Sabina B. Gesell

Culturally tailored, family-centered, behavioral obesity intervention for Latino-American preschool-aged children.

OBJECTIVE: To test the effect of a culturally tailored, family-centered, short-term behavioral intervention on BMI in Latino-American preschool-aged children. METHODS: In a randomized controlled trial, 54 parent–child dyads were allocated to the intervention and 52 dyads were allocated to an alternative school-readiness program as the control condition. Parent–child dyads were eligible if the parent self-defined Latino, was at least 18 years old, had a 2- to 6-year-old child not currently enrolled in another healthy lifestyle program, had a valid telephone number, and planned on remaining in the city for the next 6 months. The Salud Con La Familia (Health with the Family) program consisted of 12 weekly 90-minute skills-building sessions designed to improve family nutritional habits and increase physical activity. Both programs were conducted in a community recreation center serving an urban neighborhood of mostly Spanish-speaking residents. RESULTS: Forty-two percent of participating preschool-aged children were overweight or obese. Controlling for child age, gender, and baseline BMI, the effect of the treatment condition on postintervention absolute BMI was B = –0.59 (P < .001). The intervention effect seemed to be strongest for obese children. CONCLUSIONS: A skills-building, culturally tailored intervention involving parent–child dyads changed short-term early growth patterns in these Latino-American preschool-aged children. Examining long-term effects would be a prudent next step.

A patient satisfaction theory and its robustness across gender in emergency departments: a multigroup structural equation modeling investigation.

This investigation tested the patient-centered Primary Provider Theory of Patient Satisfaction across gender in national random samples of emergency patients. Using multigroup structural equation modeling, the results supported the models robustness. Physician service, waiting time, and nursing satisfaction explained 48%, 41%, and 11% of overall satisfaction plus 92% and 93% of female and male satisfaction, respectively. Unit increases in physician service satisfaction increased waiting time, nursing, and overall satisfaction by 0.991, 0.844, and 1.031 units, respectively. Unit increases in waiting time satisfaction increased nursing and overall satisfaction by 0.417 and 0.685 units, respectively. A unit increase in nursing satisfaction increased overall service satisfaction by 0.221 units. The investigation offers an alternative paradigm for measuring and achieving emergency department satisfaction, hierarchically related to patient expectations, where the primary provider has the greatest clinical utility to patients, followed by waiting for the primary provider, and then by nursing service.

The Distribution of Physical Activity in an After-school Friendship Network

OBJECTIVE: To examine whether a child’s friendship network in an afterschool program influences his/her physical activity. METHODS: Three waves of data were collected from school-aged children participating in aftercare (n = 81; mean [SD] age, 7.96 [1.74] years; 40% African American, 39% white, and 19% Latino) a name generator survey was used to map each child’s social network, and accelerometers were used to measure physical activity. We applied stochastic actor-based modeling for social networks and behavior. RESULTS: Children did not form or dissolve friendships based on physical activity levels, but existing friendships heavily influenced children’s level of physical activity. The strongest influence on the amount of time children spent in moderate-to-vigorous activity in the afterschool hours was the activity level of their immediate friends. Children consistently made adjustments to their activity levels of 10% or more to emulate the activity levels of their peers (odds ratio [OR] = 6.89, P < .01). Age (OR = 0.92, P < .10) and obesity status (OR = 0.66, P < .10) had marginally significant and relatively small direct effects on the activity. Gender had no direct effect on activity. CONCLUSIONS: These results suggest that friendship ties play a critical role in setting physical activity patterns in children as young as 5 to 12 years. Children’s activity levels can be increased, decreased, or stabilized depending on the activity level of their immediate social network during a 12-week afterschool program. Network-based interventions hold the potential to produce clinically significant changes to children’s physical activity.

The Relationship Between Hispanic Parents and Their Preschool-Aged Children's Physical Activity

OBJECTIVE: The goal of this study was to examine activity pattern associations between Hispanic parents and their preschool-aged children. METHODS: We examined baseline data collected as part of a randomized controlled trial. Self-defined Hispanic parents with children aged 3 to 5 years were randomly assigned to either a weekly healthy lifestyle group (intervention) or a monthly school-readiness group (control) for 3 months. There were no weight eligibility criteria. All participants were instructed to wear an accelerometer for up to 7 consecutive days to measure physical activity. RESULTS: Of the 106 dyads enrolled in the study, 80 children and 85 parents provided useable actigraphy data. Mean percentage of time spent in sedentary behaviors was 82.0% (SD: 10.4) for parents and 69.8% (SD: 18.5) for preschool-aged children. Percentage of awake time per day spent in sedentary behavior was strongly correlated for parents and children (r = 0.597; P < .001). Correlations between activity level were large (r = 0.895 and 0.739 for low and moderate activity levels, respectively), except for vigorous activity level, for which the parent-child correlation was nonsignificant (P = .64) because of a near-0 level of vigorous parental activity. Childs age (P = .81) and gender (P = .43) were nonsignificant predictors of child activity levels. CONCLUSIONS: These results suggest that parental activity levels are a powerful explanation of preschool-aged child activity levels, except for vigorous activity, which children do on their own without parental participation. Hispanic parents play a critical role in setting physical activity patterns in their children.

