Improving Assessment and Learning Environments for Graduate Medical Trainees to Advance Healthcare Language Equity.

Language-appropriate care is critical for equitable, high-quality health care, but educational standards to assure graduate medical trainees are prepared to give such care are lacking. Detailed guidance for graduate medical education is provided by the Accreditation Council for Graduate Medical Education through the following: (1) an assessment framework for competencies, subcompetencies, and milestones for trainees and (2) the Clinical Learning Environment Review (CLER) Pathways for assessment of trainees' learning environments. These tools do not include a robust framework to evaluate trainees' abilities to offer language-appropriate care. They also do not address the learning environment's potential to support such care. A multidisciplinary group of linguistic, medical, and educational experts drafted a new subcompetency with milestones and an expanded CLER Pathway to highlight the importance of equitable care for patients who prefer languages other than English. These resources offer residency and fellowship programs tools to guide assessment, curriculum development, and learning-environment improvements related to language-appropriate care. Recognizing that programs have unique needs and resources, we propose a range of initial actions to address language equity. A focus on language diversity in the learning environment can have a broad and lasting impact on care quality, patient safety, and health equity.

Racial and ethnic disparities in common inpatient safety outcomes in a children's hospital cohort.

BACKGROUND: Emerging evidence has shown racial and ethnic disparities in rates of harm for hospitalised children. Previous work has also demonstrated how highly heterogeneous approaches to collection of race and ethnicity data pose challenges to population-level analyses. This work aims to both create an approach to aggregating safety data from multiple hospitals by race and ethnicity and apply the approach to the examination of potential disparities in high-frequency harm conditions. METHODS: In this cross-sectional, multicentre study, a cohort of hospitals from the Solutions for Patient Safety network with varying race and ethnicity data collection systems submitted validated central line-associated bloodstream infection (CLABSI) and unplanned extubation (UE) data stratified by patient race and ethnicity categories. Data were submitted using a crosswalk created by the study team that reconciled varying approaches to race and ethnicity data collection by participating hospitals. Harm rates for race and ethnicity categories were compared with reference values reflective of the cohort and broader children's hospital population. RESULTS: Racial and ethnic disparities were identified in both harm types. Multiracial Hispanic, Combined Hispanic and Native Hawaiian or other Pacific Islander patients had CLABSI rates of 2.6-3.6 SD above reference values. For Black or African American patients, UE rates were 3.2-4.4 SD higher. Rates of both events in White patients were significantly lower than reference values. CONCLUSIONS: The combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities.

Implicit Racial Bias Attitudes and Mitigation in Neonatal Nurse Practitioners: A Quality Improvement Project.

PURPOSE: to assess the impact of education using the implicit bias recognition and management (IBRM) teaching approach. DESIGN: longitudinal quasi-experimental design. Surveys at baseline, immediate postimplementation, and 4-week postimplementation using the modified version of the Attitudes Toward Implicit Bias Instrument (ATIBI). The 4-week survey included items about implicit bias recognition and mitigation strategies. SAMPLE: thirty-six neonatal nurse practitioners assigned to the NICU in a Midwest urban children's hospital. RESULTS: one-way repeated-measures analysis of variance was used, and the score range was 16-96. The results showed a statistically significant model, F (1.49, 707.97) = 34.46, p <.001, partial η2 = 0.496. Pairwise comparisons showed improvement from pre (M = 73.08, SD = 9.36) to immediate postimplementation (M = 80.06, SD = 8.19), p <.001. Scores were sustained at 4-week postimplementation (M = 79.28, SD = 10.39), p = .744. CONCLUSIONS: The IBRM teaching approach improved scores from baseline on a modified ATIBI that remained improved 4 weeks after the education.

Effectiveness of Screening for Household Gun Ownership in an Urban Primary Care Clinic.

