Children's and parents' report of asthma education received from physicians.

OBJECTIVE: Clinical practice guidelines recommend that physicians provide asthma education to patients and their families. To characterize parents' and children's perception of physician practice, we examined: (i) proportion of parents and children reporting physician discussion of asthma education topics; (ii) age-group differences in children's report; (iii) site differences in children's and parents' report; (iv) sociodemographic and disease characteristics associated with children's report; and (v) the relation between children's report and adherence to daily controller medications. METHODS: We conducted a cross-sectional study of 125 children with asthma (mean age = 11.3 years; 62% were male) and their parents. Parents provided demographic and disease data. Children reported whether physicians had ever discussed each of 16 asthma education topics with them. We used logistic regression to examine age-group and site differences in children's report of physician discussion of each topic. Multivariate linear regression was used to determine associations between demographic (e.g., child age, race) and disease (e.g., symptom severity) variables and topics discussed. RESULTS: On average, 34.7% of children reported physician discussion of a topic; 8-10-year-olds reported significantly fewer topics discussed than children aged 11 and older (p < .05). Whereas parents' report differed by practice setting, children's report did not. In multivariate analyses, child age (ß = 0.46 (SE: 0.17); p < .01), persistent symptoms (ß = 1.59 (SE: 0.80); p < .05), and number of outpatient asthma visits (ß = 0.19 (SE: 0.08); p < .05) remained significantly associated with number of topics discussed. CONCLUSION: These results suggest that the majority of children either may not receive, or may not recall receiving, information from their physicians about the fundamentals of asthma management. Physicians have an invaluable teaching opportunity in the medical office visit and should consider capitalizing on this opportunity to build children's sense of self-efficacy and competence in their self-care.

Decreasing frequency of asthma education in primary care.

BACKGROUND: Provision of asthma education is associated with decreased hospitalizations and emergency department visits for patients with asthma. Our objective was to describe national trends in the provision of asthma education by primary care physicians in office settings. METHODS: We used the National Ambulatory Medical Care Survey, a nationally representative dataset of patient visits to office-based physicians. We identified visits to primary care physicians for patients where asthma was a reason for the visit (asthma-related visits) or who had a diagnosis of asthma, but asthma was not a specific reason for the visit (asthma-unrelated visits) and estimated the percentage of visits where asthma education was provided. Data were available for asthma-related visits from 2001-2006 and from 2005-2006 only for asthma-unrelated visits. We examined time trends in asthma education and used multivariable logistic regression to identify independent patient and system-related factors that were predictors of asthma education. RESULTS: The percentage of asthma-related visits where asthma education was provided declined during the study period, from 50% in 2001-2002 to 38% in 2005-2006 (p = 0.03). Asthma education was provided less frequently during asthma-unrelated visits compared to asthma-related visits (12% vs. 38%, p<0.0001). Independent predictors of providing asthma education included age < or = 18 years, receipt of a controller medication, incorporation of an allied health professional during the visit, longer visit duration and Northeast region. CONCLUSIONS: Asthma education is underused by primary care physicians and rates have declined from 2001-2006. Interventions designed to promote awareness and greater use of asthma education are needed.

A clinic-based lifestyle intervention for pediatric obesity: efficacy and behavioral and biochemical predictors of response.

AIM: To examine efficacy and predictors of response to a lifestyle intervention for obese youth. METHODS: Retrospective chart review of 214 children and adolescents aged 8-19 years. Linear regression identified baseline predictors of response (delta BMI z-score) at first and ultimate follow-up visits. RESULTS: Mean delta BMI z-score from baseline was -0.04 (p < 0.001) at first follow-up and -0.09 (p < 0.001) at ultimate follow-up (median time 10 mo) among 156 children and adolescents. Higher baseline BMI z-score predicted poor response at first and ultimate follow-up, explaining 10% of variance in response. Fasting insulin explained 6% of response variance at first follow-up. delta BMI z-score at the first visit along with baseline BMI z-score explained up to 50% of variance in response at ultimate visit. CONCLUSION: Clinic-based interventions improve weight status. Baseline variables predict only a small proportion of response; response at the first visit is a more meaningful tool to guide clinical decisions.

