Laurie A. Van Egeren

A meta-analysis of home visiting programs: Moderators of improvements in maternal behavior†

A meta-analysis of home visiting programs for at-risk families (K = 35, N = 6,453) examined differences in the effects of programs on maternal behavior. On average, programs with more frequent visitation had higher success rates. The frequency of home visits explained significant variance of effect sizes among studies in the United States, with two visits per month predicting a small, substantive effect. Intensive programs or programs with at least three visits per month were more than twice as effective as were less intensive programs. Home visiting programs using nurses or mental health professionals as providers were not significantly more effective than were programs using paraprofessionals. In general, programs showed a positive effect on maternal behavior, but programs with frequent home visits were more successful.

Who Participates and Why: Building a Process Model of Citizen Participation

Initiating and sustaining sufficient levels of participation among residents in low-income and urban neighborhoods have become significant focuses of many initiatives that strive to develop healthy communities. This study examines the factors associated with citizen participation levels in resident leaders and followers in seven low-income neighborhoods in one community. Overall, the findings suggest that different factors facilitate participation in leaders and followers. Leaders are more likely to actively participate in neighborhood and community affairs if they perceive themselves as having the skills needed to organize others and make change happen. Whereas perceived skill levels also matter for followers, these residents are strongly influenced by the norms for activism within their neighborhood. These norms mediate the impact of neighborhood readiness and capacity for change on citizen participation levels. Implications for funders and practitioners interested in promoting healthy communities are discussed.

Healthy babies through infant-centered feeding protocol: an intervention targeting early childhood obesity in vulnerable populations

BackgroundPoor feeding practices during infancy contribute to obesity risk. As infants transition from human milk and/or formula-based diets to solid foods, these practices interfere with infant feeding self-regulation and healthy growth patterns. Compared with other socioeconomic groups, lower-income mothers are more likely to experience difficulty feeding their infants. This may include misinterpreting feeding cues and using less-than-optimal feeding styles and practices, such as pressuring infants during mealtimes and prematurely introducing solid food and sweetened beverages. The Healthy Babies trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mother-infant dyads. The educational intervention is being conducted during the infants first 6 months of life to promote healthy transition to solids during their first year and is based on the theory of planned behavior.Methods/DesignWe will describe our study protocol for a multisite randomized control trial being conducted in Colorado and Michigan with an anticipated sample of 372 economically and educationally disadvantaged African American, Hispanic, and Caucasian mothers with infants. Participants are being recruited by county community agency staff. Participants are randomly assigned to the intervention or the control group. The intervention consists of six in-home visits by a trained paraprofessional instructor followed by three reinforcement telephone contacts when the baby is 6, 8, and 10 months old. Main maternal outcomes include a) maternal responsiveness, b) feeding style, and c) feeding practices. Main infant outcome is infant growth pattern. All measures occur at baseline and when the infant is 6 and 12 months old.DiscussionIf this project is successful, the expected outcomes will address whether the home-based early nutrition education intervention is effective in helping mothers develop healthy infant feeding practices that contribute to improving infant health and development and reducing the risk of early-onset childhood obesity.Trial RegistrationCurrent Controlled Trials ACTRN126100000415000

Effectiveness of a school- and community-based academic asthma health education program on use of effective asthma self-care behaviors in older school-age students

PURPOSE The purpose was to evaluate the effectiveness of Staying Healthy-Asthma Responsible & Prepared, an academic asthma health education and counseling program, on fostering the use of effective asthma self-care behaviors. DESIGN AND METHODS This was a phase III, two-group, cluster randomized, single-blinded, longitudinal design-guided study. Caregivers of 205 fourth- and fifth-grade students completed the asthma health behaviors survey at preintervention, and 1, 12, and 24 months postintervention. Analysis involved multilevel modeling. RESULTS All students demonstrated improvement in episode management, risk reduction/prevention, and health promotion behaviors; Staying Healthy-Asthma Responsible & Prepared students demonstrated increased improvement in episode management and risk reduction/prevention behaviors. PRACTICE IMPLICATIONS Working with schoolteachers, nurses can improve the use of effective asthma self-care behaviors.

