User-Centered Development of HEARTPrep, a Digital Health Psychosocial Intervention for Prenatally Diagnosed Congenital Heart Disease.

User-centered models for the development of digital health interventions are not consistently applied in healthcare settings. This study used a five-phase, user-centered approach to develop HEARTPrep©, a psychosocial intervention delivered via mobile app and telehealth to mothers expecting a baby with congenital heart disease (CHD) to promote maternal, family, and child well-being. Phases of intervention development were: (I) establishing partnerships; (II) creating content; (III) developing prototype and testable intervention; (IV) conducting think-aloud testing; and (V) completing beta testing. Partnerships with parents, clinicians, and design/technology experts were integral throughout the development of HEARTPrep©. Parents of children with CHD also served as participants in Phases II-V, contributing to the creation of content and providing feedback to inform the iterative refinement of HEARTPrep©. These five phases produced a refined digital health intervention with promising feasibility, usability, and acceptability results. This user-centered approach can be used to develop digital health interventions targeting various health outcomes.

How a primary care quality improvement initiative is implementing the expert recommendations on childhood obesity.

This article briefly describes the Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity and explains how the Delaware Primary Care Initiative on Childhood Overweight, a quality improvement initiative, trains primary care practices to implement them. It includes a Delaware pediatrician's first-hand description of how she incorporates the recommendations into her daily practice using motivational interviewing and the 5-2-1-Almost None healthy lifestyle message.

Knowledge and attitudes about smoking and environmental tobacco smoke: a comparison of parents and children attending upper and lower income pediatric sites.

To define differences in knowledge and attitudes about environmental tobacco smoke (ETS) and smoking among different populations of parents and children, surveys about smoking and health were administered in low-income pediatric clinics and upper-income private practices using a Likert scale. Sixty-five children and 300 parents from pediatric clinics and 149 children and 300 parents from private practices participated. At the clinics 39% of parents were white, 23% graduated college, 33% smoked, and 20% allowed smoking in their home. This differed from private practices where 93% of parents were white, 77% graduated college, 13% smoked and 6% allowed smoking in their home. Parents from private practices expressed greater agreement with fact and opinion statements about ill effects of tobacco. More lower income children reported living with a smoker (45% vs 23%). These data demonstrate differences in adult knowledge and attitudes about health effects of smoking, highlighting the need for increased intervention among lower income families.

Preventing and treating nicotine addiction: a review with emphasis on adolescent health.

This article is the fourth in a series of four providing current, state-of-the-art information about the tobacco problem and how physicians can effectively intervene. The articles review the health effects of second-hand smoke, current treatment strategies for nicotine addiction and the implementation of best practices, such as the "5 As," to effectively intervene with families with smokers. Three of the articles are accredited for free continuing medical education (CME) credit for physicians. To obtain AMA PRA Category 1 Credit(s)TM for this article, please go online to www.PedsEducation.org, your source for free continuing medical education from Nemours. Choose "Online Education" and the article, and complete the post-test as directed. CME accreditation for this educational presentation is provided at no cost as a service of Nemours, one of the nation's largest children's health systems. Nemours is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Nemours designates this educational activity for a maximum of .5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. This article will focus on the prevention of adolescent smoking and discuss a global approach to the tobacco problem among youth. It also reviews the rationale for and pharmacology of treating nicotine addiction to empower physicians to assist smokers with quitting. By reading the article and completing the post-test, it is anticipated that the following learning objectives will be met: Physicians will become familiar with: 1) Options for treating nicotine addiction, 2) The unique aspects of the tobacco problem in adolescence, 3) The risk factors for teen smoking initiation.

Adult smoking and environmental tobacco smoke: a persistent health threat to children.

