Kids' Wellness Matters Podcast Ep. 17: Fatherhood and Family Health

Dr. Craig Garfield and Dr. John James Parker (JJ) Parker discuss the often underappreciated significance of fathers in family health. They share insights from their experiences as both dads and doctors, which have informed their development of programs and research on the beneficial effects of fathers on child development and family well-being.

"Fathers are spending more and more time with their families. As we work towards gender equity in the workplace, we need to also work towards gender equity at home and with parenting. And I think now is a critical time because there is excitement in society to engage fathers.”

- Dr. James Parker 

“There are so few times around pregnancy and the first year of life that people are saying to dad, ‘How are you doing? How is it going for you?’ If there's something we can do to help and support [dad], that's going to pay off in the family.”

- Craig Garfield, MD

Show Notes

• Drs Garfield and Parker's experiences as new fathers during their medical training profoundly shaped their careers, driving their focus on the often-overlooked role of fathers in parenting and family health.
• Programs like Dr. Garfield's Family and Child Health Innovations Program and the expanded CDC PRAMS for Dads aim to gather valuable data and promote family well-being by including fathers.
• Dads are spending more time with their families as society is also changing its outlook on fatherhood. With popular media positively portraying fathers as active caregivers, old stereotypes about the role of fathers in early childhood development are being challenged.
• Involving fathers in prenatal education and providing practical advice enhances their engagement and offers support for their transition into fatherhood. Dr. Garfield notes that many dads want to be involved but are unsure how to contribute.
• The "Discharge for Dads" program at Prentice Women’s Hospital offers support through brief instructional videos on essential topics like mental health, breastfeeding, and car seat safety to help new fathers.
• Both guests discuss their studies that investigate the stress and mental health impacts of fatherhood and emphasize the importance of screening fathers for postnatal depression and stress to improve family well-being.
• Dr. Parker’s research found that fathers overall, and especially black fathers, have lower death rates than non-fathers despite fathers showing higher cardiovascular health scores.

Transcript

[00:00:00] Dr. Nina Alfieri: Welcome to Kids Wellness Matters. I'm Dr. Nina Alfieri. 

[00:00:07] Dr. Rob Sanchez: And I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world renowned Ann & Robert H. Lurie Children's Hospital of Chicago. 

[00:00:15] Dr. Nina Alfieri: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult. Because Kids Wellness Matters.

[00:00:29] Dr. Rob Sanchez: At Lurie Children's, we are dedicated to the health and wellbeing of all children, and we know family relationships play a central role in shaping an individual's wellbeing throughout their lives. While maternal health has long been studied in the context of child and family health, there's mounting evidence that paternal health plays a critical role as well. Today, we are tackling the topic of fatherhood and the health of dads with two experts in this field. Doctors John James Parker and Craig Garfield.

 You know, there are a lot of changes in our society's family structures these days, the division of labor is really more blended than it used to be in the past. And I think it's really cool that it's actually being studied more and considered more, especially in our field of pediatrics, where we interface with parents so often. I'm so excited to hear your conversation with Dr. Garfield and Dr. Parker today to talk a little bit more about the roles different partners and different people can play in the lives of children.

Yeah, and it was one of those things that during our conversation with our guests, it was brought up that it wasn't that long ago that dads weren't even allowed in the delivery room. And it's such a different experience now. But that being said, there's a lot of stuff that maybe hasn't been talked about as much. And that includes things like, the health of dads and the roles that they want to play. 

Some of the research has shown that actually it's incredibly important. and that if we don't pay enough attention, things like stress and health problems, things like that can go up too.

[00:01:49] Dr. Nina Alfieri: I can't wait to hear all about it. Let's hear it for the dads. 

[00:01:54] Dr. Rob Sanchez: Dr. John James Parker is an internist and pediatrician here at Lurie Children's with a research focus on the health of fathers and paternal contributions to the health of families. Dr. Craig Garfield is also an attending physician here at Lurie Children's and a self-proclaimed Father-ologist, who has been studying the health of dads and the role of fatherhood in the health of families for more than 25 years. JJ, Craig, welcome.

