Preliminary associations of body weight, weight bias, and dietary restriction with eating disorder diagnosis in women experiencing food insecurity.

Understanding the co-occurrence of food insecurity and eating disorders is a pressing concern. Several factors have been hypothesized to increase risk for eating disorders in women with food insecurity including dietary restriction, body weight, and weight-related bias, but few studies have tested these factors simultaneously to determine which are associated most strongly with eating disorder status. We tested cross-sectional associations of dietary restriction, current body mass index (BMI), weight suppression (i.e. the difference between current weight and highest weight), and weight bias with eating disorder diagnosis in a sample of 99 self-identified women with current food insecurity (54% White; mean [SD] age = 40.26 [14.33] years). Participants completed two virtual study visits consisting of electronic questionnaires and interviews. A binary logistic regression model was conducted to test relations between the hypothesized correlates and eating disorder diagnostic status in the past 12 months, controlling for age, food insecurity severity, and body dissatisfaction. Higher levels of weight suppression and weight bias, but not current BMI, were significantly associated with the presence of an eating disorder. Contrary to our hypothesis, greater dietary restriction was associated with lower likelihood of eating disorder diagnosis. Results suggest high levels of weight bias and weight suppression characterize women with food insecurity who meet criteria for an eating disorder. Women who experience food insecurity and have lost a relatively great deal of weight and/or hold biases about high weight should be screened for eating pathology in clinical settings.

Vitamin D and hypophosphatemia in patients with anorexia nervosa and avoidant/restrictive food intake disorder: a case control study.

BACKGROUND: Refeeding hypophosphatemia (RH) is a common complication of nutritional restoration in malnourished individuals, yet clear risk stratification remains elusive. Individuals with anorexia nervosa (AN) and avoidant/restrictive food intake disorder (ARFID) may be deficient in vitamin D, an important component of dietary phosphorus absorption in the gut. The relationship between vitamin D and RH in AN and ARFID is unknown. Therefore, the aims of this study were to (1) report rates of low serum 25-hydroxy vitamin D and RH in AN and ARFID; (2) describe associations between phosphorus and variables associated with RH identified in extant literature; (3) examine the relationship between 25-hydroxy vitamin D and RH and (4) investigate moderation by vitamin D between variables of interest and phosphorus level. METHOD: Analyses included retrospective chart review of 307 individuals admitted to the ACUTE Center for Eating Disorders and Severe Malnutrition with a diagnosis of AN or ARFID. Variables of interest included admission laboratory values (vitamin D level, comprehensive metabolic panel, hemoglobin, point-of-care blood glucose), anthropometric measures (weight, body mass index [BMI], % ideal body weight [IBW]), age, duration of illness, length of stay, feeding method, and serum phosphorus nadir. Pearson and Spearman rank correlation, one-way ANOVA, and regression analyses were used to determine the relationship between variables and serum phosphorus. RESULTS: Over 1/3 of the sample (35.3%) had serum phosphorus levels ≤ 2.9 mg/dL. There were no significant differences between groups in phosphorus nadir (p = .17, η2 = 0.12) or hypophosphatemia (p = .16, ϕc = 0.11). Thirty-five (35%) of individuals with ARFID were either deficient or insufficient in vitamin D, compared to 29% of individuals with AN. Individuals with AN had significantly higher mean vitamin D levels compared to those with ARFID (p = .03; η2 = 0.015). Nadir phosphorus showed a positive association with weight, BMI, %IBW, potassium, and calcium on admission, and a negative association with length of stay, hemoglobin, and total number of tube-fed days. Higher levels of 25-hydroxy vitamin D moderated the relationship between serum phosphorus nadir and weight on admission (p = .0004). CONCLUSION: Individuals diagnosed with ARFID are as nutritionally fragile as those with AN regarding vitamin D and RH. The negative feedback loop involving vitamin D that maintains phosphorus homeostasis may play a role in the development of RH in AN and ARFID.

Refeeding hypophosphatemia (RH) is a common and potentially serious complication of nutrition restoration, yet its risk is not fully understood. Vitamin D is an important part of phosphorus absorption in the gut. We examined 25-hydroxy vitamin D levels on admission and the relationship with RH in individuals with avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN). Results showed individuals with ARFID had significantly lower vitamin D levels than individuals with restrictive type AN, but not individuals with binge/purge type AN. Additionally, analyses showed that higher levels of vitamin D may play a role in the association between RH and weight on admission. Better understanding of RH risk may improve care.

