Soliciting views of various communities on health research: a prelude to engagement in specific research projects

BACKGROUND

Members of the public are increasingly engaged in health-service and biomedical research and provide input into the content of research, design and data sharing. As there is variation among different communities on how research is perceived, to engage all sectors of the general public research institutions need to customize their approach.

OBJECTIVE

This paper explores how research institutions and community leaders can partner to determine the best ways to engage different sectors of the public in research.

DESIGN

Following a literature review, a research institution engaged with four different sectors of the public through their respective representative community-based organizations (CBOs) by interviews with leaders, community member focus groups and a joint project.

SETTING

San Diego and Imperial Counties, California, United States of America (USA).

CONCLUSION

Before embarking on more specific research projects, investigators can gain valuable insights about different communities' attitudes to, and understanding of, health services and biomedical research by interacting directly with members of the community, collaborating with community leaders, and jointly identifying steps of engagement tailored to the community.

Case study in designing a research fundamentals curriculum for community health workers: a university-community clinic collaboration

Community health workers (CHWs) are increasingly incorporated into research teams. Training them in research methodology and ethics, while relating these themes to a community's characteristics, may help to better integrate these health promotion personnel into research teams. An interactive training course on research fundamentals for CHWs was designed and implemented jointly by a community agency serving a primarily Latino, rural population and an academic health center. A focus group of community members and input from community leaders comprised a community-based participatory research model to create three 3-hour interactive training sessions. The resulting curriculum was interactive and successfully stimulated dialogue between trainees and academic researchers. By choosing course activities that elicited community-specific responses into each session's discussion, researchers learned about the community as much as the training course educated CHWs about research. The approach is readily adaptable, making it useful to other communities where CHWs are part of the health system.

School-based mental health services

More than 20% of children and adolescents have mental health problems. Health care professionals for children and adolescents must educate key stakeholders about the extent of these problems and work together with them to increase access to mental health resources. School-based programs offer the promise of improving access to diagnosis of and treatment for the mental health problems of children and adolescents. Pediatric health care professionals, educators, and mental health specialists should work in collaboration to develop and implement effective school-based mental health services.

Assessing an intensive school-based assistance program to enroll uninsured children

Children eligible but not enrolled in subsidized health insurance programs, such as Medicaid and S-CHIP, received considerable outreach activity in recent years. Schools in low-income and middle-income communities often are cited as excellent places to find and reach parents. This study assessed the cost and effectiveness of contacting parents through schools, educating them about health insurance programs and preventive care, and assisting them with insurance applications. The accumulative cost per enrolled child was $75, and schools were able to locate and assist large numbers of uninsured children who had failed other outreach methods. School-based application assistance and parent education succeeded in improving child access to care and utilization of services.

Home environmental influences on children's television watching from early to middle childhood

Identifying correlates of children's television (TV) watching could help identify strategies to reduce children's TV watching and impact children's weight status. Children's TV time and home environment factors were assessed longitudinally among 169 families with children followed from 6 to 12 years of age. TV watching increased with age, as did the number of in-home TVs and the presence of videocassette recorders (VCRs), the frequency of meal eating while watching TV, and the percentage of children with bedroom TVs. Greater meal eating while watching TV was consistently related to overall TV watching and increases in TV watching over time. The number of in-home TVs and the presence of a bedroom TV were less consistent correlates. TV watching was related to weight status when children were younger, and when children were older, more than 2 hours of TV daily was a risk factor for higher weight. Modifying TV access, particularly by reducing the frequency of meals eaten while watching TV, could promote lower children's TV watching and adiposity.

Organized sports for children and preadolescents

Participation in organized sports provides an opportunity for young people to increase their physical activity and develop physical and social skills. However, when the demands and expectations of organized sports exceed the maturation and readiness of the participant, the positive aspects of participation can be negated. The nature of parental or adult involvement can also influence the degree to which participation in organized sports is a positive experience for preadolescents. This updates a previous policy statement on athletics for preadolescents and incorporates guidelines for sports participation for preschool children. Recommendations are offered on how pediatricians can help determine a child's readiness to participate, how risks can be minimized, and how child-oriented goals can be maximized.

