A structural model of high crime neighborhoods as a driver of toxic stress leading to asthma diagnoses among children of a large medical practice.

This study tested the relationship of neighborhood crime as a driver of pediatric asthma diagnoses via the mechanism of toxic stress utilizing data from a police department, and pediatric clinic in a large urban city in the southwestern United States. Using structural equation modeling, a full mediation model of neighborhood crime as a driver of toxic stress resulting in increased asthma diagnoses fit the data well (Χ2 = 14.0, p =.371; df = 13; RMSEA = .028 [90% CI: 0.00, 0.102]; CFI: 0.995; SRMR = .053). Advocates should explore ways to reduce neighborhood crime to address toxic stress and asthma.

The Relationship Between Hope, Meaning in Work, Secondary Traumatic Stress, and Burnout Among Child Abuse Pediatric Clinicians.

INTRODUCTION: Child abuse pediatricians continuously encounter trauma experienced by abused children, putting them at risk of secondary traumatic stress (STS), a syndrome with symptoms similar to those of posttraumatic stress disorder. OBJECTIVE: To examine the relationship between secondary trauma, hope, meaningful work, and burnout in child abuse pediatric clinicians. METHODS: Participants were solicited from the Helfer and Special Interest Group on Child Abuse for Medical Professionals listservs. They were sent a link to a Web-based survey consisting of the Oldenburg Burnout Inventory, the STS Scale, the Dispositional Hope Scale, and the Work as Meaning Inventory. RESULTS: A total of 151 participants completed the survey. Correlational analyses showed strong positive associations between the STS score and burnout (R2 = 0.47; F3,140 = 40.64; p < 0.001). Hope and meaning in work demonstrated negatively moderate associations with STS and burnout (ΔR2 = 0.07, p < 0.001). CONCLUSION: A national sample of child abuse pediatric clinicians shows that STS is associated with burnout. Meaning in work and hope can mitigate these effects.

Results of a referral-based weight management program targeted toward children aged 2 to 6 years with obesity or severe obesity.

BACKGROUND: Relatively little is known about weight management programs targeted toward young children with obesity. Using data from the Early Lifestyles Intervention program, we report outcomes from a referral-based, multi-disciplinary weight management program targeted toward children aged 2 to 6 years with obesity or severe obesity. METHODS: Data from 55 children (4.5 ± 1.3 years) medically referred to the ELI program were examined in this non-randomized investigation. At baseline, a nurse collected demographic, anthropometric and clinical measures from the study child, while parents/guardians completed questionnaires regarding their child's nutrition and activity behavior. Follow-up sessions were conducted to discuss healthy behavior strategies and collect anthropometrics from the study child. Body mass index (BMI) values were reported relative to the 95th BMI percentile (%BMIp95) and children were classified as obese (≥ 100% of 95th BMI percentile) or severely obese (≥ 120% of 95th BMI). Questionnaire data were analyzed to report group-level differences and to determine whether individual items predicted changes in %BMIp95 from baseline to follow-up. Regression models were used to examine the change in %BMIp95 by sex, ethnicity, and baseline body size. RESULTS: Certain behaviors were more frequent among non-Hispanic children compared to Hispanic children (demanding certain foods), whereas other behaviors were more frequent among children with severe obesity compared to children with obesity (requesting a second helping, getting own snack and sneaking food). Greater reductions in the study child's %BMIp95 were found among parents indicating their child requests a second helping, is a faster eater, or complains of being hungry. Among the combined sample, %BMIp95 significantly decreased from baseline to final follow-up. On average, the decrease in %BMIp95 did not differ by sex, ethnicity, or baseline body size. CONCLUSIONS: Modest improvements in body size were observed. Additional studies are needed to identify best practices for pediatric interventions seeking weight management.

Exploring the Relationship Between Adverse Childhood Experiences and Hope.

To explore the relationship between adverse childhood experiences and hope, a convenience sample of caregivers bringing in children for medical investigation of child abuse at a regional child advocacy center were surveyed for adverse childhood experiences and dispositional hope. Hope in this sample had a significant negative correlation to the adverse childhood experiences subscale "abuse" (r = -.19; p < .05). The relationship between hope and the other adverse childhood experiences subscales "neglect" (r = -.14) and "dysfunctional family" (r = -.16) was not statistically significant. An analysis of variance was performed to determine if caregivers who have experienced both sexual and physical abuse (M = 29.67; SD = 15.96) have lower hope scores compared to those caregivers who have experienced neither physical nor sexual abuse (M = 42.64; SD = 18.44). This analysis (F (1, 84) = 5.28; p < 0.05) showed that caregivers who experienced both physical and sexual abuse scored significantly lower on hope compared to their counterparts who experienced no adverse events, with an estimated effect size of moderate strength (d = 0.70). Higher adverse childhood experiences scores are associated with lower hope. This result was especially true for those adult caregivers who reported experiencing both physical and sexual abuse when compared to adults who did not experience either form of child trauma. While the empirical literature continues to demonstrate the negative consequences of adverse childhood experiences across the life span, hope offers a compelling new line of inquiry in child maltreatment research especially for studies targeting prevention or intervention.