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Background There is a growing need for quality, community care models centered on the care of the child with medical complexity. This quality improvement project was conducted in a community-based medical daycare program within a large, metropolitan, pediatric hospital network of care location. A multi-disciplinary team, led by a clinical nurse specialist, occupational therapist, and early childhood special education teacher, addressed staff frustrations and low morale related to barriers to working at top of scope and feelings of a chaotic care and learning environment for children. Aims To improve staff satisfaction through a decrease in perceived barriers to practicing at top of scope and to refocus each discipline's role. A secondary aim was to improve child engagement through restructuring the therapeutic and learning environment and reducing distractions to better meet the unique needs of the children the program serves. Methods This quality improvement (QI) project used multiple methods, including staff surveys, child observations and timecard review, to measure the project's impact on ability to work at top scope, child engagement and staff satisfaction. Results The QI project resulted in positively impacting work culture and structure by increased time professional staff practiced at the top of scope, decreased perceived barriers to do so, improved overall job satisfaction and improved child engagement. Conclusion Increased multidisciplinary collaboration and increased structure promoted an enhanced learning environment, healthier staff environment, and a more fiscally responsible program. There is little knowledge about medical daycares and further investigations in this setting is warranted.

Objective. Perinatal outcomes in the United States are poor among Hispanics, the country's fastest-growing population. Hispanics experience higher rates of obesity, diabetes, gestational diabetes, preterm birth, and pregnancy-related hypertension, as well as 20% of infant deaths. StartSmarttm, an mHealth app, screens for risk and protective factors. This project translated and culturally adapted StartSmarttm for Spanish-speaking pregnant women. Methods. Using the Beaton process for translation and cultural adaptation, we completed a six-stage process. Stage I: Translation into Spanish, Stage II: Synthesis of the translations, Stage III: Back-translation, Stage IV: Expert committee review, Stage V: Pretesting with Spanish-speaking pregnant women, Stage VI: Appraisal of process. Results. StartSmarttm was acceptable and feasible for use during prenatal visits. Participants reported ease of use and understanding the material. No issues regarding literacy were identified, and participants provided helpful feedback for refining StartSmarttm for Spanish-speaking women. Conclusions. The Beaton process ensures culturally appropriate translation.

Sensor technologies for health care, research, and consumers have expanded and evolved rapidly. Many technologies developed in commercial or engineering spaces, lack theoretical grounding and scientific evidence to support their need, safety, and efficacy. Theory is a mechanism for synthesizing and guiding knowledge generation for the discipline of nursing, including the design, implementation, and evaluation of sensors and related technologies such as artificial intelligence and machine learning. In this paper, three nurse scientists summarize their presentations at the Council for the Advancement of Nursing Science 2019 Advanced Methods Conference on Expanding Science of Sensor Technology in Research discussing the theoretical underpinnings of sensor technologies development and use in nursing research and practice. Multiple theories with diverse epistemological roots guide decision-making about whether or not to apply sensors to a given use; development of, components of, and mechanisms by which sensor technologies are expected to work; and possible outcomes.

School-aged children spend around 1,080 hr at school each year and many of them have chronic diseases; therefore, it is imperative to include school nurses as part of the health care team. Care coordination between health care providers and school nurses is currently hindered by communication that relies on an inadequate system of fax, phone, and traditional mail. Using electronic health records (EHRs) to link school nurses and health care systems is usually limited in scope despite EHRs advancement in these health care systems. No literature is currently available showing the number of hospitals and health care systems that provide EHR access to school nurses. The purpose of this article was to present a literature review on EHR access for school nurses nationally. This review along with the legal and logistical considerations for this type of implementation will be discussed.

Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate inequity and disparity in the context of childhood obesity. The National Institute of Minority Health and Health Disparities' Research Framework guides the explication of structurally racist mechanisms that influence health disparities and contribute to childhood obesity: biologic and genetic, health behaviours, chronic toxic stress, the built environment, race and cultural identity, and the health care system. Strategies and interventions to combat structural racism and its effects on children and their families are reviewed along with strategies for research and implications for policy change. From our critical review and reflection, the subtle and overt effects of societal structures sustained from years of racism and the impact on the development and resistant nature of childhood obesity compel concerted action.

• Children with obesity face increased biopsychosocial risks during COVID-19. • Stress exacerbates inflammation and immune response in obesity and COVID-19. • The COVID-19 pandemic has significantly interrupted children's daily routines. • The health effects of the obesogenic environment are exacerbated by COVID-19. • Access to timely, comprehensive healthcare is critical during COVID-19.

