Bonnie Gance-Cleveland

Recommendations for Prevention of Childhood Obesity

The majority of US youth are of healthy weight, but the majority of US adults are overweight or obese. Therefore, a major health challenge for most American children and adolescents is obesity prevention—today, and as they age into adulthood. In this report, we review the most recent evidence regarding many behavioral and practice interventions related to childhood obesity, and we present recommendations to health care providers. Because of the importance, we also suggest approaches that clinicians can use to encourage obesity prevention among children, including specific counseling strategies and practice-based, systems-level interventions. In addition, we suggest how clinicians may interact with and promote local and state policy initiatives designed to prevent obesity in their communities.

Evaluation of Technology to Identify and Assess Overweight Children and Adolescents

PURPOSE The current obesity epidemic has produced a generation of children that may be the first to have a life expectancy shorter than their parents. To address the obesity epidemic, experts have published recommendations for providers. Research suggests the publication of guidelines may not change provider behavior. DESIGN AND METHODS This study evaluates computer assistance for implementing obesity guidelines in school-based health centers. RESULTS Significant improvements in identification and assessment of obesity in children with technology support were noted. PRACTICE IMPLICATIONS Computer decision support shows promise for promoting the implementation of current recommendations by supporting providers in identifying, assessing, and providing tailored recommendations for children at risk of obesity.

Pediatric nurse practitioners' assessment and management of childhood overweight/obesity: results from 1999 and 2005 cohort surveys.

INTRODUCTION Recently, public and professional emphasis has been placed on addressing the increasing prevalence of childhood overweight. METHOD This survey study was conducted with two cohorts of pediatric nurse practitioners (N = 413) to explore differences in self-reported practice skills over time. RESULTS Significant improvements in assessment, screening, and laboratory evaluations were reported, although reduced adherence to recommended psychosocial assessments was noted. DISCUSSION This study outlines self-reported barriers to effective childhood weight management. One support that participants requested was evidence-based guidelines. Motivational interviewing may be an additional strategy to enhance provider skills to assess and manage challenging patient behavior change (e.g., dietary and activity changes).

Beyond Primary Prevention of Alcohol Use: A Culturally Specific Secondary Prevention Program for Mexican Heritage Adolescents

Classroom-based primary prevention programs with adolescents are effective in inhibiting the onset of drug use, but these programs are not designed to directly address the unique needs of adolescents at higher risk of use or already using alcohol and other drugs. This article describes the initial efficacy evaluation of a companion psychosocial small group program which aims at addressing the needs of Mexican heritage students identified by their teachers as being at higher risk for substance use or already experimenting with alcohol and other drugs. The adolescent (7th grade) small group curricula, REAL Groups, is a secondary prevention program which supplements the primary classroom-based substance use prevention program, keepin’ it REAL. Following a mutual aid approach, a total of 109 7th grade students were referred by their teachers and participated in the REAL Groups. The remaining 252 7th grade students who did not participate served as the control group. To account for biased selection into REAL Groups, propensity score matching (PSM) was employed. The estimated average treatment effect for participants’ use of alcohol was calculated at the end of the 8th grade. Results indicate that alcohol use decreased among students who participated in the REAL Groups relative to matched students who did not participate. These findings suggest that REAL Groups may be an effective secondary prevention program for higher-risk Mexican heritage adolescents.

Improving Family-Centered Care Through Research

The need for change toward more family centered care involved focusing on issues identified by families and staff on a medical-surgical infant and toddler unit of a pediatric hospital. The research process was used to identify issues of concern and to develop and evaluate interventions to improve family centered care. This article presents the research process, the interventions employed, and family and staff perceptions of family and centered care pre and post intervention.

Arkansas School Nurses’ Role in Statewide Assessment of Body Mass Index to Screen for Overweight Children and Adolescents

National surveys that have tracked weight and physical activity in the United States for more than 40 years have shown a continuing increase in the number of overweight children and adolescents. Overweight children and adolescents are showing an increase in diseases related to overweight: Type II diabetes, cardiovascular disease, hypertension, and orthopedic and respiratory conditions. Overweight children are also likely to become obese adults. This article describes Arkansas’s efforts to connect with families through schools to prevent or reduce overweight in children. Arkansas school nurses measured the heights and weights of more than 400,000 public school students during the 2003–2004 school year. A detailed protocol for accurate measurement of students is provided.

