Richard M. Shewchuk

The Role of Availability as a Moderator of Family Fruit and Vegetable Consumption

The public health objective to improve the diet of Americans includes increasing the consumption of fruits and vegetables (F&V). The availability of F&V in the home has been suggested but not confirmed as one environmental factor that influences the types and quantities of F&V eaten by family members. Using a model of parental and child influences on a child’s intake of F&V, the authors investigated F&V availability as a moderating variable for the relationships between the model constructs and how the relationships might change with varying levels of F&V availability. Path analysis and multigroup structural equation modeling were the analytic tools. Results indicated that homes with more F&V available had a richer and generally stronger set of motivating factors for parent and child F&V consumption than homes with low F&V availability. Findings have implications for parental involvement in interventions to enhance the diet of fourth-grade children.

Indulgent Feeding Style and Children’s Weight Status in Preschool

Purpose: The primary aim of this study was to examine whether parent affect and child temperament characteristics differ across feeding styles in low-income families, given suggestive evidence. The secondary aim was to examine whether feeding styles were still related to children’s body mass index independent of parent affect, child temperament, and known correlates. Methods: Participants in this study were 718 parents of childrens attending Head Start programs across two sites (Texas and Alabama). Parents were categorized into feeding styles of authoritative (n = 118), authoritarian (n = 219), indulgent (n = 240) and uninvolved (n = 141) using a parent-report questionnaire characterizing feeding in a general parenting paradigm. Parents completed questionnaires and measured height and weight was obtained from parents and children. Results: Differences were found across feeding styles on parent affect and child temperament characteristics. Indulgent parents reported lower Negative Affect for themselves and lower Negative Affectivity for their children. The indulgent feeding style was significantly associated with higher child body mass index after controlling for parent affect, child temperament, and correlates (ethnicity, child age, parent body mass index). Conclusions: The results of this study not only show a robust association between the indulgent feeding style and weight status of low-income preschool childrens, but also suggest how congruence between parent emotional affect and child temperament characteristics may contribute to excess consumption among children of indulgent parents.

Social Cognitive Model of Fruit and Vegetable Consumption in Elementary School Children

Fruit and vegetable consumption is related to reduced risk for certain forms of cancer. Health organizations recommend the increased consumption of fruit and vegetables. Despite these recommendations, few U.S. children eat the recommended number of at least five servings of fruit and vegetables per day. Understanding the determinants of consumption might improve our ability to increase consumption. Few theory-based models have been developed to explain and predict the consumption of various foods by children. This study proposed a model to explain fruit and vegetable consumption in children based on Social Cognitive Theory and on the literature in nutrition education. The model was tested using structural equation modeling techniques. Data from 414 third-graders were gathered on five predictors including availability, modeling, nutrition education, motivation (i.e., self-efficacy, outcome expectancies, food preferences), and knowledge. The proposed model was tested with two random splits of the data and also separately for males and females. Results indicate adequate fit of the models for each of the four data sets (split 1, split 2, males, females). The pattern of significant paths was similar across the data sets. Availability and motivation (i.e., self-efficacy, outcome expectancies, food preference) were most consistently related to consumption and to other constructs in the model.

Associations among parental feeding styles and children's food intake in families with limited incomes

BackgroundAlthough general parenting styles and restrictive parental feeding practices have been associated with childrens weight status, few studies have examined the association between feeding styles and proximal outcomes such as childrens food intake, especially in multi-ethnic families with limited incomes. The purpose of this study was to evaluate the association of parental feeding styles and young childrens evening food intake in a multiethnic sample of families in Head Start.MethodsParticipants were 715 Head Start children and their parents from Texas and Alabama representing three ethnic groups: African-American (43%), Hispanic (29%), and White (28%). The Caregivers Feeding Styles Questionnaire (Hughes) was used to characterize authoritative, authoritarian (referent), indulgent or uninvolved feeding styles. Food intake in several food groups was calculated from 3 days of dietary recalls for the child for evening food intakes from 3 PM until bedtime.ResultsCompared to children of authoritarian parents, intakes of fruits, juice and vegetables were lowest among children of indulgent or uninvolved parents (1.77 ± 0.09 vs 1.45 ± 0.09 and 1.42 ± 0.11 cups) as were intakes of dairy foods (0.84 ± 0.05 vs 0.67 ± 0.05 and 0.63+0.06 cups), respectively.ConclusionFindings suggest that permissive parent feeding styles like indulgent or uninvolved relate negatively to childrens intake of nutrient-rich foods fruit, 100% fruit juice, vegetables and dairy foods from 3 PM until bedtime.

Perceptual gaps in understanding patient expectations for health care service quality.

