Vicki Collie-Akers

Sleep Environment Risks for Younger and Older Infants

OBJECTIVE: Sudden infant death syndrome and other sleep-related causes of infant mortality have several known risk factors. Less is known about the association of those risk factors at different times during infancy. Our objective was to determine any associations between risk factors for sleep-related deaths at different ages. METHODS: A cross-sectional study of sleep-related infant deaths from 24 states during 2004–2012 contained in the National Center for the Review and Prevention of Child Deaths Case Reporting System, a database of death reports from state child death review teams. The main exposure was age, divided into younger (0–3 months) and older (4 months to 364 days) infants. The primary outcomes were bed-sharing, objects in the sleep environment, location (eg, adult bed), and position (eg, prone). RESULTS: A total of 8207 deaths were analyzed. Younger victims were more likely bed-sharing (73.8% vs 58.9%, P < .001) and sleeping in an adult bed/on a person (51.6% vs 43.8%, P < .001). A higher percentage of older victims had an object in the sleep environment (39.4% vs 33.5%, P < .001) and changed position from side/back to prone (18.4% vs 13.8%, P < .001). Multivariable regression confirmed these associations. CONCLUSIONS: Risk factors for sleep-related infant deaths may be different for different age groups. The predominant risk factor for younger infants is bed-sharing, whereas rolling into objects in the sleep area is the predominant risk factor for older infants. Parents should be warned about the dangers of these specific risk factors appropriate to their infant’s age.

Community-Based Participatory Research Within the Latino Health for All Coalition

Despite widespread recognition that Latinos and other minorities are at higher risk for diabetes and cardiovascular diseases, much less is known about how to create conditions for health and health equity. This report presents information about implementation of the Health for All Model in accordance with principles of community-based participatory research (CBPR). Using an empirical case study design, we reported on community changes (i.e., new or modified programs, policies, or practices) facilitated by the coalition and their distribution among primary goal areas (i.e., healthy nutrition, physical activity, and access to health services) and in different community sectors and ecological levels. Qualitative information suggested that the community and scientific partners shared decision making and control, as well as adherence to other principles of community-based participatory research. Such systematic efforts contribute to our understanding of how collaborative action can achieve the changes in conditions necessary to assure health for all.

Community Policies and Programs to Prevent Obesity and Child Adiposity

INTRODUCTION Evidence regarding impact of community policies and programs (CPPs) to prevent child obesity is limited, and which combinations of strategies and components are most important is not understood. The Healthy Communities Study was an observational study to assess relationships of characteristics and intensity of CPPs with adiposity, diet, and physical activity in children, taking advantage of variation across the U.S. in community actions to prevent child obesity. The study examined the association of CPPs to prevent child obesity with measured BMI and waist circumference, hypothesizing that communities with more-comprehensive CPPs would have children with lower adiposity. METHODS The study included 130 communities selected by probability-based sampling or because of known CPPs targeting child obesity. Data were collected at home visits on 5,138 children during 2013-2015. CPPs were scored for multiple attributes to create a CPP intensity score. A CPP target behavior score reflected the number of distinct target behaviors addressed. Scores were standardized with the smallest observed score across communities being 0 and the largest 1. Multilevel regression analysis in 2016 adjusted for community, household, and individual characteristics. RESULTS Higher CPP target behavior score was significantly associated with lower BMI and waist circumference in a dose-response relationship, with magnitude for the past 3 years of CPPs of 0.843 (p=0.013) for BMI and 1.783 cm (p=0.020) for waist circumference. CONCLUSIONS This study provides plausible evidence that comprehensive CPPs targeting a greater number of distinct physical activity and nutrition behaviors were associated with lower child adiposity.

Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals.

OBJECTIVE It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting. METHODS During an 18-month period, interns rotating on 1 of 2 otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical examination (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use. RESULTS A total of 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P < .001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% confidence interval 0.87-0.99) and sensitivity was 0.63 (95% confidence interval 0.50-0.73). Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (interquartile range 1-10 months). CONCLUSIONS A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs.

