Medication Safety Counseling Practices of Pediatric Primary Care Clinicians.

Medication exposures and poisonings are a major cause of pediatric morbidity and mortality. Unsafe patient practices are well documented despite the American Academy of Pediatrics recommending that pediatric primary care clinicians discuss medication safety with patients. Current clinician counseling practices for pediatric patients are unknown. Studies of adult patients suggest that physician counseling practices often focus on administration but not storage or disposal. To address this gap, we administered a web-based survey to clinically active pediatric primary care clinicians in two mid-Atlantic health care systems. Survey content focused on characteristics of medication safety counseling practices by age group, including safe medication storage, administration, and disposal. Of 151 clinicians emailed, 40 (26.5%) responded. The majority were physicians (93.5%), female (87.1%), and completed residency/clinical training in pediatrics >15 years ago (58.1%). Most (82.5%) reported having >1 pediatric patient (aged < 19 years) in their practice who experienced an unintentional or intentional medication exposure or poisoning event. Reported practices for medication safety counseling often varied by patient age but safe disposal was rarely addressed for any age group. Respondents generally felt less knowledgeable and less comfortable with providing counseling on safe disposal in comparison to safe storage and safe administration. Nearly all respondents (97%) would like to provide more counseling about medication safety, and the majority (81.3%) wanted additional educational resources. In this survey, we identified several modifiable deficits in pediatric medical counseling practices and a need for additional clinician training and resources, most notably in the content area of safe disposal.

Management of Neck or Back Pain in Ambulatory Care: Did Visit Mode or the COVID-19 Pandemic Affect Provider Practice or Patient Adherence?

BACKGROUND/OBJECTIVE: In recent years, 2 circumstances have changed provider-patient interactions in ambulatory care: (1) the replacement of virtual for in-person visits and (2) the COVID-19 pandemic. We studied the potential impact of each event on provider practice and patient adherence by comparing the frequency of the association of provider orders, and patient fulfillment of those orders, by visit mode and pandemic period, for incident neck or back pain (NBP) visits in ambulatory care. METHODS: Data were extracted from the electronic health records of 3 Kaiser Permanente regions (Colorado, Georgia, and Mid-Atlantic States) from January 2017 to June 2021. Incident NBP visits were defined from ICD-10 coded as primary or first listed diagnoses on adult, family medicine, or urgent care visits separated by at least 180 days. Visit modes were classified as virtual or in-person. Periods were classified as prepandemic (before April 2020 or the beginning of the national emergency) or recovery (after June 2020). Percentages of provider orders for, and patient fulfillment of orders, were measured for 5 service classes and compared on: virtual versus in-person visits, and prepandemic versus recovery periods. Comparisons were balanced on patient case-mix using inverse probability of treatment weighting. RESULTS: Ancillary services in all 5 categories at each of the 3 Kaiser Permanente regions were substantially ordered less frequently on virtual compared with in-person visits in both the prepandemic and recovery periods (both P ≤ 0.001). Conditional on an order, patient fulfillment within 30 days was high (typically ≥70%) and not likely meaningfully different between visit modes or pandemic periods. CONCLUSIONS: Ancillary services for incident NBP visits were ordered less frequently during virtual than in-person visits in both prepandemic and recovery periods. Patient fulfillment of orders was high, and not significantly different by mode or period.

Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the COVID-19 Pandemic Period?

