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McCord M, Fierman A, Sisco S, Canfield C, Manjunath S, Cohen N, Havens J, Wilcox W, Tomopoulos S, Albert MS, Abraham T, Charney A, Acri M, Piwnica-Worms K. A Two-Generation, Early Childhood Advanced Primary Care Model. Pediatrics 2024; 153:e2023062567. [PMID: 38444349 DOI: 10.1542/peds.2023-062567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 03/07/2024] Open
Abstract
It is well recognized that early experiences produce long-term impacts on health outcomes, yet many children are at risk of not achieving their full potential because of health and service disparities related largely to poverty and racism. Although many pediatric primary care (PPC) models address these needs, most are isolated, add-on efforts that struggle to be scalable and sustainable. We describe 3-2-1 IMPACT (Integrated Model for Parents and Children Together), an initiative to transform the model of PPC delivered within New York City Health + Hospitals, the largest public hospital system in the United States, to address the full range of child and family needs in early childhood. Taking advantage of the frequent contact with PPC in the early years and linking to prenatal services, the model assesses family mental, social, and physical health needs and offers evidence-based parenting supports and integrated mental health services. Launching and sustaining the model in our large health system has required coalition building and sustained advocacy at the state, city, and health system levels. Long-term sustainability of the IMPACT model will depend on the implementation of early childhood-focused advanced payment models, on which we have made substantial progress with our major contracted Medicaid managed care plans. By integrating multiple interventions into PPC and prenatal care across a large public-healthcare system, we hope to synergize evidence-based and evidence-informed interventions that individually have relatively small effect sizes, but combined, could substantially improve child and maternal health outcomes and positively impact health disparities.
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Affiliation(s)
| | - Arthur Fierman
- New York University, Grossman School of Medicine, New York, New York
| | | | - Caitlin Canfield
- New York University, Grossman School of Medicine, New York, New York
| | - Sanjana Manjunath
- New York University, Grossman School of Medicine, New York, New York
| | | | - Jennifer Havens
- New York University, Grossman School of Medicine, New York, New York
| | | | - Suzy Tomopoulos
- New York University, Grossman School of Medicine, New York, New York
| | | | | | | | - Mary Acri
- New York University, Grossman School of Medicine, New York, New York
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McArthur BA, Volkova V, Tomopoulos S, Madigan S. Global Prevalence of Meeting Screen Time Guidelines Among Children 5 Years and Younger: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:373-383. [PMID: 35157028 PMCID: PMC8845032 DOI: 10.1001/jamapediatrics.2021.6386] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Pediatric guidelines suggest that infants younger than 2 years avoid screen time altogether, while children aged 2 to 5 years receive no more than 1 hour per day. Although these guidelines have been adopted around the world, substantial variability exists in adherence to the guidelines, and precise estimates are needed to inform public health and policy initiatives. OBJECTIVE To derive the pooled prevalence via meta-analytic methods of children younger than 2 years and children aged 2 to 5 years who are meeting guidelines about screen time. DATA SOURCES Searches were conducted in MEDLINE, PsycINFO, and Embase up to March 2020. STUDY SELECTION Studies were included if participants were 5 years and younger and the prevalence of meeting (or exceeding) screen time guidelines was reported. DATA EXTRACTION AND SYNTHESIS Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive the mean prevalence rates. MAIN OUTCOMES AND MEASURES Prevalence of meeting screen time guidelines. RESULTS From 63 studies, 95 nonoverlapping samples with a total of 89 163 participants were included. For children younger than 2 years, the pooled prevalence of meeting the screen time guideline (0 h/d) was 24.7% (95% CI, 19.0%-31.5%). Moderator analyses revealed that prevalence of meeting screen time guidelines varied as a function of year of data collection (increased over time), measurement method (higher when questionnaires compared with interview), and type of device use (higher when a combination of screen use activities compared with television/movies only). For children aged 2 to 5 years, the mean prevalence of meeting the screen time guideline (1 h/d) was 35.6% (95% CI, 30.6%-40.9%). Moderator analyses revealed that the prevalence of meeting screen time guidelines varied as a function of type of device use (higher when screen time was television/movies only compared with a combination of screen use activities). CONCLUSIONS AND RELEVANCE The findings of this meta-analysis indicate that only a minority of children 5 years and younger are meeting screen time guidelines. This highlights the need to provide support and resources to families to best fit evidence-based recommendations into their lives.
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Affiliation(s)
- Brae Anne McArthur
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Valeriya Volkova
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine–Bellevue Hospital Center, New York
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
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Duh-Leong C, Tomopoulos S, Nastro A, Sharif I, Gomez LI, Di Caprio C, Nagpal N, Fierman AH. Duration of US Residence And Resource Needs In Immigrant Families With Young Children. J Child Fam Stud 2022; 31:211-219. [PMID: 36714395 PMCID: PMC9881011 DOI: 10.1007/s10826-021-02182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 06/18/2023]
Abstract
To mitigate the negative impact of resource needs on child health, practices serving low-income immigrant families have implemented screening programs to connect families to community resources. Little is known about how duration of US residence relates to patterns of resource needs and indicators of acculturation such as community resource knowledge/experience or self-efficacy. We conducted a cross-sectional analysis of a convenience sample of immigrant families with young children at an urban primary care clinic. These families were seen 5/2018-1/2020 for well child care, screening positive for ≥1 social need using a tool derived from Health Leads. Analysis of 114 families found that newly arrived families with a shorter duration of US residence (≤5 years) were more likely to report immediate material hardships like food insecurity and need for essential child supplies. Newly arrived families were also less likely to have access to technology resources such as a computer or smartphone. Long-term families with a longer duration of US residence (≥15 years) were more likely to report chronic needs like poor housing conditions, but also reported increased community resource knowledge/experience and increased self-efficacy. Primary care pediatric practices should assess immigration contextual factors to identify subgroups such as newly arrived families with young children to target resources (e.g., increase screening frequency) or enhance services (e.g., patient navigators) to relieve resource needs.
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Affiliation(s)
- Carol Duh-Leong
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Suzy Tomopoulos
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Andrew Nastro
- Division of Child & Adolescent Health, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Iman Sharif
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Laura Ibanez Gomez
- Family Health Centers at NYU Langone, 6025 6th Ave, Brooklyn, NY 11220, USA
| | - Cecilia Di Caprio
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Nikita Nagpal
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Arthur H. Fierman
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
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Tomopoulos S, Duh-Leong C, Fierman AH. Economic Coaching: Addressing Poverty as a Means of Improving Early Child Development. Pediatrics 2022; 149:183847. [PMID: 34927196 PMCID: PMC9645691 DOI: 10.1542/peds.2021-053479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Suzy Tomopoulos
- Address Correspondence to Suzy Tomopoulos MD, Department of Pediatrics, NYU Grossman School of Medicine/Bellevue Hospital Center, 462 First Ave, New York, NY 10016. E-mail:
| | - Carol Duh-Leong
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Arthur H. Fierman
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
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Duh-Leong C, Dreyer BP, Huang TTK, Katzow M, Gross RS, Fierman AH, Tomopoulos S, Di Caprio C, Yin HS. Social Capital as a Positive Social Determinant of Health: A Narrative Review. Acad Pediatr 2021; 21:594-599. [PMID: 33017683 DOI: 10.1016/j.acap.2020.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/23/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022]
Abstract
Social determinants of health influence child health behavior, development, and outcomes. This paper frames social capital, or the benefits that a child receives from social relationships, as a positive social determinant of health that helps children exposed to adversity achieve healthy outcomes across the life course. Children are uniquely dependent on their relationships with surrounding adults for material and nonmaterial resources. We identify and define three relevant aspects of social capital: 1) social support, which is embedded in a 2) social network, which is a structure through which 3) social cohesion can be observed. Social support is direct assistance available through social relationships and can be received indirectly through a caregiver or directly by a child. A child's social network describes the people in a child's life and the relationships between them. Social cohesion represents the strength of a group to which a child belongs (eg, family, community). Pediatric primary care practices play an important role in fostering social relationships between families, the health care system, and the community. Further research is needed to develop definitional and measurement rigor for social capital, to evaluate interventions (eg, peer health educators) that may improve health outcomes through social capital, and to broaden our understanding of how social relationships influence health outcomes.
