood Diabetes in Saudi Arabia by Identifying and Modelling Its Key Performance Indicators(Royal Melbourne Institute of Technology, 2024-06) Alazwari, Ahood; Johnstone, Alice; Abdollahain, Mali; Tafakori, LalehThe increasing incidence of type 1 diabetes (T1D) in children is a growing global health concern. Reducing the incidence of diabetes generally is one of the goals in the World Health Organisation’s (WHO) 2030 Agenda for Sustainable Development Goals. With an incidence rate of 31.4 cases per 100,000 children and an estimated 3,800 new cases per year, Saudi Arabia is ranked 8th in the world for number of T1D cases and 5th for incidence rate. Despite the remarkable increase in the incidence of childhood T1D in Saudi Arabia, there is a lack of meticulously carried out research on T1D in children when compared with developed countries. In addition, it is crucial to recognise the critical gaps in current understanding of diabetes in children, adolescents, and young adults, with recent research indicates significant global and sub-national variations in disease incidence. Better knowledge of the development of T1D in children and its associated factors would aid medical practitioners in developing intervention plans to prevent complications and address the incidence of T1D. This study employed statistical, machine learning and classification approaches to analyse and model different aspects of childhood T1D using local case and control data. In this study, secondary data from 1,142 individual medical records (359-377 cases and 765 controls) collected from three cities located in different regions of Saudi Arabia have been used in the analysis to represent the country’s diverse population. Case and control data matched by birth year, gender and location were used to control confounders and create a more robust and clinically relevant model. It is well documented that genetic and environmental factors contribute to childhood T1D so a wide range of potential key performance indicators (KPIs) from the literature were included in this study. The collected data included information on socioeconomic status, potential genetic and environmental factors, and demographic data such as city of residence, gender and birth year. Several techniques, such as cross-validation, hyperparameter tuning and bootstrapping, were used in this study to develop models. Common statistical metrics (coefficient of determination, R-squared, root mean squared error, mean absolute error) were used to evaluate performance for the regression models while for the classification models accuracy, sensitivity, precision, F score and area under the curve were utilised as performance measures. Multiple linear regression (MLR), artificial neural network (ANN) and random forest (RF) models were developed to predict the age at onset of T1D for all children 0-14 years old, as well as for the most common age group for onset, the 5-9 year olds. To improve the performance of the MLR models, interactions between variables were considered. Additionally, risk factors associated with the age at onset of T1D were identified. The results showed that MLR and RF outperformed ANN. The logarithm of age at onset was the most suitable dependent variable. RF outperformed the others for the 5-9 years age group. Birth weight, current weight and current height influenced the age at onset in both age groups. However, preterm birth was significant only in the 0-14 years cohort, while consanguineous parents and gender were significant in the 5-9 age group. Logistic regression (LR), random forest (RF), support vector machine (SVM), Naive Bayes (NB) and artificial neural network (ANN) models were utilised with case and control data to model the development of childhood T1D and to identify its key performance indicators. Full and reduced models were developed to determine the best model. The reduced models were built using the significant factors identified by the individual full model. The study found that full LR had the highest accuracy. Full RF and SVM with a linear kernel also performed well. Significant risk factors identified as being associated with developing childhood T1D include early exposure to cow’s milk, high birth weight, positive family history of T1D and maternal age over 25 years. Poisson regression (PR), RF, SVM and K-nearest neighbor (KNN) were then used to model the incidence of childhood T1D, taking in the identified significant risk factors. The interactions between variables were also considered to enhance the performance of the models. Both full and reduced models were created and compared to find the best models with the minimum number of variables. The full Poisson regression and machine learning models outperformed all other models, but reduced models with a combination of only two out of three independent variables (early exposure to cow’s milk, high birth weight and maternal age over 25 years) also performed relatively well. This study also deployed optimisation procedures with the reduced incidence models to develop upper and lower yearly profile limits for childhood T1D incidence to achieve the United Nations (UN) and Saudi recommended levels of 264 and 339 cases by 2030. The profile limits for childhood T1D then allowed us to model optimal yearly values for the number of children weighing more than 3.5kg at birth, the number of deliveries by older mothers and the number of children introduced early to cow’s milk. The results presented in this thesis will guide healthcare providers to collect data to monitor the most influential