The Association Between Work as a Calling and Turnover Among Early Childhood Education Professionals.

Turnover of early childhood education (ECE) professionals negatively impacts program costs, staff morale, and relationships with children. We determined whether the presence of work as a calling was associated with less intention to leave the ECE field. From an online survey administered to 265 ECE professionals in Pennsylvania, a calling score based on the Calling and Vocation Questionnaire was used to create sample-defined tertiles of low (< 38), medium (38-44), and high (> 44) presence of calling. Those intending to leave the ECE field reported that, given the option, they would most likely "find a position or get training in a completely different field," or "stop work, stay home, or retire." Analysis was restricted to 194 respondents currently employed in ECE and under age 60, of whom 94.8% were female and 53.9% were non-Hispanic White. After adjusting for race/ethnicity and workplace stress, the prevalence (95% CI) of intention to leave decreased as calling increased, from low (28.6% [17.8%, 38.4%]) to medium (12.2% [4.3%, 20.1%]) to high (9.1% [1.5%, 16.6%]). The presence of call was associated with less intention to leave the ECE field. Identifying, building, and sustaining call among ECE professionals may decrease turnover.

The Association Between Early Childhood Education Professionals' Perception of Workplace Spirituality and Their Intention to Stay in Their Current Program.

Turnover in the US early childhood education (ECE) workforce is associated with worse outcomes for children. Greater workplace spirituality, or the perception of meaningful work, sense of community, and alignment with organizational values, is associated with reduced turnover. However, this association has not been examined in ECE professionals. We administered an online survey to 265 ECE professionals in Pennsylvania (US) in the spring of 2021. Respondents were asked about their intention to stay in their current program, if given the option to leave. Workplace spirituality was measured with a 21-item scale assessing the dimensions of meaningful work, sense of community, and alignment with organizational values. The survey was completed by 246 (92.8%), and data were analyzed for 232 respondents. Of these, 94.8% were female, 54.4% were non-Hispanic White, and 70.7% had a bachelor's or graduate degree. The prevalence of intention to stay was 33.2%. After adjusting for all covariates, including gender, age, race/ethnicity, education, job position, workplace stress, and economic hardships, the prevalence (95% confidence interval [CI]) of intention to stay increased across tertiles of workplace spirituality from low to medium to high: 16.4% (7.9%, 24.9%) to 38.6% (28.4%, 48.8%) to 43.7% (32.1%, 55.3%), respectively. ECE professionals who perceived greater workplace spirituality were more likely to report they intended to stay in their current program. Turnover in the ECE workforce could potentially be reduced through efforts to increase a sense of meaning and community at work and to align the values of ECE programs with those who work in them. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-023-01506-7.

Diabetes distress and glycaemic control in young adults with type 1 diabetes: Associations by use of insulin pumps and continuous glucose monitors.

AIMS: We determined whether high diabetes distress (DD) in young adults with type 1 diabetes was associated with higher glycated haemoglobin (HbA1c ) levels and whether this association was similar among those who were and were not using diabetes devices (insulin pumps and/or continuous glucose monitors [CGMs]). METHODS: In 2017, an online survey was completed by 423 of 743 (57%) young adults (19-31 years) with type 1 diabetes receiving care at a specialty clinic in New York City. HbA1c level was the primary outcome measure, and high DD (Diabetes Distress Scale score ≥3) was the primary exposure. Associations were adjusted for sociodemographic covariates. RESULTS: Of the 419 respondents with complete DD data, 59% were female and 69% were non-Hispanic white. Both devices (pump and CGM) were used by 35%, either device by 42% and neither device by 24%. The mean (SD) HbA1c was 64 (19) mmol/mol (8.0 [1.7] %) and 24% had high DD. The adjusted mean (95% confidence interval) HbA1c was 10 (6, 14) mmol/mol (0.9 [0.5, 1.2] %) greater in those with high DD than in those without it. This HbA1c difference associated with high DD was similar regardless of device use: 9 (3, 15) mmol/mol (0.8 [0.3, 1.4] %) greater among those using both devices; and 9 (-0.9, 18) mmol/mol (0.8 [-0.1, 1.7] %) greater among those using neither device. CONCLUSIONS: High DD in young adults requires more attention because it is associated with higher HbA1c levels, even among those using insulin pumps and CGMs.