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Affiliation(s)
- Carol Duh-Leong
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine (CDL, BPD, RSG, AHF, ST, HSY), New York, NY.
| | - Benard P Dreyer
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine (CDL, BPD, RSG, AHF, ST, HSY), New York, NY
| | - Terry T-K Huang
- Department of Health Policy and Management, Center for Systems and Community Design, NYU-CUNY Prevention Research Center, City University of New York Graduate School of Public Health and Health Policy (TTKH), New York, NY
| | - Michelle Katzow
- Division of General Pediatrics, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell (MK), New Hyde Park, NY
| | - Rachel S Gross
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine (CDL, BPD, RSG, AHF, ST, HSY), New York, NY
| | - Arthur H Fierman
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine (CDL, BPD, RSG, AHF, ST, HSY), New York, NY
| | - Suzy Tomopoulos
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine (CDL, BPD, RSG, AHF, ST, HSY), New York, NY
| | | | - H Shonna Yin
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine (CDL, BPD, RSG, AHF, ST, HSY), New York, NY
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Glick AF, Farkas JS, Rosenberg RE, Mendelsohn AL, Tomopoulos S, Fierman AH, Dreyer BP, Migotsky M, Melgar J, Yin HS. Accuracy of Parent Perception of Comprehension of Discharge Instructions: Role of Plan Complexity and Health Literacy. Acad Pediatr 2020; 20:516-523. [PMID: 31954854 PMCID: PMC7200278 DOI: 10.1016/j.acap.2020.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Inpatient discharge education is often suboptimal. Measures of parents' perceived comprehension of discharge instructions are included in national metrics given linkage to morbidity; few studies compare parents' perceived and actual comprehension. We 1) compared parent perceived and actual comprehension of discharge instructions and 2) assessed associations between plan complexity and parent health literacy with overestimation of comprehension (perceive comprehension but lack actual comprehension). METHODS Prospective cohort study of English/Spanish-speaking parents (n = 192) of inpatients ≤12 years old and discharged on ≥1 daily medication from an urban public hospital. We used McNemar's tests to compare parent perceived (agree/strongly agree on 5-point Likert scale) and actual comprehension (concordance of parent report with medical record) of instructions (domains: medications, appointments, return precautions, and restrictions). Generalized estimating equations were performed to assess associations between low parent health literacy (Newest Vital Sign score ≤3) and plan complexity with overestimation of comprehension. RESULTS Medication side effects were the domain with lowest perceived comprehension (80%), while >95% of parents perceived comprehension for other domains. Actual comprehension varied by domain (41%-87%) and was lower than perceived comprehension. Most (84%) parents overestimated comprehension in ≥1 domain. Plan complexity (adjusted odds ratio 3.6; 95% confidence interval 2.9-4.7) and low health literacy (adjusted odds ratio 1.9; 1.3-2.6) were associated with overestimation of comprehension. CONCLUSIONS Parental perceived comprehension of discharge instructions overestimated actual comprehension in most domains. Plan complexity and low health literacy were associated with overestimation of comprehension. Future interventions should incorporate assessment of actual comprehension and standardization of discharge instructions.
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Affiliation(s)
- Alexander F. Glick
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA,Corresponding Author: Alexander F. Glick, MD, MS, NYU School of Medicine/Bellevue Hospital Center, Department of Pediatrics, 462 First Avenue, New York, NY 10016, Phone: 212-263-8198, Fax: 212-562-6019,
| | - Jonathan S. Farkas
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Rebecca E. Rosenberg
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Alan L. Mendelsohn
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Suzy Tomopoulos
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Arthur H. Fierman
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Benard P. Dreyer
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Michael Migotsky
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Jennifer Melgar
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - H. Shonna Yin
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
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Duh-Leong C, Jo Messito M, Katzow MW, Tomopoulos S, Nagpal N, Fierman AH, Gross RS. Material Hardships and Infant and Toddler Sleep Duration in Low-Income Hispanic Families. Acad Pediatr 2020; 20:1184-1191. [PMID: 32650047 PMCID: PMC9286002 DOI: 10.1016/j.acap.2020.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess relationships between material hardships, shortened sleep duration, and suboptimal sleep practices across infancy and toddlerhood in low-income Hispanic families. METHODS We analyzed longitudinal data of 451 low-income Hispanic mother-child pairs from a child obesity prevention trial. During infancy and toddlerhood, we used adjusted linear regression to assess associations between material hardship (financial difficulty, food insecurity, housing disrepair, and multiple hardships), sleep duration (24-hour, night), and the number of suboptimal sleep practices (eg, later bedtime, co-sleeping). We used adjusted linear regression to assess the longitudinal association between the number of suboptimal sleep practices in infancy and toddlerhood, and tested whether specific or multiple hardships moderated this association. RESULTS In infants, financial difficulty and multiple hardships were associated with decreased night sleep (B = -0.59 hours, 95% confidence interval [CI]: -1.04, -0.14; and B = -0.54 hours, 95% CI: -1.00, -0.08). Housing disrepair was associated with decreased 24-hour sleep (B = -0.64 hours, 95% CI: -1.29, -0.01). In toddlers, each additional suboptimal sleep practice was associated with a decrease in night sleep (B = -0.19 hours, 95% CI: -0.29, -0.09). Each additional suboptimal sleep practice in infancy was associated with a 0.30 increase in the number of suboptimal sleep practices in toddlerhood (P < .001), with greater increases for those with food insecurity or multiple hardships. CONCLUSION Specific and multiple hardships shortened sleep duration during infancy, and moderated the increase of suboptimal sleep behaviors between infancy and toddlerhood. Future studies should consider these early critically sensitive periods for interventions to mitigate material hardships and establish healthy sleep practices.
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Affiliation(s)
- Carol Duh-Leong
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine (C Duh-Leong, MJ Messito, S Tomopoulos, N Nagpal, AH Fierman, and RS Gross).