Vitamin D and Hypophosphatemia in Patients with Anorexia Nervosa and Avoidant/Restrictive Food Intake Disorder: A Case Control Study.

Background: Refeeding hypophosphatemia (RH) is a common complication of nutritional restoration in malnourished individuals, yet clear risk stratification remains elusive. Individuals with anorexia nervosa (AN) and avoidant/restrictive food intake disorder (ARFID) may be deficient in vitamin D, an important component of dietary phosphorus absorption in the gut. The relationship between vitamin D and RH in AN and ARFID is unknown. Therefore, the aims of this of this study were to 1) describe the prevalence of low serum 25-hydroxy vitamin D levels and RH in AN and ARFID 2) report associations between nadir phosphorus level and variables associated with RH in extant literature and 3) examine the relationship between 25-hydroxy vitamin D levels and serum phosphorus nadir in AN and ARFID. Method: Analyses included retrospective chart review of 307 individuals admitted to the ACUTE Center for Eating Disorders and Severe Malnutrition with a diagnosis of AN or ARFID. Variables of interest included admission laboratory values (vitamin D level, comprehensive metabolic panel, hemoglobin, point-of-care blood glucose), anthropometric measures (weight, body mass index [BMI], % ideal body weight [IBW]), age, duration of illness, length of stay, feeding method, and serum phosphorus nadir. Pearson and Spearman rank correlation, one-way ANOVA, and regression analyses were used to determine the relationship between variables and serum phosphorus. Results: Over 1/3 of the sample (35.3%) had serum phosphorus levels ≤ 2.9 mg/dL. There were no significant differences between groups in phosphorus nadir (p = .17, η2 = 0.12) or hypophosphatemia (p = .16, ϕc = 0.11); 44% of individuals with ARFID and 33% of individuals with AN had hypophosphatemia. Nadir phosphorus showed a positive association with weight, BMI, %IBW, potassium, and calcium on admission, and a negative association with length of stay, hemoglobin, and total number of tube-fed days. Higher levels of 25-hydroxy vitamin D moderated the relationship between serum phosphorus nadir and weight on admission (p = .0004). Conclusion: Individuals diagnosed with ARFID are as nutritionally fragile as those with AN regarding vitamin D and RH. The negative feedback loop involving vitamin D that maintains phosphorus homeostasis may play a role in the development of RH in AN and ARFID.

A reflexive thematic analysis of #WhatIEatInADay on TikTok.

Eating-related content is common on TikTok, a popular video-based social media platform, but studies of eating-related content on TikTok are limited. Given the documented association between social media use and disordered eating, investigation of eating-related content on TikTok is needed. One subset of popular eating-related content is "What I Eat in a Day" (#WhatIEatInADay), in which a creator documents the food they eat over the assumed span of a single day. We sought to evaluate the content of TikTok #WhatIEatInADay videos (N = 100) using reflexive thematic analysis. Two primary types of videos emerged. First, Lifestyle videos (N = 60), which included aesthetic elements, presentations of clean eating, stylized meals, promotion of weight loss and the thin ideal, normalization of eating as a fat woman, and disordered eating content. Second, Eating Only videos (N = 40), which were primarily focused on food, and included upbeat music, an emphasis on highly palatable foods, displays of irony, emojis, and excessive consumption of food. Because viewing eating-related social media content has been associated with disordered eating, both types of TikTok #WhatIEatInADay videos may be harmful to vulnerable youth. Given the popularity of TikTok and #WhatIEatinADay, clinicians and researchers should consider the potential impact of this trend. Future research should examine the impact of viewing TikTok #WhatIEatInADay videos on disordered eating risk factors and behaviors.

Health literacy and eating disorder pathology in women with food insecurity: A preliminary cross-sectional study.