KPIs. This would enable the initiation of suitable intervention strategies to reduce the disease burden and potentially slow the incidence rate of childhood T1D in Saudi Arabia. The research outcomes lead to recommendations to establish early intervention strategies, such as educational campaigns and healthy lifestyle programs for mothers along with child health mentoring during and after pregnancy to reduce the incidence of childhood T1D. This thesis has contributed to new knowledge on childhood T1D in Saudi Arabia by: * developing a predictive model for age at onset of childhood T1D using statistical and machine learning models. * predicting the development of T1D in children using matched case-control data and identifying its KPIs using statistical and machine learning approaches. * modeling the incidence of childhood T1D using its associated significant KPIs. * developing three optimal profile limits for monitoring the yearly incidence of childhood T1D and its associated significant KPIs. * providing a list of recommendations to establish early intervention strategies to reduce the incidence of childhood T1D.14 0Item Restricted An evaluation of the Rashaka Initiative: a school-based obesity intervention in Makkah City, Saudi Arabia(University of Technology Sydney, 2024-03) Banany, Mohammed; Sibbritt, David; Gebel, KlausBackground: Childhood overweight and obesity are public health issues worldwide. In Saudi Arabia, in 2016/2017 the Rashaka Initiative, a national school-based, multicomponent, weight-related intervention, was launched to decrease the prevalence of obesity among students by 5% within five years. Neither the development stage of the initiative nor its implementation has been evaluated to explore its processes and outcomes. Aim: This study was aimed at evaluating the implementation of the Rashaka Initiative in intermediate and secondary schools in Makkah City, Saudi Arabia, covering both process and outcome. To this end, the following objectives were pursued: (1) to develop an evaluation framework that can be used to assess the processes and outcomes of the initiative, (2) to determine whether there was a change in students’ body mass indices (BMIs) during the implementation period, and (3) to explore the knowledge and attitudes of the Rashaka stakeholders regarding the perceived barriers and facilitators of implementation in their schools. Methods: This retrospective study, conducted after the implementation of the Rashaka Initiative, was completed in three phases. In phase I, a conceptual framework called the school-based weight-related intervention evaluation framework (SWIEF) was developed by integrating some elements of the program evaluation framework used by the US Centers for Disease Control and Prevention (CDC) with the components of a logic model. In phase II, secondary data from the Rashaka Initiative were analysed. Phase III was a cross-sectional exploration of the Rashaka stakeholders’ knowledge and attitudes as well as what they perceive as facilitators and barriers to implementing the intervention at their schools. Results: The comprehensive literature review yielded a published systematic review (Banany et al. 2024, Systematic Reviews). This systematic review found 11 school-based weight-related intervention studies in the six Gulf Cooperation Council countries (GCC). Despite the methodological limitations of some of these studies, there is preliminary evidence of the possible benefits of school-based interventions on students' weight and associated lifestyle factors in these countries. A review of the literature also facilitated the development of the SWIEF. The analysis of the secondary data revealed a significant reduction in BMI (p<0.001) across schools that participated in the Rashaka Initiative over two school years (2016/17 and 2018/19). However, this reduction was not associated with the school environmental factors attributed to the initiative. The study findings found that students’ BMIs decreased more considerably in girls’ and intermediate schools than in boys’ and secondary schools (p<0.001 and p=0.031, respectively). The cross-sectional study indicated that significantly better knowledge of risk factors and interventions for childhood obesity was exhibited by female Rashaka stakeholders (vs their male counterparts), stakeholders who completed tertiary education (vs those with lower education levels) and stakeholders engaged in the initiative for more than two years (vs participants who joined more recently) (p<0.001, p<0.007 and p<0.033, respectively). School health counsellors had more positive attitudes towards children’s health and weight than principals (p<0.008). Significantly more favourable attitudes towards the Rashaka intervention were also found among female stakeholders (p<0.011) and those with better knowledge of the initiative’s objectives, components, activities, and outcomes (p<0.049). Among the stakeholders, 73% perceived collaboration with different government and private sector institutions as the most common facilitator of the Rashaka implementation at their schools, while 69% perceived a lack of time as the main barrier. Conclusions: Addressing childhood obesity is a public health priority that requires substantial efforts from all relevant key stakeholders in Saudi Arabia. The evidence derived in this thesis revealed that the Rashaka Initiative has yet to satisfy its objectives. Future studies should be more rigorous, theory-based, and holistic to tackle obesity among school students. Evaluations of school-based obesity interventions