BACKGROUND/OBJECTIVE: In recent years, 2 circumstances changed provider-patient interactions in primary care: the substitution of virtual (eg, video) for in-person visits and the COVID-19 pandemic. We studied whether access to care might affect patient fulfillment of ancillary services orders for ambulatory diagnosis and management of incident neck or back pain (NBP) and incident urinary tract infection (UTI) for virtual versus in-person visits. METHODS: Data were extracted from the electronic health records of 3 Kaiser Permanente Regions to identify incident NBP and UTI visits from January 2016 through June 2021. Visit modes were classified as virtual (Internet-mediated synchronous chats, telephone visits, or video visits) or in-person. Periods were classified as prepandemic [before the beginning of the national emergency (April 2020)] or recovery (after June 2020). Percentages of patient fulfillment of ancillary services orders were measured for 5 service classes each for NBP and UTI. Differences in percentages of fulfillments were compared between modes within periods and between periods within the mode to assess the possible impact of 3 moderators: distance from residence to primary care clinic, high deductible health plan (HDHP) enrollment, and prior use of a mail-order pharmacy program. RESULTS: For diagnostic radiology, laboratory, and pharmacy services, percentages of fulfilled orders were generally >70-80%. Given an incident NBP or UTI visit, longer distance to the clinic and higher cost-sharing due to HDHP enrollment did not significantly suppress patients' fulfillment of ancillary services orders. Prior use of mail-order prescriptions significantly promoted medication order fulfillments on virtual NBP visits compared with in-person NBP visits in the prepandemic period (5.9% vs. 2.0%, P=0.01) and in the recovery period (5.2% vs. 1.6%, P=0.02). CONCLUSIONS: Distance to the clinic or HDHP enrollment had minimal impact on the fulfillment of diagnostic or prescribed medication services associated with incident NBP or UTI visits delivered virtually or in-person; however, prior use of mail-order pharmacy option promoted fulfillment of prescribed medication orders associated with NBP visits.

Impact of COVID-19 on Trends in Outpatient Clinic Utilization: A Tale of 2 Departments.

BACKGROUND: The COVID-19 pandemic forced many US health care organizations to shift from mostly in-person care to a hybrid of virtual visits (VV) and in-person visits (IPV). While there was an expected and immediate shift to virtual care (VC) early in the pandemic, little is known about trends in VC use after restrictions eased. METHODS: This is a retrospective study using data from 3 health care systems. All completed visits from adult primary care (APC) and behavioral health (BH) were extracted from the electronic health record of adults aged 19 years and older from January 1, 2019 to June 30, 2021. Standardized weekly visit rates were calculated by department and site and analyzed using time series analysis. RESULTS: There was an immediate decrease in APC visits following the onset of the pandemic. IPV were quickly replaced by VV such that VV accounted for most APC visits early in the pandemic. By 2021, VV rates declined, and VC visits accounted for <50% of all APC visits. By Spring 2021, all 3 health care systems saw a resumption of APC visits as rates neared or returned to prepandemic levels. In contrast, BH visit rates remained constant or slightly increased. By April 2020, almost all BH visits were being delivered virtually at each of the 3 sites and continue to do so without changes to utilization. CONCLUSIONS: VC use peaked during the early pandemic period. While rates of VC are higher than prepandemic levels, IPV are the predominant visit type in APC. In contrast, VC use has sustained in BH, even after restrictions eased.

Patient Factors Associated With Use of Adult Primary Care and Virtual Visits During the COVID-19 Pandemic.

BACKGROUND: The delivery of adult primary care (APC) shifted from predominately in-person to modes of virtual care during the COVID-19 pandemic. It is unclear how these shifts impacted the likelihood of APC use during the pandemic, or how patient characteristics may be associated with the use of virtual care. METHODS: A retrospective cohort study using person-month level datasets from 3 geographically disparate integrated health care systems was conducted for the observation period of January 1, 2020, through June 30, 2021. We estimated a 2-stage model, first adjusting for patient-level sociodemographic, clinical, and cost-sharing factors, using generalized estimating equations with a logit distribution, along with a second-stage multinomial generalized estimating equations model that included an inverse propensity score treatment weight to adjust for the likelihood of APC use. Factors associated with APC use and virtual care use were separately assessed for the 3 sites. RESULTS: Included in the first-stage models were datasets with total person-months of 7,055,549, 11,014,430, and 4,176,934, respectively. Older age, female sex, greater comorbidity, and Black race and Hispanic ethnicity were associated with higher likelihood of any APC use in any month; measures of greater patient cost-sharing were associated with a lower likelihood. Conditional on APC use, older age, and adults identifying as Black, Asian, or Hispanic were less likely to use virtual care. CONCLUSIONS: As the transition in health care continues to evolve, our findings suggest that to ensure vulnerable patient groups receive high quality health care, outreach interventions to reduce barriers to virtual care use may be warranted.

