Colleen E. Huebner

Promoting Toddlers' Language Development Through Community-Based Intervention

Abstract This study evaluated an adaptation of a developmentally based, 6-week parent–child reading program (“dialogic reading”) demonstrated to facilitate vocabulary and syntactic skills of toddlers, including those at risk for language problems. In this study, dialogic reading was modified for broad dissemination through four branches of a city library system. Childrens librarians taught parents the reading techniques in two 1-hour sessions. The study design was an efficacy trial with two thirds of families randomly assigned to the dialogic reading condition n = 88 and one third to a comparison condition. The comparison condition was comprised of existing library services for parents and children n = 41 . Analysis of baseline to post-test change showed a significant intervention-group effect on parent–child reading style and childrens expressive language. In addition, at a 3-month follow-up assessment, parents in the dialogic reading group reported less parenting stress, specifically stress resulting from characteristics of their child.

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born African-American women (n = 403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important socio-demographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

Jail incarceration and birth outcomes

This study examined the relationships between jail incarceration during pregnancy and infant birth weight, preterm birth, and fetal growth restriction. We used multivariate regression analyses to compare outcomes for 496 births to women who were in jail for part of pregnancy with 4,960 Medicaid-funded births as matched community controls. After adjusting for potential confounding variables, the relationship between jail incarceration and birth outcomes was modified by maternal age. Relative to controls, women incarcerated during pregnancy had progressively higher odds of low birth weight and preterm birth through age 39 years; conversely, jail detainees older than 39 years were less likely than controls to experience low birth weight or preterm birth. For women in jail at all ages, postrelease maternity case management was associated with decreased odds of low birth weight, whereas prenatal care was associated with decreased odds of preterm birth. Local jails are important sites for public health intervention. Efforts to ensure that all pregnant women released from jail have access to enhanced prenatal health services may improve perinatal outcomes for this group of particularly vulnerable women and infants.

Our Community in Focus The Use of Photovoice for Youth-Driven Substance Abuse Assessment and Health Promotion

The successful development and implementation of prevention curricula requires seeking strategies that combine the strengths of researchers and community members. Because young people are considered to be the experts in their own lives, it is important to determine effective ways to engage them in substance abuse assessment and prevention initiatives. The community-based participatory action research methodology of photovoice is one way to engage youth in assessment of this public health issue. “Our Community in Focus” was a project that used the photovoice methodology to engage high school youth in a community-based assessment of adolescent substance use and abuse. Through the photovoice method, youth were able to reflect their community’s strengths and concerns with regards to adolescent substance abuse, as they took photographs to answer the question “What contributes to adolescents’ decisions to use or not to use alcohol and other drugs?” The youth and the community were highly receptive to the project and its methodology, and photographs taken by photovoice participants presented a compelling argument for action.

Future Directions in Leadership Training of MCH Professionals: Cross-Cutting MCH Leadership Competencies

Leadership in Maternal and Child Health (MCH) requires a repertoire of skills that transcend clinical or academic disciplines. This is especially true today as leaders in academic, government and private settings alike must respond to a rapidly changing health environment. To better prepare future MCH leaders we offer a framework of MCH leadership competencies based on the results of a conference held in Seattle in 2004, MCH Working Conference: The Future of Maternal and Child Health Leadership Training. The purpose of the conference was to articulate cross-cutting leadership skills, identify training experiences that foster leadership, and suggest methods to assess leadership training. Following on the work of the Seattle Conference, we sub-divide the 12 cross-cutting leadership competencies into 4 “core” and 8 “applied” competencies, and discuss this distinction. In addition we propose a competency in the knowledge of the history and context of MCH programs in the U.S. We also summarize the conference planning process, agenda, and work group assignments leading to these results. Based on this leadership competency framework we offer a definition of an MCH leader, and recommendations for leadership training, assessment, and faculty development. Taken as a set, these MCH leadership competencies point towards the newly-emerging construct of capability, the ability to adapt to new circumstances and generate new knowledge. “Capstone” projects can provide for both practice and assessment of leadership competencies. The competency-based approach to leadership that has emerged from this process has broad relevance for health, education, and social service sectors beyond the MCH context.