The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study.

BACKGROUND: Exposure to adverse childhood experiences (ACEs) and being female are distinct risk factors for having a major depressive episode (MDE) or an anxiety disorder (AD) in adulthood, but it is unclear whether these two risk factors are synergistic. The purpose of this study was to determine whether exposure to ACEs and being female are more than additive (synergistic) in their association with MDE and AD in US adults. METHODS: We pooled cross-sectional survey data in the Midlife in the United States study from two nationally-representative cohorts of English-speaking US adults. Data from the first cohort were collected in 2004-2006 and from the second in 2011-2014. Data from both cohorts included the 12-month prevalence of MDE and AD (generalized anxiety disorder or panic disorder) assessed with the Composite International Diagnostic Interview Short Form, gender (here termed female and male), and the count of five categories of exposure to ACEs: physical, sexual, or emotional abuse; household alcohol or substance abuse; and parental separation or divorce. RESULTS: Of the 5834 survey respondents, 4344 (74.5%) with complete data on ACEs were included in the analysis. Mean (SD) age was 54.1 (13.8) years and 53.9% were female. The prevalences of MDE, AD, and exposure to 3-5 categories of ACEs were 13.7, 10.0, and 12.5%, respectively. After adjusting for covariates (age, race, and current and childhood socioeconomic disadvantage), for those with both risk factors (female and 3-5 ACEs) the prevalence of MDE was 26.9%. This was 10.2% (95% CI: 1.8, 18.5%) higher than the expected prevalence based on the additive associations of the two risk factors. The adjusted prevalence of AD among females with 3-5 ACEs was 21.9%, which was 11.4% (95% CI: 4.0, 18.9%) higher than the expected prevalence. CONCLUSIONS: For both MDE and AD, there was synergy between the two risk factors of exposure to ACEs and being female. Identification and treatment of MDE and AD may benefit from understanding the mechanisms involved in the synergistic interaction of gender with ACEs.

The association between dispositional mindfulness and glycemic control in type 1 diabetes during early adulthood: Differences by age and adverse childhood experiences.

BACKGROUND: The study objective was to determine whether higher levels of dispositional mindfulness were associated with lower HbA1c levels among young adults with type 1 diabetes (T1D) and whether this association differed by age or exposure to adverse childhood experiences (ACEs). METHODS: An online cross-sectional survey, called T1 Flourish, was completed in 2017 by 423 of 743 (56.9%) young adults (19-31 years) with T1D receiving outpatient care at a diabetes specialty clinic in New York City. HbA1c levels were abstracted from medical records. Respondents were categorized by age, high and low dispositional mindfulness (median split on Cognitive and Affective Mindfulness Scale-Revised), and exposure to any of 10 ACEs. RESULTS: Respondents had a mean (SD) HbA1c of 64 (18) mmol/mol [8.0 (1.7)%]; 59.3% were female and 69.4% were non-Hispanic white. The covariate-adjusted association between dispositional mindfulness and HbA1c differed by age group and ACEs. Among 27- to 31-year-olds, those with high mindfulness had HbA1c levels that were 8 mmol/mol [0.7%] lower (95% confidence interval, 2-13 mmol/mol [0.2-1.2%]) than those with low mindfulness, and this association tended to be stronger in those with ≥1 ACEs. Weaker, non-significant associations in the same direction occurred in 23- to 26-year-olds. Among 19- to 22-year-olds, those with high mindfulness and no ACEs tended to have higher HbA1c levels. CONCLUSIONS: In young adults with T1D, higher mindfulness was significantly associated with lower HbA1c only among 27- to 31-year-olds. In early adulthood, the impact of mindfulness-based interventions on glycemic control may vary by age and childhood trauma history.