Charting the Course of Pediatric Nursing Research: The SPN Delphi Study

In order to inform the care of children at this pivotal time in the history of healthcare, the Society of Pediatric Nurses (SPN) sought to identify priorities for nursing research and key challenges facing pediatric nursing. A three round Delphi study was conducted electronically with SPN members. The top 10 priorities and challenges were identified and will serve as a valuable guide for pediatric nursing practice, education, policy and administration over the coming decade.

Grand Canyon Trekkers School-Based Lunchtime Walking Program

The incidence of childhood overweight is especially troubling among low income Latino youth. Grand Canyon Trekkers (GCT) was implemented as a quasi-experimental study in 10 Title 1 elementary schools with a large Latino population to examine the effects of a 16-week structured walking program on components of health-related physical fitness: Body Mass Index (BMI), waist circumference, and cardio-respiratory. Data on 1,074 research participants revealed no significance changes in BMI or waist circumference (p > .05); however, cardio-respiratory fitness increased by 37.1% over baseline. Cardiovascular fitness is an independent determinant of long-term health; therefore, the GCT program may have significantly improved the future health profile of the participants and decreased their risk of metabolic diseases.

Early Initiation of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Reduces Length of Stay: A Quality Improvement Project.

ABSTRACT Infants born at ≤ 32 weeks gestation are at risk of developmental delays. Review of the literature indicates NIDCAP improves parental satisfaction, minimizes developmental delays, and decreases length of stay, thus reducing cost of hospitalization. Half (50.6%) of the infants admitted to this 84‐bed Level IV Neonatal Intensive Care Unit (NICU) with a gestational age of ≤ 32 weeks were referred for NIDCAP. The specific aims of this quality improvement project were to 1) compare the age at discharge for infants meeting inclusion criteria enrolled in NIDCAP with the age at discharge for those eligible infants not enrolled in NIDCAP; and 2) investigate the timing of initiation of NIDCAP (e.g., within six days of admission) on age at discharge. During the 12 month period of data collection, infants enrolled in NIDCAP (M = 27.85 weeks, SD = 1.86) were 2.02 weeks younger than those not enrolled in NIDCAP (M = 29.87 weeks, SD = 2.49), and were 2.32 weeks older at discharge (M = 38.28 weeks, SD = 5.10) than those not enrolled in NIDCAP (M = 35.96 weeks, SD = 5.60). Infants who enrolled within 6 days of admission were discharged an average of 25 days sooner (p = 0.055), and at a younger post‐menstrual age (by 3.33 weeks on average), than those enrolled later (p = 0.027). HighlightsNIDCAP is a proven framework for providing developmentally supportive care in the NICU, and can mitigate risks of prematurityEarlier initiation of NIDCAP led to discharge at a younger post‐menstrual ageQuality improvement investigations are effective in addressing critical healthcare needs

Hispanic Parental Perceptions of Child Weight in Preschool-Aged Children: An Integrated Review

BACKGROUND Obesity continues to disproportionately affect ethnic minorities. Parents play an integral role in early childhood, and parental perceptions regarding their childs weight are key to obesity prevention. Cultural differences contribute to parental perceptions, and increased understandings of these characteristics provide a basis to address obesity in high-risk populations at an earlier age. The aim of this integrative review was to analyze extant literature to identify Hispanic parental perceptions of their preschool-aged childs weight status. METHODS An integrative review of studies measuring Hispanic parental perception was conducted. Computerized searches were completed using MEDLINE, PubMed, CINHAL, Eric, and PsychINFO. Articles were included if they were English, included children 2-5 years of age, included a Hispanic population, and evaluated parental perception of their childs weight status. A total of 14 articles (n=8 qualitative; n=6 quantitative) met criteria and were included in the review. Coopers integrative review methodology was used, and articles were evaluated for quality using Polit and Becks evidence hierarchy leveling system. RESULTS The results revealed six themes of Hispanic parental perceptions relative to their preschool-aged childs weight: parental perception of body weight; relationship between child weight and health; causes and consequences of overweight; familial roles and influences on child weight; prevention of overweight; and cultural influences within the United States. CONCLUSIONS This review highlights the importance of developing sociocultural approaches to addressing childhood obesity within the Hispanic population. Additional research is needed to incorporate what is known about Hispanic parental perceptions to positively influence behavior change during early childhood.