The study, led by Jennifer M. StGeorge with Emily E. Freeman and Linda E. Campbell, evaluated DadPlay across four dimensions of feasibility drawn from Bowen and colleagues’ framework: Demand, Acceptability, Implementation and Perceived Impact. The framework was chosen for its explicit focus on real-world delivery, and it was complemented by the CAPE model of parental engagement, which traces a parent’s journey from first connection with a program through attendance, participation and, ultimately, enactment of new parenting strategies in daily life. Together, the two frameworks allowed the team to dissect not just whether fathers liked DadPlay, but precisely where in the pipeline of engagement they arrived, stayed or dropped out.

The theoretical architecture of DadPlay reflects a careful reading of what shapes fathering behaviour. According to ecological models of father-child relationships, fathering emerges from interacting individual, social and societal factors that produce the cognitions, attitudes and activities which then shape child outcomes. In Australia, as across many Western democracies, social expectations for warm, involved, nurturing fathers are rising, but that cultural shift is slow. Hegemonic masculine norms of self-sufficiency and emotional restraint can make seeking parenting help feel culturally uncomfortable for some men, sitting uneasily beside dominant scripts of masculine competence. At the same time, research on father identity shows that many men hold strong commitments to being a good father, and that this identity can be a powerful motivational resource. DadPlay was designed to leverage that identity rather than fight the stigma: it framed support as a way for men to become better fathers, not as remediation for failing ones.

Two behaviour-change theories informed the program’s design. The Reasoned Action Approach holds that change occurs when interventions shift intentions, build skills and reduce environmental constraints. Social cognitive theory, meanwhile, points to self-efficacy as the engine of sustained behaviour change, built through modelling, verbal persuasion and opportunities for mastery. DadPlay operationalised both mechanisms through its medium. Each father enrolled in the program received 50 text messages over three months, roughly four per week, each a short one-to-three-sentence unit of about 60 characters. The brevity was deliberate, applying information-processing principles of chunking to reduce cognitive load, and most messages ended with a specific behavioural prompt to encourage immediate enactment. Videos demonstrated the skills, converting modelling into a pocket-sized format that required no appointment, no waiting room and no admission that anything was wrong.

The content itself was developed through a staged, iterative process. Fifty-four draft messages, grounded in research on early childhood behaviour, father-child relationships, father engagement and rough-and-tumble play, were reviewed for importance, clarity and acceptability by 30 clinicians and content experts spanning child and family psychology, family relationship services and early childhood education. Anything rated low on importance was cut; everything else was edited and then subjected to a second qualitative review. The final set of 48 messages covered four domains: child development, focused on the two core school-readiness skills most open to parenting influence, emotion regulation and behavioural inhibition; the father’s role, emphasising warm responsiveness, modelling self-regulation and self-care; co-parenting, worded inclusively for separated, same-sex, transgender and father-figure parenting partnerships; and games. One message told fathers: ‘Spending time playing with your child will help them to develop and learn.’ Another explained: ‘My brain lets information in from many of my senses all day Dad. Watch this video to see how different brains work to process all this input!’

The games deserve particular attention, because they encode the program’s most distinctive scientific claim. Vigorous, physical, big-body play between father and child contributes to the development of the prefrontal cortex, the brain region housing networks for emotion regulation and behavioural inhibition. Each DadPlay game was selected or adapted from existing programs and books to embody four characteristics: interactivity and physical father-child contact; gentle competition, of the ‘I’m the strongest’ variety; fun and novelty; and no more than everyday risk, allowing dads to practise setting limits. A 13-member reference group of family service professionals and fathering academics rated each game on whether it was playful, pushed children’s limits, inspired competition, allowed limit-setting and created connection. Volunteer fathers and their children then played the games on camera, and professional videography produced demonstration clips with embedded safety and wind-down guidance.

So what happened when the program met the real world? The demand data revealed a striking asymmetry. Of approximately 340 organisations approached, from family charities to preschools in regional, rural and remote areas, 57 percent agreed to disseminate information, and service providers proved enthusiastic, with 93 percent of those rating a one-week professional ‘taster’ judging the messages ‘just what I thought’ or ‘way better’. Yet organisational enthusiasm did not automatically become father engagement. Of 325 parents submitting expressions of interest, 108 fathers completed enrolment and 96 finished the 12-week program, a conversion rate the authors characterise as modest relative to the administrative effort involved. Engagement among those who did enrol was strong: 581 clicks on the ten further-information links, high response rates to in-program feedback, with 84 to 96 percent of responding fathers rating messages as ‘great’, and spontaneous text replies such as ‘Experienced that moment last night, so great timings.’