Food insecurity (FI), or limited consistent access to food, is associated with eating disorder (ED) pathology; however, the underlying mechanisms of this relationship remain unclear. Health literacy, or the ability to comprehend and apply health-related information to decision making, is linked to FI and has implications for outcomes across a broad range of diagnoses. The purpose of this study was to examine associations between health literacy and ED symptoms in a sample of 99 women with FI. Linear regression tested cross-sectional associations between scores on The Newest Vital Sign (NVS), a measure of health literacy, and scores on the Eating Pathology Symptom Inventory (EPSI) and behaviors reported in the Eating Disorder Diagnostic Interview (EDDI). Logistic regression examined the likelihood of ED diagnosis in relation to NVS score. The sample mean (SD) age was 40.3 (14.3) years, and participants self-identified as 54.5 % White, 30.3 % Black, and 13.8 % other. Respondents self-reported 13.1 % marginal, 28.3 % low, and 58.6 % very low food security. Mean NVS score was 4.45, and significantly higher for White compared to Black individuals (F = 3.96, p = .02, η2 = 0.76), but not between other groups. No difference in NVS score by FI status was observed. EPSI Body Dissatisfaction was positively associated with NVS score. No associations were found between remaining EPSI subscales, eating behaviors, or ED diagnosis. White women, but not other groups, were found to have significant negative relationship between NVS and EPSI restricting. Future longitudinal research including components of health literacy related to eating in individuals with FI is warranted.

Comorbid eating, depressive, and anxiety psychopathology is associated with elevated shame in women with food insecurity.

OBJECTIVE: To compare participants with current food insecurity and different psychopathology profiles on shame, guilt, anxiety, and depression using a cross-sectional design. METHOD: Women with current food insecurity (n = 99; 54% White) were placed into four groups based on their endorsement of symptoms of psychopathology: eating disorder with depression/anxiety comorbidity (ED-C group; n = 17), depression/anxiety only (Depression/anxiety group; n = 34), eating disorder only (ED group; n = 12), and No-diagnosis group (n = 36). Groups were compared on self-report measures of shame, guilt, depression, and anxiety using analysis of covariance. RESULTS: The presence of an eating disorder was associated with quadruple the risk of screening positive for comorbid depression and anxiety. The ED-C group reported elevated shame relative to the ED and No-diagnosis groups. The ED-C group reported the highest levels of anxiety, followed by the Depression/anxiety group, and the ED and No-diagnosis groups. DISCUSSION: The presence of an eating disorder with comorbidity among women with food insecurity is associated with heightened shame. Given shame's status as a transdiagnostic predictor of psychopathology, it may serve as a putative mechanism underlying the relationship between food insecurity and eating disorder comorbidity. PUBLIC SIGNIFICANCE STATEMENT: Women with food insecurity and an ED were more likely to also screen positive for depression and/or anxiety than women with food insecurity and no ED. Overlap between ED, depression, and anxiety was associated with elevated shame, a harmful, maladaptive emotion with negative psychosocial consequences.

Influence of COVID-19 on the next generation of nurses in the United States.

AIMS/OBJECTIVES: Examine the affective state (anxiety, depression), life satisfaction, stress and worry, media consumption and perceptions of pursuing a career in nursing amidst the COVID-19 pandemic. BACKGROUND: Nursing students worldwide have reported increased stress, fear and anxiety amidst challenges and risks associated with COVID-19. It remains unclear what impact COVID-19 will have on nursing students in the United States (US) as they prepare to enter the workforce. DESIGN: Cross-sectional study of undergraduate nursing students at one university in the Northeastern United States. METHODS: Students (N = 161) completed an online survey (July 2020) about health and life satisfaction, affective state (depression, anxiety), stress and interest in pursuing nursing. Descriptive statistical analysis described sample and quantitative data. Linear regression was used to examine whether media consumption, stress, affective states predicted interest in pursuing a nursing career. Qualitative thematic analysis was applied to the open-ended question, 'How has COVID-19 influenced your interest in pursuing a nursing career?'. The Standards for Reporting Qualitative Research (SRQR) checklist was used to evaluate methodological quality. RESULTS: Mean stress score was 56.6 (range 0-100), 55.6% of respondents felt unsettled about the future, and 68.2% reported feeling overwhelmed. 18.7% of students reported moderate to severe anxiety, 19.8% reported moderate to severe depression and 54.4% reported that COVID-19 influenced their interest in nursing. Six themes emerged from qualitative analysis: no change, reaffirming/confirmatory, importance of nursing, reality check, positive influence and negative influence. CONCLUSIONS: Universities/colleges and nursing faculty should prioritise universal mental health assessment for nursing students and enhance mental health services to support and monitor this population. RELEVANCE TO CLINICAL PRACTICE: Mental health services to support nursing students are warranted in the wake of the COVID-19 pandemic. Reduction in nursing workforce may have significant impacts on staffing ratios, patient outcomes, nurse burn-out and other aspects of clinical care.