The purpose of this study was to evaluate the P-REDI discharge tool for safe discharge to home following ambulatory surgery.A quasi-experimental, mixed methods with pre/post nurse surveys and retrospective chart review comparing pre-, interim- and post-implementation of P-REDI on unscheduled clinic visits, Emergency Department visits, hospital readmission, and length of stay.The P-REDI tool was developed in collaboration with anesthesia and based upon an extensive review of the literature on safe discharge from the Phase II Postanesthesia Care Unit (PACU). Nurse surveys and patient data extracted from the electronic health record through the computer-assisted reporting system were analyzed using descriptive statistics, bivariate statistics, and correlations to assess outcomes and relationships between variables.Nurses' perceptions of discharge criteria improved after implementation of P-REDI. There were no differences in adverse events before, during, and after the implementation of the P-REDI instrument. There was a significant decrease in Phase II time after implementation of the tool. There were also significant correlations with the P-REDI score and related variables such as length of surgical procedure time and length of stay.The P-REDI tool was developed to provide nurses a concrete, objective tool to increase their level of comfort with discharging patients from the Phase II PACU. The tool significantly decreased length of stay in Phase II without any change in adverse events. The cost savings to the institution needs to be examined in future studies.

Clinical decision support with individualized patient education information can facilitate the translation of evidence-based guidelines into practice to improve pediatric patient outcomes. Interdisciplinary teams are required to develop and implement this technology support into practice. Engineering expertise with attention to three components is required: backend (e.g., data science, predictions), front end (e.g., user interface), and integration (e.g., workflow) must be addressed to achieve useful technology that will be adopted. An engineering framework, Technology Acceptance Model, can be used to guide the development of clinical decision support with patient education materials and includes a partnership with end users, both clinicians and patients.

Purpose: The purpose of this study was to explore the potential risk factors for overweight/obesity in survivors of childhood cancer. Design: A retrospective chart review of childhood cancer survivors ( N = 321) seen in a cancer survivor clinic was conducted to determine the strongest risks of overweight/obesity. Risk factors were as follows: age, race, gender, cancer diagnosis, body mass index at diagnosis, and treatment. Multivariate logistic regression was used to identify risks of overweight/obesity while simultaneously adjusting for other patient factors. Findings: Data suggested that female cancer survivors, Hispanics, those with higher body mass index at diagnosis, and those with longer duration of treatment had greater odds of being overweight/obese. Conclusions: Many of the risk factors for overweight/obesity in childhood cancer survivors are consistent with the general population, and length of cancer treatment is unique to this population. Implications for Nursing: Findings from this study will inform care for childhood cancer survivors to improve long-term cardiovascular health.

Introduction: In the United States, Latino children are disproportionately affected by childhood obesity and related comorbidities. Stakeholder engagement has the potential to heighten the efficacy of interventions, thereby reducing the disparate prevalence of obesity among Latino children. The objective of this study was to identify stakeholders’ opinions on factors influencing early childhood obesity in Latino children aged 0 to 5 years. Method: This study used the Delphi technique to gather and prioritize stakeholders’ opinions about the factors and barriers considered most influential in early (age 0-5 years) childhood obesity intervention or prevention within the Latino community. Three sequential phases were used. Participants included Latina women as well as staff from community organizations serving Denver metropolitan’s Latino population. Results: Study results revealed that stakeholders value the role of the child’s primary care provider in the identification of overweight children and desire more educational support to reduce intake of nonnutritious foods. Participants further determined that obesity-related knowledge gaps and affordability of healthy foods and activities were the largest barriers to helping Latino children maintain healthy weights. Conclusion: Use of this stakeholder-informed data could assist in the development of future culturally tailored interventions aimed at reducing the rates of early childhood obesity in the Latino population.

Introduction Reliable and valid instruments to measure counseling effectiveness related to eating, activity, and inactivity are lacking. HeartSmartKids (HSK; HeartSmartKids, LLC, Boulder, Colorado) is a bilingual decision-support technology that can be used to assess and counsel families on cardiovascular risk factors in children. The purpose of this study was to establish preliminary test–retest reliability and convergent validity of HSK questions relative to a previously validated questionnaire, HABITS. Method Data were collected from children (ages 9-14 years) during an intervention study. A multitrait/multimethod correlation matrix framework was used to examine the test–retest reliability (n = 35) and convergent validity (n = 103) of HSK relative to HABITS. Results HSK had moderate/strong test–retest reliability and good convergent validity between HSK and HABITS. Discussion This study provides preliminary test–retest reliability and convergent validity of a useful clinical tool that can be used to quickly assess children's nutrition (e.g., fruit/vegetable consumption, snacks, sugar-sweetened beverages, breakfast) and activity habits to guide behavior change counseling. Additional work should be done validating HSK with objective measures.

