Jack W. Finney

Children's health care use: a prospective investigation of factors related to care-seeking.

Objectives.To determine the best predictors of the amount of children’s health care use. Research Design. Child health, psychosocial, and family status variables were collected. Families were then followed prospectively for 2 years to gather health care use data. Multivariate regression analysis was used to determine factors related to volume of child health care use. Subjects.367 mothers and children ages 5 to 11 years continuously enrolled in a staff model HMO. Measures.Child health care visits obtained from a computerized database comprised the dependent variable. Independent variables were organized into a 5-component framework including: Demographic Characteristics; Family Characteristics; Child Health and Prior Health Care Use; Child Behavior and Mental Health; and Mothers’ Mental Health and Health Care Use. Results.The volume of a child’s past health care use was the best predictor of future health care use, with the presence of past acute recurring illnesses, child pain and mother’s retrospective health care use also serving as significant predictors in the model. Analysis of a second model was conducted omitting children’s past use of health care. In this model the mother’s worry about child health was the best predictor of use, with child health and child and maternal psychosocial variables significantly contributing to explained variance in the model. Conclusions.This study supports prior research indicating past use is the best predictor of future health care use. In addition, the study suggests that maternal perceptions of child health and maternal emotional functioning influence the decision-making process involved in seeking health care on behalf of children. Effective management of pediatric health care use needs to address broader needs of the child and family beyond solely the child’s health, most notably maternal functioning.

Determinants of children's health care use: An investigation of psychosocial factors.

Factors related to the amount of health care used by 5− to 11-year-old children in a health maintenance organization (HMO) were investigated using a comprehensive multivariate model that assessed the contribution of child health need, mental health, and social functioning; maternal mental health, social support and health care utilization; and family functioning and life events. Mothers reported on the 450 participating children. Health care visits for a two-year retrospective period were obtained from the computerized encounter system.Child health need and maternal patterns of health care use were powerful predictors of the overall amount of health care used, and these factors discriminated high users from low users of care. Family conflict was associated with a higher volume of care, while childrens depressive symptoms and non-white race were related to lower use. Maternal social support, mental health, and life events were not predictive of use in either full multivariate model. Enabling factors were held relatively constant by participation of all families in a prepaid HMO. The multiple regression model explained 33% of the variance in use, slightly more than in previous studies of childrens health care use.When included in a comprehensive analysis, child and family psychosocial characteristics help to explain childrens health care use beyond what is possible using simple health and illness variables. The implications of these findings in the development of further research and to the practice of routine pediatric care are discussed. Key words: childrens health care; pediatrics; utilization; psychosocial factors. (Med Care 1993; 31:767–783)

Prevention of child-to-mother transmission of cytomegalovirus by changing behaviors: a randomized controlled trial.

BACKGROUND To determine whether a behavioral prevention approach reduces child-to-parent transmission of cytomegalovirus. METHODS Subjects were seronegative mothers whose child was less than 36 months of age and was shedding cytomegalovirus. Nonpregnant women were randomly assigned to three groups. Mothers in the education group (E) were given instructions about protective behaviors (frequent hand washing, wearing latex gloves) and risky behaviors to avoid (intimate contact with the child). Disposable diapers, liquid soap and latex gloves were provided. During biweekly home visits glove and soap use were monitored for an indirect objective measure of adherence to the protective behaviors. Throughout the study mothers self-reported the frequency they engaged in protective and risky behaviors. In addition to the procedures for Group E the adherence and education group (A) also received social reinforcement for adherence and problem solving for any perceived problems with the behavioral recommendations. The control group (C) received no intervention. A fourth group of pregnant women received an intervention equivalent to that of the education group. RESULTS Eight of 17 women in Group C and 4 of 11 women in Group E seroconverted. For both E and Group C the average time from enrollment to infection was 4 months (range, 2 to 7 months). Two of 8 women in Group A seroconverted (1 at 3 months and 1 at 8 months). None of 14 pregnant women observed for an average of 8.4 months during pregnancy seroconverted. CONCLUSIONS These results suggest that intervention for pregnant women is effective because pregnant women will perceive a higher risk and be more motivated to adhere to recommendations than nonpregnant women.

Pediatric psychology in primary health care: Brief targeted therapy for recurrent abdominal pain *

Children with recurrent abdominal pain (RAP) are frequent users of medical care services, often seeking care for a variety of illnesses and symptoms. In a clinical replication series, we treated 16 children with RAP who were referred to a primary care-based pediatric psychology service. They received a multi-component targeted therapy, which included self-monitoring, limited parent attention, relaxation training, increased dietary fiber, and required school attendance. After treatment, improvement or resolution of pain symptoms was reported for 13 (81%) children, and school absences were significantly decreased. Medical care utilization significantly decreased after treatment, whereas a comparison group of untreated children with RAP showed no change in medical care visits over time. Brief targeted therapy delivered in a primary health care setting appeared to be effective in reducing a range of problems associated with RAP. A primary care service is an ideal setting for integrating behavioral medicine services into the health care system.