Drowsy Driving, Sleep Duration, and Chronotype in Adolescents.

OBJECTIVE: To determine whether self-reported drowsy driving was associated with an evening chronotype, a biologically-based difference in circadian sleep-wake timing, and shorter school-night sleep duration in a sample of high school drivers. STUDY DESIGN: Cross-sectional observational data were obtained from an online survey in spring 2015 of 431 drivers, age 15.5-18.7 years, attending Fairfax County (Virginia) Public schools. Drowsy driving was defined as having ever "driven a car or motor vehicle while feeling drowsy" in the last year. School-night sleep duration was calculated from school-night bedtime and wake time. Those with scores in the lower and upper tertiles of the Morningness-Eveningness Scale for Children were designated as having an evening or morning chronotype, respectively. RESULTS: Among survey respondents, 63.1% drove at least several times a week and 47.6% reported drowsy driving. The covariate-adjusted prevalence of drowsy driving was 13.9% (95% CI 3.0%-24.9%) higher in students who slept <7 hours on school-nights than in those who slept 8 or more hours. Compared with those with a morning chronotype, the adjusted prevalence of drowsy driving was 15.2% (95% CI 4.5%-25.9%) higher among those with an evening chronotype. CONCLUSION: Among adolescent drivers, both an evening chronotype and shorter school-night sleep duration were associated with more frequent reports of drowsy driving. Interventions to improve the timing and duration of nighttime sleep in adolescents may reduce the occurrence of drowsy driving.

The association of fatigue with dispositional mindfulness: relationships by levels of depressive symptoms, sleep quality, childhood adversity, and chronic medical conditions.

Although mindfulness-based interventions may be effective in addressing the common symptom of fatigue, no population-based studies have examined the relationship between mindfulness and fatigue. We determined whether higher levels of dispositional mindfulness were associated with lower levels of fatigue. Cross-sectional data were obtained through the Pennsylvania Head Start Staff Wellness Survey, a 2012 web-based survey in which 2199 of 3375 (65%) eligible staff participated. The analytic sample was restricted to the 2083 female respondents with complete data on dispositional mindfulness (Cognitive and Affective Mindfulness Scale-Revised) and fatigue (Fatigue Severity Scale). We determined the mean covariate-adjusted fatigue scores in each quartile of dispositional mindfulness. This relationship was examined in the overall sample and within subgroups defined by levels of four variables: depressive symptoms, poor sleep quality, childhood adversity, and chronic medical conditions. The sample was 86% non-Hispanic White, and 61% had a bachelor's or more advanced degree. The mean (SD) Fatigue Severity Scale score was 3.3 (1.3). The adjusted mean fatigue score decreased significantly and in a graded manner across higher quartiles of mindfulness, with the adjusted fatigue score 1.4 points lower (95% confidence interval: -1.5, -1.2) among those in the highest quartile of dispositional mindfulness compared to the lowest. This significant graded relationship was present within each subgroup examined, and there was not a statistically significant interaction between dispositional mindfulness and any subgroup variable. Future trials of mindfulness-based interventions should consider assessing the outcome of fatigue in both clinical and non-clinical populations.

Bedtime in Preschool-Aged Children and Risk for Adolescent Obesity.

