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Understanding parental experiences with managing their toddler's screen use is important to inform the design of interventions addressing early childhood screen use, yet current evidence is limited. To enhance our understanding of the context of toddler screen use, this study characterizes the screen-related discord and dismay parents experience in families with toddlers.In-depth interviews were conducted to explore everyday experiences with screen use among low-income Mexican American caregivers of toddlers (21 mothers, 10 fathers, 1 grandmother). Transcripts were content analyzed to identify prominent themes.Three themes were identified. Experiences of screen-related discord and dismay arose (1) between parent and child, (2) between parents, and (3) surfaced as parental internal dissonance about toddler screen use. Parent-child discord resulted from parental limit setting and child reactions to parental screen use, which often included tantrums. Parent-partner discord included patterns of agreeing to disagree and direct disagreement between partners. Parents also reported their own feelings of ambivalence and dismay as they struggled to reconcile their preferences against their toddler's actual screen use, while living in a screen-saturated world.Findings offer insight into types of screen-related discord and dismay low-income Mexican American parents experience as they attempt to manage their toddler's screen use.Although discord in families is normal, the screen-specific discord reported by participants warrants consideration in efforts promoting healthy screen use in families. Providers can tailor their counseling to consider the range of screen-related discord families of toddlers may experience.

Synthetic surrogate head models are used in biomechanical studies to investigate skull, brain, and cervical spine injury. To ensure appropriate biofidelity of these head models, the stiffness is often tuned so that the surrogate’s response approximates the cadaveric response corridor. Impact parameters such as energy, and loading direction and region, can influence injury prediction measures, such as impact force and head acceleration. An improved understanding of how impact parameters affect the head’s structural response is required for designing better surrogate head models. This study comprises a synthesis and review of all existingex vivohead stiffness data, and the primary factors that influence the force–deformation response are discussed. Eighteen studies from 1972 to 2019 were identified. Head stiffness statistically varied with age (pediatric vs. adult), loading region, and rate. The contact area of the impactor likely affects stiffness, whereas the impactor mass likely does not. The head’s response to frontal impacts was widely reported, but few studies have evaluated the response to other impact locations and directions. The findings from this review indicate that further work is required to assess the effect of head constraints, loading region, and impactor geometry, across a range of relevant scenarios.

During cervical spine trauma, complex intervertebral motions can cause a reduction in facet joint cartilage apposition area (CAA), leading to cervical facet dislocation (CFD). Intervertebral compression and distraction likely alter the magnitude and location of CAA, and may influence the risk of facet fracture. The aim of this study was to investigate facet joint CAA resulting from intervertebral distraction (2.5 mm) or compression (50, 300 N) superimposed on shear and bending motions. Intervertebral and facet joint kinematics were applied to multi rigid-body kinematic models of twelve C6/C7 motion segments (70 ± 13 year, nine male) with specimen-specific cartilage profiles. CAA was qualitatively and quantitatively compared between distraction and compression conditions for each motion; linear mixed-effects models (α = 0.05) were applied. Distraction significantly decreased CAA throughout all motions, compared to the compressed conditions (p

Computational models of experimental data can provide a noninvasive method to estimate spinal facet joint biomechanics. Existing models typically consider each vertebra as one rigid-body and assume uniform facet cartilage thickness. However, facet deflection occurs during motion, and cervical facet cartilage is nonuniform. Multi rigid-body computational models were used to investigate the effect of specimen-specific cartilage profiles on facet contact area estimates. Twelve C6/C7 segments underwent non-destructive intervertebral motions. Kinematics and facet deflections were measured. Three-dimensional models of the vertebra and cartilage thickness estimates were obtained from pre-test CT data. Motion-capture data was applied to two model types (2RB: C6, C7 vertebrae each one rigid body; 3RB: left and right C6 posterior elements, and C7 vertebrae, each one rigid body) and maximum facet mesh penetration was compared. Constant thickness cartilage (CTC) and spatially-varying thickness cartilage (SVTC) profiles were applied to the facet surfaces of the 3RB model. Cartilage apposition area (CAA) was compared. Linear mixed-effects models were used for all quantitative comparisons. The 3RB model significantly reduced penetrating mesh elements by accounting for facet deflections (p = 0.001). The CTC profile resulted in incongruent facet articulation, whereas realistic congruence was observed for the SVTC profile. The SVTC profile demonstrated significantly larger CAA than the CTC model (p