Gun-related suicide and homicide are leading causes of death among children. Little is known about the effectiveness of screening for gun ownership in primary care. We examined positive gun ownership screens over a 2.5-year period in a pediatric primary care clinic. The main outcome was a positive screen for gun ownership. The main predictors included insurance type, neighborhood median income, number of clinic visits, and other social needs. Of 19 163 patients, 474 (2.5%) screened positive for gun ownership. Patients with private insurance and from higher income neighborhoods had 2 to 3 times higher odds of a positive screen. Patients with more visits and with food insecurity had approximately 2 to 4 times the odds of a positive screen for household gun ownership. In conclusion, the rate of positive gun ownership screens was very low and far below known gun ownership rates. Improved screening methods could better identify opportunities for gun safety advocacy.

Inclusion of Non-English-Speaking Participants in Pediatric Health Research: A Review.

Importance: The inclusion of non-English-speaking (NES) participants in pediatric research is an essential step to improving health equity for these populations. Although some studies have shown lack of progress in NES research participation in the past decade, few have examined NES inclusivity in pediatric research or details about the practices that researchers have used to communicate with NES participants. Objective: To assess how frequently NES families were included in pediatric research, how rates of inclusion changed over time, what languages were included, and methodological details about oral and written communication with NES participants. Evidence Review: In this review, all original investigation articles published in JAMA Pediatrics, Pediatrics, and The Journal of Pediatrics between January 2012 and November 2021 were screened. Eligible articles, which included those based in the US and with human participants, were reviewed to determine whether they included or excluded NES participants or whether or not there was specific mention of language. A second-round review was conducted on the subset of articles that included NES participants to determine methodological details (eg, languages included, type of study, region where the study was located, and oral and written communication practices with NES participants). Findings: Of the 8142 articles screened, 5008 (62%) met inclusion criteria; of these, 469 (9%) included NES participants. The most common language was Spanish (350 [75%]); 145 articles (31%) reported non-English or other language without specification. A total of 230 articles (49%) reported the number of NES participants, and 61 (13%) specified the methods used to determine whether participants preferred a language other than English. In all, 101 (22%) and 136 (29%) articles specified how oral and written communication occurred with NES participants, respectively. Conclusions and Relevance: This review of 3 pediatric journals provides preliminary evidence suggesting exclusion of NES communities from pediatric research from 2012 to 2021 and highlights an opportunity to provide more methodological detail about communication with NES participants. Best practices for improving inclusivity of NES participants are needed to guide researchers toward improved methods and more relevant results.

Culture and language coaching for bilingual residents: the first 10 years of the CHiCoS model.

ProblemIn the US, there are neither professional standards nor adequate formal training opportunities related to physician use of non-English languages, the most common of which is Spanish. To achieve safe, effective health care for culturally and linguistically diverse patients, the medical profession needs clear standards for physician language use and proven culture and language training models that include validated assessment of linguistic proficiency. InterventionThe authors describe the first decade of an innovative culture and language coaching program for bilingual (Spanish-English) pediatric residents, including the model's evolution and outcomes, as well as recommendations for implementing similar programs elsewhere. Over 10 years, the model has grown from a central innovation-the professional culture and language coach (CLC). The CLC provides 1:1 in-visit support and post-visit coaching to individual residents during three years of continuity clinic experience in a Spanish-language setting (Clínica Hispana de Cuidados de Salud-CHiCoS). They also provide a range of supplementary learning activities (e.g., simulations, immersion rotations, mock testing) and periodic formal assessment of language proficiency. Foundational program elements include cultural and linguistic humility, variations in language, pragmatic linguistics and trans-languaging, the inseparability of culture and language, health literacy, and a flat teaching hierarchy ("all teach, all learn"). ContextCHiCoS has been implemented continuously since 2009 in the primary care clinic of a stand-alone academic pediatric hospital in the Midwest, where pediatric residents have their continuity clinic experience over three years of residency. ImpactFifty-six residents have participated, reporting improved language skills, cultural knowledge, and ability to care for Spanish-speaking patients. Sixty-eight percent of residents not qualified bilingual upon program entry passed a validated physician language assessment by graduation. Spanish-speaking patients seen by CHiCoS residents and faculty reported higher satisfaction, trust, and communication scores than those seen in non-bilingual areas of the same clinic (p < .05 for all scores). The program increased bilingual faculty six-fold and changed attitudes and practices related to language supports throughout the residency program. Lessons LearnedCulture and language coaching provides effective preparation and assessment of bilingual physicians, leading to improved care for culturally and linguistically diverse patients. Our model offers an example for developing similar approaches for a variety of clinicians throughout health care. Such approaches should include professional standards for non-English language use, training supports customized to bilingual learners' proficiency levels, and a focus on integrating practical cultural and linguistic skills to achieve safe, effective clinical communication.

