Eloise Elliott

Universal versus targeted blood cholesterol screening among youth: The CARDIAC project.

OBJECTIVES: The goal was to determine the sensitivity and specificity of family history in identifying children with severe or genetic hyperlipidemias in a rural, predominantly white population. METHODS: A total of 20266 fifth-grade children in West Virginia, from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project, who completed a family history and fasting lipid profile were used in analyses. The relationship between hyperlipidemia and family history was determined, and the use of family history to predict the need for pharmacologic treatment among children with dyslipidemia was evaluated. RESULTS: A total of 71.4% of children met the National Cholesterol Education Program (NCEP) guidelines for cholesterol screening on the basis of positive family history. Of those, 1204 (8.3%) were considered to have dyslipidemia (low-density lipoprotein ≥130 mg/dL), and 1.2% of these children with dyslipidemia warranted possible pharmacologic treatment (low-density lipoprotein ≥160 mg/dL). Of the 28.6% who did not have a positive family history (did not meet NCEP guidelines), 548 (9.5%) had dyslipidemia, 1.7% of whom warranted pharmacologic treatment. Sensitivity and specificity data demonstrated that family history does not provide a strong indication as to whether pharmacologic treatment may be warranted. CONCLUSIONS: Results indicate that the use of family history to determine the need for cholesterol screening in children would have (1) missed many with moderate dyslipidemia and (2) failed to detect a substantial number with likely genetic dyslipidemias that would require pharmacologic treatment. The use of universal cholesterol screening would identify all children with severe dyslipidemia, allowing for proper intervention and follow-up and leading to the prevention of future atherosclerotic disease.

Effects of a Web-Based Health Program on Fifth Grade Children's Physical Activity Knowledge, Attitudes and Behavior.

Abstract American children continue to be less physically active than they were a decade ago. Web-based programs (e-Learning), requiring minimal teacher training and expertise, could contribute to improvements in childrens health-related knowledge, attitudes and behaviors. The purpose of this study was to evaluate the impact of the e-Learning module Healthy Hearts 4 Kids (HH) on the physical activity knowledge, attitudes and behaviors of 233 fifth grade children. A 2×3 repeated measures design was employed and significant changes in knowledge and attitude were found upon completion of the module and also six weeks after the post-test was completed. Results of this study suggest HH could be an effective component of a coordinated school health program (CSHP).

Individual-, Family-, Community-, and Policy-Level Impact of a School-Based Cardiovascular Risk Detection Screening Program for Children in Underserved, Rural Areas: The CARDIAC Project

The Coronary Artery Risk Detection In Appalachian Communities (CARDIAC) Project has screened more than 80,000 children (10–12 years) for cardiovascular and diabetes risk factors over the past 15 years. Simultaneous referral and intervention efforts have also contributed to the overall program impact. In this study, we examined evidence of programmatic impact in the past decade at the individual, family, community, and policy levels from child screening outcomes, referral rates, participation in subsequent services, and policies that embed the activities of the project as a significant element. Within this period of time, fifth-grade overweight and obesity rates were maintained at a time when rates elsewhere increased. 107 children were referred for additional screening and treatment for probable familial hypercholesterolemia (FH); 82 family members were subsequently screened in family-based screening efforts. 58 grants were distributed throughout the state for community-appropriate obesity intervention. A state wellness policy embedded CARDIAC as the method of assessment and national child cholesterol screening guidelines were impacted by CARDIAC findings. The sustainability and successful impact of this school-based program within a largely underserved, rural Appalachian state are also discussed.

Involving Families and Communities in CSPAP Development Using Asset Mapping.

The purpose of this article is to provide an introduction to asset mapping as a systematic approach to facilitating increased family and community involvement in comprehensive school physical activity programs (CSPAP). It includes a brief summary of the literature related to the importance of family and community in childrens physical activity promotion, an introduction to community asset mapping as a capacity-building tool, and a sample CSPAP application including key lessons learned.

Screening for Hypercholesterolemia in Children: What Strategies Can Be Employed

Purpose of ReviewFamilial hypercholesterolemia (FH) is an important, treatable cause of elevated LDL cholesterol that can be remediated to lower risk of premature coronary artery disease.Recent FindingsStrategies for identification include universal screening, cascade screening of relatives of persons found with either early cardiovascular disease (CVD) or LDL-C consistent with FH, and big data approaches to identify persons with high cholesterol and premature CVD.SummaryUniversal screening of children is advocated to find FH at an early age with still asymptomatic parents and negative family history.

The Perceived Impact of I am Moving, I am Learning on Physical Activity and Family Involvement: A Preliminary Investigation

OBJECTIVES The purpose of this study was to determine the perceived impact of I am Moving, I am Learning (IMIL) on physical activity (PA) levels, along with family and community involvement in a Head Start program in Illinois. METHODS Employing qualitative methods, data were collected via a parent/caregiver survey and program staff focus groups in Rock Island, Illinois. RESULTS IMIL was perceived to have made an impact in several areas including knowledge, health-related behaviors, and supportive school and home environments. A positive impact also was reported regarding 6 types of family involvement (parenting, communicating, decision making, volunteering, community collaboration, and learning at home). CONCLUSIONS Participants in the study reported that IMIL contributed to increased levels of PA and family/community involvement. The participants perceived that the use of IMIL helped parents/caregivers and their children become healthier, by improving the whole familys activity levels. Faculty and staff also reported that there were few barriers related to the implementation and sustainability of IMIL use in childcare settings.

An Evaluability Assessment of the West Virginia Physical Activity Plan, 2015: Lessons Learned for Other State Physical Activity Plans

Background The US National Physical Activity Plan (NPAP) was released in 2009 as a national strategic plan to increase physical activity (PA). The NPAP emphasized implementing state and local PA programs. Dissemination of information about NPAP has been limited, however. Community Context West Virginia is a predominantly rural state with high rates of chronic diseases associated with physical inactivity. In 2015 an evaluability assessment (EA) of the West Virginia Physical Activity Plan (WVPAP) was conducted, and community stakeholders were invited to participate in updating the plan. Methods A good EA seeks stakeholder input, assists in identifying program areas that need improvement, and ensures that a full evaluation will produce useful information. Data for this EA were collected via national stakeholder interviews, document reviews, discussions among workgroups consisting of state and local stakeholders, and surveys to determine how well the WVPAP had been implemented. Outcome The EA highlighted the need for WVPAP leaders to 1) establish a specific entity to implement local PA plans, 2) create sector-specific logic models to simplify the WVPAP for local stakeholders, 3) evaluate the PA plan’s implementation frequently from the outset, 4) use quick and efficient engagement techniques with stakeholders when working with them to select strategies, tactics, and measurable outcomes, and 5) understand the elements necessary to implement, manage, and evaluate a good PA plan. Interpretation An EA process is recommended for other leaders of PA plans. Our project highlights the stakeholders’ desire to simplify the WVPAP so that it can be set up as a locally driven process that engages communities in implementation.