Training experiences where residents provide Spanish-language concordant care (SLCC) have not been widely described despite their increasing need and prevalence in graduate medical education. In this qualitative study, we enrolled nonnative Spanish-speaking residents (n = 21) within SLCC training clinics from 3 geographically unique programs. Participants completed semistructured interviews focused on their overall SLCC training experience. Major themes identified included (1) high levels of satisfaction in their SLCC experience, (2) concern about ongoing language barriers, (3) demonstration of high levels of cultural humility in caring for patients with limited English proficiency, and (4) identification of several valuable programmatic and clinical resources. Based on these findings, we conclude that SLCC training experiences are of significant value to trainees in becoming pediatricians able to promote health equity. Themes identified could help inform how graduate medical education programs utilize SLCC to grow health-equity based efforts to deliver more effective and compassionate care to our linguistically diverse populations.

Screen media use starts in early childhood, despite recommendations to limit use. This study explored low-income Mexican American mothers’ and fathers’ beliefs, parenting practices, and perceived contextual contributors related to toddler screen use. We conducted interviews with 32 low-income Mexican American parents. Transcripts of audio recordings were analyzed to identify themes. Parents perceived numerous benefits to screen use, including learning and enjoyment, as well as seeing it as a helpful tool for parents. Reported risks included harmful mental and physical effects and a risk of use being all-consuming. Parents managed screen use with a variety of practices, including giving close attention to content, monitoring duration, and engaging in co-use. They also used screens for behavior management and in specific situations, such as to prepare for sleep. Some differences in beliefs and parenting practices exist by screen device type. Parents also reported that contextual factors, such as weather and neighborhood safety, influenced screen use. This study extends the current literature regarding child screen use, with its focus on low-income Mexican American toddlers. The findings offer interventionists and providers insight into the management of screens in the lives of this population.

Introduction: In the United States, Latino children are disproportionately affected by childhood obesity and related comorbidities. Stakeholder engagement has the potential to heighten the efficacy of interventions, thereby reducing the disparate prevalence of obesity among Latino children. The objective of this study was to identify stakeholders’ opinions on factors influencing early childhood obesity in Latino children aged 0 to 5 years. Method: This study used the Delphi technique to gather and prioritize stakeholders’ opinions about the factors and barriers considered most influential in early (age 0-5 years) childhood obesity intervention or prevention within the Latino community. Three sequential phases were used. Participants included Latina women as well as staff from community organizations serving Denver metropolitan’s Latino population. Results: Study results revealed that stakeholders value the role of the child’s primary care provider in the identification of overweight children and desire more educational support to reduce intake of nonnutritious foods. Participants further determined that obesity-related knowledge gaps and affordability of healthy foods and activities were the largest barriers to helping Latino children maintain healthy weights. Conclusion: Use of this stakeholder-informed data could assist in the development of future culturally tailored interventions aimed at reducing the rates of early childhood obesity in the Latino population.

Objective To describe the mixed-methods formative research phase in the development of the Healthy Environments Study (HEROs), a technology-based, interactive family intervention to promote healthy eating and activity behaviors for young children in the home environment. Design A mixed-method iterative approach, using ecocultural theory as a framework, will guide the development of both quantitative and qualitative formative research assessments. Setting Rural eastern Colorado. Participants Low-income families (n = 200) with preschool-aged children enrolled at 6 Head Start/preschool centers. Main Outcome Measures Quantitative and qualitative methodologies will garner insights into 4 key topic areas: (1) food behaviors and environments (Remote Food Photography Method, parent focus group, and survey), (2) physical activity behaviors and environments (parent interview and survey), (3) mobile device use (parent survey and interview), and (4) daily life (ecocultural family interview and teacher/staff group discussions). Analysis Results will be interpreted in combination to allow for a holistic understanding of participant behaviors, beliefs, attitudes and values related to each of the 4 topic areas. Collectively, outcomes will provide a comprehensive picture of preschoolers' daily life and inform intervention design and strategies to enhance preschoolers' eating and activity behaviors in the home environment.