[00:02:15] Dr. Craig Garfield: Thank you. 

[00:02:15] Dr. JJ Parker: Thanks so much for having us.

[00:02:16] Dr. Rob Sanchez: So as a note, when we refer to fathers on today's episode , we mean men who play a significant role in raising a child. Dr. Garfield, can you share a bit further about who we are talking about and thinking about when we use the word Father? 

[00:02:29] Dr. Craig Garfield: Yeah, that's a great question. A great way to start this off. When we think about children, they're raised parents, and those parents can take a variety of different forms. Most of the research to date really has focused on the mother child relationship. And what we've been really trying to do is expand that beyond just that and to think more inclusively. So we start with fathers, and as you mentioned these may be biological fathers, they may be fathers who are raising the child, but not biologically related. The importance here is that it's a second parent who's really heavily invested in the health and wellbeing of that child. That takes all different forms now. It may be same sex couples, it could be hetero couples, could be trans parents. It's just that we don't have very much research in these newer formations of families. And that's something that we're trying to solve first, starting with fathers, but expanding even more so to be inclusive of all types of families. 

[00:03:17] Dr. Rob Sanchez: And when w e hear more about that inclusion of families, when you first started getting into that topic, what were some of the things that you first discovered about this area? This kind of type of parent who wasn't getting quite the same amount of focus as a birthing parent or a mother of a child.

[00:03:31] Dr. Craig Garfield: Well, it actually started very personally. My first son was during residency in Massachusetts. And we were out there by ourselves, no family. And when he was 18 months old my wife was accepted actually the Children's Memorial for her internship which preceded Lurie Children's. And so we moved back to Chicago where all our family was and I decided I was gonna try it for a year to be a stay-at-home dad. And that really came from my time in pediatric training where I gave a lot of advice to parents about what they should be doing, but I had never been a parent myself. So that year at home really changed everything for me. I wanted to do something with my son during that time. So I reached out to a group here that had a mom and tot class and I called them and said, can a dad come to the mom and tot class? And the person answering the phone said I don't know. Let me ask the manager. So she called the manager and the manager said, yeah, we've never had that request before, and he'll be the only one. And so that for me really opened my eyes to what's happening in families and the kind of lip service we pay to fathers and oh, it's great you're involved with your child. Oh, are you babysitting your child? No, I'm being a father. And I think that's something that shifted for me so when I started to embark on our research career I really got interested in looking at the role of both parents and families actually, and how to support them for the best outcomes for their children. I was a, white male, physician with incredible social capital and I was getting kicked to the curb, so I could only imagine what in families that people who have suffered from structural racism and other biases are experiencing when they're interacting with the healthcare system. And all of our work really stems from welcoming, dads welcoming that second parent with an open door not closing it.

[00:05:08] Dr. Rob Sanchez: That's so remarkable and so relevant. that story that brought you into this field. JJ, we worked together. I know you have a wonderful family as well. Did you have a similar experience that drew you into this area of focus as well?

[00:05:20] Dr. JJ Parker: Very similar to Craig. I have a son and daughter. And another daughter on the way. But the birth of my son really changed my career trajectory and life course and it was such an important time in my life. I was a resident then, and when you're a resident you're working long hours and learn as much as you can, take care of the patients, try to sleep if you can. And when my son was born, it was like. Wow, how am I gonna manage all this? Like, I care so much about my son and my family and every day I'm so stressed trying to get outta there on time to see him before bed. And I had been thinking, throughout my internal medicine and pediatric residency about how we can prevent disease and how can we maintain health and prevent the transition from health to disease. And becoming a father made me much more interested in fatherhood research. So I came to Northwestern in a health service research fellowship and read about Craig's work and was sold day one. I haven't turned back to fatherhood research. It was easy when you read some of his work about all the paternal contributions to the health of families. And it's like, you don't even get taught these and you're two residencies and nobody tells you these. It's been wonderful joining Craig in this effort.

