Christine Kennedy

Methodological considerations in children's focus groups.

Focus groups are a well-known qualitative approach to gathering data in health science research. The literature on focus groups, however, primarily discusses adults as subjects. Unfortunately, the scant reports of studies using children as participants in focus groups have not described their methods in detail. This article discusses the use of children (age 6–12) in focus groups, and highlights methodological considerations in this approach, with particular attention to the integration of developmental principles. Focus groups with children can capture their perspectives, original ideas, and insights, which are often neglected in more traditional pediatric research. Focus groups can also serve as an innovative approach to understanding children’s experiences from a developmental perspective. Further, focus groups free children and investigator from the data-gathering limitations placed by literacy/reading levels that plague quantitative methods using self-report. By using relatively homogeneous groups, common cultural, emotional, and cognitive processes and responses are revealed that normally would not come to light in structured data collection. Focus groups offer a rich, interactive and developmentally effective approach to planning, content and evaluation in research with children.

Family Functioning, Parenting Style, and Chinese Children’s Weight Status:

Childhood obesity is an important health problem affecting Chinese and Chinese American children. A cross-sectional study examined factors that contributed to children’s weight status in Taiwan and the United States. Participants were 163 Chinese children (ages 8 to 10 years) and their mothers. Mothers in both countries completed basic demographic questions and the Family Assessment Device and Attitudes Toward Child-Rearing Scale. U.S. mothers also completed the Suinn-Lew Asian Self-Identity Acculturation Scale. Children had their weight and height measured and also completed the Children Self-Administered Physical Activity Checklist, Food Frequency Questionnaire, and Schoolager’s Coping Strategies Inventory. Multiple regression analyses indicated that five variables significantly contributed to the variance in children’s body mass index: older age (10%), being a boy (5.8%), more democratic parenting style (7.4%), poor communication (8.4%), and poor behavior control (3%). Families with clear communication, adequate behavior control, and structured parenting help to regulate their children’s healthy behavior.

Changes in Children’s Reports of Symptom Occurrence and Severity During a Course of Myelosuppressive Chemotherapy

The purposes of this study in children who underwent a cycle of myelosuppressive chemotherapy were to describe changes in symptom occurrence and severity during the chemotherapy cycle. Patients (N = 66) 10 to 18 years of age completed the Memorial Symptom Assessment Scale for 10- to 18-year-olds (MSAS 10-18) at the start of a chemotherapy cycle (T1) and weekly for the next 2 weeks (T2 and T3). More than 30% of children reported 10 or more symptoms at all 3 time points. Symptom occurrence trajectories were tested with multilevel logistic regression. In all, 6 symptoms (ie, fatigue, sadness, irritability, worrying, weight loss, sweating) showed a decreasing linear trend. Significant quadratic patterns of change were found for feeling drowsy, nausea, and vomiting. Changes in symptom severity over time were evaluated with multilevel negative binomial regression. No significant differences over time were found in any of the symptom severity scores on the MSAS. Children experienced a high number of symptoms at the initiation of a chemotherapy cycle that persisted over the subsequent 2 weeks.

Promotion of physical activity in children.

Purpose of review Promotion of physical activity continues to be recommended as an essential component of obesity treatment and prevention interventions. This review explores recent updates in the area of physical activity promotion and its impact on the physical and mental health consequences of childhood obesity. Recent findings Despite the availability of opportunities for physical activity in the school environment, namely recess and physical education classes, students do not appear to be meeting activity recommendations at school alone. Access to neighborhood parks may increase levels of physical activity and reduce time spent in sedentary behaviors at home. Less time spent watching television and in other sedentary behaviors such as playing videogames may contribute to higher rates of physical activity. Frequency of physical activity also appears to be related to improved mental health status, although the direction of this relationship warrants further exploration. Summary Physical activity is an evidence-based intervention that offers benefits to both physical and mental health. Pediatric health care providers are encouraged to engage in discussions with patients and families on the topic of physical activity and to assist them in finding ways to incorporate activity into daily life.

Multiple Symptoms in Pediatric Oncology Patients: A Systematic Review

Clinical experience suggests that children with cancer experience multiple symptoms as a result of their disease and/ or its treatment. These symptoms may have a negative impact on children’s ability to function and on their quality of life. No systematic review has summarized the findings from studies that assessed multiple symptoms in these patients. The purposes of this article are to summarize the findings from the studies of multiple symptoms in pediatric oncology patients and to describe directions for future research. Although there has been a recent increase in the studies of the multiple symptoms in pediatric cancer patients, only 9 studies were found that met the inclusion criteria for this review. Thus, little is known about the relationships between demographic and clinical characteristics and the occurrence of multiple symptoms. Additional research is warranted on the prevalence and impact of multiple symptoms, particularly among homogeneous samples of patients. Future directions for symptom studies in pediatric oncology include symptom cluster research and the search for biological bases for the untoward effects of cancer treatment.

