Kimberly Sidora-Arcoleo

Long-term Effects of Prenatal and Infancy Nurse Home Visitation on the Life Course of Youths: 19-Year Follow-up of a Randomized Trial

OBJECTIVE To examine the effect of prenatal and infancy nurse home visitation on the life course development of 19-year-old youths whose mothers participated in the program. DESIGN Randomized trial. SETTING Semirural community in New York. PARTICIPANTS Three hundred ten youths from the 400 families enrolled in the Elmira Nurse-Family Partnership program. Intervention Families received a mean of 9 home visits (range, 0-16) during pregnancy and 23 (range, 0-59) from birth through the childs second birthday. MAIN OUTCOME MEASURES Youth self-reports of educational achievement, reproductive behaviors, welfare use, and criminal involvement. RESULTS Relative to the comparison group, girls in the pregnancy and infancy nurse-visited group were less likely to have been arrested (10% vs 30%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.13-0.82) and convicted (4% vs 20%; 0.20; 0.05-0.85) and had fewer lifetime arrests (mean: 0.10 vs 0.54; incidence RR [IRR], 0.18; 95% CI, 0.06-0.54) and convictions (0.04 vs 0.37; 0.11; 0.02-0.51). Nurse-visited girls born to unmarried and low-income mothers had fewer children (11% vs 30%; RR, 0.35; 95% CI, 0.12-1.02) and less Medicaid use (18% vs 45%; 0.40; 0.18-0.87) than their comparison group counterparts. CONCLUSIONS Prenatal and infancy home visitation reduced the proportion of girls entering the criminal justice system. For girls born to high-risk mothers, there were additional positive program effects consistent with results from earlier phases of this trial. There were few program effects for boys.

The impact of the parental illness representation on disease management in childhood asthma.

Background: Despite significant advances in treatment modalities, morbidity due to childhood asthma has continued to increase, particularly for poor and minority children. Objectives: To describe the parental illness representation of asthma in juxtaposition to the professional model of asthma and to evaluate the impact of that illness representation on the adequacy of the childs medication regimen. Methods: Parents (n = 228) of children with asthma were interviewed regarding illness beliefs using a semistructured interview. The impact of background characteristics, parental beliefs, the childs symptom interpretation, and the parent-healthcare provider (HCP) relationship on the adequacy of the childs medication regimen were evaluated. Results: The parental and professional models of asthma differ markedly. Demographic risk factors (p = .005), low parental education (p < .0001), inaccurate symptom evaluation by the child (p = .02), and a poor parent-HCP relationship (p < .0001) had a negative effect on the parental illness representation. A parental illness representation concordant with the professional model of asthma (p = .05) and more formal asthma education (p = .02) had a direct positive effect on the medication regimen. Demographic risk factors (p = .006) and informal advice-seeking (p = .0003) had a negative impact on the regimen. The parental illness representation mediated the impact of demographic risk factors (p = .10), parental education (p =.07), and the parent-HCP relationship (p = .06) on the regimen. Discussion: Parents and HCPs may come to the clinical encounter with markedly different illness representations. Establishing a partnership with parents by eliciting and acknowledging parental beliefs is an important component of improving disease management.

Complementary and Alternative Medicine Use in Children with Asthma: Prevalence and Sociodemographic Profile of Users

Research on complementary and alternative medicine use in children with asthma is in its infancy. This study examined the prevalence, types of CAM used and sociodemographic differences in CAM use among children 5–12 years with asthma. 65% of parents reported using CAM. Usage was highest among black, poor, lesser educated parents and children with persistent symptoms. Types of CAM differed by poverty and a trend for differences by race and education emerged. Health care providers who educate themselves on CAM therapies parents use for asthma can then discuss the implications of using these therapies and potentially improve adherence to the prescribed medication regimen.