OBJECTIVE: To determine whether preschool-aged children with earlier bedtimes have a lower risk for adolescent obesity and whether this risk reduction is modified by maternal sensitivity. STUDY DESIGN: Data from 977 of 1364 participants in the Study of Early Child Care and Youth Development were analyzed. Healthy singleton-births at 10 US sites in 1991 were eligible for enrollment. In 1995-1996, mothers reported their preschool-aged (mean = 4.7 years) child's typical weekday bedtime, and mother-child interaction was observed to assess maternal sensitivity. At a mean age of 15 years, height and weight were measured and adolescent obesity defined as a sex-specific body-mass-index-for-age ≥95th percentile of the US reference. RESULTS: One-quarter of preschool-aged children had early bedtimes (8:00 p.m. or earlier), one-half had bedtimes after 8:00 p.m. but by 9:00 p.m., and one-quarter had late bedtimes (after 9:00 p.m.). Children's bedtimes were similar regardless of maternal sensitivity (P = .2). The prevalence of adolescent obesity was 10%, 16%, and 23%, respectively, across early to late bedtime groups. The multivariable-adjusted relative risk (95% CI) for adolescent obesity was 0.48 (0.29, 0.82) for preschoolers with early bedtimes compared with preschoolers with late bedtimes. This risk was not modified by maternal sensitivity (P = .99). CONCLUSIONS: Preschool-aged children with early weekday bedtimes were one-half as likely as children with late bedtimes to be obese as adolescents. Bedtimes are a modifiable routine that may help to prevent obesity.

The comparative efficacy of lifestyle intervention and metformin by educational attainment in the Diabetes Prevention Program.

OBJECTIVE: Educational attainment is inversely associated with type 2 diabetes risk, but it is unknown whether education impacts individuals' diabetes prevention efforts. We examined the comparative efficacy of intensive lifestyle intervention and metformin by educational attainment among participants in the Diabetes Prevention Program (DPP), an ongoing U.S. multi-site trial beginning in 1996. METHODS: We studied 2,910 DPP participants randomized to receive lifestyle intervention, metformin, or placebo. Stratifying by educational attainment, diabetes incidence and relative risk reductions by treatment assignment were estimated using Cox proportional hazards regression. RESULTS: 47% of participants had completed college and 53% had not. Compared to placebo, lifestyle participants who had completed college demonstrated a 68% reduction in diabetes incidence (95% CI=56, 77), whereas those with less education experienced a 47% risk reduction (95% CI=29, 61). For metformin participants, college graduates experienced a 49% relative risk reduction (95% CI=33, 62), compared to 23% (95% CI=1, 41) among those with lower educational attainment. There was a statistically significant education-by-treatment interaction with incident diabetes (p=0.03). CONCLUSIONS: Intensive lifestyle intervention and metformin have greater efficacy among highly educated individuals. Future efforts to deliver these treatments and study their dissemination may be more effective if tailored to individuals' educational background.

Neighborhoods, obesity, and diabetes--a randomized social experiment.

BACKGROUND: The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. The study reported on here uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes. METHODS: From 1994 through 1998, the Department of Housing and Urban Development (HUD) randomly assigned 4498 women with children living in public housing in high-poverty urban census tracts (in which ≥40% of residents had incomes below the federal poverty threshold) to one of three groups: 1788 were assigned to receive housing vouchers, which were redeemable only if they moved to a low-poverty census tract (where <10% of residents were poor), and counseling on moving; 1312 were assigned to receive unrestricted, traditional vouchers, with no special counseling on moving; and 1398 were assigned to a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up survey, we measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA(1c)). RESULTS: As part of our long-term survey, we obtained data on body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) for 84.2% of participants and data on glycated hemoglobin level for 71.3% of participants. Response rates were similar across randomized groups. The prevalences of a BMI of 35 or more, a BMI of 40 or more, and a glycated hemoglobin level of 6.5% or more were lower in the group receiving the low-poverty vouchers than in the control group, with an absolute difference of 4.61 percentage points (95% confidence interval [CI], -8.54 to -0.69), 3.38 percentage points (95% CI, -6.39 to -0.36), and 4.31 percentage points (95% CI, -7.82 to -0.80), respectively. The differences between the group receiving traditional vouchers and the control group were not significant. CONCLUSIONS: The opportunity to move from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes. The mechanisms underlying these associations remain unclear but warrant further investigation, given their potential to guide the design of community-level interventions intended to improve health. (Funded by HUD and others.).