Initial Validation of the Functional Impairment Scale for Children and Adolescents

OBJECTIVE Two studies assessed the validity of the Functional Impairment Scale for Children and Adolescents (FISCA), a multidimensional parent-report questionnaire. METHOD In study 1, quasi-exploratory and confirmatory procedures tested whether FISCA data for 804 inpatients (mean age = 13.4, 456 boys), collected October 1994 through December 1995, fit a 3-factor model. Study 2 (n = 330) used survival and discriminant analyses to predict recidivism status at 3 and 6 months follow-up from FISCA scores at intake. RESULTS The 8 FISCA scales reduced to 3 factors describing undercontrolled aggression, social role violations, and self-focused aspects of child functional impairment. Serious impairment on the Aggression and School scales each predicted a 3-fold increase in recidivism risk. Together, impairment scores for Aggression, School, Thinking, and Delinquency correctly identified 73% of the recidivists. However, 51% of the nonrecidivists also were classified as recidivists. CONCLUSIONS Although these data initially support the FISCAs validity, they underscore the need for more effective strategies to identify severely impaired children whose problems will be sporadic or short-lived.

Effectiveness of a school‐based academic asthma health education and counseling program on fostering acceptance of asthma in older school‐age students with asthma

PURPOSE The purpose of this study was to evaluate the effectiveness of the academic asthma education and counseling Staying Healthy-Asthma Responsible and Prepared™ (SHARP) program on fostering psychosocial acceptance of asthma. DESIGN AND METHODS This was a phase III, two-group, cluster-randomized, single-blinded, longitudinal study. Students from grades 4 and 5 (N = 205) with asthma and their caregivers completed surveys at pre-intervention and at 1-, 12-, and 24-months post-intervention. Analysis involved multilevel modeling. RESULTS All students demonstrated significant improvement in aspects of acceptance; students in SHARP demonstrated significant improvement in openness to sharing and connectedness with teachers over students in the control condition. PRACTICE IMPLICATIONS The SHARP program offers a well-tested, effective program for psychosocial acceptance of asthma, which is welcomed by schools.

Daily behavior ratings among child and adolescent inpatients: the abbreviated Child Behavior Rating Form.

OBJECTIVE Child and adolescent psychiatric inpatient facilities are in need of standardized behavior rating scales to assess continuous change in patient behaviors. This study used daily staff ratings to examine the factor structure and psychometric properties of an abbreviated version of the Child Behavior Rating Form (CBRF-A). METHOD Three hundred eighty-seven inpatients, aged 3 to 17 years, were rated daily by unit staff. Subsamples of patients and/or their parents completed additional measures of behavior problems (Child Behavior Checklist, Functional Impairment Scale for Children and Adolescents) to assess the instruments validity. RESULTS Confirmatory factor analyses identified 5 behavior problem dimensions (Oppositionalism, Attention Problems, Overactivity, Withdrawal/Depression, and Anxiety), a second-order Externalizing dimension, and 2 positive behavior dimensions (Positive/Adaptive Social and Compliance/Self-Control). The scales were found to be internally consistent and showed expected age differences, and the scale factor structures were relatively stable over 1- and 2-week intervals. The scales correlated meaningfully with parent ratings of child behavior problems and functional impairment and were predictive of total hospital days. CONCLUSIONS The psychometric properties of the CBRF-A appear adequate for daily inpatient rating; additional research is needed to determine the usefulness of the CBRF-A in assessing treatment and medication effects over the hospital stay.

Early Childhood Educators’ Self-Efficacy in Science, Math, and Literacy Instruction and Science Practice in the Classroom

ABSTRACT Research Findings: Quality early science education is important for addressing the low science achievement, compared to international peers, of elementary students in the United States. Teachers’ beliefs about their skills in a content area, that is, their content self-efficacy is important because it has implications for teaching practice and child outcomes. However, little is known about how teachers’ self-efficacy for literacy, math and science compare and how domain-specific self-efficacy relates to teachers’ practice in the area of science. Analysis of survey and observation data from 67 Head Start classrooms across eight programs indicated that domain-specific self-efficacy was highest for literacy, significantly lower for science, and lowest for math. Classrooms varied, but in general, engaged in literacy far more than science, contained a modest amount of science materials, and their instructional support of science was low. Importantly, self-efficacy for science, but not literacy or math, related to teachers frequency of engaging children in science instruction. Teachers’ education and experience did not predict self-efficacy for science. Practice or Policy: To enhance the science opportunities provided in early childhood classrooms, pre-service and in-service education programs should provide teachers with content and practices for science rather than focusing exclusively on literacy.