This article is the third in a series of four providing up-to-date information about the tobacco problem and how physicians can effectively intervene. Three of the four articles are accredited for free continuing medical education (CME) credit for physicians. To obtain AMA PRA Category 2 Credit for this article, please go online to www.pedseducation.org, your source for free Continuing Medical Education from Nemours. Choose Online Education, the article, and complete the post-test as directed. CME accreditation for this educational presentation is provided at no cost as a service of Nemours, one of the nation's largest children's health systems. Nemours is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physcians. Nemours designates this educational activity for a maximum of .5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. This article reviews the health effects of adult smoking on children. It focuses on the impact of environmental tobacco smoke (ETS). By reading the article and completing the post test it is anticipated that the following learning objectives will be met: 1) physicians will become familiar with the health effects of ETS on children, 2) physicians will become familiar with parental knowledge gaps and at risk populations and 3) physicians will understand the benefits of addressing the issue of adult smoking with parents.

Science, politics, and society: a brief history of environmental tobacco smoke.

This article is the second in a series of four providing current, state-of-the-art information about the tobacco problem and how physicians can effectively intervene. It provides an historical perspective of the issues surrounding environmental tobacco smoke in the United States. The remaining three manuscripts in this series offer free continuing medical education credits for physicians via www.pedseducation.org. Please refer to the first article in the April edition of the Delaware Medical Journal and upcoming articles in the June and July issues for further information.

What physicians can do about the tobacco problem: best practice interventions for your practice and office.

This article is the first in a series of four providing up-to-date information about the tobacco problem and how physicians can effectively intervene. Three of the four articles are accredited for free continuing medical education (CME) credit for physicians. The CME credit is being provided free of charge by Nemours via the Web site www.pedseducation.org. Physicians may obtain credit by logging on to this site, registering, and completing the post-test and evaluation materials. This article reviews the best evidence-based approaches for tobacco intervention in the busy office. It discusses the implementation of the following components of a tobacco-control program to effectively and efficiently address the tobacco problem: 1) physician counseling to promote smoking cessation, 2) strategies to promote abstinence from smoking, 3) strategies to minimize environmental tobacco smoke exposure, 4) strategies to encourage tobacco use cessation, and 5) office-based interventions. By reading the article and completing the post-test, it is anticipated that the following learning objectives will be met: 1) physicians will become familiar with best practice interventions for tobacco counseling and limiting secondhand smoke exposure, and 2) physicians will become familiar with office based strategies to promote a strong anti-smoking message.

A snapshot of tobacco-related messages relayed in pediatric offices in Delaware.

OBJECTIVE: Much research exists demonstrating that pediatricians should counsel patients and families about tobacco. However, few data are available about tobacco-related messages relayed in pediatric offices. Since an anti-tobacco office environment can be a strong component of an active tobacco prevention program, we evaluated pediatric offices in Delaware to characterize tobacco-related messages. METHODS: A convenience sample of 32 of 63 (51%) pediatric offices in Delaware was directly evaluated for the presence of tobacco-related messages. Fifty-five of 63 (87%) pediatric practices in Delaware were contacted by telephone to inquire about the presence of a tobacco coordinator. RESULTS: The 32 practices represented 71 physicians, were located in all three counties throughout the state, and were urban and non-urban in setting. The same investigator evaluated practices in a single site visit. All were located in smoke-free buildings. At one office, people were seen smoking outside; however, the presence of discarded cigarettes was much more common. Thirteen practices (41%) employed smokers, most of whom smoked outside during work hours. Twenty-one of 28 practices (75%) had waiting room magazines containing tobacco advertisements. Fifteen practices (47%) offered anti-tobacco literature while six practices (19%) displayed visual media, none exclusively addressing tobacco. Nine practices (28%) use chart flags to identify smokers. None of 55 pediatric practices in Delaware contacted by telephone identified an office tobacco prevention coordinator. CONCLUSIONS: Our data indicate that, in Delaware, the pediatric offices we visited overall convey a limited message about tobacco and could strengthen tobacco prevention strategies. Research measuring the impact of office-based anti-tobacco messages is needed. If these messages are effective in preventing tobacco use, practitioners can supplement active counseling with indirect interventions that require minimal maintenance once established and that place no additional demands on their time.