should use control groups, validated and reliable measures and rigorous data analysis. Long-term monitoring of the implemented interventions is highly recommended for their improvement and sustainability.27 0Item Restricted Predictors Associated with The Success Rate of Dental Procedures Performed on Children Treated Using Oral Conscious Sedation(Rutgers the State University of New Jersey, 2024) Alagl, Haifa; Caceda, Jorge H.Purpose: The purpose of this study was to describe, and compare the survival rate of dental procedures performed on healthy children using oral conscious sedation and to determine if age, recalls post treatment, distance traveled, and type of dental insurance were associated with the success rate of dental procedures. Methods: Dental records of 457 healthy children ages 36-60 and 61-84 months who had dental procedures performed using oral conscious sedation (OCS) by postdoctoral students of the Department of Pediatric Dentistry & Community at Rutgers School of Dental Medicine between the years 2014-2021 were retrieved from the Axium electronic health records and analyzed using the Cox Regression Model. Number of recalls, type of insurance, and distance travelled were recorded and analyzed in relation to the survival rate of dental procedures. Results: Stainless steel crowns and composite restorations showed the highest success rate when compared to strip crowns and pulpotomies (p=<0.00). Age, number of recalls, type of insurance, and distance travelled were not statistically significant in relation to the success rate of dental procedures. A significant difference was found when the type of insurance and distance travelled were compared for the recall and no recall groups. Conclusions: The COX regression model showed that age, recall visits, type of dental insurance, and distance were not statistically significant in relation to the success or failure rate of dental procedures. Stainless steel crowns and composite restorations showed the highest success rate. The type of dental insurance and distance travelled were found to be statistically significant in relation to recall and no recall groups.12 0Item Restricted Childhood Obesity and Weight Stigma: A Public Health Nutrition Approach(University of Glasgow, 2024-04-20) Abuznada, Salma; Combet, Emilie; Garcia, AdaPoor understanding of obesity, its causes and consequences contribute to weight-related stigma in the UK. Children’s understanding of obesity shapes their views and perceptions towards obesity as a disease, body image, and weight stigma behaviours. Exploring children’s and adolescents’ knowledge, perceptions and views of obesity, weight stigma, and nutrition is essential to establishing effective health promotion programmes that cater to young people’s needs, understanding and perspectives. Successful programmes also need continuous monitoring and evaluation, which are currently lacking in the UK. Perceptions and views around obesity among the public vary in different cultures and among healthcare professionals. These different perspectives lead to debates on defining, managing and treating obesity. Weight stigma research in adults tends to focus on weight stigma due to the poor understanding of obesity both among the public (especially women of white ethnicity) and healthcare professionals rather than children and adolescents. This thesis uses systematic reviews and a mixed-methods approach to explore weight stigma across the age spectrum, including children, adolescents and adults. Furthermore, the research investigates children’s and adolescents’ views on obesity and nutrition knowledge. Study 1 systematically reviewed existing observational, quantitative and qualitative studies focusing on the sources, frequency and implications of weight stigma on children’s and adolescents’ mental health, well-being and eating behaviours. The Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) were followed for study selection, screening and data extraction. Synthesis Without Meta-Analysis (SWiM) guidelines were applied to report the synthesis and results. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute (NHLBI) was used to assess the quality of the included studies. Twenty observational studies were included in the final text analysis. Synthesised evidence highlighted that bullying and victimisation play a fundamental role in developing and perpetuating weight-related stigma. Weight-related bullying was correlated with participants’ low self-esteem. Most of the included studies (N=15/20) were of fair quality (average score 5 to 8), although two were of poor quality (average score 0 to 4), and most of the quality criteria were not met. One of the main gaps identified during the literature search in Study 1 was children and adolescents were poorly represented in the studies, with an overemphasis on white adult women. After identifying existing gaps in the literature (e.g., the overemphasis on recruiting white women), Studies 2, 3 and 4 were developed to explore underrepresented groups and gain a deeper understanding of their views and opinions of obesity and weight stigma. Children’s and adolescents’ views and opinions of obesity and nutrition knowledge were explored in Study 2, using a cross-sectional questionnaire and phone interviews. The questionnaire was structured in six sections, exploring sociodemographic characteristics, anthropometric measurements, views and perceptions of obesity, nutrition knowledge, general health, and eating habits and lifestyle. Online interviews followed a narrative focusing on obesity