Virtual Care and Urinary Tract Infection Management: Comparing Ancillary Service Orders and Patient Order Fulfillments Between Virtual and In-person Encounters During the COVID-19 Pandemic in the United States.

BACKGROUND: During the COVID-19 pandemic, more health care issues were being managed remotely. Urinary tract infections (UTIs) are being managed more often using telehealth although few reports compare the rate of UTI ancillary service orders placed and fulfilled during these visits. OBJECTIVES: We aimed to evaluate and compare the rate of ancillary service orders and order fulfillments in incident UTI diagnoses between virtual and in-person encounters. RESEARCH DESIGN: The retrospective cohort study involved 3 integrated health care systems: Kaiser Permanente (KP) Colorado, KP Georgia, and KP Mid-Atlantic States. SUBJECTS: We included incident UTI encounters from adult primary care data from January 2019 to June 2021. MEASURES: Data were categorized as: prepandemic (January 2019-March 2020), COVID-19 Era 1 (April 2020-June 2020), and COVID-19 Era 2 (July 2020-June 2021). UTI-specific ancillary services included medication, laboratory, and imaging. Orders and order fulfillments were dichotomized for analyses. Weighted percentages for orders and fulfillments were calculated using inverse probability treatment weighting from logistic regression and compared between virtual and in-person encounters using χ2 tests. RESULTS: We identified 123,907 incident encounters. Virtual encounters increased from 13.4% prepandemic to 39.1% in COVID-19 Era 2. Ancillary service orders from virtual encounters were not placed as often as in-person encounters. However, the weighted percentage for ancillary service order fulfillment across all services remained above 65.3% across sites and eras, with many fulfillment percentages above 90%. CONCLUSIONS: Our study reported a high rate of order fulfillment for both virtual and in-person encounters. Health care systems should encourage providers to place ancillary service orders for uncomplicated diagnoses, such as UTI, to provide enhanced access to patient-centered care.

Health-care-Related Practices in Virtual Behavioral Health Treatment for Major Depression Before and During the COVID-19 Pandemic.

BACKGROUND: The abrupt shift to virtual care at the onset of the COVID-19 pandemic had the potential to disrupt care practices in virtual behavioral health encounters. We examined changes over time in virtual behavioral health-care-related practices for patient encounters with diagnoses of major depression. METHODS: This retrospective cohort study utilized electronic health record data from 3 integrated health care systems. Inverse probability of treatment weighting was used to adjust for covariates across 3 time periods, prepandemic (January 2019-March 2020), peak-pandemic shift to virtual care (April 2020-June 2020), and recovery of health care operations (July 2020-June 2021). First virtual follow-up behavioral health department encounters after an incident diagnostic encounter were examined for differences across the time periods in rates of antidepressant medication orders and fulfillments, and completion of patient-reported symptoms screeners in service of measurement-based care. RESULTS: Antidepressant medication orders declined modestly but significantly in 2 of the 3 systems during the peak-pandemic period but rebounded during the recovery period. There were no significant changes in patient fulfillment of ordered antidepressant medications. Completion of symptom screeners increased significantly in all 3 systems during the peak-pandemic period and continued to increase significantly in the subsequent period. CONCLUSIONS: A rapid shift to virtual behavioral health care was possible without compromising health-care-related practices. The transition and subsequent adjustment period have instead been marked by improved adherence to measurement-based care practices in virtual visits, signaling a potential new capacity for virtual health care delivery.

Development of a Common Data Model for a Multisite and Multiyear Study of Virtual Visit Implementation: A Case Study.