Responding to a call to action for health equity curriculum development in pediatric graduate medical education: Design, implementation and early results of Leaders in Health Equity (LHE).

Introduction: Recent calls to action have urged graduate medical education leaders to develop health equity-focused curricula (HEFC) to redouble efforts to promote pediatric HE and address racism. Despite this call, examples of HEFC for pediatric residents are lacking. Such curricula could catalyze educational innovations to address training gaps. Objective: To describe the design, content, and delivery of "Leaders in Health Equity (LHE)," an innovative HEFC delivered to categorical pediatric residents using multi-modal, service-free retreats. Methods: This single institution, longitudinal curriculum study occurred between 2014 and 2020 and reports multi-level outcomes including: (1) impact on trainee's health equity related knowledge, skills and satisfaction, (2) residency impact and (3) institutional impact. Educational approaches used related to design, content and delivery are summarized and detailed. Results: Trainees (n = 72) demonstrated significant improvements in pre-post knowledge and skills related to HE content. Residents also reported increased desire for advanced HE content over the course of the 6-year study period. Residency impact on operations and resources were sustainable with the opportunity for integration of LHE content in other curricular and training areas noted. Institutional impact included catalyzing organizational HE initiatives and observing an increase in resident-led quality improvement (QI) projects focused on LHE content. Conclusions: On-going adaptation and growth of LHE content to educate increasingly prepared pediatric trainees is a critical next step and a best practice for educators in this evolving field. Developing HEFC within pediatric training programs using a longitudinal, leadership-centered approach may be an effective educational strategy in addressing pediatric health disparities.

Culturally Sensitive Interventions in Pediatric Primary Care Settings: A Systematic Review.

CONTEXT: Culturally sensitive interventions in the pediatric primary care setting may help reduce health disparities. Less is known on the development of these interventions, their target groups, and their feasibility, acceptability, and impact on health outcomes. OBJECTIVE: We conducted a systematic review to describe culturally sensitive interventions developed for the pediatric primary care setting. DATA SOURCES: PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo (January 2000 to July 2020). STUDY SELECTION: Studies were eligible for inclusion if they were (1) original research on an intervention with an evaluation, (2) within a pediatric primary care setting, (3) not limited to education for providers, (4) not limited to interpreter use, and (5) based in the United States. DATA EXTRACTION: The following were extracted: study topic, study design, intervention, cultural sensitivity strategies and terminology, setting, target group, sample size, feasibility, acceptability, and health outcomes. RESULTS: Twenty-five studies described 23 interventions targeting a variety of health topics. Multiple cultural sensitivity strategies were used, most commonly sociocultural (83%). Most interventions (57%) were focused on Hispanic/Latino families. Interventions were generally reported as being feasible and acceptable; some also changed health outcomes. LIMITATIONS: Small samples and heterogenous methods subject to bias were used. Relevant articles may have been missed because of the variety of terms used to describe cultural sensitivity. CONCLUSIONS: The included articles provide preliminary evidence that culturally sensitive interventions can be feasible and effective and may help eliminate disparities for patients from communities with barriers to equitable care.

Cultural Health Beliefs and Practices Among Hispanic Parents.

Parents' beliefs about and approaches to their child's health vary with culture and change within cultures over time. To provide an updated understanding of folk and traditional medicine (FTM) among Hispanic parents in the United States, we surveyed 200 caregivers identifying their child as Hispanic in a pediatric primary care clinic about their cultural health beliefs and practices. Overall, 84% of participants believed in ≥1 folk illness, with foreign-born participants more likely than US-born to endorse folk illness beliefs. Eighty-three percent had used cultural remedies for their children. Of those, although just 15% had discussed such practices with their child's provider, 86% would feel comfortable doing so. No demographic factors predicted use of cultural remedies/healers or comfort talking to providers. Beliefs and practices related to FTM are prevalent among Hispanic parents and cannot be predicted using demographics; providers should routinely ask all families about FTM.