A block rotation in community pediatrics

OBJECTIVES

To develop, implement, and evaluate a 1-month block rotation in community pediatrics.

INTERVENTIONS

Faculty from University of California San Diego and Naval Medical Center San Diego developed a combined and integrated curriculum for second-year residents in community pediatrics. Resident activities included structured site visits to schools, day care centers, and community organizations that participate in child health promotion, advocacy, public health, and prevention activities. Resident school consultation and child advocacy projects were established and mentored during the block rotation.

EVALUATION

Formative evaluation of the program by residents was used to shape the program design. Residents' self-perceived competence in eight areas of community pediatrics was measured with questionnaires administered before and after completion of the rotation. Resident involvement in school consultation and child advocacy projects was assessed in a cross-sectional survey.

RESULTS

Twenty-three residents completed the rotation during the 1-year study period. Statistically significant improvements in self-perceived competence were noted in all eight areas of community pediatrics. Among residents who were at least 3 months beyond the rotation completion date, 55% (11/20) reported continued involvement with their school consultation or child advocacy project, and 25% (5/20) reported this involvement to be on a quarterly to monthly basis.

CONCLUSIONS

Two institutions successfully implemented and integrated a block rotation in community pediatrics. Positive short-term improvements were noted in resident self-perceived competence in community pediatrics.

Advertised foods on children's television

OBJECTIVE

To assess the quantity and nutritional value of foods advertised on children's television following new regulations and an expanded number of networks.

RESEARCH DESIGN

Children's television hours were surveyed (with use of a method modeled on previously published studies, for purposes of comparison).

SETTING

Seven local network affiliates; all but one are broadcast nationally.

RESULTS

Children viewed an average of 21.3 commercials per hour, each lasting an average of 28.6 seconds. Food advertisements accounted for 47.8% of these commercials. Ninety-one percent of advertised foods are high in fat, sugar, and/or salt. Compared with data collected before new regulations and networks, children now watch more numerous but shorter commercials. Cereals and sweet snacks are advertised proportionately less. Processed foods, canned and prepared foods, and dairy products are more frequently advertised. The proportion of foods high in fat, salt, and sugar has not changed.

CONCLUSIONS

Commercials advertising unhealthy foods account for a large portion of children's televised viewing time. Current regulations and the incursion of cable networks into the children's television market have not meaningfully impacted the nature or number of food advertisements.

Vitamin and mineral intakes of Anglo-American and Mexican-American preschoolers

OBJECTIVE

To assess vitamin and mineral intakes of Anglo-American and Mexican-American preschoolers.

DESIGN

By use of interview and observation methods, acquire food intake data, calculate total nutrient intake, and compare selected nutrients to the Recommended Dietary Allowances (RDAs) for ethnic and gender groups.

SUBJECTS

Low- to middle-income parents and their preschool children (N = 351) recruited from preschools in San Diego, Calif, consented to participate in the Study of Children's Activity and Nutrition conducted by researchers at the University of California, San Diego.

MAIN OUTCOME MEASURES

Data regarding 15 nutrients were summarized based on the average of two food intake records for each preschooler.

STATISTICAL ANALYSES PERFORMED

Means and standard deviations were used to describe micronutrient intakes for ethnic and gender groups; analyses of variance and t tests were performed to determine ethnic and gender differences.

RESULTS

Boys and Anglo-Americans had higher total nutrient intakes than girls and Mexican-Americans, respectively. Mexican-Americans had higher nutrient intakes per energy intake, which indicates a micronutrient-dense diet. When each nutrient was considered by the two thirds of the RDA criterion (66% of the RDA means adequate intake), the nutrients most likely to be inadequate were iron, zinc, vitamin D, vitamin C, and niacin. Mexican-American girls had significantly lower calcium intakes than the other gender and ethnic groups.