BACKGROUND/OBJECTIVE: In multisite studies, a common data model (CDM) standardizes dataset organization, variable definitions, and variable code structures and can support distributed data processing. We describe the development of a CDM for a study of virtual visit implementation in 3 Kaiser Permanente (KP) regions. METHODS: We conducted several scoping reviews to inform our study's CDM design: (1) virtual visit mode, implementation timing, and scope (targeted clinical conditions and departments); and (2) extant sources of electronic health record data to specify study measures. Our study covered the period from 2017 through June 2021. Integrity of the CDM was assessed by a chart review of random samples of virtual and in-person visits, overall and by specific conditions of interest (neck or back pain, urinary tract infection, major depression). RESULTS: The scoping reviews identified a need to address differences in virtual visit programs across the 3 KP regionsto harmonize measurement specifications for our research analyses. The final CDM contained patient-level, provider-level, and system-level measures on 7,476,604 person-years for KP members aged 19 years and above. Utilization included 2,966,112 virtual visits (synchronous chats, telephone visits, video visits) and 10,004,195 in-person visits. Chart review indicated the CDM correctly identified visit mode on>96% (n=444) of visits, and presenting diagnosis on >91% (n=482) of visits. CONCLUSIONS: Upfront design and implementation of CDMs may be resource intensive. Once implemented, CDMs, like the one we developed for our study, provide downstream programming and analytic efficiencies by harmonizing, in a consistent framework, otherwise idiosyncratic temporal and study site differences in source data.

Diet Quality of US Infants and Toddlers 7-24 Months Old in the WIC Infant and Toddler Feeding Practices Study-2.

Background: Despite the important implications of childhood dietary intakes on lifelong eating habits and health, data are lacking on the diet quality of low-income infants and toddlers. Objective: The objective of this study was to characterize diet quality in low-income US infants and toddlers. Methods: A national observational study was conducted of 7- to 12-mo-old (n = 1261), 13-mo-old (n = 2515), and 24-mo-old (n = 2179) children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prenatally/at birth from 2013 to 2016. The study used a 24-h dietary recall and survey questions. For 7- to 12-mo-olds, an adapted Complementary Feeding Utility Index (CFUI) was used, and for 13- and 24-mo-olds, the Healthy Eating Index-2015 (HEI-2015) was used. Descriptive statistics were calculated for CFUI and HEI-2015 scores. Results: For 7- to 12-mo-olds, the CFUI score (mean ± SE) was 0.56 ± 0.003 (range: 0.34-0.90, maximum possible 1.0). Most children met CFUI standards for exposure to iron-rich cereal (86.7%), and low exposure to energy-dense nutrient-poor foods (72.2%) and teas/broths (67.5%). Conversely, at 7-12 mo of age, exposure was low for vegetables (7.0%), fruits (14.4%), any sugary drinks (14.0%), and 12-mo breastfeeding duration (23.8%). At 13 and 24 mo of age, the HEI-2015 total score (maximum possible 100), on average, was 64.0. At both 13 and 24 mo of age, participants achieved, on average, maximal HEI-2015 component scores for total and whole fruits and dairy; however, scores for total vegetables, greens and beans, whole grains, seafood and plant proteins, fatty acids, and saturated fats were relatively low. Scores for refined grains, sodium, and added sugar were lower at 24 than at 13 mo of age, representing higher consumption, on average, over time. Conclusions: Although findings demonstrate that young children are doing well on some dietary components, there is room for improvement, especially as children age. Findings may be used to inform the Pregnancy and Birth to 24-mo (P/B-24) Project. This trial was registered at clinicaltrials.gov as NCT02031978.

Postpartum Symptoms of Depression are Related to Infant Feeding Practices in a National WIC Sample.

