Catherine A. Lesesne

National Estimates and Factors Associated With Medication Treatment for Childhood Attention-Deficit/Hyperactivity Disorder

OBJECTIVE. In this study we identified child and family-level characteristics that were associated with medication treatment for attention-deficit/hyperactivity disorder using nationally representative survey data. METHODS. National Survey of Childrens Health data from 79264 youth 4 to 17 years of age were used. Data were weighted to adjust for the complex survey design of the National Survey of Childrens Health. Gender-specific logistic regression models were generated to identify child and family-level characteristics that were collectively associated with current medication status among youth with a reported diagnosis of attention-deficit/hyperactivity disorder. RESULTS. Nationally, 7.8% of youth aged 4 to 17 years had a reported attention-deficit/hyperactivity disorder diagnosis, and 4.3% had both a disorder diagnosis and were currently taking medication for the disorder. Current medication treatment among youth with attention-deficit/hyperactivity disorder was associated with white race, younger age, English spoken in the home, health care coverage, a health care contact within the last year, and reported psychological difficulties. Gender-specific logistic regression models revealed that, together, younger age, higher income, health care coverage, having psychological difficulties, and a health care contact in the past year were associated with medication use among boys with attention-deficit/hyperactivity disorder. Among girls with the disorder, younger age, psychological difficulties, fair-to-poor paternal mental health status, and a health care contact within the last year were collectively associated with current medication use. CONCLUSIONS. Regardless of gender, younger age, the presence of psychological difficulties, and a recent health care contact were significantly associated with medication treatment for attention-deficit/hyperactivity disorder. However, additional health care access and income variables among boys and paternal mental health status among girls represented gender-specific factors that were also associated with medication treatment for the disorder. Future studies should characterize how and when the burden associated with attention-deficit/hyperactivity disorder leads to treatment, support, or services for this prevalent and impairing neurobehavioral disorder.

A Research Synthesis of the Evaluation Capacity Building Literature

The continuously growing demand for program results has produced an increased need for evaluation capacity building (ECB). The Integrative ECB Model was developed to integrate concepts from existing ECB theory literature and to structure a synthesis of the empirical ECB literature. The study used a broad-based research synthesis method with systematic decision rules and demonstrates the viability of the method for producing a reliable analysis of disparate data from a variety of designs. There was a high degree of consistency in what was reported in the empirical literature and the theoretical literature in terms of strategies and outcomes. Reported outcomes at the individual level included attitudes, knowledge, and behaviors and at the organizational level included practices, leadership, culture, mainstreaming, and resources. Collaborative processes and programmatic outcomes emerged as important issues for ECB models and practice. The consistency between the empirical and the theoretical literature indicates that the field is ready to develop common measures, use stronger designs, and report more systematically. This synthesis provides an overview of existing data and an empirical basis for refining strategies and common measures for enhancing the research and practice of ECB to achieve ECB and programmatic goals and outcomes.

Promoting Science-based Approaches to Teen Pregnancy Prevention: Proactively Engaging the Three Systems of the Interactive Systems Framework

In the field of teen pregnancy prevention many efficacious prevention programs are available but adoption of these programs is slow at the community level. In this article, we present a multi-site, capacity-building effort called the Promoting Science-based Approaches to Teen Pregnancy Prevention project (PSBA) as a case example of a proactive application of the Interactive System Framework (ISF) for dissemination and implementation. The ISF is a multi-system model leading to dissemination and implementation of science-based prevention programming through the work of three interactive systems: The “Prevention Delivery,” “Prevention Support,” and “Prevention Synthesis & Translation” Systems. This article describes the proactive use of the ISF to conceptualize and bolster the PSBA program’s goal of assisting local prevention partners in the use of science-based approaches (SBA) to prevent teen pregnancy. PSBA uses all three systems of the ISF to facilitate practice improvements and offers valuable research opportunities to investigate factors related to dissemination and implementation processes across these systems. Describing our application of this framework highlights the feasibility of actively using the ISF to build prevention infrastructure and to guide large-scale prevention promotion strategies in the area of teen pregnancy prevention. The program’s ongoing evaluation is presented as an example of early efforts to develop an evidence base around the ISF. Research implications are discussed.

