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Drouin O, Perez T, Barnett TA, Ducharme FM, Fleegler E, Garg A, Lavoie K, Li P, Métras MÉ, Sultan S, Tse SM, Zhao J. Impact of Unmet Social Needs, Scarcity, and Future Discounting on Adherence to Treatment in Children With Asthma: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e37318. [PMID: 36881458 PMCID: PMC10131837 DOI: 10.2196/37318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asthma is one of the most prevalent chronic diseases of childhood and disproportionately affects children with lower socioeconomic status. Controller medications such as inhaled corticosteroids significantly reduce asthma exacerbations and improve symptoms. However, a large proportion of children still have poor asthma control, in part owing to suboptimal adherence. Financial barriers contribute to hindering adherence, as do behavioral factors related to low income. For example, unmet social needs for food, lodging, and childcare may create stress and worry in parents, negatively influencing medication adherence. These needs are also cognitively taxing and force families to focus on immediate needs, leading to scarcity and heightening future discounting; thus, there is the tendency to attribute greater value to the present than to the future in making decisions. OBJECTIVE In this project, we will investigate the relationship between unmet social needs, scarcity, and future discounting as well as their predictive power over time on medication adherence in children with asthma. METHODS This 12-month prospective observational cohort study will recruit 200 families of children aged 2 to 17 years at the Asthma Clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary care pediatric hospital in Montreal, Canada. The primary outcome will be adherence to controller medication, measured using the proportion of prescribed days covered during follow-up. Exploratory outcomes will include health care use. The main independent variables will be unmet social needs, scarcity, and future discounting, measured using validated instruments. These variables will be measured at recruitment as well as at 6- and 12-month follow-ups. Covariates will include sociodemographics, disease and treatment characteristics, and parental stress. Primary analysis will compare adherence to controller medication, measured using the proportion of prescribed days covered, between families with versus those without unmet social needs during the study period using multivariate linear regression. RESULTS The research activities of this study began in December 2021. Participant enrollment and data collection began in August 2022 and are expected to continue until September 2024. CONCLUSIONS This project will allow the documentation of the impact of unmet social needs, scarcity, and future discounting on adherence in children with asthma using robust metrics of adherence and validated measures of scarcity and future discounting. If the relationship between unmet social needs, behavioral factors, and adherence is supported by our findings, this will suggest the potential for novel targets for integrated social care interventions to improve adherence to controller medication and reduce risk across the life course for vulnerable children with asthma. TRIAL REGISTRATION ClinicalTrials.gov NCT05278000; https://clinicaltrials.gov/ct2/show/NCT05278000. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37318.
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Affiliation(s)
- Olivier Drouin
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Tamara Perez
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Tracie A Barnett
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Francine M Ducharme
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Clinical Research and Knowledge Transfer Research Centre, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Boston, MA, United States
- Division of General Academic Pediatrics, Department of Pediatrics, Boston Medical Center and School of Medicine, Boston University, Boston, MA, United States
| | - Kim Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Ile-de-Montreal, Montreal, QC, Canada
- Department of Psychology, Université de Quebec à Montreal, Montreal, QC, Canada
| | - Patricia Li
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Division of General Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Marie-Élaine Métras
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Serge Sultan
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, QC, Canada
| | - Sze Man Tse
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Jiaying Zhao
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, BC, Canada
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Germán M, Alonzo JK, Williams IM, Bushar J, Levine SM, Cuno KC, Umylny P, Briggs RD. Early Childhood Referrals by HealthySteps and Community Health Workers. Clin Pediatr (Phila) 2022; 62:321-328. [PMID: 36113109 DOI: 10.1177/00099228221120706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored how a community health worker (CHW) within a primary care team with a HealthySteps (HS) Specialist impacted referrals to social determinant of health resources for families with children aged birth to 5 years. Medical charts with documentation of HS comprehensive services between January and June 2018 were reviewed at 3 primary care clinics: 2 with an HS Specialist (HSS Only) and 1 with an HS Specialist and CHW (HSS + CHW). Eighty-six referrals were identified, 78 of which had documented outcomes. Outcomes were categorized as successful, unsuccessful, and not documented. The HSS + CHW group had a higher rate of successful referrals (96%) than the HSS Only group (74%). Statistical analysis (χ2 = 8.37, P = .004) revealed a significant association between the referral outcome and having a CHW on a primary care team with an HS Specialist. Therefore, primary care practices should consider adapting their HS model to include CHWs.
