Using Body Mass Index to Identify Overweight Children: Barriers and Facilitators in Primary Care

Overweight is an increasingly prevalent pediatric health problem but is under-diagnosed. Despite recommendations endorsing the use of body mass index (BMI) to identify overweight children, clinicians seldom use BMI. Barriers to the use of BMI in pediatric primary care have not previously been described

Cancer risk and parental pesticide application in children of Agricultural Health Study participants.

Parental exposure to pesticides may contribute to childhood cancer risk. Through the Agricultural Health Study, a prospective study of pesticide applicators in Iowa and North Carolina, we examined childhood cancer risk and associations with parental pesticide application. Identifying information for 17,357 children of Iowa pesticide applicators was provided by parents via questionnaires (1993-1997) and matched against the Iowa Cancer Registry. Fifty incident childhood cancers were identified (1975-1998). Risk of all childhood cancers combined was increased [standardized incidence ratio (SIR) = 1.36; 95% confidence interval (CI), 1.03-1.79]. Risk of all lymphomas combined was also increased (SIR = 2.18; 95% CI, 1.13-4.19), as was risk of Hodgkin's lymphoma (SIR = 2.56; 95% CI, 1.06-6.14). We used logistic regression to explore associations between self-reported parental pesticide application practices and childhood cancer risk. No association was detected between frequency of parental pesticide application and childhood cancer risk. An increased risk of cancer was detected among children whose fathers did not use chemically resistant gloves [odds ratio (OR) = 1.98; 95% CI, 1.05-3.76] compared with children whose fathers used gloves. Of 16 specific pesticides used by fathers prenatally, ORs were increased for aldrin (OR = 2.66), dichlorvos (OR = 2.06), and ethyl dipropylthiocarbamate (OR = 1.91). However, these results were based on small numbers and not supported by prior biologic evidence. Identification of excess lymphoma risk suggests that farm exposures including pesticides may play a role in the etiology of childhood lymphoma

Understanding Breastfeeding Initiation and Continuation in Rural Communities: A Combined Qualitative/Quantitative Approach

To determine factors associated with breastfeeding in rural communities

Bolstering Confidence in Obesity Prevention and Treatment Counseling for Resident and Community Pediatricians

Objective- To assess whether equipping resident pediatricians and community pediatricians with both training and practical tools improves their perceived confidence, ease, and frequency of obesity related counseling to patients. Methods- In 2005-2006, resident pediatricians (n = 49) and community pediatricians (n=18) received training regarding three evidence-based obesity prevention/treatment tools and responded to pre-and post-intervention questionnaires. We analyzed changes in reported mean confidence, ease, and frequency of dietary, physical activity, and weight status counseling. Results- Baseline scores of confidence, ease, and frequency of counseling were higher in community pediatricians than residents. Mean scores increased significantly in the combined group, among residents only, and trended towards improvement in the community pediatricians following the intervention. Means for "control" questions were unchanged. Conclusion- Training and tools for residents and community pediatricians improved their confidence, ease, and frequency of obesity-related counseling. Practice Implications- This study demonstrates that when feasible and appropriate tools and training were provided through a simple intervention, physicians gained confidence and ease and increased their counseling frequency. The results here suggest that widespread implementation of such educational interventions for community practitioners and practitioners in training could change the way physicians counsel patients to prevent the often frustrating problem of childhood obesity. Originally published Patient Education and Counseling, Vol. 73, No. 2, Nov 200

“Pilot Evaluation of the Impact of Pediatric Primary Care Based Interventions to Promote Kindergarten Readiness”

