Darcy A. Thompson

The Association Between Television Viewing and Irregular Sleep Schedules Among Children Less Than 3 Years of Age

Background. Regular sleep schedules are an important part of healthy sleep habits. Although television viewing is associated with altered sleep patterns and sleep disorders among children and adolescents, the effect of television viewing on the sleep patterns of infants and toddlers is not known. Objective. To test the hypothesis that television viewing by infants and toddlers is associated with having irregular naptime and bedtime schedules. Methods. We used data from the National Survey of Early Childhood Health, a nationally representative, cross-sectional study of the health and health care of children 4 to 35 months of age. Our main outcome measures were whether children had irregular naptime and bedtime schedules. Our main predictor was hours of television watched on a daily basis. We performed multivariate logistic regression analyses, adjusting for a variety of factors including demographic information, measures of maternal mental health, and measures of family interactions, to test the independent association of television viewing and irregular naptime and bedtime schedules. Results. Data were available for 2068 children. Thirty-four percent of all children had irregular naptime schedules, and 27% had irregular bedtime schedules. Mean hours of television viewing per day were as follows: 0.9 hours/day (95% confidence interval [CI]: 0.8–1.0 hours/day) for children <12 months of age, 1.6 hours/day (95% CI: 1.4–1.8 hours/day) for children 12 to 23 months of age, and 2.3 hours/day (95% CI: 2.1–2.5 hours/day) for children 24 to 35 months of age. In our logistic regression model, the number of hours of television watched per day was associated with both an irregular naptime schedule (odds ratio: 1.09; 95% CI: 1.01–1.18) and an irregular bedtime schedule (odds ratio: 1.13; 95% CI: 1.04–1.24). Conclusions. Television viewing among infants and toddlers is associated with irregular sleep schedules. More research is warranted to determine whether this association is causal.

Why Do Women Use Intimate Partner Violence? A Systematic Review of Women’s Motivations

Studies report that women use as much or more physical intimate partner violence (IPV) as men. Most of these studies measure IPV by counting the number of IPV acts over a specified time period, but counting acts captures only one aspect of this complex phenomenon. To inform interventions, women’s motivations for using IPV must be understood. A systematic review, therefore, was conducted to summarize evidence regarding women’s motivations for the use of physical IPV in heterosexual relationships. Four published literature databases were searched, and articles that met inclusion criteria were abstracted. This was supplemented with a bibliography search and expert consultation. Eligible studies included English-language publications that directly investigated heterosexual women’s motivations for perpetrating nonlethal, physical IPV. Of the 144 potentially eligible articles, 23 met inclusion criteria. Over two thirds of studies enrolled participants from IPV shelters, courts, or batterers’ treatment programs. Women’s motivations were primarily assessed through interviews or administration of an author-created questionnaire. Anger and not being able to get a partner’s attention were pervasive themes. Self-defense and retaliation also were commonly cited motivations, but distinguishing the two was difficult in some studies. Control was mentioned but not listed as a primary motivation. IPV prevention and treatment programs should explore ways to effectively address women’s relationship concerns and ability to manage anger and should recognize that women commonly use IPV in response to their partner’s violence.

Parent Use of Touchscreen Computer Kiosks for Child Health Promotion in Community Settings

OBJECTIVES. The goals were to evaluate the use of touchscreen computer kiosks, containing only child health–promoting information, in urban, low-income, community settings and to characterize the users of these kiosks. METHODS. Three user-driven touchscreen computer kiosks were placed in low-income urban locations in Seattle, Washington, from March 2005 to October 2005. The locations included a public library, a Department of Motor Vehicles office, and a McDonalds restaurant. Users selected age-appropriate modules with prevention information and screening tools. Users entered the age of the child and were presented with age-appropriate modules. On exiting, users were asked to rate their experience and to provide basic demographic data. RESULTS. In total, there were 1846 kiosk sessions. Almost one half occurred at McDonalds. Seventy-eight percent of users identified themselves as first-time users. Users sought information for children of all ages. Sixty-one percent of first-time users explored 1 module. First-time users were most interested in television/media use (16%), smoke exposure (14%), attention-deficit/hyperactivity disorder screening (12%), and asthma assessment (11%). At-risk children were identified in 52% of sessions. Eighty-seven percent of first-time users who completed the asthma assessment had children whose asthma was uncontrolled. Twenty-eight percent of users responded to ≥1 question on the exit survey. Of those, 48% had less than a high school education, and 26% had never used the Internet. Approximately one half found the kiosk easy to use (57%) and the information easy to understand (55%); 66% said there was at least some new information. Fifty-five percent planned to try some of the things they had learned, and 49% intended to talk to their childs doctor about what they had learned. CONCLUSIONS. User-driven computer kiosks were used in community settings to obtain child health information. Users found the kiosks easy to use. Additional study on improving use and understanding the impact is needed.