Oral health in pregnancy: educational needs of dental professionals and office staff.

OBJECTIVE Dental care during pregnancy is important for pregnant women and their children. Comprehensive guidelines for the provision of dental services for pregnant patients were published in 2006, but there is relatively little information about their use in actual practice. The aim of this study was to examine differences in knowledge and attitudes regarding dental care in pregnancy among dentists, dental hygienists, dental assistants, and nonclinical office staff. A secondary aim was to identify sources of influence on attitudes and knowledge regarding the guidelines. METHODS A survey was used to collect information from 766 employees of a Dental Care Organization based in Oregon; responses from 546 were included in the analyses reported here. RESULTS Statistically significant differences in knowledge were found among the professional-role groups. Dentists and hygienists consistently answered more items correctly than did other respondents. Within all professional-role groups, knowledge gaps existed and were most pronounced regarding provision of routine and emergency services. Positive perceptions of providing dental care during pregnancy were associated with higher knowledge scores (z = 4.16, P < 0.001). CONCLUSIONS Updated dental education and continuing education for all dental office personnel are needed to promote the diffusion of current evidence-based guidelines for dental care during pregnancy.

Variations in Children’s Dental Service Use Based on Four National Health Surveys

OBJECTIVE: To compare estimates of dental service use and delayed dental care across 4 national surveys of children’s health. METHODS: Among children 2 to 17 years of age, prevalence estimates of the use of any dental services, preventive dental services, and delayed dental care in the past year were obtained from the 2003 and 2007 National Survey of Children’s Health, the 2003–2004 National Health and Nutrition Examination Survey (NHANES), the 2003 and 2007 National Health Interview Survey, and the 2003 and 2007 Medical Expenditure Panel Survey. Trends in parent-reported dental use, including delayed care, by sociodemographic characteristics were assessed by using logistic regression and odds ratios. RESULTS: Data collection methodologies varied across the 4 surveys, and estimates of dental service use varied accordingly. Surveys differed in the survey items used, recall time frames, and protocols for eliciting visit history. As a result, estimates of any dental use ranged from 52% to 81%, whereas estimates of preventive dental use ranged from 67% to 78%. Rates of delayed dental care were low, ranging from 3% to 8%; however, surveys showed consistent sociodemographic disparities in use of dental services and delayed dental care. CONCLUSIONS: Each survey has a unique approach to defining and eliciting parents’ reports of children’s dental service use, which could result in under- or overestimation of the number and nature of children’s dental services. Each survey’s methodology must be considered when accepting population-based estimates of dental service use to monitor progress in achieving national oral health goals.

Health-related quality of life in children with intestinal failure.

Objectives: Survival of infants with intestinal failure (IF) has increased in the past decade; however, data on their health-related quality of life (HRQOL) are lacking. We hypothesized that HRQOL would be lower among children with IF compared with that of healthy children. Methods: We performed a cross-sectional study of the HRQOL of children enrolled in the outpatient intestinal rehabilitation program at Seattle Childrens Hospital using the PedsQL 4.0 Generic Core Scales parent proxy-report and the Family Impact Module questionnaires. Parents were asked 2 open-ended questions pertaining to the suitability and completeness of the PedsQL to assess their and their childs HRQOL. Results: Parents of 23 children with IF completed the questionnaires. Compared with norms for healthy children, parents reported significantly lower total PedsQL scores for children ages 1 to 2 years (mean difference −13.16, 95% confidence interval [CI] −21.86 to −4.46; P = 0.003) and 2 to 6 years (mean difference −15.57, 95% CI −22.66 to −8.48; P < 0.001). Scores were also lower for children younger than 1 year (mean difference −6.43, 95% CI −13.93 to 1.07), although this test was not statistically significant. No measured demographic or clinical characteristics were associated with HRQOL. The majority of parents (65%) said the PedsQL failed to address important effects of IF on children and their families. Conclusions: Children with IF and their parents have a decreased HRQOL compared with healthy children as measured by the PedsQL survey. A disease-specific module or separate HRQOL questionnaire is needed for a more comprehensive assessment of HRQOL in children with IF.