North Carolina Integrated Care for Kids (NC InCK) is a child-centered health service delivery and state payment model aimed at improving the quality of care and reducing expenditures for 97,000 children insured by Medicaid or CHIP. In 2023, NC InCK launched its Alternative Payment Model (APM), which financially incentivizes pediatric primary care providers to administer 12 interventions during well child visits to improve kindergarten readiness among patients from birth to the sixth birthday. The Primary Care Kindergarten Readiness Promotion Bundle (K-Readiness Promotion Bundle) includes six universal interventions (1, conduct well visit; 2, social-emotional screening; 3, hearing and vision screening; 4, office-based literacy promotion; 5, developmental screening; 6, fluoride varnish) and six needs-based interventions (7, referral to Pre-K; 8, referral to Children’s Development Services Agency; 9, referral to Exceptional Children’s program; 10, provision of/referral to early childhood mental health services; 11, provision of/referral to parenting support program; 12, referral to a community-based literacy program). The effect of the K-Readiness Promotion Bundle on academic preparedness is unknown. We aim to examine the early impact of the K-Readiness Promotion Bundle on the Early Learning Inventory (ELI) scores, an assessment that is administered to all children in NC within the first 60 days of kindergarten initiation

Neighborhood Commute to Work Times and Self-Reported Caregiver Health Behaviors and Food Access

Time spent commuting is associated with obesity. The objective of this study was to assess the relationship between neighborhood-level commute to work (CTW) times and self-reported health behaviors and food access. We conducted a cross-sectional analysis of caregivers with infants as part of the Greenlight Study, a multisite obesity trial in Chapel Hill, New York City, Nashville, and Miami. ZIP code–based commuting estimates were determined using the US Census American Community Survey. Self-reported health behaviors and food access data were collected by directed interview. Logistic and linear regression models were used to determine associations between neighborhood CTW times and health behaviors and food access. The average neighborhood CTW time for all ZIP codes was 29 minutes (n = 846). Caregivers in longer CTW time neighborhoods were more likely to endorse fewer food choices (adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.15–1.69; P = .001) and difficulty accessing markets with fresh produce (AOR, 1.51; 95% CI, 1.02–2.25; P = .04). Neighborhood CTW time >30 minutes was associated with less caregiver physical activity (AOR, 0.58; 95% CI, 0.34–0.98; P = .044). Neighborhood CTW time was inversely related to infant television time (adjusted mean, 399 minutes/day for ≤30 minutes and 256 minutes/day for >30 minutes; P = .025). New York families in longer CTW neighborhoods were more likely to report difficulty accessing markets with fresh produce (AOR, 1.80; 95% CI, 1.03–3.14; P = .039). Neighborhood CTW time is associated with several self-reported health behaviors and perceived food access among caregivers with children. Neighborhood CTW times may represent city-specific features, including transportation infrastructure, which may impact the health of families

Satisfaction With Communication in Primary Care for Spanish-Speaking and English-Speaking Parents

Effective communication with primary care physicians is important yet incompletely understood for Spanish-speaking parents. We predicted lower satisfaction among Spanish-speaking compared to English-speaking Latino and non-Latino parents. Cross-sectional analysis at 2-month well visits within the Greenlight study at 4 pediatric resident clinics. Parents reported satisfaction with 14 physician communication items using the validated Communication Assessment Tool (CAT). High satisfaction was defined as "excellent" on each CAT item. Mean estimations compared satisfaction for communication items among Spanish- and English-speaking Latinos and non-Latinos. We used generalized linear regression modeling, adjusted for parent age, education, income, and clinic site. Among Spanish-speaking parents, we compared visits conducted in Spanish with and without an interpreter, and in English. Compared to English-speaking Latino (n = 127) and non-Latino parents (n = 432), fewer Spanish-speaking parents (n = 303) reported satisfaction with 14 communication items. No significant differences were found between English-speaking Latinos and non-Latinos. Greatest differences were found in the use of a greeting that made the parent comfortable (59.4% of Spanish-speaking Latinos endorsing "excellent" vs 77.5% English-speaking Latinos, P < .01) and discussing follow-up (62.5% of Spanish-speaking Latinos vs 79.8% English-speaking Latinos, P < .01). After adjusting for parent age, education, income, and study site, Spanish-speaking Latinos were still less likely to report high satisfaction with these communication items. Satisfaction was not different among Spanish-speaking parents when the physician spoke Spanish versus used an interpreter. Satisfaction with physician communication was associated with language but not ethnicity. Spanish-speaking parents less frequently report satisfaction with communication, and innovative solutions to enhance communication quality are needed