Behavioral treatment of food refusal and selectivity in developmentally disabled children

Abstract Dietary inadequacies involving the consumption of insufficient quantities or types of foods are prevalent among handicapped individuals and may result in excessive weight loss, malnutrition, retardation in growth, and lethargy. Techniques currently used to alleviate the problem may pose additional health risks, do not usually promote appropriate feeding behavior, or have not undergone adequate empirical evaluation. In this study, the highly selective food refusal of two developmentally disabled children was reduced using procedures consisting of delivery of preferred foods as reinforcers, extinction and fading. Results obtained with a multiple baseline design showed increased consumption of all selected foods, as well as decreased food expulsion for both children. These findings indicate that the intervention represented an effective means of treating selective food refusal, and suggest that behavioral methodology and principles may be useful tools in both the assessment and treatment of a variety of eating related disorders.

Matching treatment with recurrent abdominal pain symptoms: An evaluation of dietary fiber and relaxation treatments

We evaluated whether symptoms of recurrent abdominal pain in children provide a basis for treatment selection. Subjects were assigned to dietary fiber or relaxation treatments based upon whether they presented with symptoms of constipation. Elven subjects were treated in a combined multiple baseline and A-B or A-B-C design. As a control, some subjects recived the alternative treatment first. All four subjects with symptoms of constipation showed reductions in the number of stomachaches during the dietary fiber treatment. Of the seven subjects without symptoms of constipation, one showed reductions in stomachaches during the relaxation treatment, three showed some minimal reduction that was difficult to attribute to the relaxation treatment, two responded to the dietary fiber treatment, and one spontaneously improved during baseline. Results support the effectiveness of a dietary fiber treatment for children with symptoms of constipation. Minimal support was obtained for the effectiveness of a relaxation treatment for children without symptoms of constipation. Implications, limitations, and directions for future research are discussed.

Preventing common feeding problems in infants and young children.

Feeding is one of many important ways that parents nurture their infants and children. When parents are overly concerned about feeding, they can exacerbate temporary feeding difficulties and misbehaviors by their inappropriate responses to the childs behavior. Child health supervision visits provide opportunities for the early detection of feeding problems, for education about early feeding experiences and typical child behavior at mealtimes, and for suggestions about the prevention of feeding problems. Handouts and printed materials can provide useful guidelines for introducing solid foods and for managing childrens mealtime behavior. Early detection might reduce the likelihood that minor feeding disturbances will develop into severe feeding problems. Behavior management strategies and a pleasant social context for mealtimes can improve childrens eating and mealtime behavior. Impairments in the parent-infant relationship may lead to serious feeding problems and referrals to appropriate support services are necessary. Prevention and early treatment of feeding problems can be facilitated by health education about early food experiences and the common developmental behaviors that occur as children grow and develop.

Determinants of Children's Primary Health Care Use

We review factors that influence childrens use of primary health care services. Predictors of pediatric health care use include child health status, child mental health, parent and family functioning, demographic characteristics, and access to health care services. Health services research is marked by inconsistencies due to varying approaches to measurement, population sampling, and analysis, and models that do not incorporate situational factors. We present recommendations for practicing clinicians and discuss suggestions for future research to help identify additional factors that may influence a parents decision to seek help from pediatric physicians. Health care use is determined by multiple factors, and complex models will lead to improved strategies for maximizing health status and establishing optimal pediatric care.

Toward the empirical validation of treatment targets in children

Abstract Target selection is the process by which the clinician chooses specific foci for treatment. Target selection is a fallible process due to the operation of cognitive biases and a range of deficiencies evident in the early phases of assessment. These concerns are particularly relevant to intervention with children, who often have limited involvement in determining which behaviors are targeted for change. Following a brief overview of factors that compromise target selection decisions, we provide suggestions to improve the target selection process, and we call for the development and use of empirical strategies to validate treatment targets in children. A literature review reveals negligible use of such tactics in treatment outcome studies with children to date. The use of empirical methods in target selection is illustrated through presentation of two examples: social skill deficits and the management of juvenile diabetes. We conclude with a critique of suggested empirical methods, and we offer recommendations for future research.

Health Education for Testicular Cancer

The incidence of testicular cancer is rapidly increasing. It is highly curable when detected and treated early, yet 500 to 1,000 men die from this cancer each year. Most victims are young men whose deaths account for a large number of potential years of life lost. Risk factors for testicular cancer are known but they cannot account for the increase in incidence. Only one age group, men between 15 and 34 years, is currently exhibiting an increase in incidence and mortality and should therefore comprise the primary at-risk group. Health education for the at-risk group, including promotion of regular and accurate testicular self-examination (TSE), could lead to earlier tumor detection and treatment and thereby save lives.