Paul J. Chung

Association Between Adolescent Viewership and Alcohol Advertising on Cable Television

OBJECTIVES We examined whether alcohol advertising on cable television is associated with adolescent viewership. METHODS Using Nielsen data for every national cable alcohol advertisement from 2001 to 2006 (608 591 ads), we examined whether ad incidence in a given advertising time slot was associated with adolescent viewership (i.e., the percentage of the audience that was aged 12-20 years) after we controlled for other demographic variables. RESULTS Almost all alcohol ads appeared in time slots with audiences made up of 30% or fewer underage viewers. In these time slots (standardized by duration and number of viewers), each 1-percentage-point increase in adolescent viewership was associated with more beer (7%), spirits (15%), and alcopop (or low-alcohol refresher; 22%) ads, but fewer wine (-8%) ads (P < .001 for all). For spirits and alcopops, associations were stronger among adolescent girls than among adolescent boys (P < .001 for each). CONCLUSIONS Ad placements for beer, spirits, and alcopops increased as adolescent viewership rose from 0% to 30%, especially for female viewers. Alcohol advertising practices should be modified to limit exposure of underage viewers.

Low-Income Parents' Views on the Redesign of Well-Child Care

OBJECTIVE: To examine the perspectives of low-income parents on redesigning well-child care (WCC) for children aged 0 to 3 years, focusing on possible changes in 3 major domains: providers, locations, and formats. METHODS: Eight focus groups (4 English and 4 Spanish) were conducted with 56 parents of children aged 6 months to 5 years, recruited through a federally qualified health center. Discussions were recorded, transcribed, and analyzed by using the constant comparative method of qualitative analysis. RESULTS: Parents were mostly mothers (91%), nonwhite (64% Latino, 16% black), and <30 years of age (66%) and had an annual household income of <

Need for and Use of Family Leave Among Parents of Children With Special Health Care Needs

35000 (96%). Parents reported substantial problems with WCC, focusing largely on limited provider access (especially with respect to scheduling and transportation) and inadequate behavioral/developmental services. Most parents endorsed nonphysician providers and alternative locations and formats as desirable adjuncts to usual physician-provided, clinic-based WCC. Nonphysician providers were viewed as potentially more expert in behavioral/developmental issues than physicians and more attentive to parent-provider relationships. Some alternative locations for care (especially home and day care visits) were viewed as creating essential context for providers and dramatically improving family convenience. Alternative locations whose sole advantage was convenience (eg, retail-based clinics), however, were viewed more skeptically. Among alternative formats, group visits in particular were seen as empowering, turning parents into informal providers through mutual sharing of behavioral/developmental advice and experiences. CONCLUSIONS: Low-income parents of young children identified major inadequacies in their WCC experiences. To address these problems, they endorsed a number of innovative reforms that merit additional investigation for feasibility and effectiveness.

Parent-adolescent communication about sex in Filipino American families: a demonstration of community-based participatory research.

OBJECTIVE. Parents of children with special health care needs are especially vulnerable to work–family conflicts that family leave benefits might help resolve. We examined leave-taking among full-time–employed parents of children with special health care needs. METHODS. We identified all children with special health care needs in 2 large inpatient/outpatient systems in Chicago, Illinois, and Los Angeles, California, and randomly selected 800 per site. From November 2003 to January 2004, we conducted telephone interviews with 1105 (87% of eligible and successfully contacted) parents. Among the samples 574 full-time–employed parents, we examined whether leave benefits predicted missing any work for child illness, missing >4 weeks for child illness, and ability to miss work whenever their child needed them. RESULTS. Forty-eight percent of full-time–employed parents qualified for federal Family and Medical Leave Act benefits; 30% reported employer-provided leave benefits (not including sick leave/vacation). In the previous year, their children averaged 20 missed school/child care days, 12 doctor/emergency department visits, and 1.7 hospitalizations. Although 81% of parents missed work for child illness, 41% reported not always missing work when their child needed them, and 40% of leave-takers reported returning to work too soon. In multivariate regressions, parents who were eligible for Family and Medical Leave Act benefits and aware of their eligibility had 3.0 times greater odds of missing work for child illness than ineligible parents. Parents with >4 weeks of employer-provided leave benefits had 4.7 times greater odds of missing >4 weeks than parents without benefits. Parents with paid leave benefits had 2.8 times greater odds than other parents of missing work whenever their child needed them. CONCLUSIONS. Full-time–employed parents of children with special health care needs experience severe work–family conflicts. Although most have leave benefits, many report unmet need for leave. Access to Family and Medical Leave Act benefits and employer-provided leave may greatly affect leave-taking.