Responding to Discriminatory Patient Requests.

CASE: Julia is a 13-year-old White adolescent girl who was referred for psychological counseling given concerns related to mood, nonadherence, and adjustment secondary to her new diagnosis of type 1 diabetes. The family lives in a rural town located several hours from the academic medical center where she was diagnosed. After several months on a waitlist, the family was contacted to schedule a telehealth appointment with a predoctoral psychology trainee. When the scheduler informed the mother that her daughter would be scheduled with Ms. Huang, the mother abruptly stopped the conversation stating, "I do not want to waste everyone's time" and initially declined the appointment offered. When the scheduler asked about her hesitance, the mother disclosed previous interactions with doctors at the hospital who were "not born in the United States" that she felt were "textbook" (e.g., smiling even when discussing a new chronic medical condition) and "hard to understand" (i.e., because of different dialect/accent). The mother shared that she found these experiences to be stressful and felt the interactions had negatively affected Julia's care. When informed about the length of the waitlist for another clinician, the mother agreed to initiate services with the trainee.The supervising psychologist shared the mother's concerns and comments with Ms. Huang. After discussion, Ms. Huang agreed to provide intervention services, "as long as the family was willing." During the initial telehealth sessions, Ms. Huang primarily focused on building rapport and strengthening the therapeutic alliance with the family. During this time, Julia's mother was reluctant to incorporate suggested parent management strategies at home. Julia also made minimal improvement in her medical management (i.e., A1c levels remained high), had difficulty using behavioral coping strategies, and experienced ongoing mood symptoms (i.e., significant irritability, sleep difficulties, and depressive symptoms). Ms. Huang began to wonder whether the family's resistance and inability to implement recommendations were in some part because of the family's initial concerns and reluctance to engage in therapy with her as a clinician.Should Ms. Huang address the previously identified concerns with the patient and her family? What should be considered when determining how to approach this situation to ensure provision of both the best care for this patient and support for this trainee?

Bilingual and Bicultural Research Teams: Unpacking the Complexities.

Researchers often describe use of "bilingual/bicultural" research teams, especially for research being conducted with marginalized communities. In this perspectives article, we argue that while increasing the diversity of research teams is imperative, using the term "bilingual/bicultural" without further explanation is problematic. We first review the nuances of the terms bilingual and bicultural individually. Next, we describe how the terms bilingual and bicultural cannot be conflated. Finally, we provide recommendations for researchers, journals, and funding agencies.

Variability in Collection and Use of Race/Ethnicity and Language Data in 93 Pediatric Hospitals.

OBJECTIVE: To describe how pediatric hospitals across the USA and Canada collect race/ethnicity and language preference (REaL) data and how they stratify quality and safety metrics using such data. METHODS: Pediatric hospitals from the Solutions for Patient Safety network (125 US, 6 Canadian) were surveyed between January and March 2018 on collection and use of patient/family race/ethnicity data and patient/family language preference data. The study team created the survey using a formal process including pre-testing. Responses were analyzed using descriptive statistics. RESULTS: Ninety-three of 131 (71%) hospitals completed the survey (87/125 [70%] US, 6/6 [100%] Canadian). Patient race/ethnicity was collected by 95%, parent/guardian race/ethnicity was collected by 31%, and 5/6 Canadian hospitals collected neither. Minimum government race/ethnicity categories were used without modification/addition by 68% of US hospitals. Eleven hospitals (13%) offered a multiracial/multiethnic option. Most hospitals reported collecting language preferences of parent/guardian (81%) and/or patient (87%). A majority provided formal training on data collection for race/ethnicity (70%) and language preferences (70%); fewer had a written policy (41%, 51%). Few hospitals stratified hospital quality and safety measures by race/ethnicity (20% readmissions, 20% patient/family experience, 16% other) or language preference (21% readmissions, 21% patient/family experience, 8% other). CONCLUSIONS: The variability of REaL data collection practices among pediatric hospitals highlights the importance of examining the validity and reliability of such data, especially when combined from multiple hospitals. Nevertheless, while improvements in data accuracy and standardization are sought, efforts to identify and eliminate disparities should be developed concurrently using existing data.