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Michelle W. Katzow
- Division of General Pediatrics, Department of Pediatrics, Zucker School of Medicine at, Hofstra/Northwell, 269-01 76th Ave, New Hyde Park, NY 11040 USA
| | - Suzy Tomopoulos
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Nikita Nagpal
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Arthur H. Fierman
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
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Glick AF, Farkas JS, Mendelsohn AL, Fierman AH, Tomopoulos S, Rosenberg RE, Dreyer BP, Melgar J, Varriano J, Yin HS. Discharge Instruction Comprehension and Adherence Errors: Interrelationship Between Plan Complexity and Parent Health Literacy. J Pediatr 2019; 214:193-200.e3. [PMID: 31253406 PMCID: PMC10866623 DOI: 10.1016/j.jpeds.2019.04.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/12/2019] [Accepted: 04/25/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine associations between parent health literacy, discharge plan complexity, and parent comprehension of and adherence to inpatient discharge instructions. STUDY DESIGN This was a prospective cohort study of English/Spanish-speaking parents (n = 165) of children ≤12 years discharged on ≥1 daily medication from an urban, public hospital. Outcome variables were parent comprehension (survey) of and adherence (survey, in-person dosing assessment, chart review) to discharge instructions. Predictor variables included low parent health literacy (Newest Vital Sign score 0-3) and plan complexity. Generalized estimating equations were used to account for the assessment of multiple types of comprehension and adherence errors for each subject, adjusting for ethnicity, language, child age, length of stay, and chronic disease status. Similar analyses were performed to assess for mediation and moderation. RESULTS Error rates were highest for comprehension of medication side effects (50%), adherence to medication dose (34%), and return precaution (78%) instructions. Comprehension errors were associated with adherence errors (aOR, 8.7; 95% CI, 5.9-12.9). Discharge plan complexity was associated with comprehension (aOR, 7.0; 95% CI, 5.4-9.1) and adherence (aOR, 5.5; 95% CI, 4.0-7.6) errors. Low health literacy was indirectly associated with adherence errors through comprehension errors. The association between plan complexity and comprehension errors was greater in parents with low (aOR, 8.3; 95% CI, 6.2-11.2) compared with adequate (aOR, 3.8; 95% CI, 2.2-6.5) health literacy (interaction term P = .004). CONCLUSIONS Parent health literacy and discharge plan complexity play key roles in comprehension and adherence errors. Future work will focus on the development of health literacy-informed interventions to promote discharge plan comprehension.
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Affiliation(s)
- Alexander F Glick
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY.
| | - Jonathan S Farkas
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Alan L Mendelsohn
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Arthur H Fierman
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Suzy Tomopoulos
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Rebecca E Rosenberg
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Benard P Dreyer
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Jennifer Melgar
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - John Varriano
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - H Shonna Yin
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
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Affiliation(s)
- Suzy Tomopoulos
- Department of Pediatrics, School of Medicine, New York University, New York, New York
| | - Perri Klass
- Department of Pediatrics, School of Medicine, New York University, New York, New York
| | - Alan L Mendelsohn
- Department of Pediatrics, School of Medicine, New York University, New York, New York
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Glick AF, Tomopoulos S, Fierman AH, Elixhauser A, Trasande L. Association Between Outdoor Air Pollution Levels and Inpatient Outcomes in Pediatric Pneumonia Hospitalizations, 2007 to 2008. Acad Pediatr 2019; 19:414-420. [PMID: 30543871 PMCID: PMC6502659 DOI: 10.1016/j.acap.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Pneumonia is a leading cause of pediatric admissions. Although air pollutants are associated with poor outcomes, few national studies have examined associations between pollutant levels and inpatient pediatric pneumonia outcomes. We examined the relationship between ozone (O3) and fine particulate matter with a diameter ≤2.5 µm (PM2.5) and outcomes related to disease severity. METHODS In this cross-sectional study, we obtained discharge data from the 2007 to 2008 Nationwide Inpatient Sample and pollution data from the Air Quality System. Patients ≤18years with a principal diagnosis of pneumonia were included. Discharge data were linked to O3 and PM2.5 levels (predictors) from the patient's ZIP Code (not publicly available) from day of admission. Outcomes were mortality, intubation, length of stay (LOS), and total costs. We calculated weighted national estimates and performed multivariable analyses adjusting for sociodemographic and hospital factors. RESULTS There were a total of 57,972 (278,871 weighted) subjects. Median PM2.5 level was 9.5 (interquartile range [IQR] 6.8-13.4) µg/m3. Median O3 level was 35.6 (IQR 28.2-45.2) parts per billion. Mortality was 0.1%; 0.75% of patients were intubated. Median LOS was 2 (IQR 2-4) days. Median costs were $3089 (IQR $2023-$5177). Greater levels of PM2.5 and O3 were associated with mortality, longer LOS, and greater costs. Greater O3 levels were associated with increased odds of intubation. CONCLUSIONS Greater levels of O3 and PM2.5 were associated with more severe presentations of pneumonia. Future work should examine these relationships in more recent years and over a longer time period.
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Affiliation(s)
- Alexander F. Glick
- Department of Pediatrics, NYU Langone Health/Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA,Corresponding Author Alexander F. Glick, MD, MS, Bellevue Hospital Center, Department of Pediatrics, Administration Building, Third Floor, 462 First Avenue, New York, NY 10016, Phone: 212-562-2455, Fax: 212-562-5518,
| | - Suzy Tomopoulos
- Department of Pediatrics, NYU Langone Health/Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA
| | - Arthur H. Fierman
- Department of Pediatrics, NYU Langone Health/Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA
| | - Anne Elixhauser
- Formerly from the Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Leonardo Trasande
- Department of Pediatrics, NYU Langone Health/Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA,Departments of Environmental Medicine and Population Health, NYU School of Medicine, 403 East 34th Street, Rm 115, New York, NY, 10016, USA,NYU Wagner School of Public Service, New York, NY, 403 East 34th Street, Rm 115, New York, NY, 10016, USA,NYU College of Global Public Health, 403 East 34th Street, Rm 115, New York, NY, 10016, USA
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Choi JH, Mendelsohn AL, Weisleder A, Cates CB, Canfield C, Seery A, Dreyer BP, Tomopoulos S. Real-World Usage of Educational Media Does Not Promote Parent-Child Cognitive Stimulation Activities. Acad Pediatr 2018; 18:172-178. [PMID: 28454929 PMCID: PMC5656545 DOI: 10.1016/j.acap.2017.04.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/17/2017] [Accepted: 04/17/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether educational media as actually used by low-income families promote parent-child cognitive stimulation activities. METHODS We performed secondary analysis of the control group of a longitudinal cohort of mother-infant dyads enrolled postpartum in an urban public hospital. Educational media exposure (via a 24-hour recall diary) and parent-child activities that may promote cognitive stimulation in the home (using StimQ) were assessed at 6, 14, 24, and 36 months. RESULTS Data from 149 mother-child dyads, 93.3% Latino, were analyzed. Mean (standard deviation) educational media exposure at 6, 14, 24, and 36 months was, respectively, 25 (40), 42 (58), 39 (49), and 39 (50) minutes per day. In multilevel model analyses, prior educational media exposure had small positive relationship with subsequent total StimQ scores (β = 0.11, P = .03) but was nonsignificant (β = 0.08, P = .09) after adjusting for confounders (child: age, gender, birth order, noneducational media exposure, language; mother: age, ethnicity, marital status, country of origin, language, depressive symptoms). Educational media did predict small increases in verbal interactions and toy provision (adjusted models, respectively: β = 0.13, P = .02; β = 0.11; P = .03). In contrast, more consistent relationships were seen for models of the relationship between prior StimQ (total, verbal interactions and teaching; adjusted models, respectively: β = 0.20, P = .002; β = 0.15, P = .006; β = 0.20, P = .001) and predicted subsequent educational media. CONCLUSIONS Educational media as used by this sample of low-income families does not promote cognitive stimulation activities important for early child development or activities such as reading and teaching.