Infants born at ≤32weeks gestation are at risk of developmental delays. Review of the literature indicates NIDCAP improves parental satisfaction, minimizes developmental delays, and decreases length of stay, thus reducing cost of hospitalization. Half (50.6%) of the infants admitted to this 84-bed Level IV Neonatal Intensive Care Unit (NICU) with a gestational age of ≤32weeks were referred for NIDCAP. The specific aims of this quality improvement project were to 1) compare the age at discharge for infants meeting inclusion criteria enrolled in NIDCAP with the age at discharge for those eligible infants not enrolled in NIDCAP; and 2) investigate the timing of initiation of NIDCAP (e.g., within six days of admission) on age at discharge. During the 12month period of data collection, infants enrolled in NIDCAP (M=27.85weeks, SD=1.86) were 2.02weeks younger than those not enrolled in NIDCAP (M=29.87weeks, SD=2.49), and were 2.32weeks older at discharge (M=38.28weeks, SD=5.10) than those not enrolled in NIDCAP (M=35.96weeks, SD=5.60). Infants who enrolled within 6days of admission were discharged an average of 25days sooner (p=0.055), and at a younger post-menstrual age (by 3.33weeks on average), than those enrolled later (p=0.027).

In the United States, the vast majority of Hispanic high school students do not meet physical activity recommendations. This prospective, observational study tested the Theory of Planned Behavior (TPB) to predict physical activity in a convenience sample of 232 high school students from a predominantly Hispanic, rural-fringe, lower-income community in Southwestern United States. Mindfulness was tested as a moderator of the intention–physical activity relationship. Data were collected via self-report questionnaires. Statistical analysis included structural equation modeling (SEM) and moderation analysis. The model explained 60% and 43% of the variance in intention and physical activity, respectively. Attitude (β = 0.49, p < 0.001) and subjective norm (β = 0.44, p < 0.001) predicted intention. Intention (β = 0.58, p < 0.001) and perceived behavioral control (β = 0.13, p < 0.027) predicted physical activity. Mindfulness did not moderate the intention–physical activity relationship. The results support using the TPB to predict physical activity in this population and may inspire ideas for targeted interventions.

Introduction Childhood obesity is a major public health threat in the United States. Recent data indicate that 34.2% of children ages 6 to 11 years are overweight or obese. The purpose of this study is to describe childhood obesity levels and identify risk behaviors in two school-based health centers in Michigan, one urban and one rural. Methods This study is a secondary data analysis from a multicenter comparative effectiveness trial. Multiple logistic regression was used to examine behavioral factors associated with overweight/obesity in children. Results In this sample ( n = 105), 41.9% were obese and 16.2% were overweight. The duration of sleep per night ( p = .04) and the frequency of eating breakfast ( p = .04) were significant predictors of being overweight/obese. Discussion Health care providers in school-based health centers must be comfortable assessing, preventing, and treating childhood obesity in this high-risk group of patients. Interventions should encourage children to eat breakfast daily and to get adequate sleep.

Purpose The purpose of this study was to examine the accuracy of Hispanic parents’ perceptions of their preschool children's weight status. Design and Methods A cross-sectional descriptive design with Hispanic parent–child dyads (n = 83) from a Head Start setting was used to compare parents’ perceptions of their children's weight status with their 2- to 5-year-old children's body mass index (BMI) and weight categories. Methods included a word choice from five response options, and varying body size silhouettes presented in a linear fashion and a random circular pattern. Parents’ perceptions were compared with the children's BMI, and in relationship to parents’ demographic characteristics and BMI. Results Approximately half of parents underestimated their child's weight status, and overweight/obese parents tended to underestimate their overweight/obese children's weight status. Practice Implications Eliciting parent perception of their child's weight is one way providers can engage in obesity prevention dialogue.

Objective The purpose of this study was to evaluate school-based health center (SHBC) provider adherence to guidelines for identification and assessment of childhood obesity after participation in a virtual Health Disparities Learning Collaborative with and without HeartSmartKids™, decision-support technology with tailored patient education. Design and Setting A cluster randomized comparative effectiveness trial was conducted with 24 SBHCs from six states. Participants The sample consisted of 33 SBHC providers and review of medical charts at three time points. Chart data were collected at baseline ( n = 850), after training ( n = 691) and 6 months after training ( n = 612). Main Outcome Measures Charts from a random sample of youth 5–12 years making well-child visits were examined for the documentation of: BMI percentile, accurate weight diagnosis based upon BMI percentile, blood pressure percentile, and ordering appropriate laboratory assessment of obese youth ≥10 years old. Results Percentage of overweight/obese children in this study was 40.4–47.2%. For both the HeartSmartKids™ and non-HeartSmartKids™ groups, provider adherence significantly improved after training for BMI percentile and blood pressure percentile documentation, as well as correct diagnosis for overweight and obese. Implementation of the HeartSmartKids™ was variable at the technology sites and differences in identification and assessment were not found between groups. Conclusion The virtual collaborative approach to quality improvement resulted in improved adherence to guidelines for identification and assessment of overweight/obese children. The impact of the training with and without HeartSmartKids™ on patient outcomes needs to be evaluated. Coaching on implementation of technology needs to be included in future work.