Knowledge, Beliefs, and Attitudes About Contraception Among Rural Latino Adolescents and Young Adults.

PURPOSE: Latino youth experience significant disparities in rates of teen pregnancy, and reproductive health needs of rural Latino youth are not well understood. The purpose of this study was to describe knowledge, beliefs, and attitudes about contraception among rural Latino adolescents and young adults (Latino youth). METHODS: Eighty-four Latino youth, aged 15-24 years from rural Kansas communities participated in 15 focus groups (FG) and completed an individual survey. The survey assessed demographics and acculturation. FG participants discussed attitudes, subjective norms, and perceived sexual behaviors regarding teen sexuality, pregnancy, and contraception. RESULTS: FGs revealed multiple obstacles to accessing reproductive health services: geographical/rural location, cultural barriers, religious influences, lack of sexual education, and personal attitudes toward pregnancy and contraception use. Participants described close-knit communities with limited access to confidential reproductive health care. They identified cultural and religious factors (sexual taboo, virginity, Familismo, and family dishonor) that influence family planning behaviors among Latino youth and obstruct access to sexual health and contraception knowledge and services. Ambivalence regarding pregnancy intentions was common, along with the belief that contraception equates with abortion. CONCLUSIONS: Latino youth in rural communities face multiple physical and sociocultural obstacles to accessing family planning information and services. Community-based pregnancy prevention interventions must target these obstacles to optimize reproductive health outcomes for Latino youth in rural settings.

Parental Perceptions of Culturally Sensitive Care and Well-Child Visit Quality.

OBJECTIVE: Incorporating culturally sensitive care into well-child visits may help address pediatric preventive care disparities faced by racial and ethnic minorities, families with limited English proficiency, and immigrants. We explored parents' perspectives about the extent to which their children's pediatric care is culturally sensitive and potential associations between culturally sensitive care and well-child visit quality. METHODS: We conducted cross-sectional surveys with parents attending a well-child visit for a child ages 3 to 48 months. To measure culturally sensitive care, we created a composite score by averaging 8 subscales from an adapted version of the Clinicians' Cultural Sensitivity Survey. We assessed well-child visit quality through the Promoting Healthy Development Survey. Multivariate linear regression was used to understand associations between demographic characteristics and parent-reported culturally sensitive care. We used multivariate logistic regression to examine associations between culturally sensitive care and well-child visit quality. RESULTS: Two hundred twelve parents (71% of those approached) completed the survey. Parents born abroad, compared with those born in the United States, reported significantly higher culturally sensitive care scores (+0.21; confidence interval [CI]: 0.004, 0.43). Haitian parents reported significantly lower culturally sensitive care scores compared with non-Hispanic white parents (-0.49; CI: -0.89, -0.09). Parent-reported culturally sensitive care was significantly associated with higher odds of well-child visit quality including receipt of anticipatory guidance (adjusted odds ratio: 2.68; CI: 1.62, 4.62) and overall well-child visit quality (adjusted odds ratio: 2.54; CI: 1.59, 4.22). CONCLUSIONS: Consistent with prior research of adult patients, this study demonstrates an association between parent-reported culturally sensitive care and well-child visit quality. Future research should explore best practices to integrating culturally sensitive care in pediatric preventive health care settings.

Novel text analytics approach to identify relevant literature for human health risk assessments: A pilot study with health effects of in utero exposures.