knowledge and experience, obesity perception and the relationship between nutrition and obesity. Study 2 recruited a total of n=317 participants, 54% boys, 72% White/British, with a median age of 16 years (interquartile range (IQR) 15- 18). There was an overall lack of understanding of obesity and its causes and consequences. There was also a lack of consensus and agreement about whether obesity is a sign of disease, a disease, or merely a body shape. There was agreement that obesity can be a personal responsibility (median=4: likely, IQR 3: neutral – 4: likely). Food knowledge was low, with 83% correctly answering three questions or fewer out of six. Although participants reported and believed that they knew what obesity was, most participants linked obesity to body image and placed the responsibility of having obesity on the individuals or their parents. This can lead to increased stigmatising behaviours and isolation of children and adolescents with obesity. Proper education about obesity is imperative to help support children in understanding the general concepts behind obesity’s complexity as a disease. Study 3 used a cross-sectional questionnaire and phone interviews to explore weight stigma and its implications on weight stigma attitudes and body image perceptions in children. In Study 3 (n=667, 62% boys, 70% White/British, median age 16 years (IQR 15-18)), 50% of participants who experienced weight stigma had a BMI ≥30 kg/m². Almost two-thirds of participants who experienced weight stigma (n=259) said it happened at local community places (e.g., clubs, during extracurricular activities) (n=149, 58%). Over a quarter (n=67,26%) reported that it was extremely harsh. Participants who self-reported having obesity (n=214) experienced more weight stigma (n=114, 53%) than those who believed they have overweight (n=87, 41%) or underweight (n=13, 6%). More than half of the sample (n=408, 61%) were dissatisfied with their body image. Most participants who self-reported having obesity were dissatisfied with their body image, demonstrating a significant relationship between self-reported weight problems ‘underweight, overweight, obesity’ and body image satisfaction levels ‘dissatisfied, neutral and satisfied’". In summary, unsurprisingly, most participants who reported weight stigma had a BMI ≥30 kg/m2. Interestingly, more boys than girls who reported experiencing weight stigma believed there was weight stigma in society. To better understand the contribution and impact of childhood lived experiences of weight stigma on adult perceptions and beliefs around overweight and obesity, Study 4 employed similar methods to Study 3. In Study 4 (n=738, 52% men, 76% White/British, 39% BMI ≥30 kg/m2, median age=26 years (IQR=24-31)), less than a quarter of participants had experienced weight stigma as children (n=154, 21%). More women (n=108/154, 70%) experienced weight stigma during childhood than men (n=46/154, 30%, p≤0.001). Participants were mostly undecided about whether obesity is a disease (median=3: undecided, IQR=1: strongly disagree – 3: undecided). Experiencing weight stigma in childhood was positively associated with parents reporting their children’s weight stigma experiences. Parents dissatisfied with their body image (n=62) were more likely to be dissatisfied with their children’s body image (n=23/62, 37%) than satisfied (n=17/62, 24%). Understanding and awareness of obesity are essential in developing public health strategies and health education programmes that are child-oriented and specific to children and adolescents regarding location and intervention tools. The findings in this thesis highlight the negative impact of weight stigma on children and adolescents' physical and mental health. Moreover, a poor understanding of obesity was evident in this research. The work of this research is beneficial in informing programs explicitly targeting the gaps explored and found. This thesis attempts to improve the knowledge of public and academic domains in elements surrounding perceptions, views, and attitudes regarding obesity and weight stigma, the reasonings behind perceptions, and strategies to address obesity stigmatising behaviour.17 0Item Restricted PERSONAL AND CONTEXTUAL INFLUENCES ON SAUDI PARENTS’ WILLINGNESS AND TOLERANCE FOR CHILDREN’S RISKY PLAY(Colorado State University, 2024-03-08) Alarawi, Rana; Bundy, Anita; Lane, Shelly; Hepburn, Susan; Hickey, MatthewObjective: The purpose of this dissertation was to examine personal and environmental factors that influence Saudi parents’ willingness to promote, and tolerance of, risk taking in children’s play. In this dissertation, I tested a conceptual model that explains the transactions among multiple constructs: factors affecting parental risk willingness, coping efficacy, perceptions of child, and risk tolerance. I also introduced a new tool, the Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS) to assess personal, social and cultural factors affecting parental tolerance for risk in play. Lastly, I examined variations between Saudi mothers and fathers in relation to their willingness to allow and tolerate risk in play. Importance: Risky play is defined as “thrilling and exciting forms of physical play that involve uncertainty and a risk of physical injury” (Sandseter, 2010, p.22). Benefits of children’s participation in “risky play” are broadly recognized (Barker et al., 2014; Brussoni, Olsen, et al., 2012; Gray et al., 2015; Sandseter, 2007; Sandseter & Kennair, 2011). However, most related research originates in Western countries; none