A case study of use of data for participatory evaluation within a statewide system to prevent substance abuse.

Although evaluation is considered an essential component of community health initiatives, its function requires actual use of the data to inform practice. The purpose of this case study was to examine how often and in what ways practitioners in a state system for substance abuse prevention used participatory evaluation data. To assess uses of data, interviews and surveys (N = 13) were conducted with practitioners. Questions focused on the frequency of use for several functions of evaluation data. Results showed that 77% of participants reported using their data within the past 30 days to review progress of the initiative, and 64% had used the data to communicate successes or needed improvement to staff. Fewer participants indicated they had used the data to communicate accomplishments to stakeholders (54%) or to make adjustments to plans (38%). This study suggests that participatory evaluation data can have multiple functions and uses for community health practitioners.

Implementing Community‐Based Participatory Research with Two Ethnic Minority Communities in Kansas City, Missouri

Community‐based participatory research (CBPR) has been shown to improve aspects of health promotion initiatives. This case study examines the effects of a CBPR intervention on intermediate outcomes (changes in the community) related to preventing health disparities and chronic disease. We describe how the Kansas City‐Chronic Disease Coalition used CBPR methods to help bring about community changes to reduce risk for cardiovascular diseases and diabetes among African Americans and Hispanics in Kansas City, Missouri. Using an empirical case study design, communities and scientific partners documented and analyzed the contribution of community changes (new or modified programs, policies or practices) facilitated by the coalition in two racial/ethnic communities: African American and Hispanic. Follow‐up interviews suggest that the coalition did a better job of implementing a CBPR intervention in the African American community than in the Hispanic community. Challenges to implementing CBPR interventions in multiple and diverse ethnic communities are discussed.

REACH 2010: Kansas City, Missouri Evaluating Mobilization Strategies With Neighborhood and Faith Organizations to Reduce Risk for Health Disparities

Health disparities, differences in health status, and mortality among different groups have challenged the public health commitment to health for all. African Americans and Latinos have historically experienced greater prevalence and mortality from many chronic diseases than Whites. Community mobilization is a promising approach to addressing health disparities. The Kansas City—Chronic Disease Coalition (KC-CDC), a REACH 2010 initiative, aimed to engage neighborhoods and faith organization in changing conditions to reduce risk for cardiovascular disease and diabetes. Using a time series design replicated with each of these two sectors, we examined the effects of a microgrant strategy and a resource distribution strategy on the coalitions facilitation of community change. Results indicate that both strategies increased the implementation of community change by neighborhood and faith organizations, with higher rates of change for the microgrant strategy. This study holds important implications for public health practitioners working with neighborhood and faith-based organizations to address health disparities.Health disparities, differences in health status, and mortality among different groups have challenged the public health commitment to health for all. African Americans and Latinos have historically experienced greater prevalence and mortality from many chronic diseases than Whites. Community mobilization is a promising approach to addressing health disparities. The Kansas City-Chronic Disease Coalition (KC-CDC), a REACH 2010 initiative, aimed to engage neighborhoods and faith organization in changing conditions to reduce risk for cardiovascular disease and diabetes. Using a time series design replicated with each of these two sectors, we examined the effects of a microgrant strategy and a resource distribution strategy on the coalitions facilitation of community change. Results indicate that both strategies increased the implementation of community change by neighborhood and faith organizations, with higher rates of change for the microgrant strategy. This study holds important implications for public health practitioners working with neighborhood and faith-based organizations to address health disparities.

Associations of community programs and policies with children's dietary intakes: the Healthy Communities Study: Community programs/policies and child nutrition

The impact of community‐based obesity prevention efforts on child nutrition has not been adequately studied.

Association between community characteristics and implementation of community programmes and policies addressing childhood obesity: the Healthy Communities Study: Community characteristics and programmes

Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity.

Measuring the intensity of community programs and policies for preventing childhood obesity in a diverse sample of US communities: the Healthy Communities Study: Intensity of community programs and policies

Efforts to address the critical public health problem of childhood obesity are occurring across the USA; however, little is known about how to characterize the intensity of these efforts.