'The apple doesn't fall far from the tree': the role of parents in chronic disease self-management.

Medical nonadherence has been termed the "Achilles' heel of modern healthcare." In considering the need to improve medical adherence among chronically ill children, it is necessary to understand parent adherence. Parents have long been acknowledged to be the primary socialization agents in children's development across the various domains of functioning. Through communication of their beliefs, the behavior they model, and direct training, parents exert a powerful influence on the development of children's beliefs and behavior. Adherence may be similarly conceptualized as a socialization process, in which parents influence the development of children's beliefs and behavior regarding their eventual disease self-management. Given this perspective, it is important for clinicians to emphasize the need for parental adherence to a child's treatment regimen. An increased focus on parental adherence will require an investment of time and effort that will pay dividends in the long term.

Supplemental nocturnal nasogastric refeeding for better short-term outcome in hospitalized adolescent girls with anorexia nervosa.

OBJECTIVE: Although controversy exists regarding nasogastric refeeding for patients with anorexia nervosa, current methods of inpatient care often result in low discharge weight, a critical risk factor in relapse. This study compared the short-term outcomes of standard oral refeeding and supplemental nocturnal nasogastric refeeding. METHOD: Subjects were 100 hospitalized Caucasian adolescent girls who met DSM-IV criteria for anorexia nervosa. Subjects were partitioned into two groups: oral refeeding (N=48, mean age=15.0 years, SD=1.8) and nocturnal nasogastric refeeding (N=52, mean age=14.8 years, SD=1.9). Unpaired t tests, with Bonferroni correction, were used to compare groups at hospital admission and at discharge. Multivariate linear regression was used to establish the independent effects of nocturnal nasogastric refeeding after adjustment for potential confounding variables. RESULTS: On admission, the groups were comparable in terms of age, weight, and other factors but differed significantly in number of prior hospitalizations (the nocturnal nasogastric refeeding group had more than the oral refeeding group). A series of separate multivariate linear regression models revealed that nocturnal nasogastric refeeding was a significant predictor of weight at discharge and absolute weight gain. CONCLUSIONS: Over a comparable period of time, patients treated with nocturnal nasogastric refeeding had a greater and more rapid weight gain than patients treated with traditional oral refeeding. Supplemental nocturnal nasogastric refeeding was more effective than oral refeeding alone in weight restoration during hospitalization. However, further study is needed on its short-term and long-term effectiveness.

Nocturnal nasogastric refeeding for hospitalized adolescent boys with anorexia nervosa.

Boys with anorexia nervosa have nutritional needs exceeding those of their female counterparts. For many males with anorexia nervosa, oral refeeding alone may result in low discharge weight, a critical risk factor in relapse. This study compared the short-term outcomes of oral refeeding (OR) and a combination of OR with supplemental nocturnal nasogastric refeeding (NNGR) in a sample of hospitalized boys. This was a retrospective chart review with a cohort design. Subjects were partitioned into: The OR group (n = 8, mean age = 14.9, SD = 1.7) and the OR + NNGR group (n = 6, mean age = 13.8, SD = 2.0). The NNGR group had greater increase in weight and Body Mass Index. Their average length of hospitalization was also shorter. Nocturnal nasogastric refeeding, complementing oral refeeding, should be considered as an alternative initial therapy for weight restoration in males with anorexia nervosa.

Art therapy, psychodrama, and verbal therapy. An integrative model of group therapy in the treatment of adolescents with anorexia nervosa and bulimia nervosa.

