Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in 3 underserved populations: Colorado, North Carolina, West Virginia, 2009.

INTRODUCTION: In low-income and underserved populations, financial hardship and multiple competing roles and responsibilities lead to difficulties in lifestyle change for cardiovascular disease (CVD) prevention. To improve CVD prevention behaviors, we adapted, pilot-tested, and evaluated a problem-solving intervention designed to address barriers to lifestyle change. METHODS: The sample consisted of 81 participants from 3 underserved populations, including 28 Hispanic or non-Hispanic white women in a western community (site 1), 31 African-American women in a semirural southern community (site 2), and 22 adults in an Appalachian community (site 3). Incorporating focus group findings, we assessed a standardized intervention involving 6-to-8 week group sessions devoted to problem-solving in the fall of 2009. RESULTS: Most sessions were attended by 76.5% of participants, demonstrating participant adoption and engagement. The intervention resulted in significant improvement in problem-solving skills (P < .001) and perceived stress (P < .05). Diet, physical activity, and weight remained stable, although 72% of individuals reported maintenance or increase in daily fruit and vegetable intake, and 67% reported maintenance or increase in daily physical activity. CONCLUSION: Study results suggest the intervention was acceptable to rural, underserved populations and effective in training them in problem-solving skills and stress management for CVD risk reduction.

Parental influences on 7-9 year olds' physical activity: a conceptual model.

OBJECTIVE: Models characterizing parental influence on child and adolescent physical activity (PA) over time are limited. Preschool and Adolescent Models (PM and AM) of PA are available leaving the need to focus on elementary-aged children. We tested current models (PM and AM) with a sample of 7-9 year-olds, and then developed a model appropriate to this specific target population. METHODS: Parent-child dyads completed questionnaires in 2010-2011. All models were assessed using path analysis and model fit indices. RESULTS: For adequate power, 90 families were needed, with 174 dyads participating. PM and AM exhibited poor fit when applied to the study population. A gender-specific model was developed and demonstrated acceptable fit. To develop an acceptable model for this population, constructs from both the PM (i.e. parental perception of child competency) and AM (i.e., child-reported self-efficacy) were used. For boys, self-efficacy was a strong predictor of PA, which was influenced by various parental variables. For girls, parental PA demonstrated the greatest strength of association with child PA. CONCLUSION: This new model can be used to promote PA and guide future research/interventions. Future studies, particularly longitudinal designs, are needed to confirm the utility of this model as a bridge between currently available models.

Adaptation and cognitive testing of physical activity measures for use with young, school-aged children and their parents.

BACKGROUND: Increasing physical activity is one way to address the public health concern of childhood obesity. Physical activity measures for use with young, school-aged children are limited. METHODS: This study adapted two existing activity measures for young children, specifically self-efficacy and 7-day recall of physical activity. RESULTS: Through expert review and cognitive testing, the scales were adapted for use with young, school-aged children (ages 7-9). This article describes how the measures were adapted to insure comprehension of the child self-report measures. Reliability analyses provide support for their use in this population [Cronbach's alpha = 0.76 for the self-efficacy scale; moderate correlation between parent report and child report of child physical activity over the past week (rho = 0.52, P < 0.01]. CONCLUSIONS: Suggestions are offered for researchers interested in using similar methods when designing and adapting physical activity measures for new populations.

Video Intervention to Increase Perceived Self-Efficacy for Condom Use in a Randomized Controlled Trial of Female Adolescents.

STUDY OBJECTIVE: To assess the effects of the Seventeen Days interactive video on young women's perceived self-efficacy for using condoms 6 months after being offered the intervention, relative to a control. DESIGN: Multisite randomized controlled trial. SETTING: Twenty participating health clinics and county health departments in Ohio, Pennsylvania, and West Virginia. PARTICIPANTS: Sexually active female adolescents ages 14 to 19 years. INTERVENTIONS: Seventeen Days (treatment intervention; sex education) vs Driving Skills for Life (control intervention; driving education). MAIN OUTCOME MEASURES: Perceived self-efficacy for condom use. RESULTS: Participants in the Seventeen Days group reported higher perceived condom acquisition self-efficacy after 6 months than those in the driving group. This finding held after controlling for baseline self-efficacy scores and other covariates. CONCLUSION: The Seventeen Days program shows promise to improve perceived self-efficacy to acquire condoms among sexually active female adolescents-an important precursor to behavior change.