BACKGROUND: Systematic reviews involve mining literature databases to identify relevant studies. Identifying potentially relevant studies can be informed by computational tools comparing text similarity between candidate studies and selected key (i.e., seed) references. Challenge Using computational approaches to identify relevant studies for risk assessments is challenging, as these assessments examine multiple chemical effects across lifestages (e.g., human health risk assessments) or specific effects of multiple chemicals (e.g., cumulative risk). The broad scope of potentially relevant literature can make selection of seed references difficult. Approach We developed a generalized computational scoping strategy to identify human health relevant studies for multiple chemicals and multiple effects. We used semi-supervised machine learning to prioritize studies to review manually with training data derived from references cited in the hazard identification sections of several US EPA Integrated Risk Information System (IRIS) assessments. These generic training data or seed studies were clustered with the unclassified corpus to group studies based on text similarity. Clusters containing a high proportion of seed studies were prioritized for manual review. Chemical names were removed from seed studies prior to clustering resulting in a generic, chemical-independent method for identifying potentially human health relevant studies. We developed a case study that focused on identifying the array of chemicals that have been studied with respect to in utero exposure to test the recall of this novel literature searching strategy. We then evaluated the general strategy of using generic, chemical-independent training data with two previous IRIS assessments by comparing studies predicted relevant to those used in the assessments (i.e., total relevant). Outcome A keyword search designed to retrieve studies that examined the in utero effects of environmental chemicals identified over 54,000 candidate references. Clustering algorithms were applied using 1456 studies from multiple IRIS assessments with chemical names removed as training data or seeds (i.e., semi-supervised learning). Using a six-algorithm ensemble approach 2602 articles, or approximately 5% of candidate references, were "voted" relevant by four or more clustering algorithms and manual review confirmed nearly 50% of these studies were relevant. Further evaluations on two IRIS assessments, using a nine-algorithm ensemble approach and a set of generic, chemical-independent, externally-derived seed studies correctly identified 77-83% of hazard identification studies published in the assessments and eliminated the need to manually screen more than 75% of search results on average. Limitations The chemical-independent approach used to build the training literature set provides a broad and unbiased picture across a variety of endpoints and environmental exposures but does not systematically identify all available data. Variance between actual and predicted relevant studies will be greater because of the external and non-random origin of seed study selection. This approach depends on access to readily available generic training data that can be used to locate relevant references in an unclassified corpus. Impact A generic approach to identifying human health relevant studies could be an important first step in literature evaluation for risk assessments. This initial scoping approach could facilitate faster literature evaluation by focusing reviewer efforts, as well as potentially minimize reviewer bias in selection of key studies. Using externally-derived training data has applicability particularly for databases with very low search precision where identifying training data may be cost-prohibitive.

The Next Generation Blueprint of Computational Toxicology at the U.S. Environmental Protection Agency.

The U.S. Environmental Protection Agency (EPA) is faced with the challenge of efficiently and credibly evaluating chemical safety often with limited or no available toxicity data. The expanding number of chemicals found in commerce and the environment, coupled with time and resource requirements for traditional toxicity testing and exposure characterization, continue to underscore the need for new approaches. In 2005, EPA charted a new course to address this challenge by embracing computational toxicology (CompTox) and investing in the technologies and capabilities to push the field forward. The return on this investment has been demonstrated through results and applications across a range of human and environmental health problems, as well as initial application to regulatory decision-making within programs such as the EPA's Endocrine Disruptor Screening Program. The CompTox initiative at EPA is more than a decade old. This manuscript presents a blueprint to guide the strategic and operational direction over the next 5 years. The primary goal is to obtain broader acceptance of the CompTox approaches for application to higher tier regulatory decisions, such as chemical assessments. To achieve this goal, the blueprint expands and refines the use of high-throughput and computational modeling approaches to transform the components in chemical risk assessment, while systematically addressing key challenges that have hindered progress. In addition, the blueprint outlines additional investments in cross-cutting efforts to characterize uncertainty and variability, develop software and information technology tools, provide outreach and training, and establish scientific confidence for application to different public health and environmental regulatory decisions.

The Complexities of Assessing Language and Interpreter Preferences in Pediatrics.

Providing patients, parents, and families high-quality healthcare in the language of their choice is a fundamental component of patient-centered care in pediatric settings. However, language needs may be complex and dynamic, creating clinical and ethical challenges in cases of provider-parent discordance regarding the need for an interpreter. In this perspectives article, we use a clinical encounter as a foundation to discuss the intricacies of addressing language needs in pediatrics. We also describe the urgent need for further innovation and improvement in linguistic supports available to diverse patients and families.

A patient and family data domain collection framework for identifying disparities in pediatrics: results from the pediatric health equity collaborative.