Implementation findings were equally instructive. Reach was vast, mapped using the Modified Monash Model and indices of socio-economic disadvantage to target rural and remote communities, but most fathers who ultimately enrolled provided metropolitan postcodes, suggesting that network breadth rarely guarantees penetration into underserved communities. Every successful cold contact required at least two phone calls and two emails, and the promotional video’s 5,000-plus public views offered only a partial indicator of dissemination efficiency. The authors argue this points to a fundamental implementation lesson: securing organisational buy-in and engaging fathers are distinct tasks requiring different strategies. Organisations functioned more as passive dissemination channels than as active referral systems, and the researchers suggest future iterations should embed the program as an organisation’s working ‘curriculum’ with dads, supported by professionals embedded in the systems they hope to change.

Perceived impact data were limited by a very low post-program response rate, with only 13 fathers completing the six-item questionnaire, but the signal was promising and theoretically coherent. All responding fathers agreed DadPlay helped them feel more supported and helped their relationship with their child; ten of thirteen perceived an improved bond and ten perceived greater confidence, with mean improvement ratings of around 65 on a 100-point scale. These self-efficacy gains mirror qualitative findings from SMS4dads, the earlier text-based program on which DadPlay was modelled, and align precisely with Bandura’s mechanisms of modelling and mastery. Free-text comments described DadPlay as a helpful reminder to play, a source of reassurance and encouragement, with requests for better mapping of games to child capability. Given that every dollar invested in parenting interventions may save up to thirty dollars in downstream social service costs, the economics of getting father engagement right are compelling.

The study’s limitations are candidly acknowledged. No formal screening for child behavioural difficulties occurred at enrolment, the analytic sample of 63 fathers skewed metropolitan, tertiary-educated and financially comfortable, and the program never reached its priority populations of rural, remote and low-income fathers. Yet the central conclusion stands clear: implementation challenges stemmed from recruitment and dissemination processes, not from the program’s content, which fathers found highly acceptable. The authors call for a further trial incorporating behavioural screening, formal progression criteria, retention strategies and recruitment pathways deeply embedded within partner organisations. More broadly, the findings suggest that scaling father-focused digital interventions will require genuine co-creation with fathers, professionals and organisations, and a willingness to meet men at the point where their own identity as a good father becomes the strongest invitation to engage.

Subject of Research: Feasibility of an SMS-delivered father-focused parenting intervention for fathers of young children

Article Title: Feasibility, Development and Dissemination of a Father Focused Parenting Intervention, DadPlay

Article References: StGeorge, J. M., Freeman, E. E., & Campbell, L. E. (2026). Feasibility, Development and Dissemination of a Father Focused Parenting Intervention, DadPlay. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-026-03367-1

Image Credits: AI Generated

DOI: 10.1007/s10826-026-03367-1

Keywords: DadPlay, fathers, parenting intervention, mHealth, SMS text messages, early childhood, child behaviour, rough-and-tumble play, father engagement, feasibility study, self-efficacy, co-parenting

The findings arrive amid a widening scientific debate over fluoride, a substance added to community water supplies at 0.7 milligrams per litre to prevent tooth decay, yet one that occurs naturally in groundwater at levels that can vary dramatically with local geology. In rural New Hampshire, where many families rely on private, unregulated wells drilled into fluoride-bearing rock, concentrations can be far higher than in fluoridated municipal systems; roughly thirteen percent of wells in regions underlain by felsic igneous rock exceed the U.S. Environmental Protection Agency’s secondary maximum contaminant level of 2.0 milligrams per litre. Against this backdrop, the research team set out to test whether prenatal fluoride exposure is linked not to intelligence, which has dominated the literature, but to the social-emotional and behavioural dimensions of child development that have received far less scrutiny.

Methodologically, the study distinguishes itself through its choice of exposure biomarker. Most previous prospective studies relied on maternal urinary fluoride, which reflects intake over only about six hours—a snapshot that can fluctuate with tea drinking, meal composition, and water consumption on a given day. Toenails, by contrast, grow slowly and integrate fluoride exposure over approximately three to six months, capturing cumulative intake from all sources: drinking water, beverages prepared with fluoridated water, seafood, tea, and the inadvertent swallowing of fluoridated dental products. Because fluoride readily crosses the placenta and penetrates the blood-brain barrier, the developing fetal brain is directly exposed, making the timing and magnitude of maternal exposure biologically consequential.

The researchers analyzed toenail clippings collected from women at roughly 28 weeks of gestation and again about five weeks after delivery, yielding estimates of fluoride exposure during early pregnancy and mid-to-late pregnancy respectively. Samples were analyzed at the Indiana University School of Dentistry using a hexamethyldisiloxane microdiffusion procedure coupled with fluoride ion-selective electrode detection, and specimens weighing less than 2.5 milligrams were excluded after validation work showed that smaller samples produce unreliable results. Household tap water collected at enrollment was analyzed with a fluoride ion-selective electrode as well. The final analytic samples comprised 358 mother-child pairs with toenail fluoride data and 381 pairs with water fluoride data, drawn from a cohort recruited between 2009 and 2013 from prenatal clinics serving women using private water systems.

