Trevor A. Pickering

Preventable Hospitalizations Among Children in California Counties After Child Health Insurance Expansion Initiatives

Background:California has expanded health insurance to children in low- and middle-income families. Currently, Childrens Health Initiatives (CHIs) have been developed in 26 counties to supplement Medi-Cal and Healthy Families (SCHIP). Yet, as coverage expands, we know little about the impact of these programs on child health outcomes. Research Design:Child hospitalizations for ambulatory care sensitive conditions (ACSC) is a widely adopted measure of health outcomes. We compare rates of total ACSC hospitalizations among children ages 0–18 years in 9 operational CHI counties prior to CHI implementation to rates after the CHIs became operational. As a comparison group, we stratify the analyses by family income level and compare children in lower-income to higher-income families. Results:Between 2000 and 2005, there were 281,000 total preventable hospital pediatric admissions. After adjusting for the effects of time and county, the rate of ACSC hospitalizations was 19% lower postimplementation of CHIs versus preimplementation for children of lower-income families (rate ratio of 0.81, P = 0.0001), but not for children of higher-income families (rate ratio of 0.99, P = 0.93). We estimate that 6324 ACSC hospitalizations may have already been prevented in existing CHI counties after implementation, saving about

Relationship of medical home quality with school engagement and after-school participation among children with asthma

6.7 million over the 6 years, assuming

Two facets of stress and indirect effects on child diet through emotion-driven eating

7000 per child hospitalization. Conclusions:With health insurance coverage available for all children, and families financially able to connect with an ongoing source of primary care, some of the potential benefits of reduced ACSC hospitalizations may help to offset premium costs associated with assuring that all children have coverage.

A method for assessing implementation success of a peer-led suicide prevention program

Objectives: To examine the relationship between medical home quality and measures of daily life experiences among children with asthma. Methods: A nationally representative sample of children from the 2007 National Survey of Childrens Health (NSCH), aged 6–17 years (n = 6357), who have asthma was used to assess the relationship of a quality medical home and its features with their daily life experiences. Five medical home features – access, continuity, comprehensiveness, family-centered care, and coordination of care – were examined individually and in total in relation to measures of school engagement (missed school days, parents contacted about problems with the child, repeating a grade since kindergarten) and after-school activity participation (physical activity, sports participation, and community service or volunteer work). Results: Before and after adjustment for personal characteristics, health insurance status, family environment, neighborhood variables, and asthma severity, total medical home score was associated with more days exercised [beta (B) = 0.10, p < .05] and a greater likelihood of having performed community service or volunteer work [odds ratio (OR) = 1.16, CI: 1.02–1.31]. Additionally, the medical home features of access, comprehensiveness, and family-centered care remained favorably associated with three of the six measures of school engagement and after-school activity participation, even after adjustment. Conclusion: Medical home quality – particularly the features of access, comprehensiveness, and family-centered care – is positively associated with the daily life experiences of children with asthma. Working to enhance these aspects of primary care might be one place to start in improving the management of childrens chronic conditions and their quality of life.

Physical Activity and Variation in Momentary Behavioral Cognitions: An Ecological Momentary Assessment Study.

OBJECTIVE Stress has been associated with high-calorie, low-nutrient food intake (HCLN) and emotion-driven eating (EDE). However, effects on healthy food intake remain unknown. This study examined two facets of stress (self-efficacy, perceived helplessness) and food consumption, mediated by EDE. METHODS Cross-sectional data from fourth-graders (n=978; 52% female, 28% Hispanic) in an obesity intervention used self-report to assess self-efficacy, helplessness, EDE, fruit/vegetable (FV) intake, and high-calorie/low-nutrient (HCLN) food. RESULTS Higher stress self-efficacy was associated with higher FV intake, β=.354, p<0.001, and stress perceived helplessness had an indirect effect on HCLN intake through emotion-driven eating, indirect effect=.094, p<0.001; χ(2)(347)=659.930, p<0.001, CFI=0.940, TLI=0.930, RMSEA=0.030, p=1.00, adjusting for gender, ethnicity, BMI z-score, and program group. CONCLUSIONS AND IMPLICATIONS Stress self-efficacy may be more important for healthy food intake and perceived helplessness may indicate emotion-driven eating and unhealthy snack food intake. Obesity prevention programs may consider teaching stress management techniques to avoid emotion-driven eating.