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Affiliation(s)
- Jason H Choi
- Department of Pediatrics, NYU School of Medicine/Bellevue Hospital Center, New York, NY
| | - Alan L Mendelsohn
- Department of Pediatrics, NYU School of Medicine/Bellevue Hospital Center, New York, NY
| | - Adriana Weisleder
- Department of Pediatrics, NYU School of Medicine/Bellevue Hospital Center, New York, NY
| | | | - Caitlin Canfield
- Department of Pediatrics, NYU School of Medicine/Bellevue Hospital Center, New York, NY
| | - Anne Seery
- Department of Pediatrics, NYU School of Medicine/Bellevue Hospital Center, New York, NY
| | - Benard P Dreyer
- Department of Pediatrics, NYU School of Medicine/Bellevue Hospital Center, New York, NY
| | - Suzy Tomopoulos
- Department of Pediatrics, NYU School of Medicine/Bellevue Hospital Center, New York, NY.
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Gross RS, Mendelsohn AL, Yin HS, Tomopoulos S, Gross MB, Scheinmann R, Messito MJ. Randomized controlled trial of an early child obesity prevention intervention: Impacts on infant tummy time. Obesity (Silver Spring) 2017; 25:920-927. [PMID: 28332324 PMCID: PMC5404992 DOI: 10.1002/oby.21779] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/01/2016] [Accepted: 12/31/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe infant activity at 3 months old and to test the efficacy of a primary care-based child obesity prevention intervention on promoting infant activity in low-income Hispanic families. METHODS This study was a randomized controlled trial (n = 533) comparing a control group of mother-infant dyads receiving standard prenatal and pediatric primary care with an intervention group receiving "Starting Early," with individual nutrition counseling and nutrition and parenting support groups coordinated with prenatal and pediatric visits. Outcomes included infant activity (tummy time, unrestrained floor time, time in movement-restricting devices). Health literacy was assessed using the Newest Vital Sign. RESULTS Four hundred fifty-six mothers completed 3-month assessments. Infant activity results were: 82.6% ever practiced tummy time; 32.0% practiced tummy time on the floor; 34.4% reported unrestrained floor time; 56.4% reported ≥1 h/d in movement-restricting devices. Inadequate health literacy was associated with reduced tummy time and unrestrained floor time. The intervention group reported more floor tummy time (OR 2.16, 95% CI 1.44-3.23) and unrestrained floor time (OR 1.69, 95% CI 1.14-2.49) compared to controls. No difference in the time spent in movement-restricting devices was found. CONCLUSIONS Tummy time and unrestrained floor time were low. Primary care-based obesity prevention programs have potential to promote these activities.
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Affiliation(s)
- Rachel S. Gross
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental - Behavioral Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
- Department of Population Health, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - H. Shonna Yin
- Department of Population Health, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - Suzy Tomopoulos
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - Michelle B. Gross
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - Roberta Scheinmann
- Research and Evaluation Unit, Public Health Solutions, New York, NY, USA
| | - Mary Jo Messito
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
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Bathory E, Tomopoulos S. Sleep Regulation, Physiology and Development, Sleep Duration and Patterns, and Sleep Hygiene in Infants, Toddlers, and Preschool-Age Children. Curr Probl Pediatr Adolesc Health Care 2017; 47:29-42. [PMID: 28117135 DOI: 10.1016/j.cppeds.2016.12.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Sleep problems are common, reported by a quarter of parents with children under the age of 5 years, and have been associated with poor behavior, worse school performance, and obesity, in addition to negative secondary effects on maternal and family well-being. Yet, it has been shown that pediatricians do not adequately address sleep in routine well-child visits, and underdiagnose sleep issues. Pediatricians receive little formal training in medical school or in residency regarding sleep medicine. An understanding of the physiology of sleep is critical to a pediatrician׳s ability to effectively and confidently counsel patients about sleep. The biological rhythm of sleep and waking is regulated through both circadian and homeostatic processes. Sleep also has an internal rhythmic organization, or sleep architecture, which includes sleep cycles of REM and NREM sleep. Arousal and sleep (REM and NREM) are active and complex neurophysiologic processes, involving both neural pathway activation and suppression. These physiologic processes change over the life course, especially in the first 5 years. Adequate sleep is often difficult to achieve, yet is considered very important to optimal daily function and behavior in children; thus, understanding optimal sleep duration and patterns is critical for pediatricians. There is little experimental evidence that guides sleep recommendations, rather normative data and expert recommendations. Effective counseling on child sleep must account for the child and parent factors (child temperament, parent-child interaction, and parental affect) and the environmental factors (cultural, geographic, and home environment, especially media exposure) that influence sleep. To promote health and to prevent and manage sleep problems, the American Academy of Pediatrics (AAP) recommends that parents start promoting good sleep hygiene, with a sleep-promoting environment and a bedtime routine in infancy, and throughout childhood. Thus, counseling families on sleep requires an understanding of sleep regulation, physiology, developmental patterns, optimal sleep duration recommendations, and the many factors that influence sleep and sleep hygiene.
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Affiliation(s)
- Eleanor Bathory
- Department of Pediatrics/Department of Family and Social Medicine, Montefiore Medical Center, 3455 Jerome Ave, Bronx, NY.
| | - Suzy Tomopoulos
- Department of Pediatrics, NYU School of Medicine, New York, NY
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Yin HS, Gupta RS, Mendelsohn AL, Dreyer B, van Schaick L, Brown CR, Encalada K, Sanchez DC, Warren CM, Tomopoulos S. Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: A randomized controlled study. J Asthma 2017; 54:919-929. [PMID: 28045551 DOI: 10.1080/02770903.2016.1277542] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. METHODS A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. RESULTS 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2-0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06-0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5). CONCLUSIONS Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.
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Affiliation(s)
- Hsiang Shonna Yin
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.,c Department of Population Health , NYU School of Medicine , New York , NY , USA
| | - Ruchi S Gupta
- b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA
| | - Alan L Mendelsohn
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.,c Department of Population Health , NYU School of Medicine , New York , NY , USA
| | - Benard Dreyer
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Linda van Schaick
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Christina R Brown
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Karen Encalada
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Dayana C Sanchez
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
| | - Christopher M Warren
- b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA
| | - Suzy Tomopoulos
- a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA
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Lucas CT, Messito MJ, Gross RS, Tomopoulos S, Fierman AH, Cates CB, Johnson SB, Dreyer B, Mendelsohn AL. Characteristics Associated With Adding Cereal Into the Bottle Among Immigrant Mother-Infant Dyads of Low Socioeconomic Status and Hispanic Ethnicity. J Nutr Educ Behav 2017; 49:27-34.e1. [PMID: 27756595 PMCID: PMC5682590 DOI: 10.1016/j.jneb.2016.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Determine maternal and infant characteristics associated with adding cereal into the bottle. DESIGN Secondary data analysis. PARTICIPANTS Study participants were immigrant, low-income, urban mother-infant dyads (n = 216; 91% Hispanic, 19% US-born) enrolled in a randomized controlled trial entitled the Bellevue Project for Early Language, Literacy and Education Success. MAIN OUTCOME MEASURES Maternal characteristics (age, marital status, ethnicity, primary language, country of origin, education, work status, income, depressive symptoms, and concern about infant's future weight) and infant characteristics (gender, first born, and difficult temperament). ANALYSIS Fisher exact test, chi-square test, and simultaneous multiple logistic regression of significant (P < .05) variables identified in unadjusted analyses. RESULTS Twenty-seven percent of mothers added cereal into the bottle. After adjusting for confounding variables identified in bivariate analyses, mothers who were single (P = .02), had moderate to severe depressive symptoms (P = .01) and perceived their infant had a difficult temperament (P = .03) were more likely to add cereal into the bottle. Conversely, mothers who expressed concern about their infants becoming overweight were less likely to add cereal (P = .02). CONCLUSIONS AND IMPLICATIONS Health care providers should screen for adding cereal in infant bottles. Further research is needed to investigate the impact of adding cereal into the bottle on weight trajectories over time. Causal associations also need to be identified to effectively prevent this practice.
