Midlife Study of the Louisville Twins: Connecting Cognitive Development to Biological and Cognitive Aging.

The Louisville Twin Study (LTS) began in 1958 and became a premier longitudinal twin study of cognitive development. The LTS continuously collected data from twins through 2000 after which the study closed indefinitely due to lack of funding. Now that the majority of the sample is age 40 or older (61.36%, N = 1770), the LTS childhood data can be linked to midlife cognitive functioning, among other physical, biological, social, and psychiatric outcomes. We report results from two pilot studies in anticipation of beginning the midlife phase of the LTS. The first pilot study was a participant tracking study, in which we showed that approximately 90% of the Louisville families randomly sampled (N = 203) for the study could be found. The second pilot study consisted of 40 in-person interviews in which twins completed cognitive, memory, biometric, and functional ability measures. The main purpose of the second study was to correlate midlife measures of cognitive functioning to a measure of biological age, which is an alternative index to chronological age that quantifies age as a function of the breakdown of structural and functional physiological systems, and then to relate both of these measures to twins' cognitive developmental trajectories. Midlife IQ was uncorrelated with biological age (- .01) while better scores on episodic memory more strongly correlated with lower biological age (- .19 to - .31). As expected, midlife IQ positively correlated with IQ measures collected throughout childhood and adolescence. Additionally, positive linear rates of change in FSIQ scores in childhood significantly correlated with biological age (- .68), physical functioning (.71), and functional ability (- .55), suggesting that cognitive development predicts lower biological age, better physical functioning, and better functional ability. In sum, the Louisville twins can be relocated to investigate whether and how early and midlife cognitive and physical health factors contribute to cognitive aging.

The Louisville Twin Study: Past, Present and Future.

The Louisville Twin Study (LTS) is nationally recognized as one of the largest and most comprehensive studies of child development related to multiple birth status. The LTS is unique because of the extensive longitudinal face-to-face assessments, the frequency of data collection, the inclusion of data on additional family members (i.e., parents, siblings, grandparents; and later, twins' own spouses and children), and the variety of data collection methods used. Data preservation efforts began in 2008 and are largely complete, although efforts are ongoing to obtain funding to convert the electronic data to a newer format. A pilot study was completed in the summer of 2018 to bring the twins, who are now middle-aged, back for testing. A grant is currently under review to extend the pilot study to include all former participants who are now ≥40 years of age. Opportunities for collaboration are welcome.

Providers' Behaviors and Beliefs on Prescribing Antipsychotic Medication to Children: A Qualitative Study.

Fragmentation in behavioral and mental health care to children has resulted in suboptimal care and high rates of psychotropic medication use, especially antipsychotic medications (APM). A qualitative study, based on the Theory of Planned Behavior (TPB), aimed to better understand prescribing practices, barriers to optimal treatment, and potential interventions to safeguard the use of APM for children in Kentucky. The most common barrier to optimal care was access to mental health specialists. Social norms and pressure from families contribute to increased medication use. We identify promising interventions to safeguard the use of APM through the lens of the TPB.

Development and Initial Testing of the Parent Beliefs about Early Childhood Social-Emotional Development Instrument.

BACKGROUND: No instrument exists to measure parent beliefs about early social-emotional development, which is foundational for child outcomes. We developed and tested an instrument to measure parent beliefs. METHODS: Positive parenting was defined from the literature and 84 items were developed based on the theory of planned behavior (TPB). The instrument was tested with mothers (N=200) from the United States. RESULTS: Data support our initial supposition of five factors based upon the TPB, which accounted for 65.5% of the total variance. CONCLUSION: The instrument demonstrates strong initial psychometric properties and is ready for further testing.

Health Literacy and Preferences for Sources of Child Health Information of Mothers With Infants in the Neonatal Intensive Care Unit.

