Laureen H. Smith

Piloting the use of teen mentors to promote a healthy diet and physical activity among children in Appalachia.

PURPOSE This study tested a mentoring model that paired trained teens with younger children in an after-school setting to deliver a curriculum aimed at promoting healthier patterns of dietary intake and physical activity. DESIGN AND METHODS Using a pretest-posttest design, group comparisons were made. Descriptive, independent, and paired t-test analyses with Bonferroni corrections were conducted in a sample of 72 children. RESULTS Group differences were noted with the intention to eat healthfully. Mentored children demonstrated greater improvement in knowledge, attitudes, efficacy, perceived support, and body mass index (BMI). PRACTICE IMPLICATIONS Teen mentors can effectively impact childrens intention to improve health behaviors, which is foundational to normalizing BMI.

Comparing the Effects of Teen Mentors to Adult Teachers on Child Lifestyle Behaviors and Health Outcomes in Appalachia.

Childhood obesity prevalence rates in the United States are the highest in the rural Appalachian areas. Teens mentoring younger children to reverse obesity health risks are an understudied approach. This randomized-controlled trial compared the effects of two curriculum delivery methods and assessed the mediating effects of the number of sessions attended on the outcomes. The control group received the 8-week Just for Kids! curriculum via an adult teacher in a classroom and the experimental group received the same curriculum via individual teen mentoring. Data collected at baseline and postintervention were analyzed using multilevel linear models. Each of the outcomes (e.g., body mass index, blood pressure, current lifestyle behaviors) were modeled separately. Only the mentored children demonstrated improved current lifestyle behaviors (e.g., physical activity and dietary patterns) and health outcomes. Teen mentoring was an effective and efficacious approach to impact the lifestyle patterns and health outcomes of children in a school setting.

Exploring youth development with diverse children: correlates of risk, health, and thriving behaviors

PURPOSE This study explored the relationships between internal and external assets, risk behaviors, health behaviors, and thriving behaviors in diverse children. DESIGN AND METHODS The strength of relationships existing between measures, differences between group means based on gender, grades earned, and school, and confidence interval (p < or = .05) were tested in a sample of 61 urban sixth graders. RESULTS Few assets were related to substance use. Assets were related to delinquency acts, health behaviors, and thriving indicators. Group differences between schools and gender and the total number of assets were noted. PRACTICE IMPLICATIONS Supporting assets are important to consider when nurses perform assessments and design interventions to support youths in their maturation processes.

Health status and access to health care services: a comparison between Ohio's rural non-Appalachian and Appalachian families.

Comparisons in the health status of rural dwellers and care access have not traditionally considered culturally defined areas such as Appalachia. This study examined differences in parent health status, child health status, and access to care between those living in Ohios 29 Appalachian counties and those living in Ohios 30 rural counties. We analyzed data from the 2008 Ohio Family Health Survey including Bayesian hierarchical modeling. Child health differed by gender and ethnicity. Parent health status differed by region. Parent and child health status were related to care access. Health and access disparities exist within rural and Appalachia Ohio.

History of Forced Sex and Recent Sexual Risk Indicators Among Young Adult Males

CONTEXT It is unclear whether young adult men who have ever been forced to have sex are at increased risk for sexual risk-taking, and whether their risk differs according to the gender of the perpetrator. METHODS Data from 1,400 males aged 18-24 who participated in the 2002 National Survey of Family Growth were used to determine the prevalence of a history of forced sex and the context of each respondents most recent experience with such assaults. Logistic regression analyses were conducted to examine the relationship between victimization and having a recent indicator of sexual risk (e.g., having had sex in the past year with five or more female partners, a female injection-drug user or an HIV-positive female). Separate analyses were performed for coercion by females and coercion by males. RESULTS Six percent of men reported having been forced by a female perpetrator to have vaginal intercourse, while 1% said they had been forced by a male perpetrator to have oral or anal sex. Men had an elevated likelihood of having had one or more recent sexual risk indicators if they had ever been forced to have sex by a male (odds ratio, 6.9) or female (3.3). Verbal and physical forms of coercion and provision of alcohol and drugs were commonly used by perpetrators of both genders. CONCLUSIONS A better understanding of the pathways linking sexual victimization to sexual risk-taking among men is needed. Clinicians working with young men should screen them for victimization and provide STD testing and referrals for counseling if abuse is suspected or disclosed.