Introduction Technology decision support with tailored patient education has the potential to improve maternal and child health outcomes. The purpose of this study was to develop StartSmart, a mobile health (mHealth) intervention to support evidence-based prenatal screening, brief intervention, and referral to treatment for risk and protective factors in pregnancy. Methods StartSmart was developed using Davis' Technology Acceptance Model with end users engaged in the technology development from initial concept to clinical testing. The prototype was developed based upon the current guidelines, focus group findings, and consultation with patient and provider experts. The prototype was then alpha tested by clinicians and patients. Clinicians were asked to give feedback on the screening questions, treatment, brief motivational interviewing, referral algorithms, and the individualized education materials. Clinicians were asked about the feasibility of using the materials to provide brief intervention or referral to treatment. Patients were interviewed using the think aloud technique, a cognitive engineering method used to inform the design of mHealth interventions. Interview questions were guided by the Screening, Brief Intervention, Referral to Treatment theory and attention to usefulness and usability. Results Expert clinicians provided guidance on the screening instruments, resources, and practice guidelines. Clinicians suggested identifying specific prenatal visits for the screening (first prenatal visit, 28-week visit, and 36-week visit). Patients reported that the tablet-based screening was useful to promote adherence to guidelines and provided suggestions for improvement including more information on the diabetic diet and more resources for diabetes. During alpha testing, participants commented on navigability and usability. Patients reported favorable responses about question wording and ease of use. Discussion Clinicians reported the use of mHealth to screen and counsel pregnant patients on risk and protective factors facilitated their ability to provide comprehensive care.

Purpose To develop profiles of obesity risk behaviors for children and adolescents. Design and Methods Risk assessments were obtained from patients (n = 971) at a school-based health center. Latent class analysis was used to create subgroups based on seven indicators measuring diet, activity, and screen time. Results Four classes emerged, with 44% classified as the “Healthiest,” 8% as the “Least Healthy,” 37% as “Mixed Diet/Low Activity/Low Screen Time,” and 11% as “Mixed Diet/High Activity/High Screen Time.” Several demographic predictors distinguished the classes. Practice Implications Obesity risk factor profiles may help providers identify strengths and risks, tailor counseling, and plan interventions with families.

Introduction This descriptive study evaluated school-based health center (SBHC) providers' satisfaction with Web-based continuing education as part of a virtual childhood obesity intervention. Method Thirty-six participants from 24 SBHCs in six states participated in the training modules. Modules were divided into four learning sessions, with a total of 17 training modules. Participants completed satisfaction surveys after each module, as well as an overall survey at the end of the training. Questions were rated on a 4-point Likert scale (4 = strongly agree, 3 = agree, 2 = disagree, 1 = strongly disagree). Results Participation in the first two learning sessions was higher than the last two. Provider satisfaction of training modules by question type and content area was quite high (μ = 3.66-3.33). Overall satisfaction means ranged from 3.76 to 3.24. Many providers also reported plans to make changes in their practice after completing the training. Discussion This study demonstrated that a virtual childhood obesity collaborative is an acceptable delivery method for continuing education.

Purpose The purpose of this study was to explore potential correlates of physical activity and sedentary screen time behaviors among overweight Hispanic school-aged children, ages 7 to 14years. Design and methods We conducted an exploratory correlation analysis using baseline data of 40 child-parent dyads from the "Mind Exercise Nutrition Do It!" program conducted in the Western United States. Results Child self-esteem and parental vegetable intake were moderately associated with physical activity, while parental vegetable intake and child fruit intake were strongly associated with physical activity among males. Physical activity was not significantly associated with body mass index percentile, sedentary screen time behaviors, or body esteem. Only decreased body esteem in males was correlated with sedentary screen time behaviors. Conclusions and practice implications Understanding the correlates of physical activity and sedentary screen time behaviors in this underrepresented population allows nurses to better understand the connections between physical activity and other aspects of well-being in children. Further investigation is needed to determine how these relationships can be incorporated into physical activity interventions that improve the health of overweight Hispanic school-aged children.