focuses on outdoor play in Eastern countries, including Saudi Arabia. Further, while the literature identifies varying perspectives on risky play among parents, there is limited understanding of parental, social, and cultural contexts shaping and influencing Saudi parents’ tolerance of risk in play. Participants: The sample included 90 Saudi parents with children ages 7 to 10 years who were able to read and speak English. Parents of this age group are expected to accept risky play. iii Method: This cross-sectional, quantitative dissertation encompassed three studies. In the first study, I used moderation analysis to test a conceptual model examining the relationship among factors contributing to parents’ willingness to allow risky play and their risk tolerance. I also investigated the moderating effects of parental coping self-efficacy and parents’ perceptions of their children’s coping ability on the relationships among factors contributing to parents’ willingness to allow risky play and their risk tolerance. In the second study, I utilized Rasch analysis to explore evidence for construct validity and internal reliability of data gathered with the FAC-TRiPS. In the third study, I examined gender variations in Saudi parents’ willingness to promote, and tolerance for, risk taking in children’s play by answering two research questions: (1) Do Saudi mothers and fathers differ systematically on FAC-TRiPS items? and (2) How does the inclusion of gender influence the relationship among factors affecting parental perceptions of tolerance for children’s risky play? Results: Findings of the first study showed that play factors contributing to parents’ willingness to allow risk (e.g., fear of injury and fear of negative judgment) were negatively correlated with risk tolerance. Additionally, parents’ coping self-efficacy significantly moderated the relationships among play factors contributing to parents’ willingness to allow risk and their tolerance for encouraging children to engage in risk taking. That is, parents with high selfefficacy were more inclined to perceive less stress in such situations and were more apt to allow their children to engage in risky play. However, parental perceptions of their children’s coping ability did not have a moderating effect on the interaction between factors contributing to parents’ willingness to allow risky play, and their tolerance for, risky play. In the second study, preliminary analysis suggested that the FAC-TRiPS yielded valid and reliable data measuring factors influencing parents’ risk tolerance. Because the instrument in its early stages of iv development, further research with a larger sample is needed to refine items and enhance the instrument’s functionality and precision. In the third study, although parent gender did not significantly predict risk tolerance, Saudi mothers and fathers exhibited systematic differences on three FAC-TRiPS items. Mothers reported more fears surrounding potential negative judgment and repercussions from an authority while fathers were more influenced of Media reports. Within the context of other factors, gender appeared to play a complex and indirect role in determining parents’ risk tolerance. Conclusion: This research serves as a useful foundation for understanding the impact of context on parents’ willingness to promote children’s participation in risky play. Key themes across the three studies indicate that risk tolerance is likely influenced by a multitude of factors including personal, psychological, and cultural factors. This research represents the first to study a sample from Saudi Arabia, contributing an Eastern perspective to the existing body of research on risky play. Nevertheless, its findings invite further exploration into gender, societal, and cultural influences on how parents perceive and approach their children's participation in risky play environments. Additionally, further validation of the FAC-TRiPS and the Risk Tolerance model is needed. Findings of this research lend further support to the critical role of environmental facilitators and barriers on functioning as well as raise a need for creating a culture in which the duty of care is balanced with the dignity of risk in order to enable children of all abilities to participate in playful and age-appropriate risk-taking opportunities.18 0Item Restricted Multisensory Processing as a Concurrent Contributor to Cognitive and Language Development in School-Aged Children (A Bayesian Approach)(La Trobe University, 2024-04-24) Alhamdan, Areej; Crewther, Sheila; Murphy, MelanieMultisensory processing is fundamental to survival of higher animals, humans included. Rapid and successful integration of visual and auditory information in the brain is necessary to ensure comprehensive understanding of the environment and facilitation of motor responses. Indeed, visual and auditory multisensory processing when measured as Motor Reaction Times (MRTs) in adults has long been known to enhance accuracy and speed of responses, though few have considered how development of motor function per se influences age-related increase in multisensory MRTs and contributes to various cognitive abilities, including working memory (WM), intelligence and language development in primary school children. Thus, the current thesis employed a Bayesian approach to meta-analyze literature up to mid- 2023 to test the association between both motor and verbal measures of multisensory processing and WM development, while also showing that multisensory stimuli contributed more significantly