A Structured Peer-Mentoring Method for Physical Activity Behavior Change Among Adolescents

Despite national guidelines for regular physical activity, most adolescents are not physically active. Schools serve an estimated 60 million youth and provide an educational environment to meet the current physical activity guidelines. The obesity epidemic and chronic disease comorbidities associated with physical inactivity are not likely to be reversed without a strong contribution from local schools. This article describes how a structured peer-mentoring method provides a feasible, flexible, and tailored means to meet the current guidelines for best practice in a school setting. Structured peer mentoring using trained high school mentors to support behavior change in younger peers is an innovative method to meeting the School Health Guidelines to Promote Healthy Eating and Physical Activity. Through structured peer mentoring, adolescents are provided consistent social support in a caring and personalized manner. This support builds skills and competencies enhancing self-efficacy to sustain a lifetime of physical activity behavior.

Effective Practices to Improve Recruitment, Retention, and Partnerships in School-Based Studies

Schools are essential settings for research that tests the effectiveness of health educational interventions in natural settings (classrooms). There are several reasons schools are important research settings. First, public schools serve over 50million youth, and private schools serve an additional 5 million youth (U.S. Department of Education, National Center for Education Statistics, 2015). Most school-aged children are served by formal schools and spend most of their waking hours in school settings. Second, schools serve as a focus of community activity and identity. Many schools host community events including afterschool programs, summer programs, community meetings, and official polling locations for elections.

Rates of Obesity and Obesogenic Behaviors of Rural Appalachian Adolescents: How Do They Compare to Other Adolescents or Recommendations?

BACKGROUND To better understand the unique challenges of Appalachians, community-based studies are needed to establish benchmark rates. This study compares obesity rates and obesogenic behaviors among Appalachian adolescents to other adolescent populations or clinical recommendations. METHODS This study was conducted in 11 Appalachian schools. Body mass index, body mass index percentile, and body fat percentage were measured using a Tanita DC-430U analyzer. Physical activity was measured using Actigraph wGT3X-BT accelerometers. Sugar-sweetened beverage consumption was self-reported. Pearsons correlations, independent t tests, and multivariate analyses with tests of between-subject effects were conducted. RESULTS Mean (n = 345) age was 15.23 (SD = 1.02) years. Appalachian adolescents were extremely obese (13.1%) by more than double that of national adolescent rates. Nearly 29% of males and over 55% of females were at increased cardiovascular risk. Only 15% were moderately active for at least 60 minutes a day, but only for 1 day per week. Mean afterschool sedentary time was 4.75 hours. Only 2.1% recorded vigorous activity for a minimum of 10 minutes at 1 day per week. Nearly all regularly consumed sugar-sweetened beverages. CONCLUSION Obesogenic health disparities were evident in Appalachia. Rates of obesogenic factors among Appalachian adolescents exceed national rates. Appalachian adolescents were far less active, and extreme obesity is a major health concern.

A Review of Systematic Reviews Targeting the Prevention and Treatment of Overweight and Obesity in Adolescent Populations

PURPOSE Adolescent obesity is a powerful predictor of morbidity and mortality, yet amenable to modifiable behaviors. To accurately summarize the effects of behavioral interventions on changes in adolescent body mass index and/or weight status, we assessed existing systematic reviews for reporting transparency and methodological quality. METHODS Five databases were searched through September 2017 to identify relevant systematic reviews. Reviews were evaluated for reporting transparency and methodological quality using PRISMA Reporting Checklist and Assessment of Multiple Systematic Reviews Instrument. Evidence was synthesized across high-quality reviews. RESULTS Four of twelve systematic reviews were of high methodological quality. All four focused on the treatment of overweight/obesity in adolescent populations, representing 97 international studies. Findings indicate intervention compared with no intervention/wait list showed larger effects for improving BMI/BMI z-scores. Small improvements (averaging a 3.7-kg decrease) in weight/weight percentile were observed following a supervised exercise plus dietary and/or behavior support intervention. Health-related quality of life may improve following interventions, but overall attention to associated psychological variables (depression, self-esteem/perception) is limited. CONCLUSIONS Adherence to objective checklists and protocols for rigorous conduct and reporting of systematic reviews is warranted. Consensus evidence is urgently needed to define and report behavior change interventions related to obesity prevention and treatment.

Effective Recruitment of Schools for Randomized Clinical Trials: Role of School Nurses

In school settings, nurses lead efforts to improve the student health and well-being to support academic success. Nurses are guided by evidenced-based practice and data to inform care decisions. The randomized controlled trial (RCT) is considered the gold standard of scientific rigor for clinical trials. RCTs are critical to the development of evidence-based health promotion programs in schools. The purpose of this article is to present practical solutions to implementing principles of randomization to RCT trials conducted in school settings. Randomization is a powerful sampling method used to build internal and external validity. The school’s daily organization and educational mission provide several barriers to randomization. Based on the authors’ experience in conducting school-based RCTs, they offer a host of practical solutions to working with schools to successfully implement randomization procedures. Nurses play a critical role in implementing RCTs in schools to promote rigorous science in support of evidence-based practice.