Factors associated with refeeding hypophosphatemia in adolescents and young adults hospitalized with anorexia nervosa.

BACKGROUND: Refeeding hypophosphatemia (RH) in individuals with anorexia nervosa (AN) is a potentially fatal complication of nutrition restoration; yet, little is known about risk. This retrospective cohort study examined factors found in hospitalized youth with AN that may contribute to RH. METHODS: We reviewed medical records of 300 individuals diagnosed with AN admitted between the years of 2010 and 2016. Logistic regression examined factors associated with RH. Multivariate regression examined factors associated with phosphorus nadir. RESULTS: For 300 participants, the mean (SD) age was 15.5 (2.5) years, 88.3% were White, and 88.3% were female. Participants lost an average of 11.3 (9.7) kg of body weight and were 82% (12.1) of median body mass index (BMI). Age (P = .022), nasogastric (NG) tube feeding (P = .054), weight gain (P = .003), potassium level (P = .001), and magnesium level (P = .024) were contributors to RH. Odds of RH were 13.7 times higher for each unit reduction in magnesium, 9.2 times higher for each unit reduction in potassium, three times higher in those who received NG feeding, 1.5 times higher for each kg of weight gain, and 1.2 times higher for each year of age. Regarding phosphorus nadir, serum magnesium level (P < .001) and admission BMI (P = .002) contributed significantly. CONCLUSION: The results indicate that age, NG feeding, weight gain, electrolyte abnormalities, and BMI on admission are potential indicators of the development of RH in youth. This study identifies clinical risk factors associated with RH and may guide further investigation.

The Impact of the COVID-19 Pandemic on the Number of Adolescents/Young Adults Seeking Eating Disorder-Related Care.

PURPOSE: The COVID-19 pandemic has led to the development and worsening of eating disorder (ED) symptoms in adolescents and young adults. In order to examine COVID-19-related trends in ED care-seeking at our institution. METHODS: We used interrupted time series regression to examine pre- and postpandemic monthly summary data of the following: (1) ED-related inpatient admissions for medical stabilization; (2) ED-related hospital bed-days; (3) completed outpatient ED assessments; and (4) ED outpatient care-related inquiries at a children's hospital in Boston, MA. RESULTS: Inpatient admissions, hospital bed-days, and outpatient care-related inquiries increased on average over time postpandemic compared to stable volume over time prepandemic (p < .01). Outpatient assessments decreased precipitously initially following COVID-19-related limitations, and rose quickly back to baseline. CONCLUSION: These results indicate increased need for ED-related care during the pandemic. Bolstering resources to meet the needs of these vulnerable patients is critical as the effects of the pandemic continue to be felt.

Brain-gut psychotherapies: Promising tools to address gastrointestinal problems in patients with eating disorders.

Gastrointestinal (GI) problems are common in individuals with eating disorders (EDs) and associated with distress, impairment, and increased healthcare utilization. GI symptoms may be exacerbated by meals and other interventions central to ED recovery thereby contributing to negative clinical outcomes. Informed by models emphasizing the role of the brain-gut axis in the expression of GI symptoms, this article describes a program of research to adapt "brain-gut psychotherapies" for EDs. First, the role of the brain-gut axis in GI symptoms is described, and evidence-based brain-gut psychotherapies are reviewed, with an emphasis on cognitive behavioral therapy for GI disorders and gut-directed hypnotherapy. Next, future directions for research in EDs to (a) understand the impact of GI symptoms on illness course and outcome; (b) clarify target engagement; (c) evaluate brain-gut psychotherapies; and (d) optimize intervention reach and delivery are described. We present a conceptual model that emphasizes GI-specific anxiety and altered gut physiology as targets of brain-gut psychotherapies in EDs, and discuss several issues that need to be addressed in designing clinical trials to test these interventions. We also describe how engagement with multidisciplinary stakeholders and use of digital tools could speed translation from the laboratory to clinical settings.

Binge eating behavior among a cohort of normal weight college women.