BACKGROUND: Parents of infants hospitalized in the neonatal intensive care unit (NICU) frequently need guidance to prepare them for the care and health promotion of their child after hospital discharge. The health literacy of the parents should be considered so that education can be tailored to meet their needs. It is also important to understand the parents' preferences for how, and from whom, they receive education. PURPOSE: The purpose of this study was to identify health literacy levels of parents of infants in an NICU and preferences for who they want to provide them with education. METHODS: An exploratory, descriptive design was used to assess participant health literacy and preferences for obtaining child health information. Only mothers (no fathers) with babies in the NICU were available to complete the survey. Mean participant age was 26.4 years (SD = 6.7). RESULTS: Participants had a mean Rapid Estimate of Adult Literacy in Medicine, Revised, score of 5.64 (SD = 2.4), indicating a low level of health literacy. Questions regarding when to administer medication were correctly answered by 69% of participants. Proper medication dosage was understood by 92% of participants; however, only 30% were able to correctly convert measurements. One-on-one discussions with a physician were the preferred source of health information for 80% of participants. IMPLICATIONS FOR PRACTICE/RESEARCH: The current exploratory study provides new information that will help inform the development of future studies and increase awareness of nurses regarding health literacy and the specific types of skills for which parents need the most help.

Lessons Learned From Adolescent Mothers: Advice on Recruitment.

PURPOSE: Adolescent mothers have high rates of depressive symptoms and inadequate rates of depression evaluation and treatment. The purpose of this qualitative study was to identify characteristics of effective recruitment ads for an Internet-based depression intervention for pregnant and parenting adolescents. METHODS: Using focus group methods, participants (N = 35) were recruited and enrolled at a teen parent program, part of the public school system. Focus group sessions were analyzed for participant preferences, rationale for choices, key words, and the frequency of words within the videotapes and audiotapes. RESULTS: Findings indicated that adolescent mothers preferred pictures in which everyone looked happy, narrative that clearly indicated cost and eligibility, and words that they would use in conversation. CLINICAL RELEVANCE: The study filled an important gap in the literature by soliciting from pregnant and parenting adolescents their preferences regarding visual appeal, content adequacy, and message clarity of advertisements that would motivate them to visit an Internet intervention for depression. Results could be extrapolated to education of pregnant and parenting adolescents in clinical settings.

Acceptability and initial efficacy of education for teen mothers.

PURPOSE: Educational materials used by healthcare agencies frequently do not follow national health guidelines for plain talk. Adolescent mothers are a vulnerable population in need of accurate and accessible health information to promote their own health and that of their baby. The aims of our study were to: Determine acceptability of simple, written educational pamphlets to adolescent mothers; Determine efficacy of simple, written educational pamphlets in improving an adolescent mother's knowledge related to breastfeeding, infant care, postpartum depression, and mother-infant relationship; Determine if higher knowledge scores are maintained after a 2-week period; and Determine general parenting health literacy of adolescent mothers. STUDY DESIGN AND METHODS: Using a prospective, experimental design, students enrolled in a teen parent program (n = 123) completed a pretest and The Parent Health Literacy Activities Test (PHLAT), read the health educational materials, and completed an immediate posttest of knowledge and acceptability. Two weeks later, the same participants completed a second posttest of knowledge. RESULTS: Adolescent mothers found the intervention (simple, written educational materials) to be acceptable. The intervention was initially effective in improving knowledge scores in all four content areas. However, knowledge was not retained and scores were not significantly different from baseline at the 2-week assessment. The mean health literacy of the adolescent mothers was poor. CLINICAL IMPLICATIONS: A booster session may be necessary for knowledge retention. Other methods of education should be studied to evaluate efficacy for adolescent mothers' knowledge retention of important health information.

First We Have to Engage Them: A Mixed Methods Assessment of Low-Income Parents' Preferences for and Barriers to Receiving Child Health Promotion Information.