[00:06:25] Dr. Craig Garfield: I was just gonna, piggyback on JJ's comment that, one of the things that's really fun about the area of fatherhood research is that there is so little in the healthcare world that we really know about. There are some in psychology and sociology and things like that. Our studies often get a lot of attention because people haven't asked those questions before. So, for people who are looking for areas of research that are imminently understandable, and have a lot more to be discovered. It's a great area to be in.

[00:06:52] Dr. Rob Sanchez: Craig, as I mentioned, you call yourself a father-ologist, and that's a little tongue in cheek, but can you tell me what you mean by that term?

[00:06:59] Dr. Craig Garfield: Absolutely. One of the great things about working with men and working with fathers is that humor actually works. It's one of the things that happens clinically. We all work with kids, so there's humor kind of all the time. We're kind of laughing at whatever a kid may say or what might happen in the clinic or in the hospital. But men also respond really well to humor. It is a little tongue in cheek to be called a father-ologist. I was thinking about, well a gastroenterologist is an expert who studies the GI tract and a urologist will study the urinary tract urinary system. And I was like, I kind of study fathers, so I guess I'm a father-ologist and it really is just saying there's a lot to be learned here. There's a lot that we can study and a lot we can contribute both to science, but also to the greater society. Particularly from pediatrics where we think about the child and who's having the impact on that child, and it doesn't matter to me if this is a same-sex couple, if it's grandparents who are raising it, I wanna know how best to help those children. Our motto at the Family and Child Health Innovations Program that I founded and direct is, Children Thrive When Families Thrive. So it behooves us then to understand, A, what's a family, and B, what is thriving? And that's what all of our work focuses on.

I wanted to ask specifically about the involvement of dads, early on in pregnancy as you talked about. So you know, why should dads be included in some of these perinatal mental health discussions early on in pregnancy?

[00:08:17] Dr. Craig Garfield: So one of the things that the CDC has done for over 35 years is the Pregnancy Risk Assessment Monitoring System, which at the end of the day represents 81% of births across the country. It's a randomized sample from the birth certificate of moms who have given birth, and it collects data in the perinatal period and gives us outstanding information on maternal mental health, on access to healthcare, on exposures to all sorts of substances and things on breastfeeding success. And it was after 35 years that the mom started to write into the margins of the survey. Why do you only ask me if my partner hit, kicked, beat or slapped me during pregnancy when the only way I made it through this pregnancy was with the help and support of my partner? So the CDC approached us and asked us what would we do? How would we include dads? What would you ask dads? Where would you get information about contacting dads? And so we started that in 2018 and did that in Georgia as a pilot. We've gotten a number of studies from that data. It's excellent data and it really is the first line of sight on the public health of dads in the perinatal period. We've since expanded that now to Georgia, Ohio. North Dakota and Massachusetts 30 by 30 is our goal. 30. Dad states by 2030 is what we're looking trying to do. 

[00:09:33] Dr. Rob Sanchez: And your work truly gets at the heart of what previous misconceptions or notions that might be outdated about the role of fathers raising these children. So I'd be interested, JJ , can you speak to some of the common misconceptions about the role of fathers in infant and child health and how do you feel that media or social media is doing these days of portraying fathers in more of an active and capable light as caregivers?

[00:09:58] Dr. JJ Parker: The big picture is that fathers are spending more and more time with their families. So that's a wonderful trend As we work towards gender equity in the workplace, we need to also work towards gender equity at home and with parenting. And I think now is a critical time because there is excitement in society to engage fathers. And so we need to leverage that to really have programs and public health messaging about the importance of fathers. But I think that the big thing that needs to change is, how integral they are from day one. Sometimes I hear that fathers aren't important for the first year. It's like breastfeeding, that's all the mom and I'm just gonna like sit back and maybe I'll change a diaper in the middle of the night. But we know that every little bit of play is important. We also know that fathers and mothers and all caregivers provide different roles in different ways so they have a unique role just being who they are. I actually think that social media has done some nice things for portraying fathers. And there have been very popular influencers who have made their life around showing how they interact with their kids and how that has been a positive thing in their lives. And so, I think that has been one benefit of the social media movement.