Social network diagnostics: a tool for monitoring group interventions

BackgroundMany behavioral interventions designed to improve health outcomes are delivered in group settings. To date, however, group interventions have not been evaluated to determine if the groups generate interaction among members and how changes in group interaction may affect program outcomes at the individual or group level.MethodsThis article presents a model and practical tool for monitoring how social ties and social structure are changing within the group during program implementation. The approach is based on social network analysis and has two phases: collecting network measurements at strategic intervention points to determine if group dynamics are evolving in ways anticipated by the intervention, and providing the results back to the group leader to guide implementation next steps. This process aims to initially increase network connectivity and ultimately accelerate the diffusion of desirable behaviors through the new network. This article presents the Social Network Diagnostic Tool and, as proof of concept, pilot data collected during the formative phase of a childhood obesity intervention.ResultsThe number of reported advice partners and discussion partners increased during program implementation. Density, the number of ties among people in the network expressed as a percentage of all possible ties, increased from 0.082 to 0.182 (p < 0.05) in the advice network, and from 0.027 to 0.055 (p > 0.05) in the discussion network.ConclusionsThe observed two-fold increase in network density represents a significant shift in advice partners over the intervention period. Using the Social Network Tool to empirically guide program activities of an obesity intervention was feasible.

Social Influences on Self-Reported Physical Activity in Overweight Latino Children

Psychosocial variables influence physical activity for different age groups, sex, and ethnic groups. However, little is known about their influence on physical activity in preadolescent Latino children. The authors examined how a) confidence in ones ability to be physically active (self-efficacy); b) ideas about the consequences of being physically active (beliefs), and c) the influences of family and friends on physical activity (social influences) effect physical activity levels in overweight (body mass index ≥85%) Latino preadolescent children. One hundred and fourteen preadolescents participated in a larger intervention designed to improve healthy lifestyles for Latino families. The authors report baseline data collected at a community-based primary care clinic. Multivariate regression analyses showed that only social influences significantly predicted (P < .01) the metabolic equivalent adjusted self-reported baseline physical activity. Prevention and intervention strategies that augment social influences on physical activity are likely to result in more physical activity and improved health in these children.

Recruitment and retention of Latino children in a lifestyle intervention.

OBJECTIVE To describe promising recruitment and retention strategies for transient Latino populations, assisting investigators who work with this population in their research design and implementation. METHODS Strategies in recruitment and retention from a year-long intervention in children and their families are described. RESULTS Of the 159 families who agreed to participate in the program, 123 parent-child dyads were enrolled. Retention rates were 59% in the control group, 67% in the intervention group. CONCLUSION Building and maintaining relationships between a consistent study team contact and participants promote strong recruitment and retention outcomes. Barriers such as child care and transportation must be minimized.

Understanding the Social Networks That Form within the Context of an Obesity Prevention Intervention

Background. Antiobesity interventions have generally failed. Research now suggests that interventions must be informed by an understanding of the social environment. Objective. To examine if new social networks form between families participating in a group-level pediatric obesity prevention trial. Methods. Latino parent-preschool child dyads (N = 79) completed the 3-month trial. The intervention met weekly in consistent groups to practice healthy lifestyles. The control met monthly in inconsistent groups to learn about school readiness. UCINET and SIENA were used to examine network dynamics. Results. Childrens mean age was 4.2 years (SD = 0.9), and 44% were overweight/obese (BMI ≥ 85th percentile). Parents were predominantly mothers (97%), with a mean age of 31.4 years (SD = 5.4), and 81% were overweight/obese (BMI ≥ 25). Over the study, a new social network evolved among participating families. Parents selectively formed friendship ties based on child BMI z-score, (t = 2.08; P < .05). This reveals the tendency for mothers to form new friendships with mothers whose children have similar body types. Discussion. Participating in a group-level intervention resulted in new social network formation. New ties were greatest with mothers who had children of similar body types. This finding might contribute to the known inability of parents to recognize child overweight.

Inpatient heart failure treatment from the patient's perspective.

Objective: The objective of this study was 2-fold: (1) to identify particular opportunities for improvement in patient-centered care of heart failure patients and (2) to suggest strategies for service quality improvement focusing on those areas. Sample: A national cross-sectional sample of survey data from diagnostic-related group 127 patients was collected between December 1, 2001, and November 30, 2003. Data were split into two 12-month samples to compare results over time. The 2002 sample included 5224 patients treated at 220 hospitals; the 2003 sample included 6531 patients treated at 269 hospitals. Method: A standardized mail-out/mail-back methodology was used to collect data from random samples of patients within 5 days of discharge. Results: For both samples, the ranking of service issues was highly similar, with the same 4 areas emerging as the foremost priorities: patient involvement in decision making, staff response to concerns voiced during the hospital stay, staff sensitivity to the inconvenience of heart failure and hospitalization, and emotional/spiritual support. Improvement in these 4 service areas should be associated with the greatest increases in patient satisfaction and quality of care for heart failure patients. Conclusions: Adequately addressing these patient needs should increase patient satisfaction and quality of care for heart failure patients.

Accuracy of Perception of Body Size Among Overweight Latino Preadolescents After a 6-Month Physical Activity Skills Building Intervention

Background. Previous research has shown that overweight Latino children underestimate their body size. Erroneous perception of body size may have important health and behavioral implications and serve as a significant barrier to weight control. Objective. The aim of this study was to determine whether children’s perceptions of their body size became more accurate following a pediatric obesity intervention focused on increasing physical activity. Design/ methods. This analysis includes 61 overweight (body mass index ≥85%) Latino children (aged 8-11 years) parent—child dyads who completed a pilot randomized control trial. Results. After the intervention, 40.7% (11/27) of children in the intervention group rated their body size accurately compared with 21.2% (7/33) in the control group. The difference indicates a trend toward significance (P = .09). Conclusions. Participating in monthly physical activity skill building sessions may increase children’s accuracy in body size perception.This may be an important first step toward behavior modification.