Children’s behaviour was assessed at age five with the Behavior Assessment System for Children, Second Edition, Parent Rating Scale for preschoolers, a validated instrument that generates age-standardized T-scores across clinical scales such as hyperactivity, aggression, attention problems, anxiety, depression, and withdrawal, along with composite indices of externalizing problems, internalizing problems, and overall behavioural symptoms. Scores of 60 or above fall into the at-risk range. In this sample, most children scored near the normative mean, with between six and twenty-eight percent in the at-risk range depending on the scale. The analysis was preregistered, and the modeling strategy used generalized estimating equations to estimate the odds of at-risk outcomes per one microgram per gram increase in toenail fluoride, with interaction terms testing for differences by child sex and exposure window.

The headline result was statistically robust: each one microgram per gram increase in toenail fluoride reflecting early pregnancy was associated with thirty-nine percent higher odds of scoring in the at-risk range for externalizing problems, with a confidence interval running from fifteen to sixty-seven percent above baseline. The late-pregnancy estimate was similar in magnitude, at thirty percent higher odds, though its confidence interval narrowly included the null. On the individual clinical scales, early-pregnancy fluoride was linked to twenty percent higher odds of at-risk hyperactivity, and the late-pregnancy estimate of twenty-four percent approached significance. The pattern suggests that no single trimester stands out as uniquely vulnerable; rather, fluoride exposure across pregnancy appears relevant to externalizing behaviour.

The sex-specific findings added a further layer of complexity. Among girls, each one microgram per gram increase in early-pregnancy toenail fluoride was associated with thirty-seven percent higher odds of at-risk depressive symptoms, while no association appeared in boys—a statistically significant interaction. Suggestive but imprecise signals also emerged for anxiety and withdrawal in girls in relation to late-pregnancy exposure. This pattern is intriguing because prior fluoride studies, particularly those examining intelligence outcomes, have often reported stronger effects in boys. The authors note that internalizing and externalizing problems may share transdiagnostic roots, including emotion dysregulation, and that sex-specific biological responses to prenatal exposures could shape which behavioural domain is affected.

Plausible biological mechanisms are beginning to take shape in the literature. Fluoride has been implicated in disruption of the thyroid axis, a concern in pregnancy because the fetus depends entirely on maternal thyroid hormones during the first trimester, and even mild maternal thyroid dysfunction has been linked to both internalizing and externalizing problems in children. Fluoride exposure has also been shown to induce oxidative stress in animal and human studies, a pathway independently associated with behavioural problems in offspring. Low iodine status, which compromises thyroid hormone synthesis, may exacerbate fluoride’s effects, and emerging evidence suggests thyroid regulation and oxidative stress responses differ by fetal sex. None of these mechanisms is confirmed as the driver of the observed associations, but together they offer a coherent framework for future investigation.

Why did water fluoride fail to predict outcomes while toenail fluoride succeeded? The authors argue that toenails capture total intake from all dietary and product sources, whereas a single tap-water measurement reflects only one exposure pathway and ignores individual differences in consumption volume. This mismatch can produce exposure misclassification that biases associations toward the null. Median water fluoride in the sample was about 0.2 milligrams per litre—comparable to other communities with naturally occurring fluoride—but values ranged from 0.02 to 13.8 milligrams per litre, and correlations between water and toenail measures, while positive, were moderate. The authors also caution that some participants may have reduced tap-water consumption after learning their wells exceeded arsenic guidelines during the study.

The study’s limitations temper its implications. The cohort was predominantly white, college-educated, married, and relatively affluent, and relied on unregulated private wells, so the findings cannot be assumed to extend to populations drinking optimally fluoridated municipal water. Postnatal fluoride exposure was not measured, toenail growth rates vary between individuals, and only a small fraction of children scored in the at-risk range, limiting statistical power. Yet extensive sensitivity analyses—adjusting for co-occurring metals, imputing missing data, removing influential observations, and modeling outcomes continuously—left the primary conclusions intact. The authors call for longitudinal follow-up, validation of toenail fluoride reference ranges in pregnant populations, and exposome-wide approaches that jointly model fluoride alongside the many other prenatal environmental exposures that shape the developing brain.

Subject of Research: The association between prenatal fluoride exposure measured in maternal toenails and social-emotional and behavioural outcomes in preschool children.

Article Title: Long-term exposure to prenatal fluoride and social-emotional and behavioural outcomes in children in the New Hampshire Birth Cohort Study

Article References: Goodman, C. V., Karagas, M. R., Peacock, J. L., Korrick, S., Flora, D., Lanphear, B., Martinez-Mier, E. A., Tamayo-Cabeza, G., Lippert, F., & Till, C. (2026). Long-term exposure to prenatal fluoride and social-emotional and behavioural outcomes in children in the New Hampshire Birth Cohort Study. Environmental Advances, 25, Article 100753. https://doi.org/10.1016/j.envadv.2026.100753

Image Credits: AI Generated

DOI: 10.1016/j.envadv.2026.100753

Keywords: fluoride, prenatal exposure, child behaviour, hyperactivity, New Hampshire Birth Cohort Study, toenail biomarker, drinking water, neurodevelopment, thyroid, externalizing problems, internalizing problems, private wells