Treatment fidelity of brief motivational interviewing and health education in a randomized clinical trial to promote dental attendance of low-income mothers and children: Community-Based Intergenerational Oral Health Study “Baby Smiles”

BackgroundFidelity assessments are integral to intervention research but few published trials report these processes in detail. We included plans for fidelity monitoring in the design of a community-based intervention trial.MethodsThe study design was a randomized clinical trial of an intervention provided to low-income women to increase utilization of dental care during pregnancy (mother) or the postpartum (child) period. Group assignment followed a 2 × 2 factorial design in which participants were randomly assigned to receive either brief Motivational Interviewing (MI) or Health Education (HE) during pregnancy (prenatal) and then randomly reassigned to one of these groups for the postpartum intervention. The study setting was four county health departments in rural Oregon State, USA. Counseling was standardized using a step-by-step manual. Counselors were trained to criteria prior to delivering the intervention and fidelity monitoring continued throughout the implementation period based on audio recordings of counselor-participant sessions. The Yale Adherence and Competence Scale (YACS), modified for this study, was used to code the audio recordings of the counselors’ delivery of both the MI and HE interventions. Using Interclass Correlation Coefficients totaling the occurrences of specific MI counseling behaviors, ICC for prenatal was .93, for postpartum the ICC was .75. Participants provided a second source of fidelity data. As a second source of fidelity data, the participants completed the Feedback Questionnaire that included ratings of their satisfaction with the counselors at the completion of the prenatal and post-partum interventions.ResultsCoding indicated counselor adherence to MI protocol and variation among counselors in the use of MI skills in the MI condition. Almost no MI behaviors were found in the HE condition. Differences in the length of time to deliver intervention were found; as expected, the HE intervention took less time. There were no differences between the overall participants’ satisfaction ratings of the HE and MI sessions by individual counselor or overall (p > .05).ConclusionsTrial design, protocol specification, training, and continuous supervision led to a high degree of treatment fidelity for the counseling interventions in this randomized clinical trial and will increase confidence in the interpretation of the trial findings.Trial registrationClinicalTrials.gov: NCT01120041

Estimating determinants of dentist productivity: new evidence.

OBJECTIVE Productivity (output per unit of input) is a major driver of dental service capacity. This study uses 2006-2007 data to update available knowledge on dentist productivity. METHODS In 2006-2007, the authors surveyed 1,604 Oregon general dentists regarding-hours worked, practice size, payment and patient mix, prices, dentist visits, and dentist characteristics. Effects of practice inputs and other independent variables on productivity were estimated by multiple regression and path analysis. RESULTS The survey response rate was 55.2 percent. Dentists responding to the productivity-related questions were similar to dentists in the overall sampling frame and nationwide. Visits per week are significantly positively related to dentist hours worked, number of assistants, hygienists, and number of operatories. Dentist ownership status, years of experience, and percentage of Medicaid patients are significantly positively related to practice output. The contributions of dentist chairside time and assistants to additional output are smaller for owners, but the number of additional dentist visits enabled by more hygienists is larger for owners. CONCLUSION As in earlier studies of dental productivity, the key determinant of dentist output is the dentists own chairside time. The incremental contributions of dentist time, auxiliaries, and operatories to production of dentist visits have not changed substantially over the past three decades. Future studies should focus on ultimate measures of output--oral health--and should develop more precise measures of the practices actual utilization of auxiliaries and their skill and use of technology.