[00:11:04] Dr. Rob Sanchez: I totally agree. I mean,when you use things like social media for the good of highlighting some of the positive and important roles that caregivers, parental figures can be in a child's life. That can really spread in a positive way. Craig, so much of your work with new Fathers, things like that probably gets at the heart of those misconceptions. Have you seen some of those positive impacts of media or social media, trying to help along in the work? Like more in conjunction with the work that you're doing as opposed to maybe, perpetuating those misconceptions.

[00:11:33] Dr. Craig Garfield: Yeah, I think what happens now is more men, as they approach fatherhood are seeing examples in social media, in media in general, role models that have shifted that are different even from their fathers, but certainly from their grandfathers. People were having babies now, probably their grandfather wasn't allowed in the room for the delivery. So that's a major shift in society. The Fragile Families and Child Wellbeing study that started around 2000 or so was looking at two thirds unmarried couples and one third married couples trying to look at and see what happened in those relationships. It was called Fragile Families because of the vulnerability that was assumed in those relationships. They discovered many, many things, it's a fantastic study, but some of the early things that they found were really important to us as pediatricians. One is that greater than 90% of the dads were at the delivery of their baby. And number two is that when you asked unmarried couples, how likely are you to be engaged in raising this child, it was in the 85% range. And how likely we are to be married by a year. It was also in the 80s. Fast forward a year and only about 10% of those couples actually ended up getting married. But that's, I think, because life gets in the way, right? Things get complicated when you have a baby. Nevertheless, what that told me as a pediatrician is that they are wanting an open door, and we are oftentimes closing the door, literally in their face. Because we walk into the nursery and we say, Hey mom, how's breastfeeding going? How are you doing? How are you feeling? Great. We'll see you in follow-up clinic. Oftentimes, literally, dad is in the car or driving the car, so he doesn't have to pay for parking in the parking lot and we're giving all of our education to moms and not to dads. And, JJ can talk about the paper that we published last summer looking at breastfeeding and safe sleep behaviors and we're really missing an opportunity. One, for the child, because if we have another parent who knows what to do when it comes to safe sleep and car seat safety and even helping moms with pregnancy related complications, that's a benefit. That's a huge benefit for the family. And number two, we're missing the opportunity to say to dad's, here's how you can be involved. I know you wanna be involved. You may not be sure how to be involved. And let me tell you, the first time that your partner or the grandma says you put that diaper on, it's backwards. You're never gonna wanna put a diaper on again. Right? So it's really how do you build that support early on that a lot of our work focuses on.

[00:13:48] Dr. Rob Sanchez: I'd love to dive into that. As a person is getting ready to take on this role of fatherhood are those opportunities and why should we see this as such a critical time for the lives of people preparing to be the fathers to take on this fatherly role in their child's first year of life.

[00:14:02] Dr. JJ Parker: Yeah. It's pretty amazing when you look at some of the studies about what's happening to men as they become fathers. During the expectant time when their partner is pregnant, men have changes in their hormone, like their testosterone drops, their brain physically changes. Different centers in their brain are growing to be more receptive and caring. And they are transforming, obviously, way less than the mothers. But they're transforming as well, getting ready for this baby. And there's so much opportunity to use that critical window to promote paternal engagement in childcare and really men's health because men are interested in changing their health behaviors and maintaining their health. And we're often not doing enough in society to really use that critical window. Just thinking about my son when he was born, I was fortunate to be able to go to a breastfeeding class with my wife, I was able to go to the pre-birth hospital tour. I tried to get to all the prenatal visits that I could. And I had a prenatal visit with our pediatrician where she looked directly in my eye and gave me a list of things that I was gonna help with once my baby was born. And so one of those things that that pediatrician said to me, these are the things you can do in breastfeeding. She was like, breastfeeding is very hard and you need to provide emotional support for your wife during these times. It's also physically difficult. And she said, you find the pillow, you find the correct position. You need to help her get comfortable. She said, your wife feeds the baby, you have to feed her. You have to go to the grocery store, you have to cook for her, you have to make sure she gets water. I remember everything she said and it was incredible. And I did them all. It was like people are never told these things. And I was told even before my son was born. And I was fortunate to have those things, but that's what every parent should have along the way. And we should make it easy for parents to do that. We can have weekends, after hours , classes that are amenable to people who have less flexible jobs.