A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial

OBJECTIVES Pregnancy rates among Filipino American adolescents exceed those of other Asian and Pacific Islander adolescents. Strong parent-adolescent communication may promote healthy sexual development and protect against adolescent sexual risk behaviors. We explored communication barriers between Filipino American parents and adolescents. METHODS Using community-based participatory research (CBPR), we collaborated with Filipino American community leaders, parents, and adolescents to design a focus-group study. Trained bilingual moderators conducted focus groups with 85 Filipino Americans (41 parents and grandparents and 44 adolescents aged 14-18 years) from various neighborhoods in Los Angeles. Sessions were recorded, transcribed, coded, and analyzed for themes. RESULTS Focus-group participants appeared to divide sex information into 3 categories, which we termed facts, feelings, and values. Adolescents emphasized facts and feelings. Parents and grandparents emphasized facts and values. In general, facts were obtained through school, feelings through friends, and values through parents. The focus groups identified large barriers to value transmission, stemming from adolescent acculturation to the United States. Parents and grandparents felt that values were transmitted best through traditional Filipino respect for parents who often eschewed open discussion. Adolescents believed that open discussion was necessary for value transmission to occur. The result was bilateral withdrawal from family communication about sex. CONCLUSIONS Our focus groups found that parent-child communication about sex, especially regarding values, was limited. Potential causes included conflicts between Filipino and US beliefs regarding respect for parents and open discussion. Our results raise important questions about the effect of acculturation on sex education for Filipino American adolescents and demonstrate potential advantages of CBPR.

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

OBJECTIVE: The goal of this study was to examine the effects of a new model for well-child care (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families. METHODS: PARENT includes 4 elements designed by using a stakeholder-engaged process: (1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each well-visit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey–PLUS was used to assess receipt of recommended WCC services at 12 months’ postenrollment. Intervention effects were examined by using bivariate analyses. RESULTS: A total of 251 parents with a child aged ≤12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean child age at enrollment was 4.5 months; 64% had an annual household income less than

“Eat Healthy, Stay Active!”: A Coordinated Intervention to Improve Nutrition and Physical Activity among Head Start Parents, Staff, and Children:

20 000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of care measures (family-centeredness, helpfulness, and overall rating of care). Fifty-two percent fewer intervention children had ≥2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent care utilization. CONCLUSIONS: A parent coach–led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.

Well-Child Care Clinical Practice Redesign for Young Children: A Systematic Review of Strategies and Tools