Meta analysis: effects of interventions on premature infants feeding.

Nipple feeding of premature infants presents a challenge to neonatal nurses who are trying to prepare the infants for eventual discharge from the hospital. To determine what empirical evidence there was to support interventions that positively influence feeding performance and feeding efficiency a meta-analysis is presented. The effects of NPO, nasogastric tubes, different nipples, breast versus bottle feeding, gestational age, oral support, oral stimulation, and nonnutritive sucking on volume intake are evaluated. The results suggest that nursing care should: (a) consider the infants gestational age; (b) maturational ability and development; (c) keep track of and attempt to minimize the length of time an infant is NPO; and (d) provide prefeeding oral stimulation and oral support.

Promotion of physical activity in primary care for obesity treatment/prevention in children.

Purpose of review Physical activity has been highlighted internationally as a beneficial intervention for weight control and the improvement of physical and mental health. This review highlights findings from recent literature to guide office-based promotion of physical activity for obesity treatment and prevention. Recent findings Children worldwide participate in far less than the current physical activity recommendations. Family-based activity provides children with positive role modeling as well as motivational support for maintaining an active lifestyle. The integration of physical activity into daily life can be an effective alternative to sports and structured exercise programs. Decreasing sedentary behaviors is also a positive contribution, although its link to physical activity levels is still unclear. Some families may see neighborhood safety and access to recreational facilities as barriers to keeping their children physically active. Summary Research in the field of pediatric obesity and overweight treatment and prevention continues to find challenges and solutions. Promotion of physical activity by the pediatric provider is demonstrated by current evidence to be a positive intervention against this global problem.

Correlates of physical fitness and activity in Taiwanese children

AIM This cross-sectional study examined factors related to childrens physical fitness and activity levels in Taiwan. METHODS A total of 331 Taiwanese children, aged 7 and 8, and their mothers participated in the study. Children performed physical fitness tests, recorded their physical activities during two weekdays and completed self-esteem questionnaires. Research assistants measured the childrens body mass and stature. Mothers completed demographic, parenting style and physical activity questionnaires. RESULTS Attending urban school, lower body mass index (BMI), older age and better muscular endurance contributed to the variance in better aerobic capacity, and attending rural school and better aerobic capacity contributed to the variance in better muscular endurance in boys. Attending urban school, lower BMI and better athletic competence contributed to the variance in better aerobic capacity, and younger age, rural school and higher household income contributed to the variance in better flexibility in girls. CONCLUSION Despite the limitations of the study, with many countries and regions, including Taiwan, now emphasizing the importance of improving physical fitness and activity in children, an intervention that is gender-, geographically, and developmentally appropriate can improve the likelihood of successful physical fitness and activity programmes.

Culturally appropriate family assessment: analysis of the Family Assessment Device in a pediatric Chinese population.

As part of a larger study, we investigated the adaptation of the Family Assessment Device (FAD) to a Chinese population of hospitalized children (N = 313) compared to a sample of families with healthy children (N = 29) in Hong Kong and Chinese Mainland. Confirmatory factor analysis and exploratory factor analysis (EFA) were performed to examine the FAD structure. The results supported the notion of cultural variations in measuring family functioning. Eight factors were found to explain 30.34% of the variance in family functioning. The Cronbach’s alphas of families with hospitalized children ranged from 0.29 to 0.74. Similar reliability scores were found in nonhospitalized families. This study indicates that the Chinese FAD has a different factor structure, reliabilities, and mean scores in several subscales compared to U.S. studies. The psychometric properties of the Chinese FAD may be influenced by the fact that the sample was focused on children rather than adults.

The Effect of the Internet on Teen and Young Adult Tobacco Use: A Literature Review

Research has shown that a positive association exists between exposure to smoking imagery, such as that found in movies and print advertising, and the subsequent uptake of cigarette smoking. Children appear to be especially vulnerable to advertising messaging and other positive portrayals of smoking, given that most adult smokers develop the habit before age 18 years. Although many traditional types of media have been studied, the current generation of youth is growing up as digital natives, with young people increasingly using the Internet for entertainment and to obtain information. Currently the Internet is an essentially unregulated marketplace of ideas and images. However, the effect of the Internet on teen smoking initiation has received little attention in studies. In this literature review, we summarize and critique the existing work, identify current knowledge gaps, and offer suggestions to health care providers about how to address this issue.