This descriptive study was to determine self-reported treatment practices of school-based health center (SBHC) providers when caring for overweight/obese children. Providers (N=33) from SBHCs in 6 states (AZ, CO, NM, MI, NY, and NC) completed a baseline survey before being trained on obesity recommendations. SBHC providers reported patient/parent barriers to be more significant to treatment than clinician/setting barriers (p0.0001). Most providers (97%) indicated childhood overweight needs treatment, yet only 36% said they initiate treatment in children who do not want to control their weight. SBHC providers also did not commonly refer overweight/obese children to specialists.

Using health information technology to facilitate decision support and consumer engagement is a major component of federal electronic health record meaningful use (MU) criteria. Health information technology has the potential to improve primary care and track outcomes in the persistent problem of childhood obesity. We describe a computerized decision support tool we developed to gather patient information, raise family awareness of risks, facilitate patient-centered counseling, and implement clinical quality measures for childhood obesity. It has bilingual capacity, can be used in community screening and pediatric primary care, and provides tailored patient education materials that promote patient engagement.

In order to inform the care of children at this pivotal time in the history of healthcare, the Society of Pediatric Nurses (SPN) sought to identify priorities for nursing research and key challenges facing pediatric nursing. A three round Delphi study was conducted electronically with SPN members. The top 10 priorities and challenges were identified and will serve as a valuable guide for pediatric nursing practice, education, policy and administration over the coming decade.

Background Healthcare providers use continuing education (CE) to meet professional development requirements and to ensure optimal patient care. There has been a dramatic increase in computer-mediated CE (CMCE) programs. Aims To synthesize the literature regarding the current state of the science on the efficacy of CMCE for healthcare professionals, particularly as it relates to provider learning and patient outcomes. Specifically, this review assesses the methodological quality of existing systematic reviews and meta-analyses. Methods A literature search was conducted using Cochrane Library, PubMed, and CINAHL. Review articles evaluating the efficacy of CMCE for healthcare providers were included. Publications were searched between 2002 and 2013 and limited to those printed in English. An objective measurement tool, AMSTAR, was used to assess the methodological quality of each review. AMSTAR is an 11-item instrument, in which individual criteria were evaluated and a composite score of all 11 components was determined for each review. Outcomes of each review were also categorized based on Kirkpatrick's levels for summative evaluation: (i) Learner satisfaction, (ii) Learning outcomes, (iii) Performance improvement, (iv) Patient/health outcomes. Results Starting with 231 articles, 11 met the inclusion criteria for this evaluation. AMSTAR quality scores of the reviews ranged from 7 to 11, with 11 indicating the strongest quality. Although weak research design of many studies and heterogeneous topics covered make summative evaluations difficult, there were some common themes covered in the articles reviewed. Healthcare providers were largely satisfied with using CMCE programs. Overall, the studies comparing CMCE to traditional CE methods found the impact on learning outcomes to be comparable, with neither method necessarily superior. Additionally, all reviews lacked evaluation of practice outcomes. Linking Evidence to Action While results of this review show promise for CMCE, further evaluation and more rigorously conducted research is necessary. Particular focus is needed to determine the effects of CMCE on health outcomes.

This paper reports the findings of motivational interviewing (MI) training with and without technology support on school-based health center (SBHC) providers' satisfaction with MI training, providers' self-report of behavioral counseling related to childhood overweight/obesity, and parents' perception of care after training.The effects of training and technology on MI is part of a larger comparative effectiveness, cluster randomized trial. Twenty-four SBHCs in six states received virtual training on MI. Half the sites received HeartSmartKids™, a bilingual (English/Spanish), decision-support technology. The technology generated tailored patient education materials. Standard growth charts were plotted and health risks were highlighted to support MI counseling. The results of the MI training included provider satisfaction with MI training and parent assessment of the components of MI in their child's care. Providers and parents were surveyed at baseline, after training, and six months after training.Providers were satisfied with training and reported improvements in counseling proficiency (p0.0007) and psychological/emotional assessment (p=0.0004) after training. Parents in the technology group reported significant improvement in provider support for healthy eating (p=0.04).Virtual training has the potential of preparing providers to use MI to address childhood obesity. Technology improved parent support for healthy eating. Future research should evaluate the impact of technology to support MI on patient outcomes.Childhood obesity guidelines emphasize that MI should be used to promote healthy weight in children. Training providers on MI may help more providers incorporate obesity guidelines in their practice.