Barriers to Parent Support for Physical Activity in Appalachia.

BACKGROUND: Parent support for child physical activity is a consistent predictor of increased childhood activity. Little is known about factors that prevent or facilitate support. The purpose of this research was to identify barriers to parent support for child physical activity in Appalachian parents. METHODS: A cross-sectional study assessed parents whose children participated in Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) screenings in a rural Appalachian state. Barriers to parental support for physical activity, demographics, geographic location, and parental support for activity were measured. RESULTS: A total of 475 parents completed surveys. The majority were mothers (86.7%), parents of kindergarteners (49.5%), white (89.3%), and living in a nonrural area (70.5%). Community-level factors were most frequently cited as barriers, particularly those related to the built environment. Rural and low-income parents reported significantly higher barriers. Community, interpersonal, and intrapersonal barriers were negatively correlated with parent support for child physical activity. Parents of girls reported a higher percentage of barriers related to safety. CONCLUSIONS: Reported barriers in this sample differed from those reported elsewhere (Davison, 2009). Specific groups such as low-income and rural parents should be targeted in intervention efforts. Future research should explore gender differences in reported barriers to determine the influence of cultural stereotypes.

Use of public health nurse competencies to develop a childcare health consultant workforce.

UNLABELLED: The purpose of this article is to describe the efforts in the state of Georgia to train public health nurse-childcare health consultants (PHN-CCHCs) using the framework of the "Core competencies for public health practice." OBJECTIVES: The goal of the training was twofold: (1) to prepare a statewide cadre of PHNs as the primary workforce for Georgia's emerging childcare health consultation (CCHC) system and (2) to prepare their district nurse directors to lead and support CCHCs. DESIGN: Administrators attended a 2-day workshop followed by access to executive coaching for their management teams. PHNs participated in a three-phase training program, with phases 1 and 3 offered as 3-day workshops with field experiences, and phase 2 offered online and as a practicum. SAMPLE: Forty-four administrators and over 85 PHN-CCHCs completed the training. RESULTS: Graduates of the program reported satisfaction with training and reported the use of PHN core competencies in CCHC. Graduates also found enhanced skills in using core competencies to be applicable to a variety of population-based practices. Beyond CCHC being instituted in selected health districts, interest in CCHC has occurred statewide. CONCLUSIONS: The PHN-CCHC program enhanced the knowledge and use of core competencies and heightened interest in CCHC statewide.

Assessing the need for child-care health consultants.

This study surveyed health and safety needs of child-care programs; examined the perceptions of directors, the person identified as being responsible for a program, concerning health consultation; and determined how directors would secure funds to pay for consultative services. The survey was conducted in a state without mandates for child-care health consultation and minimal access to consultants. The researchers designed and pilot-tested a Child Care Health and Safety Survey. Working with a task group of statewide child health experts, the researchers revised the survey and mailed it to a random sample of child-care programs. Twenty-two Head Start Programs, 122 licensed child-care centers, and 116 family child-care homes participated, representing a return rate of 73, 36, and 30%, respectively. The majority of programs expressed interest in child-care health consultation offered for free or fee-based. Directors identified reasonable means of obtaining funds to support consultation. All programs had needs related to supporting health practices in their settings, provision of health services for staff, and health screening for children. Public health nurses, specially trained to advise child care, are well positioned to offer consultation. Systems of health consultation may be accepted as fee-for-service arrangements, supporting sustainability.

Public health emergency preparedness in the setting of child care.

Many of America's youngest children are enrolled in child care and parents expect their child care providers to be prepared to handle emergencies. Emergency preparedness in child care is complex, complicated further by threats of public health emergencies, including terrorism. Unfortunately, minimal attention has been given to the needs of child care in planning for these emergencies. Involving Child Care Health Consultants promotes child care preparedness that is integrated in to community plans. This article discusses child care emergency preparedness, offering recommendations for consultants working with child care providers.

Partnership to build sustainable public health nurse child care health support.

Child care health consultation, an emerging health care delivery system aimed at improving the health and well-being of children enrolled in child care settings, is consistent with the public health core function of assurance. Public health nurses are the primary workforce for such consultation. Few states have critical masses of consultants, and many are struggling to financially support such programs. Through an academic-community partnership, Georgia's public health nurses are building a consultative system of child care health support. This partnership focuses on adding value in child care while strategically and financially supporting the sustainability of this population-focused practice.