Television Viewing by Young Hispanic Children: Evidence of Heterogeneity

OBJECTIVES To determine if hours of daily television viewed by varying age groups of young children with Hispanic mothers differs by maternal language preference and to compare these differences with young children with white mothers. DESIGN Cross-sectional analysis of data collected in 2000 from the National Survey of Early Childhood Health. SETTING Nationally representative sample. PARTICIPANTS One thousand three hundred forty-seven mothers of children aged 4 to 35 months. MAIN EXPOSURE Subgroups of self-reported maternal race/ethnicity (white or Hispanic) and within Hispanic race/ethnicity, stratification by maternal language preference (English or Spanish). OUTCOME MEASURE Hours of daily television the child viewed. RESULTS Bivariate analyses showed that children of English- vs Spanish-speaking Hispanic mothers watched more television daily (1.88 vs 1.31 hours, P < .01). Multivariable regression analyses stratified by age revealed differences by age group. Among 4- to 11-month-old infants, those of English- and Spanish-speaking Hispanic mothers watched similar amounts. However, among children aged 12 to 23 and 24 to 35 months, those of English-speaking Hispanic mothers watched more television than children of Spanish-speaking Hispanic mothers (incidence rate ratio [IRR], 1.61; 95% confidence interval [CI], 1.17-2.22; IRR, 1.66; 95% CI, 1.10-2.51, respectively). Compared with children of white mothers, children of both Hispanic subgroups watched similar amounts among the 4- to 11-month-old group. However, among 12- to 23-month-old children, those of English-speaking Hispanic mothers watched more compared with children of white mothers (IRR, 1.57; 95% CI, 1.18-2.11). Among 24- to 35-month-old children, those of English-speaking Hispanic mothers watched similar amounts compared with children of white mothers, but children of Spanish-speaking Hispanic mothers watched less (IRR, 0.69; 95% CI, 0.50-0.95). CONCLUSION Television-viewing amounts among young children with Hispanic mothers vary by child age and maternal language preference, supporting the need to explore sociocultural factors that influence viewing in Hispanic children.

Impact of Language Proficiency Testing on Provider Use of Spanish for Clinical Care

OBJECTIVE: To measure the impact of an objective evaluation of provider Spanish-language skills on self-reported language proficiency and comfort using Spanish in a range of clinical scenarios. METHODS: We enrolled pediatric residents with any self-reported Spanish language ability from 3 residency programs. Participants completed a baseline survey, objective language testing, and a posttest survey. We gathered demographics, self-reported Spanish ability, and comfort using Spanish in various clinical scenarios, which were grouped and analyzed by degree of complexity. Between surveys, a language testing service administered a 20-minute, telephone-based assessment of general Spanish proficiency. Scores were reported on a scale from 1 to 12, with scores ≥9 designated “proficient.” Participants received a numeric score and brief qualitative feedback on their language ability. RESULTS: Following testing, residents (n = 76) were significantly less likely to report comfort using Spanish in straightforward clinical scenarios, from 64% to 51% (P = .007). That difference was accounted for entirely by residents who tested at a non-proficient level (56% to 39%, P = .006). Testing had no impact on comfort using Spanish in complex or medical-legal scenarios, at any proficiency level. We found no change in self-reported Spanish proficiency in any resident group. CONCLUSIONS: Objective Spanish-language testing decreased nonproficient resident comfort using Spanish in straightforward clinical encounters, but it did not change comfort in complex or legal scenarios. In combination with education and enforceable policies, language testing may play an important role in decreasing nonproficient Spanish use and improving care for patients with limited English proficiency.

Clinical Spanish use and language proficiency testing among pediatric residents.

Purpose To describe patterns of clinical Spanish use by pediatric residents, and to compare self-assessment of language proficiency against an objective language test. Method In 2010, the authors e-mailed a survey to all 247 pediatric residents at three institutions, inviting those with any level of Spanish language ability to participate. Participants completed a survey reporting Spanish proficiency, interpreter use, and comfort using Spanish in a range of clinical scenarios. Clinical scenarios were grouped and analyzed by degree of complexity. Self-reported Spanish proficiency was compared with tested proficiency, as measured by a 20-minute telephone assessment of general language ability. Scores were categorized as “not proficient,” “proficient,” and “highly proficient.” Results Of the 247 residents, 78 (32%) participated, self-reporting a range of Spanish skills; 23% of those reported spoken proficiency (“proficient” or “fluent”). Participants at all levels of proficiency reported using Spanish without interpretation, including 63% of those who were not proficient. The majority (56%) of nonproficient residents reported comfort using Spanish in straightforward clinical scenarios, and 10% reported comfort in clinical scenarios with legal implications. Self-reported proficiency had a positive predictive value of 67% for testing at a proficient level and 22% for testing at a highly proficient level. Conclusions Regardless of level of Spanish proficiency, pediatric residents provide clinical care to patients in Spanish. Self-reported Spanish proficiency does not reliably predict tested ability, especially when using stringent criteria to define proficiency. Provider language “credentialing” is an important step in implementing a policy to improve care for limited English proficiency patients.

Caring for patients with limited English proficiency: are residents prepared to use medical interpreters?