OBJECTIVE: To examine the association between elevated maternal postpartum depression symptoms and select targets of nutrition education within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), including infant feeding beliefs, feeding practices, and dietary intake choices. DESIGN: Longitudinal analysis of secondary data from the WIC Infant and Toddler Feeding Practices Study-2. SETTING: Eighty WIC sites. PARTICIPANTS: The WIC Infant and Toddler Feeding Practices Study-2 participants interviewed through 13 months postpartum (n = 1,851). MAIN OUTCOME MEASURES: Latent factor variables for infant feeding beliefs, feeding practices, and dietary intake choices. ANALYSIS: Confirmatory factor analysis using structural equation modeling; multivariable linear regression models. RESULTS: Biological mothers with elevated postpartum depression symptoms engaged in significantly less optimal feeding practices than biological mothers with fewer symptoms of depression, in multivariable analyses controlling for sociodemographic variables (ß = -0.26; P = 0.02). Maternal depression symptoms were not significantly associated with infant feeding beliefs or dietary intake choices. CONCLUSIONS AND IMPLICATIONS: Maternal depression symptoms are specifically associated with infant feeding practices. The Special Supplemental Nutrition Program for Women, Infants, and Children could consider screening for depressive symptoms and referring mothers for treatment. For mothers with elevated depression symptoms, nutrition education may need greater emphasis on healthy and safe feeding practices.

Breastfeeding Duration in a Low-Income Sample Is Associated With Child Diet Quality at Age Three.

BACKGROUND: Little research has focused on breastfeeding and diet quality, particularly in low-income populations at risk for shorter breastfeeding duration and poorer diet quality. RESEARCH AIM: The aim of this study was to examine the association between breastfeeding duration and later diet quality in a low-income population. METHODS: For this longitudinal prospective cohort study we conducted a secondary analysis of data from the Infant and Toddler Feeding Practices Study-2, a national study of infant feeding practices and child outcomes. Study infants were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children by 2.5 months of age and followed until 36 months (N = 1,223). We examined the association between breastfeeding duration until 13 months of age, and child diet quality derived from a 24-hour dietary recall with a usual intake adjustment at child age 36 months. Multiple regression analyses were used to examine the association of breastfeeding duration with overall diet quality, as measured by the Heathy Eating Index 2015, and with consumption of specific food groups. RESULTS: Longer breastfeeding duration during infancy was associated with better diet quality at child age 36 months after controlling for key socio-demographic variables. In follow-up analyses, the origin of the association was narrowed to greater consumption of mature/dried beans and peas. CONCLUSIONS: Longer breastfeeding duration in infancy was associated with better diet quality at 36 months, in a population at risk for shorter breastfeeding duration and poorer diet quality. Breastfeeding was particularly associated with children's consumption of mature/dried beans and peas. CLINICAL TRIAL REGISTRATION: This study is registered at clinicaltrials.gov as Feeding My Baby-A National WIC Study, NCT02031978.

Prenatal and Postnatal Experiences Predict Breastfeeding Patterns in the WIC Infant and Toddler Feeding Practices Study-2.

Objective: To examine pre- and postnatal experiential factors associated with desirable breastfeeding patterns in a nationally representative population of low-income women who prenatally enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and initiated breastfeeding. Materials and Methods: Using data from the longitudinal WIC Infant and Toddler Feeding Practices Study-2, multivariable, hierarchical logistic regression analyses identified prenatal and postnatal experiential factors associated with three breastfeeding patterns: (1) breastfeeding at 6 months, (2) breastfeeding at 1 year, and (3) breastfeeding at 1 year without introducing formula through age 6 months. Results: After controlling for covariates, one prenatal factor, breastfeeding intentions, and one postnatal factor, receipt of a doctor's recommendation to breastfeed, raised the odds of exhibiting the patterns analyzed. Another postnatal factor, returning to full-time employment before infant age 3 months, lowered the odds of exhibiting the patterns. Prior WIC participation significantly increased the odds of breastfeeding at 1 year, while postnatal employment before infant age 3 months significantly decreased the odds of exhibiting this pattern. Conclusions: Health care providers and those working in public health programs, including WIC, play an important role in helping low-income women mitigate shorter breastfeeding durations. Their efforts should continue focusing on bolstering women's prenatal breastfeeding intentions, reducing structural barriers to breastfeeding in the early postnatal period, particularly among those women returning to work, and connecting low-income families with WIC if they are not already enrolled in the program. This study is registered at clinicaltrials.gov as Feeding My Baby-A National WIC Study, NCT02031978.

