Objectives Health-related quality of life (HRQOL) is an important, but understudied construct in pediatric IBD. Family-level predictors of HRQOL have been understudied as are the mechanisms through which disease activity impacts HRQOL. The current study examines the relationship between a family-level factor (parenting stress) and HRQOL in youth with Crohn's disease. Parenting stress is examined as a mechanism through with disease activity impacts HRQOL. Methods 99 adolescents with Crohn's disease and their parents were recruited across three sites. Adolescents completed the IMPACT-III (IBD-specific HRQOL). Parents completed the Pediatric Inventory for Parents, a measure of medically-related parenting stress that assesses: 1) stress due to the occurrence of medical stressors and 2) stress due to the perceived difficulty of stressors. Disease activity was obtained from medical records. Results Parenting stress due to the occurrence of medical stressors partially mediated the disease severity-HRQOL relationship, reducing the relationship between these variables from 49.67% to 31.58% (B = -.56, p <.0001). Boot strapping analysis confirmed that the indirect effect of disease severity on HQROL via parenting stress significantly differed from zero. Parenting stress due to the perceived difficulty of medical stressors partially mediated the disease severity-HRQOL relationship, reducing the relationship from 49.67% to 30.29% (B = -.55, p < .0001). The indirect effect was confirmed via bootstrapping procedures. Conclusions As disease severity increased, parenting stress also increased, and adolescent HRQOL decreased. Parenting stress should be considered and assessed for along with medical factors as part of a comprehensive approach to improving HRQOL in adolescents with Crohn's disease.

The purpose of the study was to investigate the influence of weight bias and demographic characteristics on the assessment of pediatric chronic pain. Weight status, race, and sex were manipulated in a series of virtual human (VH) digital images of children. Using a web-based platform, 96 undergraduate students with health care-related majors (e.g., Health Science, Nursing, Biology, and Pre-Medicine) read a clinical vignette and provided five ratings targeting the assessment of each VH child's pain. Students also answered a weight bias questionnaire. Group-based analyses were conducted to determine the influence of the VH child's weight and demographic cues, as well as greater weight bias on assessment ratings. Male and VH children with obesity were rated as more likely to avoid non-preferred activities due to pain compared to female and healthy weight children, respectively (both p < .001). The pain of VH children with obesity was rated as more likely to be influenced by psychological/behavioral issues compared to the pain of healthy weight VH children (p = .022). African American VH children were rated as experiencing significantly greater pain than Caucasian VH children (p = .037). As child weight increased, low weight bias participants felt more sympathy, while high weight bias participants felt less sympathy (p = .002). Also, low weight bias participants showed increased motivation to help, while high weight bias participants showed less motivation to help, as VH patient weight increased (p = .008). Child weight and evaluator weight bias may be influential in the assessment of pediatric pain. If supported by future research, results highlight the importance of training in evidence-based practice and education on weight bias for students majoring in health-care fields.