Academic Pediatrics - Articles in Press

Pediatric Resident Perceptions of Family-Friendly Benefits - Corrected Proof

Carol D. Berkowitz, Mary Pat Frintner, William L. Cull — 2010-08-09

Abstract: Objective: The aim of this study was to examine the importance of family-friendly features in residency program selection, benefits offered to and used by residents, and importance of benefits in future job selection.Methods: A survey of a random, national sample of 1000 graduating pediatric residents in 2008 was mailed and e-mailed.Results: Survey response rate for graduating resident respondents was 59%. Among the respondents, 76% were women. Thirty-seven percent of men and 32% of women were parents. Residents with children were more likely than residents without children to rate family-friendly characteristics as very important in their residency selection (P < .05). Many residents reported that their programs offered maternity leave (88%), paternity leave (59%), individual flexibility with schedule (63%), and lactation rooms (55%), but fewer reported on-site child care (24%), care for ill children (19%), and part-time residency positions (12%). Among residents reporting availability, 77% of women with children used maternity leave and lactation rooms. Few held part-time residency positions (2%), but many expressed interest (23% of women with children). The majority of residents with and without children reported that flexibility with schedule was important in their future job selection. Most women with children (71%) and many women without children (52%) considered part-time work to be very important in their job selection.Conclusions: Family-friendly benefits are important to residents, particularly those with children. The data provides a benchmark for the availability and use of family-friendly features at pediatric training programs. The data also shows that many residents are unaware if benefits are offered, which suggests a need to make available benefits more transparent to residents.

PAS Research Award: Making Research Matter: Promoting Dissemination and Sustainability - Corrected Proof

Dimitri A. Christakis — 2010-08-05

Thank you very much. This is very much an unexpected honor for which I want to thank the selection committee. The APA (Academic Pediatric Association) Web site lists prior winners of this award, and it resembles a 21st century pantheon of academic pediatrics. I am truly humbled to join that group.

Training Clinicians in Mental Health Communication Skills: Impact on Primary Care Utilization - Corrected Proof

Anne Gadomski, Lawrence S. Wissow, Eric Slade, Paul Jenkins — 2010-08-05

Abstract: Objective: Although it is known that children with mental health problems utilize primary care services more than most other children, it is unknown how addressing mental health problems in primary care affects children’s subsequent services utilization. This study measures primary care utilization in the context of a randomized trial of a communication skills training program for primary care clinicians that had a positive impact on child mental health outcomes.Methods: From 2002 to 2005, 48 pediatric primary care clinicians at 13 sites in rural upstate New York, urban Maryland, and Washington, DC, were randomized to in-office training or to a control group. Consecutive primary care patients between the ages of 5 and 16 years were screened for mental health problems, as indicated by a possible or probable score on the Strengths and Difficulties Questionnaire (SDQ). For 397 screened children, primary care visits during the next 6 months were identified using chart review and administrative databases. Using generalized estimating equation regression to account for clustering at the clinician level, primary care utilization was compared by study group and SDQ status.Results: The number of primary care visits to the trained clinicians did not differ significantly from those made to control clinicians (2.5 for both groups; P = .63). Children with possible or probable SDQ scores made, on average, 0.38 or 0.65 more visits on a per child basis, respectively, during the 6-month follow-up period than SDQ unlikely children (P = .0002).Conclusions: Seeing a trained clinician did not increase subsequent primary care utilization. However, primary care utilization was greater among children with mental health problems as measured by the SDQ. Addressing children’s mental health in primary care does not increase the primary care visit burden. Research on overall health services utilization is needed.