Anorexia nervosa and bulimia nervosa typically afflict individuals in adolescence. Given the intractability of these diseases in combination with the natural recalcitrance of adolescence, treatment with this population presents a daunting challenge. Traditional group therapy that focuses on verbal therapy is often not effective with this population, particularly in the acute stages of the diseases. A group therapy approach that integrates art therapy, psychodrama, and verbal therapy offers an innovative alternative to traditional group therapy.

Adolescents' self-presentation on a teen dating web site: a risk-content analysis.

PURPOSE: To analzye adolescents' profiles on MyLol.net, a teen dating Web site, for risk content. We hypothesized that risk content would vary by age and gender. METHODS: We selected and coded 752 publicly viewable profiles of adolescents aged 14-18 years for the following five risks: sex, alcohol, drugs, cigarettes, and violence. RESULTS: Of the total profiles, 27.7% contained risk-related content: 15.8% sexual behavior, 13.8% alcohol use, 1.6% drug use, 6.8% cigarette smoking, and .9% violence activity. Being female, "single" relationship status, and use of profanity (p < .05) were associated with risk content. CONCLUSIONS: Females' profiles were most likely to include risky content, especially sexual content. Adolescent females who have internalized social norms that place a high value on female sexuality may reflect this in their online profiles. Online mention of interest/involvement in risky behavior may have negative consequences (e.g., cyberbullies and sexual predators). Stronger universal Internet policies and education are needed to help protect adolescents.

Media exposure, internalization of the thin ideal, and body dissatisfaction: comparing Asian American and European American college females.

Internalization of the thin ideal mediates the media exposure-body dissatisfaction relation in young adult European American females. There is little related research on Asian Americans. We used structural equations modeling to test: (1) whether media exposure was associated with body dissatisfaction in Asian American young adult females, (2) internalization of the thin ideal mediated any such association, and (3) whether the mediational model provided equivalent fit for European American and Asian American samples. Participants were 287 college females (154 Asian Americans, 133 European Americans). Internalization of the thin ideal explained the media exposure-body dissatisfaction association equally well for both groups. Results suggest that Asian Americans may be employing unhealthy weight control behaviors, and may be prone to developing eating disorders, at rates similar to European American young adult females. Clinicians need to screen carefully for body dissatisfaction, unhealthy weight control behaviors, and eating disorders in Asian American females.

Does delivering preventive services in primary care reduce adolescent risky behavior?

PURPOSE: To determine whether the delivery of preventive services changes adolescent behavior. This exploratory study examined the trajectory of risk behavior among adolescents receiving care in three pediatric clinics, in which a preventive services intervention was delivered during well visits. METHODS: The intervention consisted of screening and brief counseling from a provider, followed by a health educator visit. At age 14 (year 1), 904 adolescents had a risk assessment and intervention, followed by a risk assessment 1 year later at age 15 (year 2). Outcomes were changes in adolescent behavior related to seat belt and helmet use; tobacco, alcohol, and drug use; and sexual behavior. Analysis involved age-related comparisons between the intervention and several cross-sectional comparison samples from the age of 14-15 years. RESULTS: The change in helmet use in the intervention sample was 100% higher (p < .05), and the change in seat belt use among males was 50% higher (p = .14); the change in smoking among males was 54% lower (p < .10), in alcohol use was no different, and in drug use was 10% higher (not significant [NS]); and the change in rate of sexual intercourse was 18% and 22% lower than cohort comparison samples (NS). CONCLUSIONS: The intervention had the strongest effect in the area of helmet use, shows promise for increasing seat belt use and reducing smoking among male adolescents, and indicates a nonsignificant trend toward delaying the onset of sexual activity. Participation in the intervention seemed to have no effect on the rates of experimentation with alcohol and drugs between the ages of 14 and 15 years.

At what age do children start taking daily asthma medicines on their own?