Objectives A cross-sectional study comparing weight-for-length status of children 6–24 months old who participated in Nurse-Family Partnership (NFP) or Special Supplemental Program for Women, Infants, and Children (WIC). Methods Secondary analysis of NFP (n = 44,980) and WIC (n = 31,294) national datasets was conducted to evaluate infant and toddler growth trajectories. Weight-for-length status was calculated at 6, 12, 18, and 24 months based on World Health Organization criteria. Demographics and breastfeeding rates were also evaluated. Binary logistic regression was used to calculate odds ratios for high weight-for-length (≥97.7 percentile) at each time point. Results At 6 months, approximately 10 % of WIC and NFP children were classified as high weight-for-length. High weight-for-length rates increased for both groups similarly until 24 months. At 24 months, NFP children had significantly lower rates of excess weight (P = 0.03) than WIC children, 15.5 and 17.5 % respectively. At all time points, non-Hispanic white children had lower rates of high–weight for length than Hispanic and non-Hispanic black children. NFP infants were also found to have higher rates of ever being breastfed than WIC infants (P

Motivational interviewing (MI) is a popular evidence-based method to support health behavior change. We examined evaluations from 10 years of interprofessional workshops on MI to identify trends in trainees’ MI-related knowledge, attitude, and behavior. From 2006 to 2015, 394 trainees participated in continuing education MI workshops with our team and completed a validated posttraining questionnaire. Participants were 90% female and 66% White, with M = 12 years in practice. They worked in pediatric and adult care; urban and rural locations; and inpatient, outpatient, and nonhealth settings. The largest groups were nurses (20%), allied health professionals (20%), and health educators or case managers (15%). Trainees’ professional diversity increased over time, their average age and years in practice decreased, and the percentage with prior MI training increased. Practitioners in telehealth and nonhealth settings had lower scores overall. Outcomes varied significantly by professional discipline: Mental health professionals, case managers, health educators, and nurses had higher scores on some outcome variables than nonhealth professionals. Years of clinical experience predicted MI-consistent attitude, but prior training, other demographic variables, and training process variations had no consistent effects. Although many trainees had already received MI training, outcome measures showed room for improvement. MI presents continued opportunities for interprofessional education.

Salud con Sabor Latino is a culturally sensitive obesity prevention curriculum that incorporates the traditions and values of the Latino community and family. The 4-week curriculum meets twice a week and includes an education and cooking component. Key components of the curriculum are portion size, reading food labels, taking small steps, eating a variety of foods, and the importance of physical activity. The curriculum is taught in English and Spanish by a bicultural promotora. Participants are primarily low income and uninsured. Goals of the program are to improve (a) knowledge of fitness and nutrition, (b) physical activity, (c) healthy eating, and (d) body fat measures. This study was a pretest and posttest evaluation of nutrition, physical activity, and body fat after the obesity prevention intervention with Latinos (n = 82). Results indicated a significant increase in physical activity (t[75] = − 6.35, p

Purpose: Although previous studies have confirmed the relationship between socioeconomic status, ethnicity, education, and occupation on birth outcomes, less is known about the relationship of providers influence or hospital characteristics on birth outcomes for minority women. It is not well understood whether hospital or physician characteristics exert an equal or greater affect compared with maternal sociodemographic factors, particularly for Black childbearing women known to be at particular risk for adverse birth outcomes. Design: This retrospective descriptive study sought to determine whether variation in neonatal birth outcomes for Black women was attributable to hospital characteristics, physician influence, or patient sociodemographics. Methods: Fixed and random effects were conducted to empirically determine the relative importance of hospital, physician, and patient characteristics (partitioning the variation of differences in birth outcome to each component) using a large administrative dataset. Findings: Considerable variability existed among hospitals over and above hospital ownership or number of hospital beds. Conclusions: Ethnicity was a statistically significant predictor of adverse outcomes, as was the number of prenatal visits and maternal education. There is a significant relationship between adverse newborn outcomes and ethnicity after controlling for hospital and physician characteristics. Clinical Relevance: Ongoing birth disparities in African American childbearing women are a significant public policy issue with important research and clinical implications. This research adds to nursing knowledge by helping eliminate some factors previously thought to have contributed to the high incidence of perinatal complications for African American women and their newborns.

Summary The purpose of this systematic review was to examine 15 studies which evaluated interventions aimed at improving primary care providers' identification, assessment, prevention and/or management of obesity in children and adolescents. Interventions were evaluated in terms of length, components addressing nutrition, physical activity and behavioural counselling consistent with expert recommendations, and inclusion of components of the Chronic Care Model. Overall, training interventions were delivered face to face or in a combination of lecture, assigned readings, preceptorship with experienced providers, and critiqued evaluations of interactions of the provider with the patient and family. Many studies incorporated training of providers as an initial step prior to delivering an obesity intervention for children and adolescents measuring weight loss and behaviour change as outcomes. Each study was evaluated for components of the Chronic Care Model. The interventions most frequently utilized the elements of self-management support (69%), decision support (100%), delivery system support (77%) and clinical information systems (23%). Although science in this area is emerging, results suggest that intervention programmes that included more components of the Chronic Care Model were more effective.