[00:15:51] Dr. Craig Garfield: Just to add on to that, I think having done this for a couple of decades, I feel a little bit more comfortable being a bit prescriptive for dads because I've encountered so many of them who really want to be involved but are a little bit shy and a little bit standing back. So I love that. JJs pediatrician said, here are things for you to be doing. And I use that all the time now. When you tell them what to do, they're like, oh my God, thank God I knew I needed to do something, but I didn't know what it was. And even to that extent, that's come into our research too, where we just finished a study at Prentice Women's Hospital called Discharge for Dads, where we basically shot really short videos of what we think are really important topics for dads to know. Kind of, basically the cliff notes are cramming now that the baby's here. 

 We shot videos that were all edited down to about three to four minutes, so easy to watch on topics like mental health, breastfeeding, car seat safety, safe sleep, bathing, crying, all these really important things that are key for those first couple months. And really almost the first year of life. And then we tested it and we wanted to see would dads actually agree to do research in the newborn nursery during that crazy time? Would they watch the videos and did those videos influence their knowledge? And did they keep that and maintain that a month out? So we're just writing up the results of that. But, the kicker is dads are more than willing to be included in the research. They just wanna be asked. They're willing to watch those videos and they do actually gain some knowledge from those videos. And it does impact their behavior too. So it opens up another door, which I think JJ's work and mine is all about saying what's a new perspective we can take on families and on child health.

[00:17:22] Dr. Rob Sanchez: That's so valuable,really opening that door and inviting them in. I'm curious with those particular topics, were there ones that really seemed to resonate? 

[00:17:31] Dr. Craig Garfield: Dads initially are just so grateful to be included. Those are the comments that we often get at the end of our surveys is thank you for asking, no one asked how I'm doing, or no one has really thought about me and I know I should be here at these prenatal visits, or I know I should be here at the pediatric visits, but no one really pays any attention to me. So that acknowledgement is actually the first thing that I think that really resonates with me that here is someone who we know is important to the family, but we really have neglected from research to policy all the way along that now we're starting to pay attention to. And I think it makes a big difference. I think there's a lot of gratitude towards learning more about crying and what I should do about crying and also around the mental health, not only the mental health of the mother, but also the mental health of the father that can impact the family after the birth of the child as well. 

[00:18:14] Dr. JJ Parker: So Craig and I were able to publish a paper in pediatrics last year that utilized data from the Pregnancy Risk Assessment Monitoring System for Dads. That's PRAMS for Dads and PRAMS is a program of surveillance for new moms that's been part of the CDC and state departments for over 35 years. We use the data from the first PRAMS survey. And in our paper we found that fathers who indicated that they wanted their infant to breastfeed, those infants were much more likely to have successful breastfeeding, both initiation and breastfeeding at eight weeks. To us that's not surprising. We know that fathers are playing an important role in breastfeeding, but to many other people, they're like, oh, that's not a father's role. But I think that was a huge take home and got a lot of nice media. press We were also able to look at safe sleep in our study. We assess for the way that fathers put their infants to sleep, which is important because there's not many studies of just fathers that ask them how they put their kids to sleep. So we had some really important data. Overall we found that fathers rate of safe sleep position, like doing the correct things, which is putting your infant on their back to sleep in a crib or bassinet with nothing else in the crib. It was pretty low. But it was actually similar to what moms are doing. So they're an important target. 99% of them were putting their kids to sleep. They weren't doing it correctly as much as we want them to do. And they weren't getting healthcare information as much as mothers. And one major take home from the study was that, people are very excited to know how fathers can be involved and how they impact the health of their families. 

[00:19:42] Dr. Rob Sanchez: We've touched a little bit about the stress, the mental health challenges that come with being a new parent. And I wanted to touch on that a little bit. We know that things like screening for maternal depression, maternal health is something that's part of our regular screening tools, but it's not something that had be done previously on fathers. Can y'all speak to that about why that's important, why it might have been something that's been overlooked in the past and how you'd like to see it move forward in terms of increasing our awareness and support for individuals who can be such a key figure in the role of the family.