BACKGROUND AND OBJECTIVES: Children with medical complexity (CMC) account for disproportionately high hospital use, and it is unknown if hospitalizations may be prevented. Our objective was to summarize evidence from (1) studies characterizing potentially preventable hospitalizations in CMC and (2) interventions aiming to reduce such hospitalizations. METHODS: Our data sources include Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases from their originations, and hand search of article bibliographies. Observational studies (n = 13) characterized potentially preventable hospitalizations, and experimental studies (n = 4) evaluated the efficacy of interventions to reduce them. Data were extracted on patient and family characteristics, medical complexity and preventable hospitalization indicators, hospitalization rates, costs, and days. Results of interventions were summarized by their effect on changes in hospital use. RESULTS: Preventable hospitalizations were measured in 3 ways: ambulatory care sensitive conditions, readmissions, or investigator-defined criteria. Postsurgical patients, those with neurologic disorders, and those with medical devices had higher preventable hospitalization rates, as did those with public insurance and nonwhite race/ethnicity. Passive smoke exposure, nonadherence to medications, and lack of follow-up after discharge were additional risks. Hospitalizations for ambulatory care sensitive conditions were less common in more complex patients. Patients receiving home visits, care coordination, chronic care-management, and continuity across settings had fewer preventable hospitalizations. Conclusions: There were a limited number of published studies. Measures for CMC and preventable hospitalizations were heterogeneous. Risk of bias was moderate due primarily to limited controlled experimental designs. Reductions in hospital use among CMC might be possible. Strategies should target primary drivers of preventable hospitalizations.

Staff-Only Pediatric Hospitalist Care of Patients With Medically Complex Subspecialty Conditions in a Major Teaching Hospital

Purpose. Examine the effectiveness of the “Eat Healthy, Stay Active!” pilot program, a multisite, 6-month educational intervention to promote healthy nutrition and physical activity among Head Start staff, parents, and children. Design. Comparison of within-group preintervention and postintervention knowledge and behavior, along with anthropomorphic measurements. Setting. The study was conducted in a convenience sample of six large Head Start agencies in five states. Subjects. Participants included 496 staff, 438 parents, and 112 preschool children. Intervention. The 6-month intervention consisted of core trainings and reinforcing activities for staff and parents that aligned with childrens curricula. Measures. Pre-post questionnaires and anthropometric measurements examined changes in body mass index (BMI), knowledge, and behaviors related to nutrition and physical activity. Analysis. Paired t-tests to compare preintervention and postintervention weights and BMI; multiple regression analyses to examine associations between weight changes and other covariates, including knowledge and behavior changes, controlling for sociodemographic variables. Results. Each group of participants demonstrated significant reductions in BMI (mean = 30.1 to 29.2; p < .001 in adults and 17.0 to 16.6; p < 0.001 in children) and in the proportion of obese children (30% to 21%; p < .001) and adults (45% to 40%; p < .001). Child weight changes correlated with parent weight changes. Conclusion. This intervention showed promising initial results, with potential effectiveness as an intervention to promote healthier behaviors among adults and children in Head Start settings.

Does well-child care have a future in pediatrics?

BACKGROUND AND OBJECTIVE: Various proposals have been made to redesign well-child care (WCC) for young children, yet no peer-reviewed publication has examined the evidence for these. The objective of this study was to conduct a systematic review on WCC clinical practice redesign for children aged 0 to 5 years. METHODS: PubMed was searched using criteria to identify relevant English-language articles published from January 1981 through February 2012. Observational studies, controlled trials, and systematic reviews evaluating efficiency and effectiveness of WCC for children aged 0 to 5 were selected. Interventions were organized into 3 categories: providers, formats (how care is provided; eg, non–face-to-face formats), and locations for care. Data were extracted by independent article review, including study quality, of 3 investigators with consensus resolution of discrepancies. RESULTS: Of 275 articles screened, 33 met inclusion criteria. Seventeen articles focused on providers, 13 on formats, 2 on locations, and 1 miscellaneous. We found evidence that WCC provided in groups is at least as effective in providing WCC as 1-on-1 visits. There was limited evidence regarding other formats, although evidence suggested that non-face-to-face formats, particularly web-based tools, could enhance anticipatory guidance and possibly reduce parents’ need for clinical contacts for minor concerns between well-child visits. The addition of a non–medical professional trained as a developmental specialist may improve receipt of WCC services and enhance parenting practices. There was insufficient evidence on nonclinical locations for WCC. CONCLUSIONS: Evidence suggests that there are promising WCC redesign tools and strategies that may be ready for larger-scale testing and may have important implications for preventive care delivery to young children in the United States.