Predictors of WIC Participation Through 2 Years of Age.

OBJECTIVE: To examine factors associated with Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation through 2 years of age. DESIGN: Longitudinal data from the WIC Infant and Toddler Feeding Practices Study-2. SETTING: Eighty WIC sites. PARTICIPANTS: The WIC Infant and Toddler Feeding Practices Study-2 participants interviewed through 2 years of age (n = 1,250). MAIN OUTCOME MEASURE: WIC participation through 2 years of age. ANALYSIS: Multivariate logistic regression and odds ratios. RESULTS: Infants in households with incomes ≤100% of the federal poverty level (FPL) were more than twice as likely as those with incomes above 100% FPL to continue WIC participation through 2 years (odds ratio = 2.22; 95% confidence interval [CI], 1.34-3.66). The odds of WIC participation through 2 years were 2.84 times higher for infants fully breastfed for 6 months or longer compared with infants breastfed for less than 6 months (95% CI, 1.43-5.66). Infants in households in which caregivers reported they made a change in how they fed their family on the basis of something they learned from WIC had 2.60 higher odds of continued WIC participation than infants in households in which caregivers did not report making a change (95% CI, 1.67-4.07). CONCLUSIONS AND IMPLICATIONS: In addition to lower household income, longer breastfeeding duration and application of WIC nutrition education are important predictors of WIC participation through 2 years of age.

Longer Participation in WIC Is Associated with Better Diet Quality in 24-Month-Old Children.

BACKGROUND: Little is known about duration of exposure to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in relation to children's diet quality. OBJECTIVE: The objective of the study was to examine the association between duration of WIC participation and diet quality of 24-month-old children. DESIGN: A national longitudinal observational study was conducted with participants initially enrolled in WIC in 2013. Telephone interviews were conducted with study mothers from 2013 to 2016. Duration of WIC participation was categorized as high, medium, or low based on the number of interviews during which participants reported receiving WIC benefits. PARTICIPANTS: Participants in the WIC Infant and Toddler Feeding Practices Study 2 who had completed a baseline interview and all interviews through 24 months were included; participants who reported discontinuing WIC due to perceived program ineligibility were excluded from analyses (N=1,250). Data were weighted to represent the study-eligible population. MAIN OUTCOME MEASURE: Healthy Eating Index 2015 scores of children at age 24 months were calculated based on 24-hour dietary recalls. STATISTICAL ANALYSES PERFORMED: Unadjusted analysis of variance examined Healthy Eating Index 2015 scores by WIC participation duration. Multivariate linear regression analysis tested independent effects of WIC duration on Healthy Eating Index 2015 total scores, controlling for sociodemographic factors. RESULTS: After controlling for covariates, WIC participation duration was significantly associated with diet quality. Children in the high duration group had significantly higher Healthy Eating Index 2015 total scores (adjusted mean 59.3, 95% CI 58.6 to 60.1) than children in the low duration group (adjusted mean 55.3, 95% CI 51.6 to 59.0) (P=0.035). CONCLUSIONS: Children who received WIC benefits during most of the first 2 years of life had better diet quality at age 24 months than children who, despite remaining eligible for benefits, discontinued WIC benefits during infancy. Findings suggest nutritional benefits for eligible children who stay in the program longer.