APPLICATION

Parents and day care providers must ensure that preschoolers, especially girls and Mexican-Americans, eat nutrient-rich foods in adequate quantities that will achieve the recommended intakes.

Illness and injury in family day care: a seasonal survey

Many mothers with children under age 6 are employed and it is not usually feasible for a parent to stay home with a child who is mildly ill. Such ill children likely remain in child day care programs. The extent to which this occurs and the management of these children in family day care was studied. Over the course of a year, 1 to 3 visits were made to 714 family day care homes in order to survey providers. With enrollments ranging between 0 and 18 children per day care home at the time of each visit, information on 3,630 "child enrollment days" was collected. The median age of children in care was 2 years. An average of 16% of all children were ill on any one day (with seasonal variation); 1% were injured. Of ill children, 82% attended day care that day, 49% had contacted a physician about that illness, and 28% were administered a medication at the day care setting. Twenty-one percent of children receiving medication in day care had no contact with a physician for that illness. These data show that mild childhood illnesses are routinely managed by child day care providers. Physicians who traditionally limit their illness-management education to parents need to recognize the health education and consultation needs of day care providers.

Blood pressure reactivity in young children: comparing three stressors

Blood pressure (BP) reactivity in children, the transient elevation of BP after an acute stressor, is a stable characteristic that may predict cardiovascular disease (CVD) and hypertension. The purpose of the present study was to assess the generalizability of BP reactivity across various stressors in young children. BP reactivity was measured in 85 children (ages 3 to 6 years) after each of three different stressors. Systolic BP reactivity level was highest after physical exertion (104 mm Hg), followed by competitive task (95 mm Hg) and cognitive task (93 mm Hg). Resting systolic BP was 90. The 2-week test-retest reliability was higher for physical stress systolic BP reactivity level (r = .66) than for baseline systolic BP (r = .58) and the other two stressors. The reliability of the systolic BP change score was significant only for physical stressor (r = .33). Correlations among the three stressors ranged from .75 to .79 for systolic BP reactivity level and from .37 to .50 for change in systolic BP. Change in systolic BP after physical stress correlated with skin-fold thickness (r = .32). There was evidence of generalizability across stressors. The physical task is the most promising for future study of BP reactivity in young children.

Routine neonatal circumcision: a cost-utility analysis

A cost-utility analysis was performed to evaluate the relative importance of each of the various elements in the current circumcision debate. Elements used in the analysis included the cost of the procedure, the pain associated with the procedure, the risk of urinary tract infections, and the risk of penile cancer. The net, discounted lifetime dollar cost of routine circumcision is $102 per person, while the net, discounted lifetime health cost is 14 hours of healthy life. These results suggest that the financial and medical advantages and disadvantages of routine neonatal circumcision cancel each other and that factors other than cost or health outcomes must be used in decision making.

Ten years of graduates evaluate a pediatric residency program

Ten years of graduates (1979 through 1988) from a pediatric residency program with a primary care track were surveyed for their perceived level of comfort gained in training for 28 different content/specialty areas of pediatrics and for their recommendations for increasing emphasis/time during residency for these areas. The response rate was 73%. The highest levels of comfort and fewest recommendations for increasing emphasis were for neonatal problems and health maintenance. The lowest perceived comfort levels and the most recommendations for increasing emphasis were for economics of pediatric practice and sports medicine/orthopedics. Graduates from the primary care track of the pediatric residency program expressed more comfort than did regular track graduates for some, but not all, areas of pediatrics emphasized in the primary care track program. Graduates of the first 5 years of study were not as comfortable with their training overall as were graduates from the most recent 5 years. This survey method and its results can provide useful information to medical educators faced with evaluation and revision of pediatric residency training programs.