[00:20:11] Dr. Craig Garfield: I can start with an anecdote. I co-authored the American Academy of Pediatrics clinical report on fathers and pediatricians in the early 2000s along with Will Coleman, who was a behavioral developmental pediatrician. And it was the first time that the AAP had ever put out something specifically on fathers. And in that we actually, kind of had a call to action to screen dads for postnatal depression. This was around 2004, and the reviews came back and one of the reviewers said, there's no such thing as paternal postnatal depression. You can't just make stuff up and start screening people. We're like, oh, okay 'cause anecdotally, I think we all know parents and fathers who've come and who are depressed. Right? And we know from the mother's literature that's probably gonna impact the child's attachment and bonding the relationship within the family and the co-parenting. But there was no data. So we backed off around 2004 and said, okay, just check on dad and his transition into fatherhood. And then it was around 2006 or so that Paulson and Ramchandani published their first papers out of Lancet and JAMA that actually started to define and give data on rates of paternal depression in the postnatal period. And so the next AAP report, which came out around 2012 we actually started to say, here is all the data that's been now compiled and all the research that's been done looking at paternal postal depression. And so now we're working on the third one. I'm co-authoring that with Michael Yagman, and we are really starting now to provide the evidence that there should be, like we have universal screening for moms, and that is covered by most insurance companies, there should be the same for fathers too. The time to be doing it is in the four to six month visit, which fits nicely into the well child visits. And by doing that, we can start to figure out how best to help families from the mental health perspective of the parents. Now there's a lot of things that make that a little bit more challenging. Right. But I think that we should be screening. We have the tools. We've written a lot about what tools are available, whether it's the Edinborough, whether it's the PHQ-9. There's a number of different validated tools out there for fathers. There's even, this is so cool, a proxy measure that you can give Mom to report on the non-birth parent about their mental health. And it's just a screener, right? And not everybody who screens positive is gonna end up needing psychoanalysis and medication. They may just need to be talked to say, how's it going? Right? How do you feel like you're doing? But to just turn a blind eye doesn't really help anyone. And then there's the barrier of, you know, just the costs of screening and can you get reimbursed for that? So our hope is that through these clinical reports, we're able to actually build up some of the evidence to actually get this supported in general pediatrics.

[00:22:44] Dr. Rob Sanchez: A testament to just how important it is, again, speaks to the misconceptions that could have been there. Oh, dads don't get depressed. It could be such a small thing to engage in them in a way that can make a huge difference. And we know that, I mean, we've lived it, being a parent is stressful. There's so much challenges that come with it. And I believe Craig, you even did a study that measured stress hormone levels in dads in particularly challenging situations and how you could measure that too. We know it internally, physiologically, right? But we also know it from like a psychosocial aspect too. Can you speak to that because I found that stuff fascinating as well.