Adverse childhood experiences, dispositional mindfulness, and adult health.

OBJECTIVE: To determine whether greater dispositional mindfulness is associated with better adult health across a range of exposures to adverse childhood experiences (ACEs). METHODS: In 2012, a web-based survey of 2160 Pennsylvania Head Start staff was conducted. We assessed ACE score (count of eight categories of childhood adversity), dispositional mindfulness (Cognitive and Affective Mindfulness Scale-Revised), and the prevalence of three outcomes: multiple health conditions (≥ 3 of 7 conditions), poor health behavior (≥ 2 of 5 behaviors), and poor health-related quality of life (HRQOL) (≥ 2 of 5 indicators). RESULTS: Respondents were 97% females, and 23% reported ≥ 3 ACEs. The prevalences of multiple health conditions, poor health behavior, and poor HRQOL were 29%, 21%, and 13%, respectively. At each level of ACE exposure, health outcomes were better in those with greater mindfulness. For example, among persons reporting ≥ 3 ACEs, those in the highest quartile of mindfulness had a prevalence of multiple health conditions two-thirds that of those in the lowest quartile (adjusted prevalence ratio (95% confidence interval)=0.66 (0.51, 0.86)); for those reporting no ACEs, the ratio was 0.62 (0.41, 0.94). CONCLUSION: Across a range of exposures to ACEs, greater dispositional mindfulness was associated with fewer health conditions, better health behavior, and better HRQOL.

Maternal-infant relationship quality and risk of obesity at age 5.5 years in a national US cohort.

BACKGROUND: Poor quality relationships between mothers and toddlers have been associated with higher risk for childhood obesity, but few prospective studies of obesity have assessed maternal-child relationship quality in infancy. In addition it is not known whether the increased risk is associated with the mother's or the child's contribution to the relationship quality. METHODS: We analyzed data (n = 5650) from the Early Childhood Longitudinal Study, Birth Cohort, a national study of U.S. children born in 2001 and followed until they entered kindergarten. At 9 months of age, the Nursing Child Assessment Teaching Scale (NCATS) was used to assess the quality of observed playtime interactions between mothers and infants, yielding separate scores for maternal and infant behaviors. Obesity (BMI ≥95th percentile) at age 5.5 years was based on measured weight and height. RESULTS: The prevalence (95% confidence interval) of obesity at 5.5 years of age was higher among children in the lowest quartile of maternal NCATS score (20.2% [95% CI: 17.2%, 23.2%]) than in the highest quartile (13.9% [11.3%, 16.5%]), but maternal NCATS score was not significantly associated with obesity after adjustment for race/ethnicity, maternal education and household income. The prevalence of obesity at 5.5 years of age was similar among children in the lowest quartile of infant NCATS score (17.4% [14.4%, 20.3%]) and in the highest quartile (17.6% 14.4%, 20.8%]), and was not changed with covariate adjustment. CONCLUSIONS: Maternal-infant relationship quality, assessed by direct observation at 9 months of age in a national sample, was not associated with an increased risk of obesity at age 5.5 years after controlling for sociodemographic characteristics.

The association between obesity and health-related quality of life among urban Latinos.