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Affiliation(s)
- Candice Taylor Lucas
- Department of Pediatrics, New York University School of Medicine, New York, NY; Department of Pediatrics, Pediatric Exercise and Genomics Research Center, University of California, Irvine School of Medicine, Irvine, CA.
| | - Mary Jo Messito
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Rachel S Gross
- Department of Pediatrics, Children's Hospital of Montefiore and Albert Einstein College of Medicine, Bronx, NY
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Arthur H Fierman
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | | | - Samantha Berkule Johnson
- Department of Pediatrics, New York University School of Medicine, New York, NY; Department of Psychology, Marymount Manhattan College, New York, NY
| | - Benard Dreyer
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Alan L Mendelsohn
- Department of Pediatrics, New York University School of Medicine, New York, NY
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Glick AF, Tomopoulos S, Fierman AH, Trasande L. Disparities in Mortality and Morbidity in Pediatric Asthma Hospitalizations, 2007 to 2011. Acad Pediatr 2016; 16:430-437. [PMID: 26768727 PMCID: PMC10843839 DOI: 10.1016/j.acap.2015.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Asthma is a leading cause of pediatric admissions. Although several factors including race have been linked to increased overall asthma morbidity and mortality, few studies have explored factors associated with inpatient asthma outcomes. We examined factors associated with mortality and morbidity in children admitted for asthma. METHODS Data were obtained from the US Nationwide Inpatient Sample for 2007 to 2011. Patients 2 to 18 years old with a primary diagnosis of asthma were included. Predictor variables were sociodemographic and hospital factors and acute/chronic secondary diagnoses. Outcomes were mortality, intubation, length of stay (LOS), and costs. Weighted national estimates were calculated. Multivariable analyses were performed. RESULTS There were 97,379 (478,546 weighted) asthma admissions. Most patients were male (60.6%); 30% were white, 28% black, and 18% Hispanic. Mortality rate was 0.03%, and 0.3% were intubated. Median LOS was 2 (interquartile range, 1-3) days. Median costs were $2,950 (interquartile range, $1990-$4610). Native American race, older age (13-18 years), and West region were significant independent predictors of mortality. Intubation rate was lower in Hispanic compared with white children (P = .028). LOS was shorter in Asian compared with white children (P = .022) but longer in children with public insurance and from low income areas (P < .001). Average costs were higher in black, Hispanic, and Asian compared with white children (P < .05). CONCLUSIONS With the exception of Native Americans, race/ethnicity is not associated with inpatient asthma mortality and has varied effects on morbidity. Recognition of factors associated with increased asthma mortality and morbidity might allow for earlier, more effective treatment and avoidance of complications.
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Affiliation(s)
- Alexander F Glick
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York.
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
| | - Arthur H Fierman
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York; Departments of Environmental Medicine and Population Health, New York University School of Medicine, New York; New York University Wagner School of Public Service, New York; Department of Nutrition, Food & Public Health, New York University Steinhardt School of Culture, Education, and Human Development, New York; New York University Global Institute of Public Health, New York
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Yin HS, Gupta RS, Tomopoulos S, Mendelsohn AL, Egan M, van Schaick L, Wolf MS, Sanchez DC, Warren C, Encalada K, Dreyer BP. A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study. Pediatrics 2016; 137:peds.2015-0468. [PMID: 26634774 DOI: 10.1542/peds.2015-0468] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. METHODS Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. PRIMARY OUTCOME MEASURES medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. RESULTS 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P < .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1-123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P < .001; OR = 6.7; 95% CI, 2.9-15.8), address need for daily medications when sick (93.4% vs 34.5%, P < .001; OR = 27.1; 95% CI, 8.6-85.4), use explicit symptoms (eg, "ribs show when breathing," 54.1% vs 3.4%, P < .001; OR = 33.0; 95% CI, 7.4-147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). CONCLUSIONS Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles.
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Affiliation(s)
- H Shonna Yin
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York;
| | - Ruchi S Gupta
- Center for Community Health, and Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Alan L Mendelsohn
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York
| | - Maureen Egan
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Linda van Schaick
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Michael S Wolf
- Health Literacy and Learning Program, Center for Communication in Healthcare, Division of General Internal Medicine, and Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dayana C Sanchez
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | | | - Karen Encalada
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Benard P Dreyer
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
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Tomopoulos S, Brockmeyer Cates C, Dreyer BP, Fierman AH, Berkule SB, Mendelsohn AL. Children under the age of two are more likely to watch inappropriate background media than older children. Acta Paediatr 2014; 103:546-52. [PMID: 24812713 PMCID: PMC4067319 DOI: 10.1111/apa.12588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To establish whether young children watched foreground electronic media or background media that was not aimed at them or was inappropriate for their age. METHODS We performed a longitudinal analysis of mother-infant dyads participating in a larger parenting study. The primary dependent variable was maternal reports of watching habits from media diaries at 6, 14, 24 and 36 months. Independent variables were child age, programme content and whether the programme was turned on specifically for the child. RESULTS We analysed 3570 programme exposures in 527 children, mostly from television. Children were significantly more likely to actually watch programmes if they were older, if the content was coded as 'educational young child' or if the parent tuned on the programme specifically so the child could watch it. Children under the age of two were more likely than older children to watch background media that featured age-inappropriate content or had not been turned on for them to watch [30% versus 16% of programmes; AOR = 2.19 (95%CI 1.82-2.65)]. CONCLUSION Young children under the age of two frequently watch background media that has age-inappropriate content or has not been turned on for them to watch.
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Affiliation(s)
- Suzy Tomopoulos
- New York University School of Medicine and Bellevue Hospital Center, Department of Pediatrics
| | | | - Benard P Dreyer
- New York University School of Medicine and Bellevue Hospital Center, Department of Pediatrics
| | - Arthur H Fierman
- New York University School of Medicine and Bellevue Hospital Center, Department of Pediatrics
| | - Samantha B Berkule
- New York University School of Medicine and Bellevue Hospital Center, Department of Pediatrics
- Marymount Manhattan College, Department of Psychology
| | - Alan L Mendelsohn
- New York University School of Medicine and Bellevue Hospital Center, Department of Pediatrics
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Yin HS, Gupta RS, Tomopoulos S, Wolf MS, Mendelsohn AL, Antler L, Sanchez DC, Lau CH, Dreyer BP. Readability, suitability, and characteristics of asthma action plans: examination of factors that may impair understanding. Pediatrics 2013; 131:e116-26. [PMID: 23209106 DOI: 10.1542/peds.2012-0612] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Recognition of the complexity of asthma management has led to the development of asthma treatment guidelines that include the recommendation that all pediatric asthma patients receive a written asthma action plan. We assessed the readability, suitability, and characteristics of asthma action plans, elements that contribute to the effectiveness of action plan use, particularly for those with limited literacy. METHODS This was a descriptive study of 30 asthma action plans (27 state Department of Health (DOH)-endorsed, 3 national action plans endorsed by 6 states). OUTCOME MEASURES (1) readability (as assessed by Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast), (2) suitability (Suitability Assessment of Materials [SAM], adequate: ≥ 0.4; unsuitable: <0.4), (3) action plan characteristics (peak flow vs symptom-based, symptoms, recommended actions). RESULTS Mean (SD) overall readability grade level was 7.2 (1.1) (range = 5.7-9.8); 70.0% were above a sixth-grade level. Mean (SD) suitability score was 0.74 (0.14). Overall, all action plans were found to be adequate, although 40.0% had an unsuitable score in at least 1 factor. The highest percent of unsuitable scores were found in the categories of layout/typography (30.0%), learning stimulation/motivation (26.7%), and graphics (13.3%). There were no statistically significant differences between the average grade level or SAM score of state DOH developed action plans and those from or adapted from national organizations. Plans varied with respect to terms used, symptoms included, and recommended actions. CONCLUSIONS Specific improvements in asthma action plans could maximize patient and parent understanding of appropriate asthma management and could particularly benefit individuals with limited literacy skills.