OBJECTIVE: Use of daily controller medications is a critical task in management of persistent asthma. Study aims were to examine (1) the association between child age and extent of daily controller-medication responsibility in a sample aged 4 to 19 years, (2) parent, child, and disease predictors of child daily controller-medication responsibility and overall daily controller-medication adherence, and (3) the association between child daily controller-medication responsibility and overall daily controller-medication adherence. METHODS: We conducted a cross-sectional telephone survey of 351 parents of children who were prescribed daily controller medication. Children's mean age was 10.4 years; 61.5% were male, and 88.1% were white. Parents provided all data, including an estimate of the percentage of child and parent daily controller-medication responsibility. Daily controller-medication adherence was measured as parents' report of percentage of daily doses taken per doses prescribed in a typical week. We used multivariate linear regression to determine associations between parent race/ethnicity, education, income, number of dependents, child age, gender, years since diagnosis, parent perception of symptom severity and control, and dependent variables (child daily controller-medication responsibility and daily controller-medication adherence). We also examined associations between child daily controller-medication responsibility and daily controller-medication adherence. RESULTS: Child daily controller-medication responsibility increased with age. By age 7, children had assumed, on average, almost 20% of daily controller-medication responsibility; by age 11, approximately 50%; by age 15, 75%; and by age 19, 100%. In multivariate models, child age and male gender remained significantly associated with child daily controller-medication responsibility, and child's age and parents' race/ethnicity remained significantly associated with daily controller-medication adherence. CONCLUSIONS: Clinicians may need to screen for child daily controller-medication management and include even young children when educating families on the use of asthma medications and other key asthma-management tasks.

"Just three more bites": an observational analysis of parents' socialization of children's eating at mealtime.

The objective of this study was to describe comprehensively the structure and process of the childhood mealtime environment. A socioeconomically diverse sample of 142 families of kindergarteners (52% females) was observed at dinnertime using a focused-narrative observational system. Eighty-five percent of parents tried to get children to eat more, 83% of children ate more than they might otherwise have, with 38% eating moderately to substantially more. Boys were prompted to eat as often as girls and children were prompted to eat as many times in single- as in two-parent households. Children were very rarely restricted in their mealtime intake. High-SES parents used reasoning, praise, and food rewards significantly more often than low-SES families. Mothers used different strategies than fathers: fathers used pressure tactics with boys and mothers praised girls for eating. Future research should examine the meanings children ascribe to their parents' communications about food intake and how perceived parental messages influence the development of long-term dietary patterns. Interpreted alongside the evidence for children's energy self-regulation and the risk of disruption of these innate processes, it may be that parents are inadvertently socializing their children to eat past their internal hunger/satiety cues. These data reinforce current recommendations that parents should provide nutritious foods and children, not parents, should decide what and how much of these foods they eat.

Parents' specific concerns about daily asthma medications for children.

Specific concerns from 706 parents regarding their children's (M age = 8.0, SD = 3.9) use of daily asthma medications were systematically identified and organized. 270 (38.2%) of 706 parents expressed a total of 470 concerns (M = 1.74, SD = 0.93; Range 1-5), including concerns about side effects (48.9%; e.g., growth retardation); aspects of the regimen (29.3%; e.g., medication amount); and "steroid" use (10.4%). Independent predictors of parental concern included use of inhaled corticosteroids (OR = 1.60, 95% CI 1.07-2.40), nasal corticosteroids (OR = 1.70, 95% CI 1.21-2.38), and alternative therapies (OR = 1.84, 95% CI 1.32-2.56). Providers should be prepared to address a wide range of medication concerns, especially those related to side effects.

Racial/ethnic differences in mother-daughter communication about sex.

White, Black, Latina, and Asian mothers (n = 6929) were compared on aspects of mother-daughter communication about sex. Non-Whites reported higher discomfort. Latinas and Asians were least likely to have discussed sex but most likely to know daughters' sexual status. The converse was observed for Black mothers. Research on the influence of ethnicity on adolescent sexual behavior may inform the design of more effective interventions to reduce sexual risk behavior.