Objectives Parental beliefs about child television viewing may affect the way parents regulate child television viewing. Despite this, little research has focused on the development of measures of parental beliefs about child television viewing, particularly among ethnic minority parents and parents of young children. This study's objective was to develop and test a culturally-based measure of parental beliefs about television viewing in low-income Mexican American mothers of preschoolers. Methods Using a cross-sectional study design, 22 items reflecting parental beliefs about influences of TV on children were developed and assessed for psychometric properties in a sample of 312 low-income Mexican American mothers of preschoolers. Results Using exploratory factor analysis, we identified four factors reflecting four domains of parental beliefs: positive general beliefs, positive sleep-related beliefs, positive functional beliefs, and negative general beliefs. Internal reliabilities were acceptable (Cronbach's alpha = 0.70-0.89) for all factors except negative general beliefs (Cronbach's alpha = 0.61). Positive sleep-related beliefs and Positive Functional Beliefs were correlated with children's average daily hours of TV (r = 0.16, p

Differences in parental feeding practices revealed across and within different ethnic/ cultural groups indicate that cultural examinations of feeding practices in understudied non-European-American populations require urgent attention. China ranks as the second largest source country for children in foreign-born U.S. households. Contrary to the stereotype of slender Asians, Chinese-American young children are at high risk for obesity but have not received sufficient attention from researchers and practitioners dealing with parental feeding practices and childhood obesity. The present study aimed to understand food-related parenting practices among Chinese immigrants in the U.S. using qualitative focus groups. Twenty-two mothers with preschool aged children participated in a discussion regarding parent-child food-related interactions and feeding practices. A thematic approach was adopted to analyze the focus group data following five stages of framework analysis. Thirteen key themes of feeding practices were identified, including 9 that are in existing feeding measures (pre-exiting practices) and 4 practices that have not been documented or emphasized in previous feeding measures (culturally-emphasized practices), including regulating healthy routines and food energy, spoon-feeding, using social comparison to pressure the child to eat, and making an effort to prepare/cook specific foods. Through the use of an emic approach and meaning-centered evidence, the complexities of parent-child interactions and unique nuances of parental feeding in this understudied population were revealed. Our findings can guide future development of culturally-appropriate measurement and inform intervention programs to promote the healthy development of Chinese-American children.

AimParenting practices can reduce how much television (TV) children watch. This study evaluated the longitudinal association between maternal regulation of TV content and the amount of TV watched by low-income ethnic minority children.MethodsThis was a secondary data analysis of the Welfare, Children & Families: A Three City Study. Data were used from ethnic minority mothers with a child from birth to 4 years old, collected over two waves approximately 16 months apart. The dependent variable was the amount of TV watched by the child (wave two). The main independent variable was the maternal regulation of TV content (wave one). Using multiple linear regression, we evaluated the relationship between maternal regulation of TV content and the amount of TV watched by the child, adjusting for covariates.ResultsOf the 835 mothers, 71% were high content regulators and 8% reported no content regulation. Children whose mothers reported no regulation watched more TV approximately 16 months later than those whose mothers reported high regulation of content (β = 0.91, 95% CI: 0.09-1.73).ConclusionOur findings suggest that regulating content influences viewing amounts in young children approximately 16 months later. Interventions focused on heightening parental regulation of content may improve content and diminish viewing amounts.

Parental misperception of minority preschoolers’ body image remains a major barrier to obesity prevention. Differences in child body image perception between Latino and African-American parents may inform etiologies to obesity disparities. Using pooled data from studies implementing validated child body sketches, frequency of parental misperception in these two populations are analyzed and associations with provider commentary and parental acculturation reported. Two convenience samples were utilized (Latino parents: n=73, African-American parents: n=150). Over half of Latino parents (58%) compared to 5% of African-American parents misperceived their obese child as lighter than a healthy weight (p=.002). In contrast to our prior study, provider commentary was not associated with reduced risk of misperception in Latino parents. Misperception occurred most frequently in mild-moderately acculturated Latino parents. Increased rates of misperception and limitations on the potential role of the provider commentary indicate a critical need to better strategize communication with low-income, moderately acculturated Latino parents.

Background: Specific information on the development and evaluation of patient/family engagement in health care improvement for populations with limited English profi - ciency (LEP) is lacking. Objectives: We sought to provide information for use by other health care organizations aiming to engage LEP popu- lations through advisory groups. Methods: Informed by community-based research princi- ples, we formed a family advisory board of LEP Latino fami- lies and conducted a multimodal evaluation of initial implementation and partnership development. Results: The board met process measures goals for sustained engagement of LEP families and for establishing a group structure and process. Board outcomes included contributions to clinic educational materials and initiation of a project to increase the child friendliness of the physical space. Mothers on the board reported satisfaction with their participation. Conclusions: We successfully sustained engagement of LEP Latino families in health care improvement using an advisory board. To promote patient-centered care and address health care disparities, LEP populations should be included in patient engagement programs.