A Comparison of School Injuries Between Children With and Without Disabilities - Corrected Proof

Marizen Ramirez, Erin Fillmore, Alex Chen, Corinne Peek-Asa — 2010-08-02

Abstract: Objective: The aim of this study was to compare rates, nature, and mechanisms of school injuries in children with and without disabilities.Methods: We conducted a retrospective cohort study with repeated measures of 269 919 children with and without disabilities who were enrolled in 35 adapted schools from a large urban school district. Reports of injuries sustained from 1994 to 1998 were collected by the district's insurance division, and disability was assessed using special education guidelines determined by the California Department of Education. A generalized estimating equations model was used to estimate rate ratios, accounting for the repeated, nested nature of the data.Results: Children with disabilities had more than double the rate of injury reported than children without disabilities (incidence density ratio [IDR] 2.3, 95% CI, 2.2–2.5). Almost one third of these injuries were due to fights, roughhousing, and assaults. Among all disabled children, those with orthopedic disabilities had the highest risk, with rates over 5 times that of children without disabilities (IDR 5.4, 95% CI, 4.4–6.6). Children with cognitive disabilities had comparatively lower rates of injury than children with physical disabilities.Conclusions: For children with disabilities, physical impairment may play a greater role than cognitive impairment in managing risk for injury at school. Individual education programs (IEP), developed for children in special education, could be tailored to include injury prevention strategies.

Adolescent Fighting: Racial/Ethnic Disparities and the Importance of Families and Schools - Corrected Proof

Rashmi Shetgiri, Sheryl Kataoka, Ninez Ponce, Glenn Flores, Paul J. Chung — 2010-08-02

Abstract: Objective: To identify factors associated with fighting among African American, Asian/Pacific Islander, Latino, and white youth, with a focus on family and school connectedness.Methods: Subjects were 4010 adolescents (12–17 years old) from the 2003 California Health Interview Survey. Stratified logistic regression examined whether fighting in the past year was associated with various risk and protective factors among African American, Asian/Pacific Islander, Latino, and white youth subsamples.Results: Fighting was reported by 27% of African American, 24% of Latino, 16% of white, and 6% of Asian/Pacific Islander youth. Male gender, alcohol use, and smoking were associated with higher odds of fighting among whites and Latinos. Poverty was associated with higher odds of fighting among whites and African Americans, as was depression among Latinos. Higher family support was associated with decreased odds of fighting for white youth. Higher school support was associated with decreased odds of fighting for Latino youth.Conclusions: A higher proportion of African American and Latino youth report fighting than do whites and Asians/Pacific Islanders. There is, however, important variation in racial/ethnic disparities in risk and protective factors associated with fighting. Family and school factors may be protective against fighting. Prevention and intervention efforts to decrease youth violence might benefit from tailoring to communities' racial/ethnic composition and paying greater attention to family and community influences on adolescent fighting.

Parental Understanding of Infant Health Information: Health Literacy, Numeracy, and the Parental Health Literacy Activities Test (PHLAT) - Corrected Proof

2010-08-02

Abstract: Objective: To assess parental health literacy and numeracy skills in understanding instructions for caring for young children, and to develop and validate a new parental health literacy scale, the Parental Health Literacy Activities Test (PHLAT).Methods: Caregivers of infants (age <13 months) were recruited in a cross-sectional study at pediatric clinics at 3 academic medical centers. Literacy and numeracy skills were assessed with previously validated instruments. Parental health literacy was assessed with the new 20-item PHLAT. Psychometric analyses were performed to assess item characteristics and to generate a shortened, 10-item version (PHLAT-10).Results: A total of 182 caregivers were recruited. Although 99% had adequate literacy skills, only 17% had better than ninth-grade numeracy skills. Mean score on the PHLAT was 68% (standard deviation 18); for example, only 47% of caregivers could correctly describe how to mix infant formula from concentrate, and only 69% could interpret a digital thermometer to determine whether an infant had a fever. Higher performance on the PHLAT was significantly correlated (P < .001) with education, literacy skill, and numeracy level (r = 0.29, 0.38, and 0.55 respectively). Caregivers with higher PHLAT scores were also more likely to interpret age recommendations for cold medications correctly (odds ratio 1.6, 95% confidence interval 1.02, 2.6). Internal reliability on the PHLAT was good (Kuder-Richardson coefficient of reliability = 0.76). The PHLAT-10 also demonstrated good validity and reliability.Conclusions: Many parents do not understand common health information required to care for their infants. The PHLAT and PHLAT-10 have good reliability and validity and may be useful tools for identifying parents who need better communication of health-related instructions.