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Affiliation(s)
- H Shonna Yin
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York 10016, USA.
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Mendelsohn AL, Dreyer BP, Brockmeyer CA, Berkule-Silberman SB, Huberman HS, Tomopoulos S. Randomized controlled trial of primary care pediatric parenting programs: effect on reduced media exposure in infants, mediated through enhanced parent-child interaction. ACTA ACUST UNITED AC 2011; 165:42-8. [PMID: 21199979 DOI: 10.1001/archpediatrics.2010.266] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To determine whether pediatric primary care-based programs to enhance parenting and early child development reduce media exposure and whether enhanced parenting mediates the effects. DESIGN Randomized controlled trial. SETTING Urban public hospital pediatric primary care clinic. PARTICIPANTS A total of 410 mother-newborn dyads enrolled after childbirth. INTERVENTIONS Patients were randomly assigned to 1 of 2 interventions, the Video Interaction Project (VIP) and Building Blocks (BB) interventions, or to a control group. The VIP intervention comprised 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading through review of videotapes made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. The BB intervention mailed parenting materials, including age-specific newsletters suggesting activities to facilitate interactions, learning materials, and parent-completed developmental questionnaires (Ages and Stages questionnaires). OUTCOME MEASURES Electronic media exposure in the home using a 24-hour recall diary. RESULTS The mean (SD) exposure at 6 months was 146.5 (125.0) min/d. Exposure to VIP was associated with reduced total duration of media exposure compared with the BB and control groups (mean [SD] min/d for VIP, 131.6 [118.7]; BB, 151.2 [116.7]; control, 155.4 [138.7]; P = .009). Enhanced parent-child interactions were found to partially mediate relations between VIP and media exposure for families with a ninth grade or higher literacy level (Sobel statistic = 2.49; P = .01). CONCLUSION Pediatric primary care may represent an important venue for addressing the public health problem of media exposure in young children at a population level. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212576.
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Affiliation(s)
- Alan L Mendelsohn
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Bellevue Hospital Center, New York University School of Medicine, New York, NY 10016, USA.
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Abstract
OBJECTIVE To determine whether duration and content of media exposure in 6-month-old infants are associated with development at age 14 months. DESIGN Longitudinal analysis of 259 mother-infant dyads participating in a long-term study related to early child development, from November 23, 2005, through January 14, 2008. SETTING An urban public hospital. PARTICIPANTS Mothers with low socioeconomic status and their infants. MAIN EXPOSURE Duration and content of media exposure at age 6 months. MAIN OUTCOME MEASURES Cognitive and language development at age 14 months. RESULTS Of 259 infants, 249 (96.1%) were exposed to media at age 6 months, with mean (SD) total exposure of 152.7 (124.5) min/d. In unadjusted and adjusted analyses, duration of media exposure at age 6 months was associated with lower cognitive development at age 14 months (unadjusted: r = -0.17, P < .01; adjusted: β = -0.15, P = .02) and lower language development (r = -0.16, P < .01; β = -0.16, P < .01). Of 3 types of content assessed, only 1 (older child/adult-oriented) was associated with lower cognitive and language development at age 14 months. No significant associations were seen with exposure to young child-oriented educational or noneducational content. CONCLUSIONS This study is the first, to our knowledge, to have longitudinally assessed associations between media exposure in infancy and subsequent developmental outcomes in children from families with low socioeconomic status in the United States. Findings provide strong evidence in support of the American Academy of Pediatrics recommendations of no media exposure prior to age 2 years, although further research is needed.
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Affiliation(s)
- Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine-Bellevue Hospital Center, New York, NY 10016, USA.
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Mendelsohn AL, Brockmeyer CA, Dreyer BP, Fierman AH, Berkule-Silberman SB, Tomopoulos S. Do Verbal Interactions with Infants During Electronic Media Exposure Mitigate Adverse Impacts on their Language Development as Toddlers? Infant Child Dev 2010; 19:577-593. [PMID: 21593996 PMCID: PMC3095495 DOI: 10.1002/icd.711] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The goal of this study was to determine whether verbal interactions between mothers and their 6-month-old infants during media exposure ('media verbal interactions') might have direct positive impacts, or mitigate any potential adverse impacts of media exposure, on language development at 14 months. For 253 low-income mother-infant dyads participating in a longitudinal study, media exposure and media verbal interactions were assessed using 24-hour recall diaries. Additionally, general level of cognitive stimulation in the home [StimQ] was assessed at 6 months and language development [Preschool Language Scale-4] was assessed at 14 months. Results suggest that media verbal interactions play a role in the language development of infants from low-income, immigrant families. Evidence showed that media verbal interactions moderated adverse impacts of media exposure found on 14-month language development, with adverse associations found only in the absence the these interactions. Findings also suggest that media verbal interactions may have some direct positive impacts on language development, in that media verbal interactions during the co-viewing of media with educational content (but not other content) were predictive of 14-month language independently of overall level of cognitive stimulation in the home.