Effectiveness of differing levels of support for family meals on obesity prevention among head start preschoolers: the simply dinner study

BackgroundDespite slight decreases in obesity prevalence in children, nearly 25% of preschool-aged children are overweight or obese. Most interventions focused on promoting family meals as an obesity-prevention strategy target meal planning skills, knowledge and modeling of healthy eating without addressing the practical resources that enable implementation of family meals. There is a striking lack of evidence about what level of resources low-income parents need to implement family meals. This study will identify resources most effective in promoting family meals and, subsequently, test associations among the frequency of family meals, dietary quality and children’s adiposity indices among children enrolled in Head Start.MethodsThe Multiphase Optimization Strategy, employed in this study, is a cutting-edge approach to maximizing resources in behavioral interventions by identifying the most effective intervention components. We are currently testing the main, additive and interactive effects of 6 intervention components, thought to support family meals, on family meal frequency and dietary quality (Primary Outcomes) as compared to Usual Head Start Exposure in a Screening Phase (N = 512 low-income families). Components yielding the most robust effects will be bundled and evaluated in a two-group randomized controlled trial (intervention and Usual Head Start Exposure) in the Confirming Phase (N = 250), testing the effects of the bundled intervention on children’s adiposity indices (Primary Outcomes; body mass index and skinfolds). The current intervention components include: (1) home delivery of pre-made healthy family meals; (2) home delivery of healthy meal ingredients; (3) community kitchens in which parents make healthy meals to cook at home; (4) healthy eating classes; (5) cooking demonstrations; and (6) cookware/flatware delivery. Secondary outcomes include cooking self-efficacy and family mealtime barriers. Moderators of the intervention include family functioning and food security. Process evaluation data includes fidelity, attendance/use of supports, and satisfaction.DiscussionResults will advance fundamental science and translational research by generating new knowledge of effective intervention components more rapidly and efficiently than the standard randomized controlled trial approach evaluating a bundled intervention alone. Study results will have implications for funding decisions within public programs to implement and disseminate effective interventions to prevent obesity in children.Trial registrationClincaltrials.gov Identifier NCT02487251; Registered June 26, 2015.

Comparative Effectiveness on Cognitive Asthma Outcomes of the SHARP Academic Asthma Health Education and Counseling Program and a Non-Academic Program.

Asthma morbidity and mortality is higher among older school-age children and early adolescents than other age groups across the lifespan. NIH recommended expanding asthma education to schools and community settings to meet cognitive outcomes that have an impact on morbidity and mortality. Guided by the acceptance of asthma model, an evidence-guided, comprehensive school-based academic health education and counseling program, Staying Healthy-Asthma Responsible & Prepared™ (SHARP), was developed. The program complements existing school curricula by integrating biology, psychology, and sociology content with related spelling, math, and reading and writing assignments. Feasibility, benefits, and efficacy have been established. We compared the effectiveness of SHARP to a non-academic program, Open Airways for Schools, in improving asthma knowledge and reasoning about symptom management. A two-group, cluster-randomized, single-blinded design was used with a sample of 205 students in grades 4-5 with asthma and their caregivers. Schools were matched prior to randomization. The unit of analysis was the student. Certified elementary school teachers delivered the programs during instructional time. Data were collected from student/caregiver dyads at baseline and at 1, 12, and 24 months after the intervention. In multilevel modeling, students enrolled in the academic SHARP program demonstrated significant (p< .001) improvement in asthma knowledge and reasoning over students enrolled in the non-academic program. Knowledge advantages were retained at 24 months. Findings support delivery in schools of the SHARP academic health education program for students with asthma.