Contribution of WIC-Eligible Foods to the Overall Diet of 13- and 24-Month-Old Toddlers in the WIC Infant and Toddler Feeding Practices Study-2.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides supplemental foods to assist participants in meeting their dietary needs. Few studies have described the extent to which WIC-eligible foods contribute to the overall diet of children who were enrolled in WIC prenatally or in early infancy. OBJECTIVE: Our aims were to examine commonly consumed foods and estimate the proportion of dietary intake contributed by WIC-eligible foods among 13- and 24-month-old children, and to assess differences by WIC participation status at 24-months. DESIGN: This was a national observational study. PARTICIPANTS/SETTING: Children participating in the WIC Infant and Toddler Feeding Practices Study-2 were included (13 months old [n=2,777] and 24 months old [n=2,450]) from 2013 to 2016. MAIN OUTCOME MEASURES: Dietary intakes were assessed using 24-hour dietary recalls at 13 and 24 months. The 10 most commonly consumed foods were described using the What We Eat in America food category classification system. WIC-eligible foods were defined as meeting the WIC nutrient criteria set forth in the Federal regulation. STATISTICAL ANALYSES PERFORMED: The estimated proportion (mean±standard error) of WIC-eligible foods to total daily intake was calculated for energy, macronutrients, and select micronutrients. Multiple linear regression, adjusted for confounders, was conducted to compare the estimated proportion of nutrient intake from WIC-eligible foods by WIC participation at 24 months. RESULTS: At 13 and 24 months, most (60% and 63%, respectively) of the commonly consumed foods were eligible for purchase as part of the child WIC food package. WIC-eligible foods provided >40% of calories and close to 50% or more of other nutrients, and the contribution of WIC-eligible foods to overall micronutrient intake increased between 13 and 24 months. Children still on WIC at 24 months obtained a larger proportion of calories and most other nutrients from WIC-eligible foods than children no longer on WIC. CONCLUSIONS: WIC-eligible foods could contribute to the overall diet of toddlers who were enrolled in WIC prenatally or in early infancy. Further, there may be additional nutritional benefits of staying on the program through 24 months.

Longitudinal prediction of child outcomes from differing measures of parenting in a low-income sample.

This study examined predictions from preschool parenting measures to middle childhood cognitive and socioemotional child outcomes to explore whether parenting assessment methodologies that require more time, training, and expense yield better predictions of child outcomes than less intensive methodologies. Mother-child dyads (N = 278) in low-income African American families were assessed when the child was in preschool, using maternal report, the Home Observation for Measurement of the Environment-Short Form (P. Baker & F. Mott, 1989; R. Bradley & B. Caldwell, 1984), and structured observational measures of parenting. Child outcomes reported by children, mothers, teachers, and direct assessment were collected 4 years later. All parenting methodologies showed some predictive value; however, observational parenting measures showed the strongest and most consistent predictions of child outcomes.

Predictability of observed mother-child interaction from preschool to middle childhood in a high-risk sample.

This study examined predictability of observed parent-child interaction from preschool to middle childhood in 283 mother-child dyads. Participants were welfare recipients enrolled in the Observational Study of the Job Opportunities and Basic Skills Training Program. Structured observational sessions were conducted both at preschool age and middle childhood, and were coded for maternal social behavior, child social behavior, and dyadic interaction. Analyses explored direct relations between the assessments; relations between the assessments with possible third-variable influences, such as maternal literacy, covaried out; and moderated relations. Results indicated that observed mother-child interaction in middle childhood could be significantly predicted from observed interaction 4 years earlier. Risk status moderated the relations such that those families with greater risk factors tended to show more stability, although this stability was, at times, through maintaining suboptimal functioning.

Continuity, discontinuity, and coherence in attachment from infancy to late adolescence: sequelae of organization and disorganization.

This longitudinal study examines continuity and discontinuity of attachment quality from infancy to late adolescence in a sample of 125 participants considered at birth to be at high-risk due to poverty. Strange Situations were conducted at 12 and 18 months; Adult Attachment Interviews were administered at age 19. Child and maternal characteristics and experiences and observational assessments of the families were explored as correlates of continuity and discontinuity in attachment. Contrary to findings of continuity from low-risk samples, analyses demonstrated no significant overall continuity in attachment security. Disorganized infants were significantly more likely than organized infants to be insecure or unresolved in late adolescence. Additionally, infant disorganization predicted unresolved abuse scores on the AAI for those participants who experienced childhood abuse. Significant correlates of continuity and change spanned a variety of age periods and included infant temperament, maternal life stress, family functioning at pre-adolescence, child maltreatment and features of the home environment. Findings are discussed as supporting the coherence of attachment over time.