Anticipatory guidance for prevention of childhood obesity: design of the MOMS project.

The prevalence of childhood overweight and obesity in the United States has increased by more than 100% since 1971. Primary care clinicians have a unique opportunity to influence child health during the first year of life via anticipatory guidance (AG). However, little is known about whether AG regarding feeding and meal structure is effective in promoting optimal nutrition and eating behaviors. The purpose of this project, "Making our Mealtimes Special" (MOMS), was to assess 2 distinct methods of pediatric AG during infancy versus a "usual care" condition, with the ultimate goal of prevention of childhood overweight and obesity. The purpose of this article is to describe the ( a) study design and rationale, (b) implementation plan, (c ) assessment of outcomes, and (d) population enrolled. This project will generate important information on the usefulness of nutritional AG during the first year of life in promoting healthy eating behaviors during early childhood.

Stress and coping responses to proficiency testing in school-age children.

Nurses encounter school-age children experiencing multiple stressors and stress symptoms. Performance on proficiency tests is viewed as stressor. The purpose of this repeated measures study was to assess 53 fourth grade children's appraisal of proficiency tests, concurrent stressors, stress symptoms, and coping strategies. During October, February, March, and April, children completed a ranking of their stress associated with proficiency testing and also reported their stressors, stress symptoms, and coping strategies. Results indicated that children appraised proficiency tests as most stressful at the beginning of the school year but less stressful at the time of the test. Stressors and stress symptoms increased from baseline to 1 month before testing then declined. The number of coping strategies used by the children decreased throughout the year. Nurses can work with parents and teachers to identify children with test anxiety and target these children for interventions to improve their coping strategies.

Witnessing violence: biopsychosocial impact on children.

Many school-age children from low-income areas witness violence such as gang activities, gunshots, and physical assault, which can lead to an acute stress response. A correlational, descriptive design was used with a convenience sample of 62 children, ages 7-14 years, from an inner-city school district to assess children's appraisal of violence and their biopsychosocial symptoms associated with violent encounters. Most (95%) of these children witnessed violent acts. Appraisals of these events were consistent with Lazarus' appraisal categories of harm/loss and threat. Total number of witnessed violent encounters correlated with the number of stress symptoms (r = .272) and frequency of symptoms (r = .336). There was no significant difference between gender and race and exposure to violence or their biopsychosocial symptoms. These results enhance our understanding of children's perceptions of violence and their stress responses.

A school-based intervention to teach third grade children about the prevention of heart disease.

Coronary heart disease continues to be a leading cause of death in adults. Because many risk factors for heart disease make their first appearance in childhood, early intervention is an attractive strategy for this disease. A convenience sample of 58 third grade children participated in a year-long, quasi-experimental study to compare a school-based educational program, HeartPower!, to the standard health education curriculum. Variables examined included knowledge, hypercholesterolemia, obesity, sedentary lifestyle, hypertension, exposure to cigarette smoke, and parental participation. The students who participated in the HeartPower! Program showed improvement (p < 0.05) in their knowledge of healthy lifestyles. Modest improvements in hypertension and exposure to tobacco smoke were observed. These results indicate that focused instruction on important health issues may be preferable to a broad approach.

An evaluation of mother-centered anticipatory guidance to reduce obesogenic infant feeding behaviors.

OBJECTIVE: To evaluate the effect of 2 anticipatory guidance styles (maternal focused [MOMS] and infant focused [Ounce of Prevention]) directed at mothers of infants aged newborn to 6 months on their infant feeding behaviors at 1 year compared with routine advice as outlined in Bright Futures (BF). METHODS: This is a cluster randomized trial. A total of 292 mother/infant dyads were enrolled at their first well-child visit to 3 urban pediatric clinics in Columbus, Ohio. Intervention-specific brief advice and 1-page handouts were given at each well visit. In addition to infant weights and lengths, surveys about eating habits and infant feeding practices were completed at baseline and 12 months. RESULTS: Baseline data revealed a group with high rates of maternal overweight (62%) and obesogenic habits. At 12 months, the maternal-focused group gave their infants less juice (8.97 oz vs 14.37 oz, P < .05), and more daily servings of fruit (1.40 vs 0.94, P < .05) and vegetables (1.41 vs 1.03, P < .05) compared with BF mothers. Ounce of Prevention mothers also gave less juice (9.3 oz, P < .05) and more fruit servings (1.26 P < .05) than BF. CONCLUSIONS: Brief specific interventions added to well-child care may affect obesogenic infant feeding behaviors of mothers and deserves further study as an inexpensive approach to preventing childhood obesity.

Recruitment and retention strategies in longitudinal clinical studies with low-income populations.