OBJECTIVES: To examine differences in health-related quality of life (HRQL) by obesity status in a community-based sample of urban Latinos. To determine if sex moderates the relationship between HRQL and obesity status in this cohort. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study of 202 foreign-born Latinos with low levels of acculturation, living in an urban setting. MAIN OUTCOME MEASURE: Health-related quality of life by the Medical Outcomes Study Short-Form Health Survey (SF-12). METHODS: Including the entire study cohort, t-tests were used to determine the unadjusted difference between obese and non-obese participants on SF-12 physical and mental functioning scores (PCS and MCS, respectively). Linear regression was used to estimate the adjusted difference in SF-12 scores between obese and non-obese participants after adjusting for potential confounders. The association between obesity status and HRQL summary scores were then assessed separately in men and women both with and without adjustment for potential confounders. RESULTS: There was a small but statistically significant unadjusted difference between obese and non-obese participants in the physical functioning domain of HRQL (-2.2, 95% CI -4.0, -.4), which was no longer significant in multivariate analysis (difference -1.5, 95% CI -3.3, .3). There were no significant differences in mental functioning scores in unadjusted or adjusted analyses. Sex did not moderate the relationship between obesity status and HRQL scores in stratified analyses. CONCLUSIONS: Our results in an under-studied population suggest that obesity may have little impact on HRQL in urban Latinos. Future studies with larger and more diverse Latino populations are needed to further investigate the relationship between obesity and HRQL, and explore how acculturation impacts the association between these two factors.

Acculturation and the prevalence of diabetes in US Latino Adults, National Health and Nutrition Examination Survey 2007-2010.

INTRODUCTION: US Latinos are growing at the fastest rate of any racial/ethnic group in the United States and have the highest lifetime risk of diabetes. Acculturation may increase the risk of diabetes among all Latinos, but this hypothesis has not been studied in a nationally representative sample. The objective of this study was to test the hypothesis that acculturation was associated with an increased risk of diabetes in such a sample. METHODS: We conducted a cross-sectional analysis including 3,165 Latino participants in the 2007-2010 National Health and Nutrition Examination Survey. Participants with doctor-diagnosed diabetes and participants without diagnosed diabetes who had glycated hemoglobin (HbA1C) values of 6.5% or higher were classified as having diabetes. An acculturation score, ranging from 0 (lowest) to 3 (highest), was calculated by giving 1 point for each of 3 characteristics: being born in the United States, speaking predominantly English, and living in the United States for 20 years or more. Logistic regression was used to determine the association between acculturation and diabetes. RESULTS: The prevalence of diabetes among Latinos in our sample was 12.4%. After adjusting for sociodemographic factors, the likelihood of diabetes (95% confidence interval [CI]) increased with level of acculturation- 1.71 (95% CI, 1.31-2.23), 1.63 (95% CI, 1.11-2.39), and 2.05 (95% CI, 1.27-3.29) for scores of 1, 2, and 3, respectively. This association persisted after further adjustment for body mass index (BMI), total dietary calories, and physical inactivity. CONCLUSION: Acculturation was associated with a higher risk of diabetes among US Latinos, and this risk was only partly explained by BMI and weight-related behaviors. Future research should examine the bio-behavioral mechanisms that underlie the relationship between acculturation and diabetes in Latinos.

The Association of Childhood Parental Connection With Adult Flourishing and Depressive Symptoms.

OBJECTIVES: To determine whether a common measure of childhood emotional neglect, scored instead as a continuous measure of increasing parental connection, is associated with adult flourishing and depressive symptoms, and to compare the magnitude of these 2 associations. METHODS: We pooled cross-sectional survey data from the Midlife in the United States study, collected from 2 national cohorts (2004-2006 and 2011-2014) of English-speaking, US adults, aged 25 to 74 years. Using the 5-item emotional neglect subscale of the Childhood Trauma Questionnaire, a score of increasing childhood parental connection was created by not reverse-scoring responses. The adult outcomes were standardized scores of flourishing, from Ryff's Psychological Well-Being Scale, and depressive symptoms, from the Center for Epidemiologic Studies Depression Scale. RESULTS: Data were available for 2079 of 2118 participants (98.2%). The mean (SD) age was 53.1 (12.6) years and 54.6% were female. After adjusting for covariates (age, gender, race and ethnicity, marital status, chronic disease, socioeconomic disadvantage), the adult flourishing score was 0.74 (95% confidence interval 0.63-0.86) SD units higher in those in the highest quartile of childhood parental connection compared with the lowest, whereas the depressive symptoms score was lower by a similar magnitude (-0.65 [95% confidence interval -0.77 to -0.54] SD units). CONCLUSIONS: When emotional neglect is reframed as parental connection, it has associations with adult flourishing and depressive symptoms that are of similar magnitude but opposite direction. Clinicians and researchers should consider the more positive and aspirational frame of parental connection and its potential contribution to life course flourishing.

