Material Hardships and Infant and Toddler Sleep Duration in Low-Income Hispanic Families

© 2020 Academic Pediatric Association Objective: To assess relationships between material hardships, shortened sleep duration, and suboptimal sleep practices across infancy and toddlerhood in low-income Hispanic families. Methods: We analyzed longitudinal data of 451 low-income Hispanic mother-child pairs from a child obesity prevention trial. During infancy and toddlerhood, we used adjusted linear regression to assess associations between material hardship (financial difficulty, food insecurity, housing disrepair, and multiple hardships), sleep duration (24-hour, night), and the number of suboptimal sleep practices (eg, later bedtime, co-sleeping). We used adjusted linear regression to assess the longitudinal association between the number of suboptimal sleep practices in infancy and toddlerhood, and tested whether specific or multiple hardships moderated this association. Results: In infants, financial difficulty and multiple hardships were associated with decreased night sleep (B = −0.59 hours, 95% confidence interval [CI]: −1.04, −0.14; and B = −0.54 hours, 95% CI: −1.00, −0.08). Housing disrepair was associated with decreased 24-hour sleep (B = −0.64 hours, 95% CI: −1.29, −0.01). In toddlers, each additional suboptimal sleep practice was associated with a decrease in night sleep (B = −0.19 hours, 95% CI: −0.29, −0.09). Each additional suboptimal sleep practice in infancy was associated with a 0.30 increase in the number of suboptimal sleep practices in toddlerhood (P \u3c .001), with greater increases for those with food insecurity or multiple hardships. Conclusion: Specific and multiple hardships shortened sleep duration during infancy, and moderated the increase of suboptimal sleep behaviors between infancy and toddlerhood. Future studies should consider these early critically sensitive periods for interventions to mitigate material hardships and establish healthy sleep practices

Readability, Suitability, and Characteristics of Asthma Action Plans: Examination of Factors That May Impair Understanding

OBJECTIVE: Recognition of the complexity of asthma management has led to the development of asthma treatment guidelines that include the recommendation that all pediatric asthma patients receive a written asthma action plan. We assessed the readability, suitability, and characteristics of asthma action plans, elements that contribute to the effectiveness of action plan use, particularly for those with limited literacy. METHODS: This was a descriptive study of 30 asthma action plans (27 state Department of Health (DOH)–endorsed, 3 national action plans endorsed by 6 states). Outcome measures: (1) readability (as assessed by Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast), (2) suitability (Suitability Assessment of Materials [SAM], adequate: ≥0.4; unsuitable: &amp;lt;0.4), (3) action plan characteristics (peak flow vs symptom-based, symptoms, recommended actions). RESULTS: Mean (SD) overall readability grade level was 7.2 (1.1) (range = 5.7–9.8); 70.0% were above a sixth-grade level. Mean (SD) suitability score was 0.74 (0.14). Overall, all action plans were found to be adequate, although 40.0% had an unsuitable score in at least 1 factor. The highest percent of unsuitable scores were found in the categories of layout/typography (30.0%), learning stimulation/motivation (26.7%), and graphics (13.3%). There were no statistically significant differences between the average grade level or SAM score of state DOH developed action plans and those from or adapted from national organizations. Plans varied with respect to terms used, symptoms included, and recommended actions. CONCLUSIONS: Specific improvements in asthma action plans could maximize patient and parent understanding of appropriate asthma management and could particularly benefit individuals with limited literacy skills. </jats:sec

Social Capital as a Positive Social Determinant of Health: A Narrative Review

© 2020 Academic Pediatric Association Social determinants of health influence child health behavior, development, and outcomes. This paper frames social capital, or the benefits that a child receives from social relationships, as a positive social determinant of health that helps children exposed to adversity achieve healthy outcomes across the life course. Children are uniquely dependent on their relationships with surrounding adults for material and nonmaterial resources. We identify and define three relevant aspects of social capital: 1) social support, which is embedded in a 2) social network, which is a structure through which 3) social cohesion can be observed. Social support is direct assistance available through social relationships and can be received indirectly through a caregiver or directly by a child. A child\u27s social network describes the people in a child\u27s life and the relationships between them. Social cohesion represents the strength of a group to which a child belongs (eg, family, community). Pediatric primary care practices play an important role in fostering social relationships between families, the health care system, and the community. Further research is needed to develop definitional and measurement rigor for social capital, to evaluate interventions (eg, peer health educators) that may improve health outcomes through social capital, and to broaden our understanding of how social relationships influence health outcomes

A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study

BACKGROUND AND OBJECTIVES: The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy–informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. METHODS: Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. Primary outcome measures: medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. RESULTS: 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P &amp;lt; .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1–123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P &amp;lt; .001; OR = 6.7; 95% CI, 2.9–15.8), address need for daily medications when sick (93.4% vs 34.5%, P &amp;lt; .001; OR = 27.1; 95% CI, 8.6–85.4), use explicit symptoms (eg, “ribs show when breathing,” 54.1% vs 3.4%, P &amp;lt; .001; OR = 33.0; 95% CI, 7.4–147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). CONCLUSIONS: Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles. </jats:sec