[00:23:16] Dr. Craig Garfield: So we knew this was again, in the neonatal intensive care unit, so these are parents of very low birth weight infants. And they had been in the NICU for a while and there had been studies of mother's salivary cortisol levels.The stress hormone that's in saliva is pretty easy to measure. You just have to get people to agree to spit into a tube and then you measure it. And so God bless these parents because they were willing to spit in a tube when they were in the NICU ready to go home, then when they were at home for a day, then they were home for five days and they were home at two weeks. And what was so interesting is that we decide to include dads and we said, all right, dad and mom, can you please spit in this tube on these different days? And then we're gonna measure your cortisol levels. And so when we did that we found that mom's cortisol levels in the NICU were high. That meaning that they were very stressed in the NICU and they went home and they pretty much stayed the same. They remained high throughout their time at home too, up to two weeks after going home. But dads who had never been measured before in this way in the NICU, when they were in the NICU, they were high they were the same level as the moms. And when they went home their levels actually increased. And that was fascinating to us because we thought, gosh, what is going on here? And what we thought is happening is that in the NICU you're at a status quo, right? You've got outstanding clinical care in the NICU. You kind of meet up at the end of the day because most of the dads are back at work because we don't have any good family leave in this country. Suddenly you're at home and dads who have been waiting for this to happen, they're so excited to be home. Now I have to take care of their baby. They have to take care of their partner. They have to take care of themselves and they're back at work probably full-time. So that's, I think, what was responsible for the increase in the stress. The other kicker was, to your point, Rob, is that we had dads fill out survey questions about stress, and whereas the moms would say, yes, I'm stressed, and their cortisol levels would be represented as being stressed. Dads, their cortisol levels would be stressed, but their self-report was, I'm not stressed. So that gives us two different ideas. One is either not answering the questions truthfully, that could be, or the second is they may not be in touch with it. And so then that becomes an issue because if you wonder about the dad who is quick to anger. Maybe drinking more, maybe working more, showing avoidant behavior. All of those things could be signs of the stress that they're going through. And what I've seen in hundreds and hundreds of dads that I've worked with in the NICU is that their stress comes out later. That once things are kind of settled a little bit. You can't both be stressed out at the same time. It doesn't work at a couple. Right? And we probably all know that. So someone gets to be the lead stressed person and someone else is then playing, backup and support and then they switch places. So that's again, why that four to six months after the birth of the child is when dads are like, wow, this is a big change. It may be that that's when they're finally in touch with enough of what's happening with them emotionally, that they can actually respond to those surveys and those screeners so that we can get the help to those that need it.

[00:26:02] Dr. JJ Parker: It reminds me of this saying that I've heard about how the body keeps the score, how like these stresses that maybe we're not even fully acknowledging internally, it's gonna impact us. And I wanted to use that as a transition point to some of JJ's work as well, which is a little bit more hot off the presses, which is looking at how fatherhood and heart health are intertwined, it's less so in that newborn period, but more so years later down the road. So JJ, I wanted to ask you to kind of speak to this because some of the work that you've done revealed some of these hidden costs of fatherhood on the heart health of fathers. Can you share some of those findings? Absolutely. The big takeaway was that in this study, the fathers had a lower cardiovascular health score or heart score which is a combination of health factors and behaviors that are known to be associated with cardiovascular disease. And promotion of cardiovascular health is vital to prevent cardiovascular disease. This study started, based on some of these studies that Craig is talking about, and we know that fatherhood influences health, but we haven't had many studies about it. And there's been some interesting studies done in other countries, but really nothing was done in the United States. And so we use this multiethnic study of atherosclerosis . It was a multi-ethnic sample, which was fantastic, and it had a lot of disease outcomes so we could really kind of test for some of these things. And we found that cardiovascular health was different which ties into the fact that fatherhood may be stressful. And we know fatherhood causes less sleep. Fatherhood also can lead to worse diets. Craig has shown that it causes an increase in BMI and he's proven the dad bod is a real phenomenon. And so these are all components of heart health and so bits and pieces been shown. And so we wanted to look at this multi-ethnic sample to see where are we in older age and we found a difference. And so that's, kind of the foot in the door, like, okay, now let's look into this more. Let's kind of understand more about it. One other interesting main take home which really highlights the fact that fatherhood is a social influence of health is that fathers actually had lower age adjusted death rates and that was the highest for black fathers. So fathers overall and black fathers had lower death rates than non fathers, despite this cardiovascular health score being worse. And this cardiovascular health score is really predictive of health outcomes, especially cardiovascular disease. And so we know that marriage is protective against, you know, all cause death, we controlled for that. But there's other factors with fatherhood that we can't control for. Such as,what's your support system? Understanding like what it means an old age to be a father and living for your grandchildren and wanting to be there. There's so much to study. And I think it was really valuable and important that we could do the multi-ethnic sampling and understand that this might be different for races and ethnicities. And, what does it mean for black fathers and what can we learn from that to really harness fatherhood and as we have this transition period, talk about how important it is gonna be for them and what they can do. And. Interesting old data, but black fathers actually are the most involved when they're interacting with their children. They are the most hands-on outta any race and ethnicity. So there's myths out there about black fathers, but they are very involved. And so we need to engage 'em and get them there. That's the critical step is get them involved in their family and they will be there. 