Trauma-Informed Undergraduate Medical Education: A Pathway to Flourishing with Adversity by Enhancing Psychological Safety.

We describe the Life Experiences Curriculum (LEC), which attempts to integrate medical student well-being with trauma-informed medical education. The long-term goal of LEC is to help medical students flourish with adversity and trauma, where flourishing refers to having a sense of purpose that arises from awareness of one's strengths and limitations, shaped by life experiences. The short-term goal of LEC is to develop students' relational capacities, such as acceptance and awareness of self and others, while building and maintaining students' psychological safety. We describe the conceptual rationale for these goals and the curriculum's development, implementation, evaluation, and limitations. The curriculum extends over four years and involves a preclinical seminar and students' individual and group reflection sessions with LEC faculty. The seminar addresses the coexistence of trauma and flourishing across life experiences, as well as how safety in relationships is impaired by traumatic experiences and must be restored for healing and growth. The physician faculty have no role in student evaluation and co-lead all LEC activities. LEC is intended to provide students with new language for understanding the process of trauma and flourishing in both individuals and systems and to build and sustain students' relational capacities. There are ongoing efforts to re-imagine self-care as communal-care in which care and support are given and received in a community of students and faculty. Such a model may help build the relational capacities needed to deliver trauma-informed care and also promote flourishing with adversity in healers and in those seeking to be healed.

The physical and mental health of Head Start staff: the Pennsylvania Head Start staff wellness survey, 2012.

INTRODUCTION: Despite attention to the health of low-income children in Head Start, little is known about the health of adults working for the program. The objective of our study was to compare the physical and mental health of women working in Pennsylvania Head Start programs with the health of US women who have similar sociodemographic characteristics. METHODS: We used data from a web-based survey in 2012 in which 2,199 of 3,375 (65.2%) staff in 66 Pennsylvania Head Start programs participated. For the 2,122 female respondents, we determined the prevalence of fair or poor health status, frequent (≥14 d/mo) unhealthy days, frequent (≥10 d/y) work absences due to illness, diagnosed depression, and 3 or more of 6 physical health conditions. We compared these prevalences with those found in 2 national samples of employed women of similar age, education, race/ethnicity, and marital status. RESULTS: Among Head Start staff, 85.7% were non-Hispanic white, 62.4% were married, and 60.3% had completed college. The prevalence (% [95% confidence interval]) of several health indicators was higher in Head Start staff than in the national samples: fair or poor health (14.6% [13.1%-16.1%] vs 5.1% [4.5%-5.6%]), frequent unhealthy days (28.3% [26.3%-30.2%] vs 14.5% [14.1%-14.9%]), diagnosed depression (23.5% [21.7%-25.3%] vs 17.6% [17.1%-18.0%]), and 3 or more physical health conditions (21.8% [20.0%-23.6%] vs 12.6% [11.7%-13.5%]). CONCLUSION: Women working with children in Head Start programs have poorer physical and mental health than do US women who have similar sociodemographic characteristics.

Relational Health as a Pathway from Trauma to Flourishing in School Communities.