Family-Centered Care provides a forum for sharing information about basic components of caring for children and families, including respect, information sharing, collaboration, family-to-family support, and confidence building.

The need for change toward more family centered care involved focusing on issues identified by families and staff on a medical-surgical infant and toddler unit of a pediatric hospital. The research process was used to identify issues of concern and to develop and evaluate interventions to improve family centered care. This article presents the research process, the interventions employed, and family and staff perceptions of family and centered care pre and post intervention.

PURPOSE. The current obesity epidemic has produced a generation of children that may be the first to have a life expectancy shorter than their parents. To address the obesity epidemic, experts have published recommendations for providers. Research suggests the publication of guidelines may not change provider behavior. DESIGN AND METHODS. This study evaluates computer assistance for implementing obesity guidelines in school-based health centers. RESULTS. Significant improvements in identification and assessment of obesity in children with technology support were noted. PRACTICE IMPLICATIONS. Computer decision support shows promise for promoting the implementation of current recommendations by supporting providers in identifying, assessing, and providing tailored recommendations for children at risk of obesity.

In 2005, the Journal of Pediatric Health Care published an article citing the importance of educational material in the treatment and prevention of pediatric obesity, including handouts that could be copied for use (Ward-Begnoche & Gance-Cleveland, 2005). With the increased clinical use of these educational handouts, the need for Hispanic versions of the handouts to use with Spanishspeaking patients and families has become clear. This article reviews the need for language-specific educational material, and includes the Spanish versions of the handouts on Metabolism, Nutrition for Kids, Healthy Snacks, Portion Sizes, Fitness for Children and Adolescents, Behavioral Recommendations for Overweight Children and Adolescents, and Exercise Activities for Kids. Concerns for culturally appropriate treatment approaches also are reviewed. In addition, a list of online resources and books is provided to assist in behavioral change for overweight Hispanic youth. Research suggests that there is an ethnic disparity in risk for pediatric obesity, with Hispanic youth being at highest risk (Ogden et al., 2006), suggesting the need to target this population with prevention and intervention efforts. Yet youth (including Hispanic youth) report rarely receiving preventive counseling regarding specific recommendations for nutritional intake or physical activity changes during routine primary care visits (Taveras et al., 2007). Taveras and colleagues suggest that social class disparities should be included in the design of prevention counseling and treatment. Most of the literature on pediatric obesity has focused on White, middle-class samples, thus telling us little about how best to deliver chronic disease self-management interventions to low-income, Wendy L. Ward-Begnoche, Associate Professor of Pediatrics, Department of Pediatrics,UniversityofArkansas forMedical Sciences,CollegeofMedicine,andArkansas Children’s Hospital, Little Rock, AR.

Introduction: A school-based obesity prevention program was designed using the community-based participatory approach to promote health-related behavioral changes. Methods: All physical education students in the middle school (6th, 7th, 8th graders) received the curriculum in a 9-week period as part of the normal class curriculum. A large subset of these students (pre-testing n = 226 and post-testing n = 214) agreed to participate in the research project evaluating its effectiveness. All subjects enrolled in the study were assessed on height, weight, nutritional knowledge, nutritional behaviors, physical activity behaviors, parental and peer support of nutrition and physical activity changes. A feedback questionnaire was completed by parents and students. Results: The program successfully impacted nutritional intake and physical activity as well as having a positive impact on both peer and parent support of behavioral change. Discussion: The positive results found in the present study are discuss...

BACKGROUND Adolescents with substance-abusing parents need interventions to reduce their risk for a variety of problems. School-based support groups (SBSGs) have been proposed to increase resilience in this population. OBJECTIVE The purpose of this study was to evaluate a SBSG for adolescents with substance-abusing parents. STUDY DESIGN The randomized, controlled study was conducted with high-school students (n = 109) to evaluate the impact of SBSGs on resiliency. Resiliency was operationalized as positive physical health, mental health, and risk behaviors in the presence of adverse life events. Data were collected pre- and postintervention. RESULTS Significant improvements in knowledge of substance abuse were noted. Findings suggested gender differences in coping and health outcomes and positive trends in substance use. CONCLUSIONS SBSGs may increase resilience in this at-risk population. However, there were gender differences in response to the intervention, and group facilitators should be aware that participants' gender may influence response to the groups.J Am Psychiatr Nurses Assoc, 2008; 14(4), 297-309. DOI: 10.1177/1078390308321223

This article describes the design and implementation of a school-based obesity prevention program, the successes associated with its implementation, and challenges with development and application of the program's curriculum base. The program is described, including purpose and goals, content and structure of the curriculum, type and training of personnel, and budgetary concerns. Formative program evaluation results were reviewed, including whether the target population was reached, whether the implementation followed the content and structure originally designed, revisions made to the implementation process and curriculum, feedback and reactions from instructors, school personnel, and students, and an overview of strengths and limitations of the program. Recommendations for others considering implementation of school-based prevention programs in real-time settings are offered. Future research expanding and refining the program and its curriculum is planned, using a community-based participatory ...