Children's television-viewing habits and the family environment

Pediatricians are encouraged to modify the impact of television on children, based on the assumption that parents mediate children's viewing habits through the home environment. Sixty-six parents of children aged 3 to 8 years responded to an interviewer-administered questionnaire. Responses to questions on family environment were compared with reported childhood viewing of educational programming (Public Broadcasting Service) and the child's television-viewing hours. Most homes surveyed had a videocassette recorder, cable television, and more than one television set. Frequent parental discussion of program content with children was reported by 38% of respondents. Availability of television and parent-child discussion of content were not correlated with viewing hours or viewing Public Broadcasting Service. Frequent use of television as a distraction for the child correlated positively with viewing hours. Viewing Public Broadcasting Service correlated negatively with parent-child coviewing and with use of television as a form of entertainment. Children's own television viewing content correlated positively with viewing Public Broadcasting Service. Of all measured factors in the home environment, parental attitudes were most closely associated with children's viewing habits.

Television's influence on children's diet and physical activity

Understanding the impact of TV on children's diet and physical activity is important for developing strategies to prevent obesity and sedentary lifestyles. Determining parents' perceptions of television's influence on children's dietary intake and physical activity may provide useful information on this important topic. A questionnaire was developed to assess viewing habits and child requests for food and sport items advertised on TV. It was administered to 66 mothers of children, ages 3-8. Foods that children requested because they had seen them on TV paralleled the frequencies with which these foods were advertised on TV. Weekly viewing hours correlated significantly with (a) reported requests by children and purchases by parents of foods influenced by TV, and (b) children's caloric intake. Children's requests for sport items and physical activities were not significantly correlated with the number of hours of TV viewing. It appears from these data that parents perceive that television influences family purchasing patterns through the mechanism of their children's requests.

Early childhood diet: recommendations of pediatric health care providers

With the abundance of literature on cardiovascular disease (CVD) prevention during childhood, recommendations for restricted dietary sodium and fat intakes during infancy and childhood are both advocated for preventive health care and criticized because the safety is undetermined. Dietitians, nurse practitioners, and pediatricians were surveyed to determine what dietary recommendations they give to parents and what source of information most influenced their decisions. A fourth group, pediatricians with particular expertise in nutrition, were surveyed as well. The overall response rate was 76%, with a total usable sample of 252. In all professional groups, 54% had no preference for any one commercially prepared formula. More importance was given to sodium content than to fat composition of formulas. On the choice of whole, low-fat, or non-fat milk for both 1- and 6-year-old children, professional groups differed significantly. Dietitians and the subgroup of pediatricians with nutrition expertise were more likely to recommend milk with higher fat content than other professional groups. Recommendations for both sodium- and fat-modified diets for children depended on CVD risk, and opinions varied between groups. Pediatricians and nurse practitioners were more likely to recommend dietary modifications for children with higher CVD risk. The variation in dietary recommendations within and between professional groups strongly indicates the need for research on the safety and efficacy of dietary restrictions in childhood.

Adult heart disease prevention in childhood: a national survey of pediatricians' practices and attitudes

There is controversy about the role of pediatric care givers in reducing presumed risk factors for cardiovascular diseases in children. A national mail survey of 2,000 pediatricians was designed to determine the attitudes, current practices, and knowledge among primary care pediatricians regarding these risks. The response rate was 60% (779 primary care pediatricians). Responses indicated that a majority of pediatricians take a family history of cardiovascular diseases, assess BP, recommend exercise to school-aged children, and advise patients and parents against smoking. Few pediatricians felt confident in their ability to affect change in patient life-styles. There was a relatively low level of provision of dietary advice, and most pediatricians do not measure serum cholesterol levels, except in high-risk older children. A substantial minority do not discuss smoking, even with adolescents. Practices and attitudes varied with the age of the patient. Obesity was the topic most frequently chosen for continuing medical education. Older pediatricians were most likely to advocate and practice risk reduction in children. Attitudes and reported practices also varied by gender and geographic location of the pediatrician as well as the ethnic composition of the practice. Implications for continuing medical education are discussed.