BACKGROUND: Because traumatic life experiences are common, teaching and learning can be difficult without recognizing how trauma can make people feel psychologically unsafe. Safety can be restored through healthy relationships. CONTRIBUTIONS TO THEORY: We present a framework for how relational health-the capacity to develop and maintain safe, stable, and nurturing relationships with others-may allow flourishing in school communities, even amidst past and ongoing adversity. We propose four key assets for relational health-awareness of self, acceptance of self, awareness of others, and acceptance of others. To support this framework, we developed a relational asset score using data from a survey of 214 early childhood education professionals and examined its association with meaningful work, purpose in life, work satisfaction, and intention to stay in one's program. IMPLICATIONS FOR SCHOOL HEALTH: School health requires relational health. Research should evaluate the associations between relational assets and the perceptions of safety and connection in school communities. Leadership can prioritize relational health by supporting staff in building and using their relational assets. CONCLUSIONS: School communities may be more likely to flourish, even amidst adversity, if all adults in the community prioritize relational health, which provides the psychological safety required for teaching and learning.

A qualitative study of the aspirations and challenges of low-income mothers in feeding their preschool-aged children.

BACKGROUND: The prevalence of obesity among preschool-aged children has increased, especially among those in low-income households. Two promising behavioral targets for preventing obesity include limiting children's portion sizes and their intake of foods high in solid fats and/or added sugars, but these approaches have not been studied in low-income preschoolers in the home setting. The purpose of this study was to understand the contextual factors that might influence how low-income mothers felt about addressing these behavioral targets and mothers' aspirations in feeding their children. METHODS: We recruited 32 English-speaking women in Philadelphia, Pennsylvania who were eligible for the Supplemental Nutrition Assistance Program and who were the biologic mothers of children 36 to 66 months of age. Each mother participated in 1 of 7 focus groups and completed a brief socio-demographic questionnaire. Focus group questions centered on eating occasions, foods and drinks consumed in the home, and portion sizes. Each focus group lasted 90 minutes and was digitally recorded and transcribed verbatim. Three authors independently identified key themes and supporting quotations. Themes were condensed and modified through discussion among all authors. RESULTS: Thirty-one mothers identified themselves as black, 15 had a high school education or less, and 22 lived with another adult. Six themes emerged, with three about aspirations mothers held in feeding their children and three about challenges to achieving these aspirations. Mothers' aspirations were to: 1) prevent hyperactivity and tooth decay by limiting children's sugar intake, 2) use feeding to teach their children life lessons about limit setting and structure, and 3) be responsive to children during mealtimes to guide decisions about portions. Especially around setting limits with sweets and snacks, mothers faced the challenges of: 1) being nagged by children's food requests, 2) being undermined by other adults in the family, and 3) having bad memories from childhood that made it hard to deny children's food requests. CONCLUSIONS: Although the primary aspirations of low-income mothers in feeding their preschool-aged children were not focused on children's weight, these aspirations were compatible with obesity prevention strategies to limit children's portion sizes and their intake of solid fats and/or added sugars.

Perceptions of low-income African-American mothers about excessive gestational weight gain.

A rising number of low-income African-American mothers gain more weight in pregnancy than is recommended, placing them at risk for poor maternal and fetal health outcomes. Little is known about the perceptions of mothers in this population that may influence excessive gestational weight gain. In 2010-2011, we conducted 4 focus groups with 31 low-income, pregnant African-Americans in Philadelphia. Two readers independently coded the focus group transcripts to identify recurrent themes. We identified 9 themes around perceptions that encouraged or discouraged high gestational weight gain. Mothers attributed high weight gain to eating more in pregnancy, which was the result of being hungrier and the belief that consuming more calories while pregnant was essential for babies' health. Family members, especially participants own mothers, strongly reinforced the need to "eat for two" to make a healthy baby. Mothers and their families recognized the link between poor fetal outcomes and low weight gains but not higher gains, and thus, most had a greater pre-occupation with too little food intake and weight gain rather than too much. Having physical symptoms from overeating and weight retention after previous pregnancies were factors that discouraged higher gains. Overall, low-income African-American mothers had more perceptions encouraging high gestational weight gain than discouraging it. Interventions to prevent excessive weight gain need to be sensitive to these perceptions. Messages that link guideline recommended weight gain to optimal infant outcomes and mothers' physical symptoms may be most effective for weight control.