Family Mediators of Acculturation and Adolescent Sexual Behavior Among Latino Youth

The present study develops and evaluates a theoretical framework of mediators of the relationship between acculturation and adolescent sexual behavior. Four hundred Latino mother–adolescent dyads from the Bronx, New York were interviewed. The study explored the relationship between intentions to have sexual intercourse and explanatory variables such as adolescent romantic relationship status and partner preferences, maternal approval of dating, adolescent perceptions of maternal approval of dating, and maternal and adolescent levels of familismo and acculturation. Findings revealed complex dynamics between acculturation and adolescent sexual behavior. Protective and risk-inducing associations were observed, with important gender differences operating for boys and girls. Implications for the development of applied prevention programs are discussed.

Measurement of Compliance With New York City’s Regulations on Beverages, Physical Activity, and Screen Time in Early Child Care Centers

Introduction Policy interventions designed to change the nutrition environment and increase physical activity in child care centers are becoming more common, but an understanding of the implementation of these interventions is yet to be developed. The objective of this study was to explore the extent and consistency of compliance with a policy intervention designed to promote nutrition and physical activity among licensed child care centers in New York City. Methods We used a multimethod cross-sectional approach and 2 independent components of data collection (Center Evaluation Component and Classroom Evaluation Component). The methods were designed to evaluate the impact of regulations on beverages served, physical activity, and screen time at child care centers. We calculated compliance scores for each evaluation component and each regulation and percentage agreement between compliance in the center and classroom components. Results Compliance with certain requirements of the beverage regulations was high and fairly consistent between components, whereas compliance with the physical activity regulation varied according to the data collection component. Compliance with the regulation on amount and content of screen time was high and consistent. Conclusion Compliance with the physical activity regulation may be a more fluid, day-to-day issue, whereas compliance with the regulations on beverages and television viewing may be easier to control at the center level. Multiple indicators over multiple time points may provide a more complete picture of compliance — especially in the assessment of compliance with physical activity policies.

Evaluation design of New York City's regulations on nutrition, physical activity, and screen time in early child care centers.

This article describes the multi-method cross-sectional design used to evaluate New York City Department of Health and Mental Hygiene’s regulations of nutrition, physical activity, and screen time for children aged 3 years or older in licensed group child care centers. The Center Evaluation Component collected data from a stratified random sample of 176 licensed group child care centers in New York City. Compliance with the regulations was measured through a review of center records, a facility inventory, and interviews of center directors, lead teachers, and food service staff. The Classroom Evaluation Component included an observational and biometric study of a sample of approximately 1,400 children aged 3 or 4 years attending 110 child care centers and was designed to complement the center component at the classroom and child level. The study methodology detailed in this paper may aid researchers in designing policy evaluation studies that can inform other jurisdictions considering similar policies.

Developing a prevention synthesis and translation system to promote science-based approaches to teen pregnancy, HIV and STI prevention.

The Interactive Systems Framework for Dissemination and Implementation (ISF) is a multi-system framework that can guide research-to-practice efforts by building and supporting the work of three interacting systems: the Prevention Delivery, Support, and Synthesis and Translation Systems. The Synthesis and Translation system is vital to bridging science and practice, yet how to develop it and train support system partners to use it is under-researched. This article bridges this gap by offering a case example of the planning, development, and use of a synthesis and translation product called Promoting Science-based Approaches to Teen Pregnancy Prevention using Getting To Outcomes. The case presented documents the process used for developing the synthesis and translation product, reports on efforts to engage the Prevention Support system to use the product, and how we approached building interaction between the Synthesis and Translation System and the Support System partners. Practice-oriented evaluation data are also presented. Implications for practice, policy and research are discussed.