to WM capacity than unisensory visual or auditory stimuli alone. The three experimental studies presented in this thesis employed a simple multisensory MRT task, to explore the interaction of motor development and cognitive abilities in children aged 5-10 years. The first study aimed to examine developmental changes in multisensory MRTs, visuomotor responses and non-motor visual Inspection threshold Time tasks in school children to highlight the more significant contributions of age to motor than sensory function. The second study aimed to investigate the development of visual and auditory WM and visually based nonverbal intelligence, and their relationship to multisensory and visuomotor tasks. Our findings demonstrated that age-related performance on nonverbal intelligence and visual rather than auditory WM were the strongest unique predictors of multisensory MRTs. The final study investigated the association between multisensory and visuomotor processing and the development of receptive and expressive vocabulary abilities, and showed that children with faster MRTs in multisensory and visuomotor processing tasks demonstrated higher complex expressive vocabulary scores (as opposed to simple receptive vocabulary). Overall, the findings of this thesis highlight the interaction of motor development and cognitive abilities and demonstrate that simple, fast, and easily accessible assessment measures of multisensory processing, visuomotor coordination, and nonverbal intelligence as measures of both on-going developmental and neurodevelopmental status in school children.30 0Item Restricted Temperature Extremes Exposure and Children’s Health: Extreme Heat- and Cold-Related Impacts in Edmonton, Alberta(University of Alberta, 2024) Alsunaidi, Sara; Jones, C. Allyson; Yamamoto, Shelby S.; Osornio-Vargas, AlvaroIn the current context of escalating climate change effects on public health, Canada's distinctive geographic position causes it to warm at double the global average rate. This phenomenon leads to potentially heightened health risks for its residents through direct and indirect mechanisms. Particularly at risk are the most vulnerable age groups, such as children aged 0-5 years. Extreme temperature events—both hot and cold—pose latent health threats, especially to this demographic. It is imperative to note that while all children within this age range are at risk, certain age-specific and sex-specific factors may exacerbate or mitigate their vulnerability. Given the transformative developmental stages within these early years and the pronounced physiological differences between sexes, these factors are crucial to understand. This study, focusing on Edmonton, AB, aims to explore the health ramifications of such temperature extremes on children aged 0-5. To achieve a comprehensive analysis, the research segments its investigation based on age brackets (0-1, 2-3, 4-5 years) and sex (male and female). The objective is to examine the association between outdoor exposure to extreme temperature conditions and the incidence rate of hospital admissions and emergency visits for children in this age group. It utilizes health data from Alberta Health Services (AHS) and environmental data from the Alberta Climate Information Service (ACIS) from 2015 to 2018, focusing on age- and sex-specific trends. Time-series analysis, including Poisson and negative binomial regression, were applied to examine the correlation between temperature extremes—quantified by the 95th and 5th percentiles of weekly average temperatures—and pediatric hospital admissions and emergency visits. The analyses were stratified by age and sex and adjusted for confounding variables such as air pollution, relative humidity, seasonality, and long-term trends. During the study period, we recorded 5,970 hospital admissions and emergency visits for the 0-5 age group, with a notable majority (92.2%) for respiratory diseases. A significant increase in health service utilization was found in the 2–3-year age group during extreme heat (IRR= 1.36, 95% CI 1.03-1.80, p=0.03) and cold (IRR= 1.30, 95% CI 1.01-1.67, p=0.05) events. No significant associations were found in the 0-1- and 4-5-year age brackets, nor were there sex-based differences in health outcomes. The study revealed that pediatric respiratory diseases, such as asthma, bronchiolitis, and pneumonia, were significantly associated with extreme temperature events in the 2–3-year age group. The effects of cold temperatures persisted up to four weeks post-exposure (IRR= 1.30, 95% CI 1.00-1.69, p=0.05), while the impact of heat was more immediate (IRR= 1.36, 95% CI 1.01-1.83, p=0.04), suggesting different temporal patterns of risk. These findings demonstrate a rising trend in the risk of negative respiratory health effects in young children linked to extreme hot and cold temperatures, highlighting the need for a more thorough assessment across various health outcomes. Additionally, they emphasize the need for ongoing research to refine our understanding of how these events affect pediatric health and develop comprehensive mitigation and adaptation strategies. Future studies should investigate more precise and direct methods for assessing the health impacts of such events, explore the contributing factors of these temperature extremes, including the role of climate change, and explore preventative strategies to mitigate their effects. This research is crucial for developing robust measures to protect our youngest and most vulnerable residents from the health hazards of extreme climate variability.9 0