PurposeTo describe patterns of clinical Spanish use by pediatric residents, and to compare self-assessment of language proficiency against an objective language test.MethodIn 2010, the authors e-mailed a survey to all 247 pediatric residents at three institutions, inviting those with any level of Sp

Purpose To evaluate whether educational sessions on interpreter use and experience with interpreters are associated with resident self-efficacy in the use of professional interpreters. Method In 2010, the authors surveyed residents from seven pediatric residency programs. Their 29-item survey collected data on training and experience with interpreters and self-efficacy in (1) determining when an interpreter is needed and (2) using a professional interpreter. The authors conducted bivariate and multivariate regression analyses. Results Among the 271 respondents, 82% reported that ≥ 10% of their patients had limited English proficiency (LEP), 53% indicated they had "a lot" of experience with interpreters, and 54% reported never receiving any educational sessions on interpreter use. The majority reported high self-efficacy in knowing when an interpreter is needed (69%) and in using an interpreter (68%). Residents reporting a high experience level with interpreters were more likely to report high self-efficacy in knowing when an interpreter is needed (odds ratio [OR] = 1.85; 95% confidence interval[CI] = 1.03-3.32) and in using an interpreter (OR = 3.97; 95% CI = 1.19-13.31). Formal training on using interpreters was also associated with high self-efficacy in interpreter use(OR = 1.62; 95% CI = 1.22-2.14). Conclusions Many residents who care for patients with LEP have never received educational sessions on interpreter use. Such training is associated with high self-efficacy and may enhance patient-provider communication. Incorporating this training into residency programs is necessary to equip providers with skills to communicate with patients and families with LEP.

Objective: To evaluate the usability of touchscreen mediated nutrition and feeding educational modules among low-income Latino immigrant parents. Methods: A cross-sectional study was performed March-August, 2010 in an outpatient pediatric setting among low-income Spanish-speaking parents of children < 3 years. Culturally-targeted educational modules focused on infant/toddler nutrition and feeding were delivered via touchscreen to participants in Spanish using a multimedia format including text, audio and pictures. Viewing of all modules lasted 25 minutes. Demographic and computer use data was collected. The outcomes assessed were perceived ease of use of the touchsreen and usefulness of the educational modules. Results: The majority of the eighty participants reported rarely/never using a computer 64%; n=51 and 46% reported ≤ 8th grade education. 92% of participants found the touchscreen 'easy'/'very easy' to use. Nearly all users found the modules 'useful' 95% and 'easy' to understand 96%. Higher educated individuals were more likely to find the touchscreen 'very easy' versus 'easy' to use Odds Ratio=3.67, 95% CI:1.18--11.43 and the modules 'very easy' to understand OR=3.99, 95% CI:1.37--11.62. Conclusions: Despite low computer experience levels, participants perceived touchscreens and the content presented as highly usable. Ongoing evaluation of providing targeted health education via touchscreens in this population is indicated.

Studies report that women use as much or more physical intimate partner violence (IPV) as men. Most of these studies measure IPV by counting the number of IPV acts over a specified time period, but counting acts captures only one aspect of this complex phenomenon. To inform interventions, women’s motivations for using IPV must be understood. A systematic review, therefore, was conducted to summarize evidence regarding women’s motivations for the use of physical IPV in heterosexual relationships. Four published literature databases were searched, and articles that met inclusion criteria were abstracted. This was supplemented with a bibliography search and expert consultation. Eligible studies included English-language publications that directly investigated heterosexual women’s motivations for perpetrating nonlethal, physical IPV. Of the 144 potentially eligible articles, 23 met inclusion criteria. Over two thirds of studies enrolled participants from IPV shelters, courts, or batterers’ treatment programs. Women’s motivations were primarily assessed through interviews or administration of an author-created questionnaire. Anger and not being able to get a partner’s attention were pervasive themes. Self-defense and retaliation also were commonly cited motivations, but distinguishing the two was difficult in some studies. Control was mentioned but not listed as a primary motivation. IPV prevention and treatment programs should explore ways to effectively address women’s relationship concerns and ability to manage anger and should recognize that women commonly use IPV in response to their partner’s violence.