Symptom reporting in childhood asthma: a comparison of assessment methods

Background: One barrier to receiving adequate asthma care is inaccurate estimations of symptom severity. Aims: To interview parents of children with asthma in order to: (1) describe the range of reported illness severity using three unstructured methods of assessment; (2) determine which assessment method is least likely to result in a “critical error” that could adversely influence the child’s care; and (3) determine whether the likelihood of making a “critical error” varies by sociodemographic characteristics. Methods: A total of 228 parents of children with asthma participated. Clinical status was evaluated using structured questions reflecting National Asthma Education and Prevention Panel (NAEPP) criteria. Unstructured assessments of severity were determined using a visual analogue scale (VAS), a categorical assessment of severity, and a Likert scale assessment of asthma control. A “critical error” was defined as a parent report of symptoms in the lower 50th centile for each method of assessment for children with moderate–severe persistent symptoms by NAEPP criteria. Results: Children with higher severity according to NAEPP criteria were rated on each unstructured assessment as more symptomatic compared to those with less severe symptoms. However, among the children with moderate–severe persistent symptoms, many parents made a critical error and rated children in the lower 50th centile using the VAS (41%), the categorical assessment (45%), and the control assessment (67%). The likelihood of parents making a critical error did not vary by sociodemographic characteristics. Conclusions: All of the unstructured assessment methods tested yielded underestimations of severity that could adversely influence treatment decisions. Specific symptom questions are needed for accurate severity assessments.

Pediatric nurse practitioners' assessment and management of childhood overweight/obesity: results from 1999 and 2005 cohort surveys.

INTRODUCTION Recently, public and professional emphasis has been placed on addressing the increasing prevalence of childhood overweight. METHOD This survey study was conducted with two cohorts of pediatric nurse practitioners (N = 413) to explore differences in self-reported practice skills over time. RESULTS Significant improvements in assessment, screening, and laboratory evaluations were reported, although reduced adherence to recommended psychosocial assessments was noted. DISCUSSION This study outlines self-reported barriers to effective childhood weight management. One support that participants requested was evidence-based guidelines. Motivational interviewing may be an additional strategy to enhance provider skills to assess and manage challenging patient behavior change (e.g., dietary and activity changes).

Validation of the Asthma Illness Representation Scale (AIRS).

Background. Research has suggested a link between parents’ illness representations (IRs), use of complementary and alternative medicine, inhaled/oral corticosteroids and leukotriene antagonists, and childrens health outcomes. The Asthma Illness Representation Scale (AIRS©) provides a structured assessment of the key components of asthma IRs allowing the healthcare provider (HCP) to quickly identify areas of discordance with the professional model of asthma management. Methods. These analyses extend the initial validation of the AIRS© and compares data from the original study conducted among a primarily white and African American sample in Rochester, NY (N = 228) with data obtained from a predominantly inner-city, ethnic minority sample (Puerto Rican, African American, and Afro-Caribbean) from the Bronx, New York (N = 109). Results. A larger proportion of the Rochester sample was white and non-poor and had graduated high school. Bronx parents were more likely to perceive their childs asthma to be moderate or severe than the Rochester parents. Bronx children were older and had longer duration of asthma and reported more acute health care visits (past year). Bronx parents reported total AIRS© scores more closely aligned with the lay model than Rochester parents. The AIRS© instrument demonstrated acceptable internal reliability among the Bronx sample (total score α = 0.82) and the AIRS© subscale Cronbachs alpha coefficients were remarkably similar to those obtained from the original validation study (range = 0.54–0.83). Poor parents and those with less than a high school education had lower total AIRS© scores than their counterparts. White parents had AIRS© scores more closely aligned with the professional model compared to each of the ethnic subgroups. A perception of less severe asthma, fewer reports of asthma and somatization symptoms, and a positive HCP relationship were associated with IRs congruent with the professional model. IRs aligned with the professional model were associated with fewer acute asthma-related healthcare visits. Conclusions. The AIRS© instrument exhibited good internal reliability, external validity, and differentiated parents based on ethnicity, poverty, and education. Assessment of asthma IRs during the healthcare visit will allow the HCP and parent to discuss and negotiate a shared asthma management plan for the child, which will hopefully lead to improved medication adherence and asthma health outcomes.

Treatment Regimens and Health Care Utilization in Children with Persistent Asthma Symptoms

This study evaluated the anti-inflammatory medication regimens in children with persistent asthma, determined their health care utilization patterns, and evaluated factors associated with failure to seek and/or receive appropriate treatment. Parents of 68% of children who qualified for anti-inflammatory medications by National Asthma Education and Prevention Program (NAEPP) guidelines reported their use. However, only 14% received an optimal regimen (mild intermittent symptoms), while 55% were still symptomatic despite reported medications (suboptimal regimen). Nearly half of symptomatic children did not have a health care visit; of those who did, 61% had no corrective action documented. Factors contributing to variations in regimen and utilization are discussed.