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Affiliation(s)
- Alan L. Mendelsohn
- Department of Pediatrics, New York University School of Medicine-Bellevue Hospital Center, New York, NY, USA
| | - Carolyn A. Brockmeyer
- Department of Pediatrics, New York University School of Medicine-Bellevue Hospital Center, New York, NY, USA
| | - Benard P. Dreyer
- Department of Pediatrics, New York University School of Medicine-Bellevue Hospital Center, New York, NY, USA
| | - Arthur H. Fierman
- Department of Pediatrics, New York University School of Medicine-Bellevue Hospital Center, New York, NY, USA
| | - Samantha B. Berkule-Silberman
- Department of Pediatrics, New York University School of Medicine-Bellevue Hospital Center, New York, NY, USA
- Department of Psychology, Manhattanville College, Purchase, NY, USA
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine-Bellevue Hospital Center, New York, NY, USA
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Green CM, Berkule SB, Dreyer BP, Fierman AH, Huberman HS, Klass PE, Tomopoulos S, Yin HS, Morrow LM, Mendelsohn AL. Maternal literacy and associations between education and the cognitive home environment in low-income families. ACTA ACUST UNITED AC 2009; 163:832-7. [PMID: 19736337 DOI: 10.1001/archpediatrics.2009.136] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine whether maternal literacy level accounts for associations between educational level and the cognitive home environment in low-income families. DESIGN Analysis of 369 mother-infant dyads participating in a long-term study related to early child development. SETTING Urban public hospital. PARTICIPANTS Low-income mothers of 6-month-old infants. MAIN EXPOSURE Maternal literacy level was assessed using the Woodcock-Johnson III/Bateria III Woodcock-Munoz Tests of Achievement, Letter-Word Identification Test. Maternal educational level was assessed by determining the last grade that had been completed by the mother. MAIN OUTCOME MEASURE The cognitive home environment (provision of learning materials, verbal responsivity, teaching, and shared reading) was assessed using StimQ, an office-based interview measure. RESULTS In unadjusted analyses, a maternal literacy level of ninth grade or higher was associated with increases in scores for the overall StimQ and each of 4 subscales, whereas a maternal educational level of ninth grade or higher was associated with increases in scores for the overall StimQ and 3 of 4 subscales. In simultaneous multiple linear regression models including both literacy and educational levels, literacy continued to be associated with scores for the overall StimQ (adjusted mean difference, 3.7; 95% confidence interval, 1.7-5.7) and all subscales except teaching, whereas maternal educational level was no longer significantly associated with scores for the StimQ (1.8; 0.5-4.0) or any of its subscales. CONCLUSIONS Literacy level may be a more specific indicator of risk than educational level in low-income families. Studies of low-income families should include direct measures of literacy. Pediatricians should develop strategies to identify mothers with low literacy levels and promote parenting behaviors to foster cognitive development in these at-risk families.
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Affiliation(s)
- Cori M Green
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, 550 First Avenue, New York, NY 10016, USA
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Cutler CB, Legano LA, Dreyer BP, Fierman AH, Berkule SB, Lusskin SI, Tomopoulos S, Roth M, Mendelsohn AL. Screening for maternal depression in a low education population using a two item questionnaire. Arch Womens Ment Health 2008; 10:277-83. [PMID: 17710366 DOI: 10.1007/s00737-007-0202-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 07/29/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess a two-question screening tool, the Patient Health Questionnaire-2 (PHQ-2), for identifying depressive symptomatology in economically disadvantaged mothers of children in pediatric settings and to explore risk factors associated with a positive depression screen. METHODS A convenience sample of mothers was enrolled at an inner city well-child clinic with children age 3 days to 5 years. The PHQ-2 and Edinburgh Postnatal Depression Scale (EPDS) (as reference scale) were completed. RESULTS Ninety-four mothers participated. Agreement of the PHQ-2 and EPDS was moderate. The sensitivity of the PHQ-2 for identifying a positive screen on the EPDS was 43.5%; the specificity was 97.2%. The sensitivity of the PHQ-2 was higher for mothers with education beyond high school compared to those with less education. Perceived lack of support with child care and having two or more children were associated with a positive screen. The rate of positive screen was similar for mothers with infants and with older children. CONCLUSION Given the low sensitivity of the PHQ-2 in lower educated mothers, additional research in populations with varying sociodemographic characteristics is indicated. Similar rates of symptoms for mothers within and beyond the postpartum period and mothers previously screened support the need for periodic screening.
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Affiliation(s)
- C B Cutler
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY 10016, USA.
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Mendelsohn AL, Berkule SB, Tomopoulos S, Tamis-LeMonda CS, Huberman HS, Alvir J, Dreyer BP. Infant television and video exposure associated with limited parent-child verbal interactions in low socioeconomic status households. Arch Pediatr Adolesc Med 2008; 162:411-7. [PMID: 18458186 PMCID: PMC3081686 DOI: 10.1001/archpedi.162.5.411] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess verbal interactions related to television and other electronic media exposure among mothers and 6 month-old-infants. DESIGN Cross-sectional analysis of 154 mother-infant dyads participating in a long-term study related to early child development. SETTING Urban public hospital. PARTICIPANTS Low socioeconomic status mothers of 6-month-old infants. Main Exposure Media exposure and content. MAIN OUTCOME MEASURES Mother-infant verbal interaction associated with media exposure and maternal coviewing. RESULTS Of 154 low socioeconomic status mothers, 149 (96.8%) reported daily media exposure in their infants, with median exposure of 120 (interquartile range, 60-210) minutes in a 24-hour period. Among 426 program exposures, mother-infant interactions were reported during 101 (23.7%). Interactions were reported most frequently with educational young child-oriented media (42.8% of programs), compared with 21.3% of noneducational young child-oriented programs (adjusted odds ratio, 0.4; 95% confidence interval, 0.1-0.98) and 14.7% of school-age/teenage/adult-oriented programs (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.3). Among coviewed programs with educational content, mothers reported interactions during 62.7% of exposures. Coviewing was not reported more frequently for educational young child-oriented programs. CONCLUSIONS We found limited verbal interactions during television exposure in infancy, with interactions reported for less than one-quarter of exposures. Although interactions were most commonly reported among programs with educational content that had been coviewed, programs with educational content were not more likely to be coviewed than were other programs. Our findings do not support development of infant-directed educational programming in the absence of strategies to increase coviewing and interactions.
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Affiliation(s)
- Alan L Mendelsohn
- Department of Pediatrics, New York University School of Medicine, 550 First Ave, NB 8 South 4-11, New York, NY 10016, USA.
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Mendelsohn AL, Valdez PT, Flynn V, Foley GM, Berkule SB, Tomopoulos S, Fierman AH, Tineo W, Dreyer BP. Use of videotaped interactions during pediatric well-child care: impact at 33 months on parenting and on child development. J Dev Behav Pediatr 2007; 28:206-12. [PMID: 17565287 PMCID: PMC3083927 DOI: 10.1097/dbp.0b013e3180324d87] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We performed a randomized, controlled trial to assess the impact of the Video Interaction Project (VIP), a program based in pediatric primary care in which videotaped interactions are used by child development specialists to promote early child development. METHOD Ninety-nine Latino children (52 VIP, 47 controls) at risk of developmental delay based on poverty and low maternal education were assessed at age 33 months. VIP was associated with improved parenting practices including increased teaching behaviors. RESULTS VIP was associated with lower levels of parenting stress. VIP children were more likely to have normal cognitive development and less likely to have developmental delays. CONCLUSION This study provides evidence that a pediatric primary care-based intervention program can have an impact on the developmental trajectories of at-risk young preschool children.
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Affiliation(s)
- Alan L Mendelsohn
- New York University School of Medicine/Bellevue Hospital Center, New York, NY 10016, USA.
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Tomopoulos S, Dreyer BP, Valdez P, Flynn V, Foley G, Berkule SB, Mendelsohn AL. Media Content and Externalizing Behaviors in Latino Toddlers. ACTA ACUST UNITED AC 2007; 7:232-8. [PMID: 17512884 DOI: 10.1016/j.ambp.2007.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2006] [Revised: 02/07/2007] [Accepted: 01/24/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE There has been limited study of the association between media exposure and behavior in children younger than age 3 years. We sought to study this association in toddlers and determine whether the association varied depending on media content. METHODS We carried out a secondary analysis of a cohort of Latino mother-infant dyads followed from birth to 33 months. We assessed media exposure at 21 and 33 months with a 24-hour recall diary that included information about the duration and content of each program watched. Behavior was assessed at 33 months by the Child Behavior Checklist. RESULTS This analysis included 99 dyads. Results from multiple logistic regression analyses indicated associations of child behavior outcomes with 21-month total media exposure and both 21-month and 33-month exposure to noneducational young child media such as cartoons, after adjusting for maternal education, country of origin, and depressive symptoms, participation in a parenting program, and difficult child temperament. Media exposure has most consistent associations with aggressive behavior and externalizing problems. CONCLUSIONS Media exposure was associated with externalizing behavior in Latino toddlers, with the strongest association for media oriented toward young children but without educational content. This finding has importance for both parents of young children and pediatricians as they provide anticipatory guidance.