BACKGROUND: Conducting longitudinal research studies with low-income and/or minority participants present a unique set of challenges and opportunities. PURPOSE: To outline the specific strategies employed to successfully recruit and retain participants in a longitudinal study of nutritional anticipatory guidance during early childhood, conducted with a low-income, ethnically diverse, urban population of mothers. METHODS: We describe recruitment and retention efforts made by the research team for the 'MOMS' Study (Making Our Mealtimes Special). The 'multilayered' approach for recruitment and retention included commitment of research leadership, piloting procedures, frequent team reporting, emphasis on participant convenience, incentives, frequent contact with participants, expanded budget, clinical staff buy-in, a dedicated phone line, and the use of research project branding and logos. RESULTS: Barriers to enrollment were not encountered in this project, despite recruiting from a low-income population with a large proportion of African-American families. Process evaluation with clinic staff demonstrated the perception of the MOMS staff was very positive. Participant retention rate was 75% and 64% at 6 months and 12 months post-recruitment, respectively. We attribute retention success largely to a coordinated effort between the research team and the infrastructure support at the clinical sites, as well as project branding and a dedicated phone line. CONCLUSIONS: Successful participant recruitment and retention approaches need to be specific and consistent with clinical staff buy in throughout the project.

Secondary analysis of the "Love Me...Never Shake Me" SBS education program.

OBJECTIVE: Shaken baby syndrome (SBS) is preventable; however, an estimated 21-74 per 100,000 children worldwide are victims annually. This study examined the effectiveness of an SBS prevention program in the US. METHODS: A descriptive, secondary analysis of the Prevent Child Abuse Ohio (PCAO) "Love Me...Never Shake Me" SBS education program database included 7,051 women who completed a commitment statement, pre and post-test, and follow-up survey. RESULTS: Participants were mostly White (76%), had at least some college education (62%), were privately insured (62%), and lived with the father and infant (63%). Mothers knew of the dangers of shaking (96%) and recommended SBS education for all parents (98%) because they found it helpful (97%). Scores on the pre and post-tests were significantly different, but there was no difference based on education site or demographics. There was a significant increase in a pre/post-test item pertaining to infant crying. At follow-up, participants remembered postpartum SBS education (98%), but post-discharge did not receive SBS education from their primary care provider (62%). Most mothers practiced infant soothing techniques (79%) provided in the education; however, few women practiced self-coping techniques (36%) and accessed community support services (9%). CONCLUSIONS: Postpartum SBS prevention education should continue. Development of SBS programs should result from these study findings focusing on education content and program evaluation. PRACTICE IMPLICATIONS: Mothers report that shaken baby syndrome education is important for all parents and memorable at follow-up. Postpartum SBS education should continue because the hospital is the primary place they receive education. Mothers' report they less frequently receive education from healthcare sources post-discharge. Diligence of primary care providers to incorporate SBS prevention education in well child visits will increase parental exposure to this information. Education may need to place greater emphasis on infant crying and soothing, as well as parent support and self-coping techniques versus the dangers of shaking.

Health promotion model for childhood violence prevention and exposure.

AIMS AND OBJECTIVES: To discuss the Health Promotion Model for Violence Prevention and Exposure and intervention strategies for implementation. BACKGROUND: Violence causes physical and psychosocial harm to children. Because little collaboration exists between specialties in the USA, a model that incorporates both a public health and psychosocial approach is needed to assess the risk for exposure to violence and the effects of violence as well as developing prevention strategies. Prevention and intervention includes primary, secondary and tertiary levels that focus on either the community or individual. However, primary and secondary prevention, such as anticipatory guidance and screening, can be implemented by both community and primary care nurses. METHODS: A review of the literature and on-line resources focusing on children's exposure to violence provided the basis for discussion of the commonalities and differences between the public health and psychosocial approach to assessing, preventing and intervening with children exposed to violence. This discussion led to the development of the proposed model. CONCLUSIONS: This model can identify more children at risk for social, physical and psychological harm because of exposure to violence. Implementing prevention or treatment interventions can decrease the impact of violence on children. RELEVANCE TO CLINICAL PRACTICE: This model can be implemented by public health, psychiatric and primary care nurses by incorporating the model into the well-child exam, school screenings and after-school programs. Collaboration between specialties will increase referrals for participation in anti-violence programs or treatment interventions.

Human figure drawings as a measure of children's emotional status: critical review for practice.

Human figure drawing is a common measurement that is used in practice and research. Drawing is a fun, inexpensive, and easy-to-administer method used to provide school-age children a projective means of expressing attitudes and emotions. As cognition matures, the content of drawing develops. The inclusion of emotional indicators in drawing signifies possible emotional problems. Recently, drawing has been used in countries and cultures other than the United States. Drawing can be implemented in any setting by all health care professionals.

Measures of overweight status in school-age children.

Identifying and intervening with overweight children may decrease their likelihood of developing heart disease later in life. This secondary analysis of 58 children in the 3rd grade examined the prevalence of overweight children, methods for measuring overweight status, and the relationship among these measures and other risk factors for heart disease. Approximately one third of the 58 children were categorized as overweight. Several measures, such as weight, body fat percentage, body mass index (BMI), and skin-fold, are available to school nurses for measuring overweight status. The highest correlations were between BMI and weight and between BMI and body fat. Anthropometric measurements cannot predict cholesterol level, 24-hour diet recall, or family history. Blood pressure can be predicted by weight, body fat percentage, and BMI. BMI and body fat percentage highly correlate; however, body fat percentage is more liberal in identifying children at risk for overweight status. Therefore, body fat percentage is recommended for identification of overweight status in school-age children.