Purpose To evaluate whether educational sessions on interpreter use and experience with interpreters are associated with resident self-efficacy in the use of professional interpreters. Method In 2010, the authors surveyed residents from seven pediatric residency programs. Their 29-item survey collected data on training and experience with interpreters and self-efficacy in (1) determining when an interpreter is needed and (2) using a professional interpreter. The authors conducted bivariate and multivariate regression analyses. Results Among the 271 respondents, 82% reported that ≥ 10% of their patients had limited English proficiency (LEP), 53% indicated they had “a lot” of experience with interpreters, and 54% reported never receiving any educational sessions on interpreter use. The majority reported high self-efficacy in knowing when an interpreter is needed (69%) and in using an interpreter (68%). Residents reporting a high experience level with interpreters were more likely to report high self-efficacy in knowing when an interpreter is needed (odds ratio [OR] = 1.85; 95% confidence interval[CI] = 1.03–3.32) and in using an interpreter (OR = 3.97; 95% CI = 1.19–13.31). Formal training on using interpreters was also associated with high self-efficacy in interpreter use(OR = 1.62; 95% CI = 1.22–2.14). Conclusions Many residents who care for patients with LEP have never received educational sessions on interpreter use. Such training is associated with high self-efficacy and may enhance patient–provider communication. Incorporating this training into residency programs is necessary to equip providers with skills to communicate with patients and families with LEP.

Television Viewing in Low-Income Latino Children: Variation by Ethnic Subgroup and English Proficiency

BACKGROUND Television viewing is associated with an increased risk for obesity in children. Latino children are at high risk for obesity and yet little is known about differences in television viewing habits within this population. The purpose of this study is to determine if hours of television viewed by young children with low-income Latina mothers differs by maternal ethnic subgroup and English language proficiency. METHODS This was a cross-sectional analysis of data from the Welfare, Children, & Families: A Three City Study. Participants were 422 low-income Latina mothers of Mexican and Puerto Rican descent with children ages 0-4 years old. The dependent variable was hours of daily television viewed by the child. The independent variable was maternal ethnic subgroup and English language proficiency. Analyses involved the use of multiple negative binomial regression models, which were adjusted for demographic variables. RESULTS Multivariable regression analyses showed that compared to children with mothers of Mexican descent, children of mothers of Puerto Rican descent watch more daily television (<2 years old, incidence rate ratio (IRR)=4.18, 95% confidence interval (CI) 1.68, 10.42; 2-4 years, IRR=1.54, 95% CI 1.06, 2.26). For children with mothers of Mexican descent, higher maternal English language proficiency was associated with higher amounts of child television viewing (IRR=1.29, 95% CI 1.04, 1.61). No relationship was found for children of Puerto Rican descent. CONCLUSIONS Child television viewing varies in low-income Latino children by maternal ethnic subgroup and English language proficiency. Interventionists must consider the varying sociocultural contexts of Latino children and their influence on television viewing.

Getting Past Getting By: Training Culturally and Linguistically Competent Bilingual Physicians

ffective health care depends on clear communication. It follows that effective health care education must emphasize physicians’ communication skills. For the growing number of limited English-proficient (LEP) patients and families in the United States, health care and health outcomes frequently suffer due to miscommunication. Yet, in our work with LEP families and in our training of physicians to provide them care, we often find ourselves struggling to just “get by.” Physicians and other providers “get by” using less than proficient second language skills. Training programs “get by” with a relative lack of formal education on effective communication with LEP patients and an absence of stated expectations for the use of second languages by resident physicians. Concern for safety, ethical, and legal consequences of getting by have led to national standards mandating the assurance of bilingual providers’ abilities. Despite such mandates, there has been no profession-wide commitment among physicians in the United States to create the systems necessary for such assurance. In most settings, providers wishing to give care in a second language do so at will, without proving proficiency, a practice that can lead to unsafe communication, ineffective health care, and poor health outcomes. Increasing attention has been given to the lack of language assurance over the past decade. Kaiser Permanente recently developed a physician-specific tool for telephone assessment of medical Spanish and cultural competence. Some hospitals have created home-grown systems that evaluate provider language skills and recommend when those skills should be used. However, system-wide there is little structure to aid bilingual physicians in assessing and improving their language skills.

Maternal Beliefs and Parenting Practices Regarding Their Preschool Child’s Television Viewing An Exploration in a Sample of Low-Income Mexican-Origin Mothers

Objective. To explore maternal beliefs about television (TV) viewing and related parenting practices in low-income Mexican-origin mothers of preschoolers. Methods. Semistructured interviews were conducted with 21 low-income Mexican-origin mothers of preschoolers. Interviews were audio recorded and analyzed using a theoretically based thematic analytic approach. Results. Mothers described strong beliefs about the positive and negative impact of TV content. Mothers emphasized the educational value of specific programming. Content restrictions were common. Time restrictions were not clearly defined; however, many mothers preferred short versus long episodes of viewing. Mothers spoke positively about family viewing and the role of TV viewing in enabling mothers to accomplish household tasks. Discussion. These findings have implications for intervening in this population. Interventionists should consider the value mothers place on the educational role of TV viewing, the direct benefit to mothers of viewing time, the lack of clear time limits, and the common practice of family co-viewing.