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Affiliation(s)
- Suzy Tomopoulos
- New York University School of Medicine, Bellevue Hospital Center, Department of Pediatrics, New York, NY 10016, USA.
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Tomopoulos S, Valdez PT, Dreyer BP, Fierman AH, Berkule SB, Kuhn M, Mendelsohn AL. Is Exposure to Media Intended for Preschool Children Associated With Less Parent-Child Shared Reading Aloud and Teaching Activities? ACTA ACUST UNITED AC 2007; 7:18-24. [PMID: 17261478 DOI: 10.1016/j.ambp.2006.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 09/19/2006] [Accepted: 10/12/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether electronic media exposure is associated with decreased parental reading and teaching activities in the homes of preschool children. METHODS A convenience sample presenting for well-child care to an urban hospital pediatric clinic was enrolled. Inclusion criteria were: child's age 3 to 5 years and not yet in kindergarten. Electronic media exposure (TV, movies/video, computer/video games) was assessed with a 24-hour recall diary and characterized on the basis of industry ratings. Reading aloud and teaching activities were assessed with the StimQ-Preschool READ and PIDA (Parental Involvement in Developmental Advance) subscales, respectively. RESULTS A total of 77 families were assessed. Children were exposed to a mean (SD) of 200.8 (128.9) minutes per day of media, including 78.2 (63.7) minutes of educational young child-oriented, 62.0 (65.6) minutes of noneducational young child-oriented, 14.8 (41.4) minutes of school age/teen-oriented, and 29.2 (56.6) minutes of adult-oriented media, as well as to 16.6 (47.5) minutes of media of unknown type. A total of 79.2% watched 2 or more hours per day. Noneducational young child-oriented exposure was associated with fewer reading (semipartial correlation coefficient [SR] = -0.24, P = .02) and teaching (SR = -0.27, P = .01) activities; similar relationships were not found for other media categories. Children exposed to 2 or more hours of total electronic media per day had 1.6 (95% confidence interval, 0.4-2.9) fewer days per week of reading than children exposed to less than 2 hours (SR = -0.27, P = .01). CONCLUSIONS This study found an association between increased exposure to noneducational young child-oriented media and decreased teaching and reading activities in the home. This association represents a mechanism by which media exposure could adversely affect development.
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Affiliation(s)
- Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine, Bellevue Hospital Center, 550 First Avenue, New York, NY 10016, USA.
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Tomopoulos S, Dreyer BP, Tamis-LeMonda C, Flynn V, Rovira I, Tineo W, Mendelsohn AL. Books, Toys, Parent-Child Interaction, and Development in Young Latino Children. ACTA ACUST UNITED AC 2006; 6:72-8. [PMID: 16530142 DOI: 10.1016/j.ambp.2005.10.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 10/12/2005] [Accepted: 10/13/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the interrelationships between books and toys in the home, parent-child interaction, and child development at 21 months among low-income Latino children. METHODS Latino mother-infant dyads enrolled in a level 1 nursery and infants were followed to 21 months. The subjects consisted of the control group of a larger intervention study. At 6 and 18 months, the number of books and toys in the home and the frequency of reading aloud were measured by the StimQ. At 21 months, child cognitive and language development and parent-child interaction were assessed by the Bayley Mental Development Index (MDI), the Preschool Language Scale-3 (PLS-3), and the Caregiver-Child Interaction Rating Scale, respectively. Eligibility for early intervention (EI) services was determined on the basis of the MDI and PLS-3. RESULTS Data were obtained for 46 (63.0%) of 73 at 21 months. In multiple regression analysis, books provided at 18 months predicted both cognition (semipartial correlation [sr] = .49, P= .001) and receptive language (sr = .37, P= .02), whereas toys provided at both 6 and 18 months predicted 21-month receptive language (sr = .40, P= .01; sr = .32, P= .047, respectively). Reading aloud by parents > or =4 days a week was associated with decreased EI eligibility (adjusted odds ratio = 0.16, 95% confidence interval 0.03-0.99). CONCLUSIONS Reading aloud and provision of toys are associated with better child cognitive and language development as well as with decreased likelihood of EI eligibility.
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Affiliation(s)
- Suzy Tomopoulos
- New York University School of Medicine and Bellevue Hospital Center, Department of Pediatrics, NY, USA.
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Mendelsohn AL, Dreyer BP, Flynn V, Tomopoulos S, Rovira I, Tineo W, Pebenito C, Torres C, Torres H, Nixon AF. Use of videotaped interactions during pediatric well-child care to promote child development: a randomized, controlled trial. J Dev Behav Pediatr 2005; 26:34-41. [PMID: 15718881 PMCID: PMC4435697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The authors performed a randomized, controlled trial to assess the impact of the Video Interaction Project (VIP), a program based in pediatric primary care in which videotaped interactions are used by child development specialists to promote early child development. Ninety-three Latino children (51 VIP, 42 control) at risk of developmental delay on the basis of poverty and low maternal education (none had completed high school) were assessed for cognitive and language development at age 21 months. Results differed depending on the level of maternal education; the VIP was found to have a moderate impact on children whose mothers had between seventh and 11th grade education (approximately 0.75 SD for cognitive development, 0.5 SD for expressive language) but little impact on children whose mothers had sixth grade or lower education.
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Affiliation(s)
- Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, 550 First Avenue, New York, NY 10016, USA.
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Jacobson MS, Tomopoulos S, Williams CL, Arden MR, Deckelbaum RJ, Starc TJ. Normal growth in high-risk hyperlipidemic children and adolescents with dietary intervention. Prev Med 1998; 27:775-80. [PMID: 9922057 DOI: 10.1006/pmed.1998.0356] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to assess the safety and efficacy of lowering dietary intake of total fat, saturated fat, and cholesterol in growing children and adolescents with severe hyperlipidemia. STUDY DESIGN This is a 3-year follow-up study conducted on a sample of convenience at three pediatric referral centers in New York City and its suburbs. Subjects were 138 children and adolescents 2 to 15 years of age (54% male), who had been referred with a diagnosis of hyperlipidemia. Those selected had total serum cholesterol values greater than the 95th percentile for age and had at least three visits over 3 years. They were placed on diets restricting total fat content to 30% of total calories and saturated fat to 10% of total calories (National Cholesterol Education Program Step I diet). Anthropometric measures, lipid profiles, and dietary assessment were obtained at each visit. Anthropometric data were analyzed by sex and age. Z scores for height and weight were calculated from NHANES II data and were compared by paired t tests (Hamill et al., 1979, Am J Clin Nutr 32:607-29). RESULTS Total serum cholesterol dropped from 262 mg/dL at baseline to 249 mg/dL at 3-year follow-up (P = 0.003). There was no significant change in height or weight percentile, expressed as Z score, from baseline to 3-year follow up. CONCLUSIONS In this population the supervised dietary interventions resulted in a sustained improvement of the lipid profile, with no demonstrable adverse effect on growth.
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Affiliation(s)
- M S Jacobson
- Division of Adolescent Medicine, Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
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