BACKGROUND AND PURPOSE: Binge eating (BE) has been linked to the development of eating disorders and obesity, and it has been reported in college women. Few studies investigate BE by weight category. The purpose of this study was to examine BE in "normal" weight college women. METHODS: Secondary analysis of Web-based survey at a private university in the northeastern United States. RESULTS: Sample was 317 female subjects, 75.4% were White. Binge eating was reported by 99 women (31.2%); 7.6% of binge eaters were underweight, 73.5% normal weight, 15.3% overweight, and 4.1% obese. Normal weight binge eaters were more likely to purge (x = 6.830; p = .033) and overexercise (x = 15.179, p = .019). All binge eaters reported feeling sad, guilty, or distressed after eating and weight dissatisfaction. Normal weight binge eaters reported negative affect before (x = 33.187; p < .001) and after eating (x = 36.329; p < .001) more frequently than normal weight non-binge eaters. Normal weight binge eaters more often described themselves as overweight when compared with normal weight non-binge eaters (x = 9.267; p = .026). IMPLICATIONS FOR PRACTICE: Nearly one third of college women report BE, the majority are of normal weight. These women are more likely to engage in compensatory mechanisms and have distorted body image and a negative affective state with eating. Findings highlight the importance of screening for BE in college women regardless of weight.

Engaging Youth (Adolescents and Young Adults) to Change Frequent Marijuana Use: Motivational Enhancement Therapy (MET) in Primary Care.

PURPOSE: To characterize information elicited from adolescent/young adults with frequent cannabis use in Motivational Enhancement Therapy (MET), and determine whether differences exist across stages of change (SOC) for reducing use. DESIGN AND METHODS: Primary care patients 15-24 years old using cannabis ≥3 times/week enrolled in a pilot randomized intervention trial. All youth were offered two 1-hour MET sessions. Content analysis was used to code and categorize main reasons for use, alternative behaviors, goals, values, pros and cons of change, and compared results between youth in Pre-Contemplation vs. Contemplation SOC. RESULTS: Fifty-six youth completed MET session 1, 46 completed session 2. Most reported their main reason for use was related to emotional coping, negative feelings were a top-3 trigger, and distraction was an alternative way to meet their needs. Youth most frequently described progress in education or career/job as 1-year goals. More than half identified family as a very important value. They most frequently reported pros of using less related to achieving goals, self-improving, and saving money, and a con related to stress/coping. Compared to youth in Pre-Contemplation SOC, those in Contemplation were more likely to identify relationships as both a pro and con of using less cannabis. CONCLUSIONS: MET can reveal developmentally appropriate goals, healthy values, and ambivalence about cannabis use that can be used to facilitate movement along the stages of behavior change toward reduction/cessation. PRACTICE IMPLICATIONS: Brief motivational therapy can be used in primary care to gather information important in helping youth to reduce cannabis use.

Pilot randomized trial of MOMENT, a motivational counseling-plus-ecological momentary intervention to reduce marijuana use in youth.

BACKGROUND: Ecological momentary interventions (EMIs) influence behavior in real time, in real life. We evaluated trial feasibility and preliminary efficacy of MOMENT, a counseling-plus-EMI to reduce frequent marijuana use in youth in primary care. METHODS: Primary care patients age 15-24 years using marijuana at least 3 times/week were randomized to MOMENT [motivational enhancement therapy (MET)/smartphone-based momentary assessment/responsive motivational messaging] vs. No-messages (MET/momentary assessment) vs. MET-only. In MOMENT, two MET sessions were followed by 2 weeks of momentary assessment of marijuana use and factors related to use, with motivational messaging displayed after report of marijuana triggers, desire, use, and effort to avoid use. We evaluated study feasibility (recruitment, retention, and response rates; feedback survey responses) and explored intervention effects on marijuana desire and use at three months with linear mixed effects modeling. RESULTS: Seventy youth [mean (M) =20.7 years, 60% female] were assigned to MOMENT (n=27), No-messages (n=15; assignment suspended to enrich other arms), or MET-only (n=28). Most attrition occurred during baseline, before MET. Of those completing MET session 1, 82% completed their assigned treatment and 79% provided 3-month data. Participants highly rated acceptability; comments reflected changing motivation and behavior. Across arms, participants reported significantly lower marijuana use, desire, and problems at follow-up vs. baseline. Momentary marijuana desire declined more in MOMENT vs. MET-only. Marijuana use following a targeted context or behavior was less likely in MOMENT and No-messages, vs. MET-only. CONCLUSIONS: The MOMENT intervention is feasible to deliver, acceptable, and potentially efficacious in reducing marijuana desire and use among adolescent and young adults in primary care. A larger randomized trial to evaluate efficacy is warranted.

Procedures and Protocols for Weight Assessment During Acute Illness in Individuals With Anorexia Nervosa: A National Survey.