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Affiliation(s)
- Miguelina Germán
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | - Jayxa K Alonzo
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | - I Mihiri Williams
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | | | - Sydney M Levine
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | - Kate C Cuno
- Maimonides Children's Hospital, Brooklyn, NY, USA
| | - Polina Umylny
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | - Rahil D Briggs
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA.,ZERO TO THREE, Washington, DC, USA
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Krijger A, ter Borg S, Elstgeest L, van Rossum C, Verkaik-Kloosterman J, Steenbergen E, Raat H, Joosten K. Lifestyle Screening Tools for Children in the Community Setting: A Systematic Review. Nutrients 2022; 14:nu14142899. [PMID: 35889854 PMCID: PMC9325265 DOI: 10.3390/nu14142899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Screening of children’s lifestyle, including nutrition, may contribute to the prevention of lifestyle-related conditions in childhood and later in life. Screening tools can evaluate a wide variety of lifestyle factors, resulting in different (risk) scores and prospects of action. This systematic review aimed to summarise the design, psychometric properties and implementation of lifestyle screening tools for children in community settings. We searched the electronic databases of Embase, Medline (PubMed) and CINAHL to identify articles published between 2004 and July 2020 addressing lifestyle screening tools for children aged 0–18 years in the community setting. Independent screening and selection by two reviewers was followed by data extraction and the qualitative analysis of findings. We identified 41 unique lifestyle screening tools, with the majority addressing dietary and/or lifestyle behaviours and habits related to overweight and obesity. The domains mostly covered were nutrition, physical activity and sedentary behaviour/screen time. Tool validation was limited, and deliberate implementation features, such as the availability of clear prospects of actions following tool outcomes, were lacking. Despite the multitude of existing lifestyle screening tools for children in the community setting, there is a need for a validated easy-to-administer tool that enables risk classification and offers specific prospects of action to prevent children from adverse health outcomes.
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Affiliation(s)
- Anne Krijger
- Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, 3000 CB Rotterdam, The Netherlands;
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.E.); (H.R.)
- Correspondence: ; Tel.: +31(0)6-2461-2722
| | - Sovianne ter Borg
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Liset Elstgeest
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.E.); (H.R.)
- Reinier Academy, Reinier de Graaf Hospital, 2600 GA Delft, The Netherlands
| | - Caroline van Rossum
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Janneke Verkaik-Kloosterman
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Elly Steenbergen
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.E.); (H.R.)
| | - Koen Joosten
- Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, 3000 CB Rotterdam, The Netherlands;
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Drouin O, Winickoff JP, Thorndike AN. Parental Optimism About Children's Risk of Future Tobacco Use and Excessive Weight Gain. Acad Pediatr 2019; 19:90-96. [PMID: 30248470 DOI: 10.1016/j.acap.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adults tend to underestimate their personal risk of disease, but little is known about parents' perceptions of children's risk. METHODS In total, 648 parents of children 0 to 18 years old attending 2 pediatric practices were surveyed about their children's exposure to smoking; 344 parents with children ≥2 years old also were asked about their children's sugar-sweetened beverage (SSB) consumption and physical activity. Children were categorized as "at risk" or "not at risk" for each factor. Parents estimated the risk of their child becoming a smoker or gaining excessive weight and were categorized as "optimistic" if they believed their children were less likely than others to use tobacco or gain weight. RESULTS Overall, 92% of parents thought their children were at lower risk than average for tobacco use, and 86% believed their children were at lower risk for excessive weight gain. A high frequency of optimistic bias occurred even among parents with "at-risk" children, including parents with children exposed to tobacco use (70.4%), SSB consumption (77.6%), >2 hours of screen time (82.1%), and low physical activity (84.1%). In multivariable analyses, parents with children exposed to tobacco smoke (odds ratio = 0.21, 95% confidence interval, 0.09-0.51); or who consumed SSBs daily (odds ratio = 0.44, 95% confidence interval 0.20-0.97) were less likely to be optimistic about their child's future tobacco use and excessive weight gain, respectively. CONCLUSIONS Most parents believed their children were at lower risk than average for tobacco use or excessive weight gain. Eliciting parents' optimistic biases might facilitate behavior change counseling in pediatric settings.
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Affiliation(s)
- Olivier Drouin
- Division of General Academic Pediatrics (O Drouin and JP Winickoff); Harvard-wide Pediatric Health Services Research Fellowship (O Drouin).
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics (O Drouin and JP Winickoff); Harvard Medical School (JP Winickoff and AN Thorndike), Boston, Mass; Julius B. Richmond Center of Excellence, American Academy of Pediatrics (JP Winickoff), Itasca, Ill
| | - Anne N Thorndike
- Division of General Internal Medicine, Department of Medicine (AN Thorndike), Massachusetts General Hospital; Julius B. Richmond Center of Excellence, American Academy of Pediatrics (JP Winickoff), Itasca, Ill
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