Dodi Meyer

How a Community-Based Organization and an Academic Health Center Are Creating an Effective Partnership for Training and Service

Community–academic partnerships in the training of doctors offer unique learning opportunities of great importance. Such partnerships can induce a paradigm shift such that physicians view community as a teaching resource and partner rather than as a passive recipient of services or solely as a placement site. The authors describe a model of a community–academic partnership in New York City, begun in 1995, in which, for training and service, pediatric residents are integrally involved in a community-based program. Principles adapted from the Community-Campus Partnerships for Healths principles of partnership provide a framework for portraying the essential elements of developing and maintaining the partnership. The authors explain the clashes that may arise between partners and show how the principles of partnership guide partnership members in working and learning within a setting that by its nature entails conflict and inequality. This report is based on the knowledge gained from the structured reflections of both members of this partnership: the residency program at a large academic health center and the community-based social service organization. Such partnerships provide the training ground for the development of physicians who understand the social and cultural determinants of health and constructively use community agencies’ input in promoting child health and well-being. Within this framework, community-based organizations are not solely service providers but become educators of physicians-in-training who, with new knowledge gained through the partnership, more effectively contribute to the overall health of the communities they serve.

Attitudes and Decision Making About Neonatal Male Circumcision in a Hispanic Population in New York City

Objective. To understand attitudes and decision making regarding neonatal male circumcision. Methods. Parents (n = 150) with a son 3 years old were interviewed regarding demographics, communication with a medical provider, attitudes, and process by which the neonatal circumcision decision was made. Results. Thirty-three percent of sons were circumcised. In univariate analyses, choosing male circumcision was associated with parents being interviewed in English, the father being circumcised, positive attitudes, being informed of the advantages of circumcision, making a decision before birth, and being offered a choice. In the final model, parents who came from a culture and family that believed in circumcision and who believed that it was not too risky were more likely to circumcise their sons. Conclusions. Decisions regarding circumcision appear to be influenced by values, risk perceptions, and medical providers. Future research should address ways of ensuring that families have the opportunity to make an informed decision.

Childhood Poverty and Its Effect on Health and Well-being: Enhancing Training for Learners Across the Medical Education Continuum

OBJECTIVE Childhood poverty is unacceptably common in the US and threatens the health, development, and lifelong well-being of millions of children. Health care providers should be prepared through medical curricula to directly address the health harms of poverty. In this article, authors from The Child Poverty Education Subcommittee (CPES) of the Academic Pediatric Association Task Force on Child Poverty describe the development of the first such child poverty curriculum for teachers and learners across the medical education continuum. METHODS Educators, physicians, trainees, and public health professionals from 25 institutions across the United States and Canada were convened over a 2-year period and addressed 3 goals: 1) define the core competencies of child poverty education, 2) delineate the scope and aims of a child poverty curriculum, and 3) create a child poverty curriculum ready to implement in undergraduate and graduate medical education settings. RESULTS The CPES identified 4 core domains for the curriculum including the epidemiology of child poverty, poverty-related social determinants of health, pathophysiology of the health effects of poverty, and leadership and action to reduce and prevent povertys health effects. Workgroups, focused on each domain, developed learning goals and objectives, built interactive learning modules to meet them, and created evaluation and faculty development materials to supplement the core curriculum. An editorial team with representatives from each workgroup coordinated activities and are preparing the final curriculum for national implementation. CONCLUSIONS This comprehensive, standardized child poverty curriculum developed by an international group of educators in pediatrics and experts in the health effects of poverty should prepare medical trainees to address child poverty and improve the health of poor children.

The Healthy Schools Healthy Families Program - Physical Activity Integration Into Elementary Schools In New York City

Increasing physical activity delivers proven results in combating childhood obesity. The high prevalence of childhood obesity and the lack of effective treatment mandate a prevention approach that targets all children. School based programming is an important tool to reach all children. Healthy Schools Healthy Families (HSHF) partnered with teachers, community groups and school leadership to increase physical activity during school hours, targeting all children in seven low resource inner city schools. The intervention targeted 5000 children in seven inner city schools in New York City. Results are reported from 2009-2010. A multi-faceted approach targeted in-class, recess and gym time with programming varying from school to school, tailored to specific school needs. Minutes of physical activity were tracked using a classroom-based logging system, with incentives provided to teachers, school-aides and schools documenting the most activity. HSHF schools averaged 110.8 minutes/week/class with significant variation between schools. HSHF successfully generated by, at all school levels, with 2010 data reaching the CDC recommendation for physical activity during school hours, despite severe resource limitations in program schools. HSHF offers a feasible model for increasing activity for all children in low-resource, inner city schools and for tracking results.

Improving the Proficiency of Research Consent Administrators

To describe the development and testing of a module to improve consent administrators’ skills when obtaining research consent from culturally and linguistically diverse and low literacy populations.

In-classroom physical activity and its impact on physical activity outside of school in a Hispanic community.

BACKGROUND School-based physical activity programs can reach large populations of at-risk children however evidence for the sustainability of healthy behaviors as a result of these programs is mixed. Healthy Schools Healthy Families (HSHF) is a physical activity and nutrition program for elementary students in a predominantly minority community. The program includes short teacher led classroom-based physical activities, also known as Transition Exercises (TE). Our aim was to assess whether TE was associated with childrens reported recreational physical activity outside of school. METHODS We surveyed HSHF students in grade 5 (n = 383) about their recreational physical activity at the start and end of the school year. Multivariable analysis was used to determine what factors including TE contributed to their reported activity. RESULTS Students were predominantly Hispanic with a mean age of 10 ± .03. There was an increase in reported recreational physical activity from the start to the end of the school year (73.6% to 82.4%, P < .05). Students who participated in more TE had a 2.75 times greater odds of reporting participation in recreational activity than students who participated in less TE. CONCLUSIONS For students in HSHF, TE was significantly associated with an increase in recreational physical activity.

Wellness Councils Build Capacity for School-Based Obesity Prevention in Harlem and Washington Heights, New York City:

Schools experience barriers when implementing wellness policies, and there is a dearth of research detailing how district wellness policies are implemented at the school level. Wellness councils were established in 7 elementary schools in Harlem and Washington Heights, New York City (NYC), to help these schools implement the NYC district wellness policy. Data on 4 wellness council process indicators and wellness council self-evaluation scores were correlated with obesity prevention process outcomes using Kendall tau correlations. An average of 8.9 (standard deviation = 0.7) wellness council meetings were held per school throughout the 10-month academic year. The average attendance at each meeting ranged from 7.1 to 15.2 members. There was a positive relationship between wellness council attendance and the number of participant encounters at staff physical activity events (r = .71, P = .02). Higher self-evaluation scores on staff wellness initiatives were associated with more student nutrition encounters (...