Investigation of Social Networks and Discussions in STEM Education Communities on Twitter

Background Peer leader programs that prepare opinion leaders to spread healthy practices through their social networks reduce high-risk sex behaviors and show promise in preventing adolescent substance use and suicidal behavior. However, knowledge of implementation processes is very limited. To address this limitation, we drew on the Stages of Implementation Completion (SIC) framework to measure a key phase of peer leader implementation.

Healthy Kids insurance and experiences of medical home quality for vulnerable children.

BACKGROUND Decisions to perform moderate-to-vigorous physical activity (MVPA) involve behavioral cognitive processes that may differ within individuals depending on the situation. METHODS Ecological momentary assessment (EMA) was used to examine the relationships of momentary behavioral cognitions (ie, self-efficacy, outcome expectancy, intentions) with MVPA (measured by accelerometer). A sample of 116 adults (mean age, 40.3 years; 72.4% female) provided real-time EMA responses via mobile phones across 4 days. Multilevel models were used to test whether momentary behavioral cognitions differed across contexts and were associated with subsequent MVPA. Mixed-effects location scale models were used to examine whether subject-level means and within-subjects variances in behavioral cognitions were associated with average daily MVPA. RESULTS Momentary behavioral cognitions differed across contexts for self-efficacy (P = .007) but not for outcome expectancy (P = .53) or intentions (P = .16). Momentary self-efficacy, intentions, and their interaction predicted MVPA within the subsequent 2 hours (Ps < .01). Average daily MVPA was positively associated with within-subjects variance in momentary self-efficacy and intentions for physical activity (Ps < .05). CONCLUSIONS Although momentary behavioral cognitions are related to subsequent MVPA, adults with higher average MVPA have more variation in physical activity self-efficacy and intentions. Performing MVPA may depend more on how much behavioral cognitions vary across the day than whether they are generally high or low.

STEM conversations in social media: Implications on STEM education

With the increasing importance of STEM education and the popularity of micro blogging, it becomes important to study the nature of the social network within STEM education in order to observe how members of that community work together. A social network analysis (SNA) was conducted to examine the nature of the STEM education community and its key players on Twitter. The findings from the SNA will show: categories of the key players in this social network, to what extent a community exists on the Twitter platform, and the types of interactions that users contribute to the community, and kinds of information being discussed.

Is Online Partner-Seeking Associated with Increased Risk of Condomless Sex and Sexually Transmitted Infections Among Individuals Who Engage in Heterosexual Sex? A Systematic Narrative Review

ObjectivesTo examine the relationship of enrollment in Healthy Kids insurance (locally funded insurance products for low-income children ineligible for other public insurance) with parent-reported experiences of primary care medical home quality. MethodsA cross-sectional survey of parents of 4011 children stratified by established enrollees in Healthy Kids (enrolled 1 y or longer), new enrollees (less than 1 y), and children on a waitlist. We examined differences across groups in having an ongoing source of primary care, and experiences of 6 features of a medical home—accessibility, continuity, comprehensiveness, contextual knowledge, communication, and coordination—and a summary medical home measure. ResultsCompared with waitlisted children, new and established enrollees were more likely to have a regular source of care [odds ratio (OR)=2.49; 95% confidence interval (CI): 1.74-3.57 and OR=6.51; CI: 4.64-9.13, respectively] and a personal doctor or nurse (OR=3.41; CI: 2.42-4.80 and OR=7.00; CI: 5.07-9.66). Among those with a regular source of care and visit in the past year, new and established enrollees reported better medical home experiences in 4 and 6 of the 7 measures, respectively. ConclusionsDespite many barriers to care for vulnerable children, Healthy Kids enrollment was positively associated with having an ongoing source of primary care and better medical home experiences. As these children are mostly left out of healthcare reform, Healthy Kids programs may be a good model for other counties and states to help to connect such children to primary care.

Friendship networks and sun safety behavior among children

This paper investigated conversations in social media on STEM over the course of a year to find who are the most important people that may influence STEM education discussions as well as the trends in the topics of conversations. The findings reveal that the most influential users represent organizations (businesses and non-profits relating to STEM fields and STEM education), although facilitation of such conversations are influenced by individuals. Further, the trends in conversations largely center on topics, such as K-12 and graduate studies, engaging K-12 STEM practices, specific STEM disciplines, and STEM careers.