INTRODUCTION: The aim of this study is to understand low-income parents' preferences for and barriers to receiving child health promotion information. METHODS: A mixed-methods approach was used. Data were collected in an urban pediatric primary care setting serving predominantly low-income African American families. Parents (n = 190) of 3- to 8-year-old children completed a survey; a randomly selected subset participated in focus groups. RESULTS: The quantitative and qualitative samples differed with regard to whether they would like to get parenting information from their doctors. The most commonly cited obstacles to attending parenting classes were time (50.6%), work schedule (40.6%), transportation (37.7%), and own health (22.4%). DISCUSSION: New and creative methods are needed to promote child health and development that do not increase the burden associated with raising children in the context of limited resources.

Evaluation of printed health education materials for use by low-education families.

PURPOSE: Millions of adults lack adequate reading skills and many written patient education materials do not reflect national guidelines for readability and suitability of materials, resulting in barriers to patients being partners in their own health care. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to health care providers for how to improve the materials. METHODS: Materials (N = 97) from three clinical areas that represented excellence in nursing care in our organization (stroke, cancer, and maternal-child) were reviewed for a composite reading grade level and a Suitability Assessment of Materials (SAM) score. RESULTS: Twenty-eight percent of the materials were at a 9th grade or higher reading level, and only 23% were 5th grade or below. The SAM ratings for not suitable, adequate, and superior were 11%, 58%, and 31%, respectively. Few materials were superior on both scales. The SAM scale was easy to use and required little training of reviewers to achieve interrater reliability. CONCLUSIONS: Improving outcomes and reducing health disparities are increasingly important, and patients must be partners in their care for this to occur. One step to increasing patient understanding of written instructions is improving the quality of the materials in the instruction for all patients and their families, especially those with limited literacy skills. CLINICAL RELEVANCE: Using materials that are written in a manner that facilitates the uptake and use of patient education content has great potential to improve the ability of patients and families to be partners in care and to improve outcomes, especially for those patients and families with limited general literacy or health literacy skills.

Evaluation of the factor structure of the obstacles to engagement scale with low-income african american parents.

OBJECTIVE: Parenting anticipatory guidance is one way to promote optimal child health and development and minimize disparities between children from lower socio-economic status families and their higher income peers. However, low rates of attendance at and completion of parenting programs has been demonstrated. Understanding barriers to participation has important implications. The Obstacles to Engagement Scale (OES) has been used in some populations but it has not been evaluated for use with low-income African American samples. The aim of the current study is to evaluate the factor structure of the OES with a sample of low-income, African American parents. METHOD: Parents or legal guardians with children aged 3-8 years completed a survey in the waiting room of a primary care pediatric academic practice in an urban location in the southern United States of America (N = 114). Almost 87% had <12th grade education and 93% of the children received Medicaid services. The OES was one measure from a larger study and only participants with complete data on the OES were included in the exploratory factor analysis (EFA). RESULTS: The EFA did not support the previous 4-factor solution (intervention demands, personal or family stressors or obstacles, relevance of or trust in intervention, and time and scheduling demands. Instead, a 3-factor statistical solution emerged but not all items held together conceptually. CONCLUSION: The current study supports the necessity for evaluating study instruments for use with specific populations. Larger samples are needed to disentangle the effects of educational and poverty status from race and ethnicity and to develop and validate instruments that are appropriate for the study population.

Health promotion in pediatric primary care: importance of health literacy and communication practices.

Health literacy has been shown to predict health behaviors and outcomes above the effects of education or socioeconomic status. Much remains unknown about the health literacy of parents and the role it plays in children's health outcomes or in health disparities. The current study explored the health communication needs and health literacy indicators in a diverse sample of parents (n = 75) to identify potential areas for future interventions. The sample consisted of parents of children 18 to 36 months old who were visiting 3 different pediatric medical offices, 2 of which served low-income families and 1 located in an affluent suburb. When comparisons were made between 2 educational attainment groups, there were variations in indicators of health literacy and health communication needs. These data can be used to guide the development of interventions by primary care providers to improve parent education.