[00:29:11] Dr. Rob Sanchez: It's really tremendous 'cause it really is opening up this box and recognizing just how huge this impact could be. JJ, I know you and I were both trained as internal medicine and pediatrician as well, and it just makes me think of the ways in which, especially early on where we touch base with mothers and making sure that they're talking to their OB/GYN and following up with them after the birth of the child. Is that an opportunity to engage with fathers and say, Hey, have you seen your primary care doc? Have you checked out your blood pressure? How's it going with your dad bod, so to speak? Do you think that those are the kinds of opportunities that your work is opening up so that we could really engage and help, not just from the wonderful parenting and fatherhood aspect, but also just the psychosocial, physiologic health of parents that are taking on this role. I'd love to hear your thoughts on that. 

[00:29:53] Dr. JJ Parker: Fatherhood is this key time where men are wanting to be healthier and their brain and body are changing to be ready to be a parent. And they are actually interacting with healthcare a lot. But half of men don't have a primary care doctor. They're in the space and we can easily make a few recommendations. Even just notifying them that this is gonna cause a lot of changes to their body and their health, and they should see a primary care doctor or try to find one. It's pretty easy to get a list of primary care doctors that they can call. Or advice, use your insurance card, call the back find out primary care providers in your area. Do it now 'cause it's gonna take three or four months. And these little things can make a huge difference. And Craig and I are looking into how do we do that and how do we create programs that can be easily implementable in the clinical space. I think that's a huge next step.

[00:30:42] Dr. Rob Sanchez: I wanted to transition to a bit of a funner topic. As we were talking about, the influence of pop culture, and social media on just the role the father, I'm curious, do either of y'all have someone as you think of, as a bit of a pop culture icon when it comes to fatherhood , in your mind, that you like to either refer to or think about when you think about this topic?

[00:31:00] Dr. JJ Parker: That is a fun question. The first thing that comes to mind is a cartoon named Bandit from the show Bluey. My son is almost five, my daughter's two and a half. And that's a great kid show that a lot of parents like, and there's actually been a lot on social media on how the father is kind of the idol for parents. And it is exceptional and how involved he is as a father. There's just so many like little games that he plays with his kids that my kids are like, you do this. And I'm like, okay, I'll be daddy robot. It makes it very normal for him to be silly and to play with kids, which we know is important. It's so important for them to play with their children. He's just always being silly. Like he has to be the baby at a grocery store in one episode, and he just like, walks around calling his daughter mom. And then everybody's buying it. They're calling him baby and the checkout. It's just a great show. Good messaging and the dad is a great character.

[00:31:48] Dr. Rob Sanchez: A great choice for sure. I definitely agree with that one. Craig, anyone that you idolize or think?

[00:31:52] Dr. Craig Garfield: Yeah. One of my favorite books I used to read to my kids was called Owl Moon, and it's this beautiful story of a dad and a daughter who go out on a full moon in the snow way out into the country to look for owls. And there's not much dialogue between the dad and the daughter, it's like very cold and she's bundled up and she's got a scarf over her face and they actually find an owl and they follow the owl as it's flying from one tree to another tree. And it's just really beautiful. It's just about spending time together as a child and a parent and how beautiful that can be. Even just walking in the woods.

[00:32:27] Dr. Rob Sanchez: I haven't read that one personally, but I want to go check it out. I like exactly how you describe it. It doesn't have to be a ton said, but it's incredibly impactful.  So thank you for sharing that.I wanna thank both of y'all for giving our listeners an opportunity to engage in this and hear more about the wonderful work that you're doing and kind of opening this door for how we can continue to engage fathers in that important role that they're taking in the lives of their families. Thank you so much for being and talking with us today.

[00:32:51] Dr. Craig Garfield: Thank you, Rob.

[00:32:52] Dr. JJ Parker: Thanks for having us. 

[00:32:53] Dr. Rob Sanchez: Thanks for listening to Kids Wellness Matters.

[00:32:57] Dr. Nina Alfieri: For more information on this episode and all things kids wellness, please visit luriechildrens.org