This article assesses how well physicians, health administrators, patient-contact employees, and especially medical and nursing students understand patient expectations for service quality as measured by the SERVQUAL scale. Using a cross-sectional research design and discriminant analysis, it was found that health administrators were most likely to accurately estimate the service expectations of patients, while medical and nursing students were most likely to underestimate them.

Reasons for Not Intensifying Medications: Differentiating “Clinical Inertia” from Appropriate Care

Background“Clinical inertia” has been defined as inaction by physicians caring for patients with uncontrolled risk factors such as blood pressure. Some have proposed that it accounts for up to 80% of cardiovascular events, potentially an important quality problem. However, reasons for so-called clinical inertia are poorly understood.ObjectiveTo derive an empiric conceptual model of clinical inertia as a subset of all clinical inactions from the physician perspective.MethodsWe used Nominal Group panels of practicing physicians to identify reasons why they do not intensify medications when seeing an established patient with uncontrolled blood pressure.Measurements and Main ResultsWe stopped at 2 groups (N = 6 and 7, respectively) because of the high degree of agreement on reasons for not intensifying, indicating saturation. A third group of clinicians (N = 9) independently sorted the reasons generated by the Nominal Groups. Using multidimensional scaling and hierarchical cluster analysis, we translated the sorting results into a cognitive map that represents an empirically derived model of clinical inaction from the physician’s perspective. The model shows that much inaction may in fact be clinically appropriate care.Conclusions/RecommendationsMany reasons offered by physicians for not intensifying medications suggest that low rates of intensification do not necessarily reflect poor quality of care. The empirically derived model of clinical inaction can be used as a guide to construct performance measures for monitoring clinical inertia that better focus on true quality problems.

Family caregiver social problem-solving abilities and adjustment during the inital year of the caregiving role.

The authors examined the relation of social problem-solving abilities to trajectories of adjustment of family caregivers in the initial year of their caregiving role. Persons who recently assumed the caregiver role for a family member with a recent-onset spinal cord injury completed measures of problem solving, depression, anxiety, and health during the inpatient rehabilitation program and at 3 other times throughout the year. Hierarchical linear modeling showed that negative problem orientation explained significant variation in the rates of change in caregiver depressive behavior, anxiety, and health complaints. Caregivers with a greater negative orientation were at risk to develop psychological and health problems at a significantly higher rate over the year. Implications for psychological interventions and health policy concerning the needs of family caregivers and their care recipients are discussed.

Hospital information technology and positive financial performance: a different approach to finding an ROI.

EXECUTIVE SUMMARY This empirical study examined the relationship between information technology (IT) utilization and hospital financial performance. Using primary and secondary data, we specified and tested a series of regression models that examined this relationship in Florida hospitals. In addition, we employed performance group analysis for a select group of operational performance indicators. Findings suggested a significant and positive relationship between increased levels of IT use and various measures of financial performance, even after controlling for case‐mix acuity and bed size. Regardless of the analysis or method employed, the results indicated that IT adoption is consistently related to improved financial outcomes both overall and operationally. This relationship was present when examining IT collectively and for clinical IT, administrative IT, and strategic IT as individual measures. Lastly, although higher IT use was associated with a higher level of revenues, income, or cash flow, higher use was also associated with ratios based on higher expenses. This probably reflects the relatively high acquisition costs associated with obtaining and maintaining sophisticated IT systems. Given that a true return on investment is so difficult to obtain for many individual hospitalwide IT systems, our data can serve as a proxy for hospital leaders and policymakers who want to understand the potential financial effects of investing in IT in the acute care setting.

Somatic complaints and the CES-D.

To evaluate the Center for Epidemiology Surveys‐Depression (CES‐D) scale for inordinate false positives, due to measurement of non‐depression‐related somatic complaints.

DYNAMIC PROCESSES IN HEALTH OUTCOMES AMONG CAREGIVERS OF PATIENTS WITH SPINAL CORD INJURIES

The developmental trajectories of health outcomes in caregivers of patients with spinal cord injuries (SCIs) were studied as a function of caregiver and patient characteristics. Hierarchical linear modeling analysis examined (a) intraindividual developmental patterns of depressive behavior, anxiety, and physical symptoms over the 1st year of the caregiving career and (b) correlates of heterogeneity in the developmental patterns among 62 caregivers of persons with SCIs. Physical symptoms and anxiety were highly interdependent. Anxiety was a salient predictor of initial levels of and the rate of change in physical symptoms of caregivers. Physical symptoms and younger patient age were significantly predictive of initial levels of anxiety. Physical symptoms and positive affect predicted initial levels of depressive behavior among caregivers. Expressive support predicted the rate of change in anxiety and depressive behavior over time. These findings illustrate the value of studying caregiving as a developmental process.