Objective To analyze the content of food and drink commercials aired during after-school hours on Spanish-language television. Study design We performed a content analysis of food and drink advertisements, evaluating product type, food category, and message content. All advertisements aired during after-school hours (3 to 9 p.m .) on 2 U.S. Spanish-language television stations were sampled over a 1-week period in the spring of 2006. Results We reviewed 60 hours of programming. Of the non-program content, 47% was for product advertisements, 15% (n = 153) of which was for food/drink. A mean of 2.5 food/drink commercials aired per hour (range 0-8), and the median duration was 30 seconds; 31% of food/drink commercials advertised fast food, and 27% advertised drinks, most (54%) of which were sugared. About one third (31%) of the food/drink commercials targeted children, 12% featured Latino celebrities, and 19% made reference to Latino culture. Only 16% of the food/drink commercials had health-related content. Conclusions Children viewing Spanish-language television in the United States after school are exposed to food and drink commercials, most of which advertise unhealthy foods, including fast food and sugared drinks. Food and beverage advertising on Spanish-language television may play an important role in the high risk of overweight among Latino children.

OBJECTIVES. The goals were to evaluate the use of touchscreen computer kiosks, containing only child health–promoting information, in urban, low-income, community settings and to characterize the users of these kiosks.METHODS. Three user-driven touchscreen computer kiosks were placed in low-income urban locations in Seattle, Washington, from March 2005 to October 2005. The locations included a public library, a Department of Motor Vehicles office, and a McDonald's restaurant. Users selected age-appropriate modules with prevention information and screening tools. Users entered the age of the child and were presented with age-appropriate modules. On exiting, users were asked to rate their experience and to provide basic demographic data.RESULTS. In total, there were 1846 kiosk sessions. Almost one half occurred at McDonald's. Seventy-eight percent of users identified themselves as first-time users. Users sought information for children of all ages. Sixty-one percent of first-time users explored 1 module. First-time users were most interested in television/media use (16%), smoke exposure (14%), attention-deficit/hyperactivity disorder screening (12%), and asthma assessment (11%). At-risk children were identified in 52% of sessions. Eighty-seven percent of first-time users who completed the asthma assessment had children whose asthma was uncontrolled. Twenty-eight percent of users responded to ≥1 question on the exit survey. Of those, 48% had less than a high school education, and 26% had never used the Internet. Approximately one half found the kiosk easy to use (57%) and the information easy to understand (55%); 66% said there was at least some new information. Fifty-five percent planned to try some of the things they had learned, and 49% intended to talk to their child's doctor about what they had learned.CONCLUSIONS. User-driven computer kiosks were used in community settings to obtain child health information. Users found the kiosks easy to use. Additional study on improving use and understanding the impact is needed.

Objectives To determine parental rankings of known factors related to early-childhood obesity and compare reports between parents of healthy weight and overweight children. Methods Parents of 2- to 5-year-old children seeking well-child care ranked card-sort statements including risks, barriers, and motivating factors for achieving a healthy weight child. Frequencies and means of ranked factors are reported and compared. Results Of the 150 participants, few parents (7.4%) considered low levels of physical activity a top risk factor compared with other known risks. Inability to control the food choices of alternate caregivers was the greatest perceived barrier to achieving a healthy child weight (34%). There were no differences in rankings by child weight groups. Conclusion Low-income parents of preschoolers are aware of high-risk feeding behaviors, but few recognize the risk of inactivity in their young child. Innovations that promote adequate physical activity and engage influential caregivers during counseling are necessary.

Background National Institutes of Health asthma guidelines recommend questionnaires to assess asthma control, but these questionnaires are not useable across the entire pediatric age spectrum and have not been validated among significant numbers of minority or Spanish-speaking children. Objective We sought to evaluate a questionnaire designed to assess asthma control across a broad age range of minority and Spanish-speaking children cared for in an outpatient setting. Methods Between July 1, 2007, and September 30, 2010, we collected information using the Pediatric Asthma Control and Communication Instrument (PACCI), the Asthma Control Test (ACT; or the childhood ACT for children 4-11 years old), the Pediatric Asthma Caregiver Quality of Life Questionnaire, and lung function and clinicians' ratings of asthma status among a population of children presenting for routine asthma specialist care. The PACCI measure of asthma control was validated by evaluating accuracy, internal reliability, and concurrent, discriminative, and known-groups validity. Results We collected information on 265 English- and 52 Spanish-speaking children (mean age, 8.2 years; 58% male; 44% African American). Across all age groups and in both languages, PACCI control showed good internal reliability and strong concurrent, discriminative, and known-groups validity with ACT and Pediatric Asthma Caregiver Quality of Life Questionnaire scores and clinicians' ratings of asthma control. The accuracy of the PACCI in classifying children with uncontrolled asthma was good (area under the curve, 0.83; 95% CI, 0.79-0.88). Conclusions The PACCI accurately measures asthma control in English- and Spanish-speaking children. The PACCI should be useful to clinicians to assess and classify asthma according to National Institutes of Health asthma guidelines.