BACKGROUND: By 2020, the child population is projected to have more racial and ethnic minorities make up the majority of the populations and health care organizations will need to have a system in place that collects accurate and reliable demographic data in order to monitor disparities. The goals of this group were to establish sample practices, approaches and lessons learned with regard to race, ethnicity, language, and other demographic data collection in pediatric care setting. METHODS: A panel of 16 research and clinical professional experts working in 10 pediatric care delivery systems in the US and Canada convened twice in person for 3-day consensus development meetings and met multiple times via conference calls over a two year period. Current evidence on adult demographic data collection was systematically reviewed and unique aspects of data collection in the pediatric setting were outlined. Human centered design methods were utilized to facilitate theme development, facilitate constructive and innovative discussion, and generate consensus. RESULTS: Group consensus determined six final data collection domains: 1) caregivers, 2) race and ethnicity, 3) language, 4) sexual orientation and gender identity, 5) disability, and 6) social determinants of health. For each domain, the group defined the domain, established a rational for collection, identified the unique challenges for data collection in a pediatric setting, and developed sample practices which are based on the experience of the members as a starting point to allow for customization unique to each health care organization. Several unique challenges in the pediatric setting across all domains include: data collection on caregivers, determining an age at which it is appropriate to collect data from the patient, collecting and updating data at multiple points across the lifespan, the limits of the electronic health record, and determining the purpose of the data collection before implementation. CONCLUSIONS: There is no single approach that will work for all organizations when collecting race, ethnicity, language and other social determinants of health data. Each organization will need to tailor their data collection based on the population they serve, the financial resources available, and the capacity of the electronic health record.

Chinese, Vietnamese, and Asian Indian Parents' Perspectives About Well-Child Visits: A Qualitative Analysis.

OBJECTIVES: Well-child visits are a critical component of pediatric health care; however, disparities in attendance and quality of care exist for Asian children. Limited research has explored Asian immigrant parents' perspectives about their well-child visit experience. METHODS: Qualitative interviews were conducted with Chinese, Vietnamese, and Asian Indian immigrant parents. Participants were recruited from community-based organizations in the Boston area. Interviews focused on parents' perceptions about well-child visits, including individual attitudes, social and cultural factors affecting their opinions, perceived behavioral control, and improving visits for Asian immigrant families. Data were coded and analyzed using thematic analysis. RESULTS: Fifty-one parents participated. Although participants reported attending well-child visits, they thought language barriers and unfamiliarity with US preventive health care may limit attendance for other Asian immigrant families. Some reported high-quality visits, while others described them as "too simple," recollecting health care experiences from their countries of origin where more tests were completed. Participants described seeking advice about their children's preventive care from elder family members. Many expressed the importance of culturally concordant health care providers and culturally sensitive care, while others thought that culture was less relevant. Differences emerged among the 3 subgroups around culturally concordant care and traditional medicine. CONCLUSIONS: Querying parents about their past health care experiences and providing information about well-child visits may be useful when caring for immigrant families. Social influences on children's health outside of the parent-provider-child triad may also be important. Further work should explore how to deliver culturally sensitive care that considers not only a family's language preferences but also their unique cultural identity.

Parental Feeding Style and Pediatric Obesity in Latino Families.

INTRODUCTION: Pediatric obesity has become an epidemic in the United States. Previous research has shown that parenting factors related to feeding style affect child weight and that Latino families are especially at risk for pediatric obesity. The goal of the current study was to evaluate the relationship between parental feeding style and child body mass index (BMI) in Latino families. METHOD: Latino parents of children between the ages of 2 and 8 ( N = 124) completed a survey on parental feeding styles, acculturation, and demographics. The outcome variable was child BMI. RESULTS: Among respondents, 89% were mothers, 72% were overweight or obese, and 40% reported an indulgent feeding style. Children had a mean age of 59 months ( SD = 23.8) and a mean BMI z score of 0.77 ( SD = 1.14). A demanding parental feeding style was associated with lower child BMI z score, r = -.179, p < .05, and higher acculturation level, r = .213, p < .05. CONCLUSIONS: Findings from the current study can be used to inform health care practitioners of the need to use culturally sensitive interventions that consider parents' feeding behaviors. Future research is warranted in the area of ethnic variations of parenting and how these affect feeding and obesity in this highly vulnerable population.