BACKGROUND: Weight assessment is a key component of nursing care for individuals with the acute illness of anorexia nervosa (AN). However, there is little data to guide protocols and procedures regarding weight assessment. OBJECTIVE: To describe institutional practices regarding weight assessment of individuals during acute illness of AN. DESIGN: Treatment facilities ( N = 24) completed a survey about written protocols and procedures regarding weight assessment and disclosure of weight to patients. RESULTS: The majority of facilities ( n = 22; 92%) have written protocols for weight assessment. Weight assessments occurred mostly in the morning ( n = 23; 95.8%), in hospital gowns ( n = 21; 87.5%), and after voiding ( n = 14; 58.3%). Respondents described mixed practices for disclosing weight to patients. CONCLUSION: Results indicate widespread variability in weight assessment and disclosure of weight. Further research is necessary to help develop evidence-based guidelines about weighing practices during acute illness for individuals with AN.

Meal Supervision During Medical Hospitalization for Eating Disorders.

The focus of medical hospitalization for restrictive eating disorders is weight gain; however, no guidelines exist on how to achieve successful and safe weight gain. Meal supervision may be a supportive intervention to aid in meal completion and weight gain. The aim of this study was to examine the effect of standardized meal supervision on weight gain, length of stay, vital signs, electrolytes, and use of liquid caloric supplementation in hospitalized adolescents and young adults with restrictive eating disorders. A chart review compared patients who received meal supervision from admission through discharge to an earlier cohort who received meal supervision as needed. There were no differences in weight, electrolytes, or vital signs between the two cohorts. Length of stay for those who received meal supervision from admission was 3 days shorter than earlier cohort. Nursing supervised meals beginning at admission may shorten length of stay and decrease health care costs.

Nasogastric Tube Feeding for Individuals With Anorexia Nervosa: An Integrative Review.

BACKGROUND: The use of nasogastric (NG) feeding in individuals with anorexia nervosa (AN) is endorsed by national professional organizations; however, no guidelines currently exist. OBJECTIVES: The objectives of this review were to identify and evaluate outcomes of NG feedings for individuals with AN and to develop recommendations for future research, policy, and practice. DESIGN: An integrative review of the research literature was conducted. RESULTS: Of the 19 studies reviewed, all indicated short-term weight gain following NG feeding. Four studies examined adherence; nearly 30% of subjects were nonadherent as evidenced by tube manipulation. Seven studies reported psychiatric outcomes, suggesting NG feeding reduces eating disorder behaviors but not overall symptomology. CONCLUSIONS: NG feeding promotes short-term weight gain; however, long-term outcomes are poorly understood. Future research, using rigorous methods, is still needed to inform practice.

Nursing Care Considerations for the Hospitalized Patient with an Eating Disorder.

Eating disorders are chronic psychiatric illnesses with significant medical complications, psychological distress, and psychiatric comorbidity. Although many patients are treated on an outpatient basis, inpatient care for the more severely ill hospitalized patient can be challenging given the severity of illness and concurrent issues requiring intervention. This article provides an overview of the clinical characteristics of eating disorders typically seen for inpatient care, focusing primarily on anorexia nervosa and bulimia nervosa, and the associated key areas for nursing assessment, diagnoses, and plan of care during hospitalization.

The teachable moment captured: a framework for nurse-led smoking cessation interventions for parents of hospitalized children.

This article explores the topic of smoking cessation counseling for parents in the context of pediatric hospitalization. Teachable moments, a widely used concept in the literature, uses three key concepts including perception of risk, emotional response, and self-concept to precipitate change (McBride, Health Education Research, 18 [McBride, 2003], 156-170). The interweaving of these concepts with institutional systems; clinically trained personnel; parental smoking considerations; parent presence; and external supports, or collectively the novel idea of the "capturable moment", may allow for an increased rate of parental smoking cessation. Using these concepts, the authors constructed a hospital model for pediatric nursing efforts in parental smoking cessation. The pilot study built on this framework in February 2010 began enrolling parents of hospitalized pediatric patients into two intervention groups to motivate smoking cessation. Starting in September 2010, new electronic medical record-based systems of identifying parents who smoke were implemented in the hopes of enhancing enrollment numbers and streamlining recruitment. It is hoped that by introducing this process and framework, there will be increased national dialogue related to secondhand smoke (SHS) exposure, routine screening for SHS exposure, and nursing recognition of teachable moments.