PURPOSE. This study aims to examine the association between adolescent health, including physical complaints, mood, and social adjustment, and perceived severity of parental substance abuse. DESIGN AND METHODS. Baseline data from a study of school-based support groups for adolescents with substance-abusing family members (n = 121) were used to examine the relationship between the severity of substance abuse and adolescent health. RESULTS. Participants were divided into three groups on the basis of severity of parental substance abuse. The high-severity group had significantly more medical conditions, physical symptoms, and negative moods than those in the low- or moderate-severity groups (p

The majority of US youth are of healthy weight, but the majority of US adults are overweight or obese. Therefore, a major health challenge for most American children and adolescents is obesity prevention—today, and as they age into adulthood. In this report, we review the most recent evidence regarding many behavioral and practice interventions related to childhood obesity, and we present recommendations to health care providers. Because of the importance, we also suggest approaches that clinicians can use to encourage obesity prevention among children, including specific counseling strategies and practice-based, systems-level interventions. In addition, we suggest how clinicians may interact with and promote local and state policy initiatives designed to prevent obesity in their communities.

Many health care conditions require behavior change by the patient or parent to improve health outcomes. Poor outcomes may be attributed to the lack of adherence to the behavior change recommendations. A shift from the authoritarian, expert providing advice to a more family-centered, collaborative model using motivational interviewing (MI) results in improved adherence. The principles of MI are exploring ambivalence, reflective listening, reinforcing positive behavior, and rolling with resistance. The process for MI is establishing relationships; setting an agenda; assessing importance, confidence, and readiness; exploring importance; and helping families select an action plan and building confidence in their ability to change.

The purpose of this study was to examine the accuracy of Hispanic parents' perceptions of their preschool children's weight status.A cross-sectional descriptive design with Hispanic parent-child dyads (n = 83) from a Head Start setting was used to compare parents' perceptions of their children's weight status with their 2- to 5-year-old children's body mass index (BMI) and weight categories. Methods included a word choice from five response options, and varying body size silhouettes presented in a linear fashion and a random circular pattern. Parents' perceptions were compared with the children's BMI, and in relationship to parents' demographic characteristics and BMI.Approximately half of parents underestimated their child's weight status, and overweight/obese parents tended to underestimate their overweight/obese children's weight status.Eliciting parent perception of their child's weight is one way providers can engage in obesity prevention dialogue.

Obesity continues to disproportionately affect ethnic minorities. Parents play an integral role in early childhood, and parental perceptions regarding their child's weight are key to obesity prevention. Cultural differences contribute to parental perceptions, and increased understandings of these characteristics provide a basis to address obesity in high-risk populations at an earlier age. The aim of this integrative review was to analyze extant literature to identify Hispanic parental perceptions of their preschool-aged child's weight status.An integrative review of studies measuring Hispanic parental perception was conducted. Computerized searches were completed using MEDLINE, PubMed, CINHAL, Eric, and PsychINFO. Articles were included if they were English, included children 2-5 years of age, included a Hispanic population, and evaluated parental perception of their child's weight status. A total of 14 articles (n=8 qualitative; n=6 quantitative) met criteria and were included in the review. Cooper's integrative review methodology was used, and articles were evaluated for quality using Polit and Beck's evidence hierarchy leveling system.The results revealed six themes of Hispanic parental perceptions relative to their preschool-aged child's weight: parental perception of body weight; relationship between child weight and health; causes and consequences of overweight; familial roles and influences on child weight; prevention of overweight; and cultural influences within the United States.This review highlights the importance of developing sociocultural approaches to addressing childhood obesity within the Hispanic population. Additional research is needed to incorporate what is known about Hispanic parental perceptions to positively influence behavior change during early childhood.

To develop profiles of obesity risk behaviors for children and adolescents.Risk assessments were obtained from patients (n = 971) at a school-based health center. Latent class analysis was used to create subgroups based on seven indicators measuring diet, activity, and screen time.Four classes emerged, with 44% classified as the "Healthiest," 8% as the "Least Healthy," 37% as "Mixed Diet/Low Activity/Low Screen Time," and 11% as "Mixed Diet/High Activity/High Screen Time." Several demographic predictors distinguished the classes.Obesity risk factor profiles may help providers identify strengths and risks, tailor counseling, and plan interventions with families.