The Ripples of Adolescent Motherhood: Social, Educational, and Medical Outcomes for Children of Teen and Prior Teen Mothers - Corrected Proof

2010-08-02

Abstract: Objective: We examined medical, educational and social risks to children of teen mothers and children of nonadolescent mothers with a history of teen birth (prior teen mothers) and considered these risks at both the individual and societal level.Methods: A population-based, retrospective cohort study tracked outcomes through young adulthood for children born in Manitoba, Canada (n = 32 179). χ2 and logistic regression analyses examined risk of childhood death or hospitalization, failure to graduate high school, intervention by child protective services, becoming a teen mother, and welfare receipt as a young adult.Results: For children of both teen and prior teen mothers, adjusted likelihoods of death during infancy, school-aged years, and adolescence were more than 2-fold higher than for other children. Risks for hospitalization, high hospital use, academic failure, and poor social outcomes were also substantially higher. At a societal level, only 16.5% of cohort children were born to teen and prior teen mothers. However, these children accounted for 27% of first-year hospitalizations, 34% of deaths (birth to 17 years), 30% of failures to graduate high school, 51% in foster care, 44% on welfare as young adults, and 56% of next-generation young teen mothers.Conclusions: Children of prior teen mothers had increased risks for poor health and for educational and social outcomes nearly equal to those seen in children of teen mothers. Combined, these relatively few children experienced a large share of the negative outcomes occurring among young people. Our results suggest the need to expand the definition of risk associated with adolescent motherhood and target their children for enhanced medical and social services.

The Medical Home, Preventive Care Screenings, and Counseling for Children: Evidence from the Medical Expenditure Panel Survey - Corrected Proof

Melissa A. Romaire, Janice F. Bell — 2010-08-02

Abstract: Objective: Little is known about the role of the medical home in promoting essential preventive health care services in the general pediatric population. This study examined associations between having a medical home and receipt of health screenings and anticipatory guidance.Methods: We conducted a cross-sectional analysis of the 2004–2006 Medical Expenditure Panel Survey (MEPS). Our sample included 21 055 children aged 0 to 17 years who visited a health care provider in the year prior to the survey. A binary indicator of the medical home was developed from 22 questions in MEPS, reflecting 4 of the 7 American Academy of Pediatrics' recommended components of the medical home: accessible, family-centered, comprehensive, and compassionate care. Multivariable logistic regression was used to examine the association between the medical home and receipt of specific health screenings and anticipatory guidance, controlling for confounding variables.Results: Approximately 49% of our study sample has a medical home. The medical home, defined when the usual source of care is a person or facility, is significantly associated with 3 health screenings (ie, weight, height, and blood pressure) and several anticipatory guidance topics (ie, advice about dental checkups, diet, exercise, car and bike safety), with odds ratios ranging from 1.26 to 1.54.Conclusions: The medical home is associated with increased odds of children receiving some health screenings and anticipatory guidance. The medical home may provide an opportunity to improve the delivery of these services for children.

Internal Psychometric Properties of the Children with Special Health Care Needs Screener - Corrected Proof

Adam C. Carle, Stephen J. Blumberg, Charlie Poblenz — 2010-03-15

Objective: Insufficient research has established the measurement properties of the Children with Special Health Care Needs (CSHCN) Screener. This leaves unclear whether CSHCN Screener–based estimates reliably identify CSHCN. We used classical and modern test theory to establish the CSHCN Screener's internal psychometric properties.Methods: Data came from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a nationally representative survey of US children (N = 359 154).Results: Cronbach's α, a measure of internal reliability, equaled .76. Confirmatory factor analysis for ordered-categorical measures indicated that a single underlying trait that we label health-condition-complexity underlies CSHCN Screener responses. Item response theory showed that responses provide particularly precise measurement among children experiencing elevated health-condition-complexity trait levels.Conclusions: Findings demonstrate that responses to the CSHCN Screener as used in the NS-CSHCN have good internal psychometric properties and include minimal random measurement error. Epidemiologists, clinicians and others can rely on CSHCN Screener responses to reliably identify CSHCN experiencing 1 or more of the 5 consequences included on the CSHCN Screener.