Differential Effects of a Nurse Home-Visiting Intervention on Physically Aggressive Behavior in Children

OBJECTIVE The objective of this study is to examine the differential effects of nurse home visiting (NV) on physical aggression (PA) among children aged 2-12 years. METHODS This study used secondary data analysis from a randomized trial of NV intervention. RESULTS There were significant reductions in PA observed among NV girls at 2 years old and NV children of high-psychological-resource mothers at 6 and 12 years old. Mediation analyses suggest that reductions in PA yield increased verbal ability among girls. CONCLUSIONS Differential effects of intervention on PA by gender and mothers psychological resources highlight the importance of subgroup analyses. Identification of groups most likely to benefit may lead to more successful interventions.

Validation and Psychometric Properties of the Neonatal Intensive Care Unit Parental Beliefs Scale

Background:Parental perception of their infants and confidence/beliefs about their parenting are among the most salient factors influencing outcomes of preterm infants. Objectives:The purpose of this study was to assess the psychometric properties of scores on the Neonatal Intensive Care Unit Parental Beliefs Scale (NICU PBS) in a sample of mothers and fathers of preterm infants receiving intensive care. The NICU PBS is a rating instrument designed to assess parental beliefs about their premature infant and their role during hospitalization. Methods:The sample consisted of 245 mothers and 143 fathers. As part of the Creating Opportunities for Parent Empowerment trial, participants completed the NICU PBS 4–8 days after NICU admission and again approximately 4 days before discharge. Validation data were obtained at various times throughout the study. Confirmatory factor analysis was used to evaluate the NICU PBS factor structure. Results:A three-factor solution was accepted (Parental Role Confidence, Parent–Baby Interaction, and Knowledge of the NICU). Reliability of scores on the total scale and subscales was high; Cronbach’s alpha ranged from .75 to .91. Test–retest correlations ranged from .84 to .92. Younger maternal age; birth of another child; return to work within the past 12 months; and lower stress, depression, and anxiety were all significantly associated with higher scores on all subscales and the total score. Lower education, lower household income, receipt of Medicaid, and non-White race were associated with higher scores on the parent role confidence subscale and total. Lower household income and receipt of Medicaid were associated with higher Parent–Baby Interaction scores. Discussion:The NICU PBS can be used reliably with mothers and fathers of premature infants who are hospitalized in the NICU, and it may be a useful scale in predicting parental stress, depression, and anxiety.

Validation of the Asthma Illness Representation Scale-Spanish (AIRS-S © )

Background. To expand knowledge surrounding parental illness representations (IRs) of their childrens asthma, it is imperative that culturally appropriate survey instruments are developed and validated for use in clinical and research settings. The Asthma Illness Representation Scale (AIRS©) provides a structured assessment of the key components of asthma IRs, allowing the health care provider (HCP) to quickly identify areas of discordance with the professional model of asthma management. The English AIRS was developed and validated among a geographically and ethnically diverse sample. The authors present the validation results of the AIRS-S© (Spanish) from a sample of Mexican and Puerto Rican parents. Methods. The AIRS was translated and back translated per approved methodologies. Factor analysis, internal reliability, external validity, and 2-week test-retest reliability (on a subsample) were carried out and results compared with the validated English version. Data were obtained from 80 Spanish-speaking Mexican and Puerto Rican parents of children with asthma. The sample was recruited from two school-based health centers and a free medical clinic in Phoenix, Arizona, and a hospital-based asthma clinic in Bronx, New York. Results. The original Nature of Asthma Symptoms, Facts About Asthma, and Attitudes Towards Medication Use subscales emerged. Remaining factors were a mixture of items with no coherent or theoretical distinction between them. Interpretation of results is limited due to not meeting the minimum requirement of 5 observations/item. Cronbachs alpha coefficients for the total score (α = .77) and majority of subscales (α range = .53–.77) were acceptable and consistent with the English version. Parental reports of a positive relationship with the HCP significantly predicted AIRS scores congruent with the professional model; longer asthma duration was associated with beliefs aligned with the lay model; and AIRS scores congruent with the professional model were related to lower asthma severity. Stability in AIRS-S scores over 2 weeks was demonstrated. Conclusions. The AIRS-S is a culturally appropriate instrument that can be used by HCPs to ascertain Spanish-speaking parents’ asthma illness beliefs and assess discordance with the professional model of asthma management. This information can be used by the HCP when discussing parents asthma management strategies for their children during clinical encounters.