Relationship between child care centers' compliance with physical activity regulations and children's physical activity, New York City, 2010.

Introduction Physical activity may protect against overweight and obesity among preschoolers, and the policies and characteristics of group child care centers influence the physical activity levels of children who attend them. We examined whether children in New York City group child care centers that are compliant with the city’s regulations on child physical activity engage in more activity than children in centers who do not comply. Methods A sample of 1,352 children (mean age, 3.39 years) served by 110 group child care centers in low-income neighborhoods participated. Children’s anthropometric data were collected and accelerometers were used to measure duration and intensity of physical activity. Multilevel generalized linear regression modeling techniques were used to assess the effect of center- and child-level factors on child-level physical activity. Results Centers’ compliance with the regulation of obtaining at least 60 minutes of total physical activity per day was positively associated with children’s levels of moderate to vigorous physical activity (MVPA); compliance with the regulation of obtaining at least 30 minutes of structured activity was not associated with increased levels of MVPA. Children in centers with a dedicated outdoor play space available also spent more time in MVPA. Boys spent more time in MVPA than girls, and non-Hispanic black children spent more time in MVPA than Hispanic children. Conclusion To increase children’s level of MVPA in child care, both time and type of activity should be considered. Further examination of the role of play space availability and its effect on opportunities for engaging in physical activity is needed.

Neighborhood Disparities in Prevalence of Childhood Obesity Among Low-Income Children Before and After Implementation of New York City Child Care Regulations

Introduction New York City Article 47 regulations, implemented in 2007, require licensed child care centers to improve the nutrition, physical activity, and television-viewing behaviors of enrolled children. To supplement an evaluation of the Article 47 regulations, we conducted an exploratory ecologic study to examine changes in childhood obesity prevalence among low-income preschool children enrolled in the Nutrition Program for Women, Infants, and Children (WIC) in New York City neighborhoods with or without a district public health office. We conducted the study 3 years before (from 2004 through 2006) and after (from 2008 through 2010) the implementation of the regulations in 2007. Methods We used an ecologic, time-trend analysis to compare 3-year cumulative obesity prevalence among WIC-enrolled preschool children during 2004 to 2006 and 2008 to 2010. Outcome data were obtained from the New York State component of the Centers for Disease Control and Prevention’s Pediatric Nutrition Surveillance System. Results Early childhood obesity prevalence declined in all study neighborhoods from 2004–2006 to 2008–2010. The greatest decline occurred in Manhattan high-risk neighborhoods where obesity prevalence decreased from 18.6% in 2004–2006 to 15.3% in 2008–2010. The results showed a narrowing of the gap in obesity prevalence between high-risk and low-risk neighborhoods in Manhattan and the Bronx, but not in Brooklyn. Conclusion The reductions in early childhood obesity prevalence in some high-risk and low-risk neighborhoods in New York City suggest that progress was made in reducing health disparities during the years just before and after implementation of the 2007 regulations. Future research should consider the built environment and markers of differential exposure to known interventions and policies related to childhood obesity prevention.

Sex Differences in School Safety and Bullying Experiences Among Sexual Minority Youth

Schools play an integral role in creating safe, supportive environments for students, especially for sexual minority youth (SMY). Using 2016 questionnaire data from seven high schools in a Florida school district, we obtained a sample of 1,364 SMY. Logistic regressions controlling for sex (as applicable), age, grade, race/ethnicity, and school explored differences between SMY and nonsexual minority youth (non-SMY). Sex differences related to school environment perceptions and experiences related to safety, bullying, and hearing homophobic remarks were also explored. SMY were more likely than non-SMY to report several negative school environment perceptions and experiences. Where differences existed within SMY, male SMY were more likely than female SMY to have missed school in the past 30 days (odds ratio [OR] = 1.66, p = .03), report avoiding spaces at school due to safety concerns (OR = 1.38, p = .02), and report hearing homophobic remarks from teachers (OR = 2.00, p = .01). Implications for school nursing are discussed.