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OBJECTIVE: In 2009, the National Children’s Study (NCS) Vanguard Study tested the feasibility of household-based recruitment and participant enrollment by using a birth rate probability sample. In 2010, the NCS Program Office launched 3 alternative recruitment methods. We tested whether direct outreach (DO) recruitment could be a more efficient strategy to recruit women of child-bearing age. METHODS: The NCS DO recruitment approach recruited women, 18 to 49 years, who were pregnant or trying to conceive using passive recruitment methods emphasizing broad community outreach and engagement to create study awareness. Study mailings to listed households included a pregnancy screening questionnaire to identify potentially eligible women from selected neighborhoods to contact the study center. Unique features of this recruitment approach included the following: (1) expansion of selected neighborhoods to maximize potential participant recruitment and enrollment while minimizing in-person participant contact and (2) offering 2 levels of study participation distinguished by data collection intensity. RESULTS: Ten study centers listed 255 475 geographically eligible households for contact representing, on average, 3.3% of households per Primary Sampling Unit. A total of 19 354 women were identified for screening, and 17 421 completed a pregnancy screener representing 6.8% of eligible households. Study-eligible pregnant women were older, more educated, and less likely to be Hispanic than the general population. Only 16% (2786) of 17 421 screened women were study-eligible, and 81.1% of these 2786 women consented to participate. CONCLUSIONS: Although feasible, the DO approach recruited a sample of study-eligible pregnant women significantly different from the population. This recruitment approach was labor intensive for the yield of enrolled women.

OBJECTIVE: Few studies have reported the outcome of direct outreach methods for recruitment of research participants in population-based samples. We describe the relationship of outreach strategies that are tailored to specific community factors to recruitment and consent outcomes in 10 National Children’s Study direct outreach study locations (all were single counties). METHODS: Each study center collected data from a target population of women who resided in selected county segments that were sampled based on a geographic area probability sampling design. Based on county characteristics of the 10 study locations, each study center used site-specific marketing approaches (direct mail, mass media, provider referrals, social networking) to recruit study participants. Recruitment success was measured by the number of recruited women as well as by a qualitative assessment of the effectiveness of various recruitment methods. RESULTS: The number of women who consented varied from 67 to 792. The majority of women were pregnant at the time of consent. Community awareness varied from CONCLUSIONS: In a small sample of 10 US counties, recruitment success was not associated with community characteristics. It was, however, associated with certain types of outreach strategies that may be more effective in close-knit communities.

Objectives. We examined how maternal work and welfare receipt are associated with children receiving recommended pediatric preventive care services. Methods. We identified American Academy of Pediatrics–recommended preventive care visits from medical records of children in the 1999–2004 Illinois Families Study: Child Well-Being. We used Illinois administrative data to identify whether mothers received welfare or worked during the period the visit was recommended, and we analyzed the child visit data using random-intercept logistic regressions that adjusted for child, maternal, and visit-specific characteristics. Results. The 485 children (95%) meeting inclusion criteria made 41% of their recommended visits. Children were 60% more likely (adjusted odds ratios [AOR` = 1.60; 95% confidence interval [CI] = 1.27, 2.01) to make recommended visits when mothers received welfare but did not work compared with when mothers did not receive welfare and did not work. Children were 25% less likely (AOR = 0.75; 95% CI = 0.60, 0.94) to make preventive care visits during periods when mothers received welfare and worked compared with welfare only periods. Conclusion. The Temporary Assistance for Needy Families maternal work requirement may be a barrier to receiving recommended preventive pediatric health care.

To estimate whether there is an association between chronic psychosocial stress and low birth weight neonates in low-income women.Between 1999 and 2004, a random sample of women receiving welfare in nine Illinois counties was selected. The women were then interviewed annually. Women who delivered during this period were identified. Self-reported stress that occurred in temporal proximity to the delivery was assessed by 1) external stressors, 2) enhancers of stress, 3) buffers against stress, and 4) perceived stress and was compared between women who delivered low birth weight neonates and women who delivered normal birth weight neonates.Of the 1,363 women in the study, 294 women (21.6%) became pregnant and delivered during the study period. Of the 294 deliveries, 39 (13.3%) were low birth weight. The only demographic factor associated with a low birth weight delivery was increasing maternal age. However, multiple psychosocial factors, including food insecurity (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4-7.2), a child with chronic illness in the home (OR 3.4, 95% CI 1.5-7.9), increased crowding in the home (OR 2.7, 95% CI 1.3-5.6), unemployment (OR 3.1, 95% CI 1.2-7.9), and poor coping skills (OR 3.8, 95% CI 1.7-8.7), were significantly associated with low birth weight delivery (P.01 for all comparisons). These significant associations persisted after adjusting for maternal age in multivariable analysis.This study provides evidence that chronic psychosocial stress may be associated with low birth weight neonates in a low-income population of women.II.

Objectives . To examine the acceptability of non-medical, community-based interviewers obtaining blood samples during in-home interviews from low-income study participants. Methods . Two separate focus groups were conducted, one with ten non-medical community-based interviewers and the other with eight research participants from a low- income population. (Both the interviewers and the research participants had previously taken part in a research project over the course of five years.) Results . Participants and interviewers were comfortable with finger stick blood samples performed in the home. The interviewers felt that adequate training was critical. Participants identified key issues: blood would not be used for other purposes and that the interviewers would be trained to handle blood safely. Both groups felt that it was crucial to communicate the study purpose and results. Recommendations from the focus groups were implemented and the acceptance rate for blood sampling was 99.5% (205/206). Conclusion. Proper training of interview- ers, organization of supplies, and communication with participants can be combined to maximize acceptance of in-home, finger stick blood sample collection by community-based interviewers among a low-income population.

OBJECTIVE: To examine effects of Temporary Assistance for Needy Families welfare cash assistance and maternal work requirements on “on-time” childhood vaccination rates. METHODS: A stratified random sample of Illinois children from low-income families affected by welfare reform was monitored from 1997 to 2004. Medical records from pediatricians' offices and Medicaid claims data were used to identify the timeliness of 18 recommended vaccinations. Random-intercept logistic models were used to estimate on-time vaccine administration as a function of welfare receipt and maternal work with adjustment for characteristics of the children and mothers and time-varying covariates pertaining to the administration window for each recommended vaccine dose. RESULTS: Of all recommended vaccinations, 55.9% were administered on time. On-time vaccination rates were higher when families were receiving welfare than not (57.4% vs 52.8%). Children in families that either were receiving welfare or had working mothers were 1.7 to 2.1 times more likely to receive vaccinations on time compared with children in families that were not receiving welfare and did not have working mothers. When vaccine doses were stratified according to welfare status, maternal work was associated with decreased on-time vaccination rates (odds ratio: 0.73 [95% confidence interval: 0.59–0.90]) when families received welfare but increased on-time vaccination rates (odds ratio: 1.68 [95% confidence interval: 1.27–2.22]) when they did not receive welfare. CONCLUSIONS: These results indicate that maternal work requirements of Temporary Assistance for Needy Families had negative effects on timely administration of childhood vaccinations, although receipt of welfare itself was associated with increased on-time rates.

Background Food allergy prevalence is increasing in US children. Presently, the primary means of preventing potentially fatal reactions are avoidance of allergens, prompt recognition of food allergy reactions, and knowledge about food allergy reaction treatments. Focus groups were held as a preliminary step in the development of validated survey instruments to assess food allergy knowledge, attitudes, and beliefs of parents, physicians, and the general public. Methods Eight focus groups were conducted between January and July of 2006 in the Chicago area with parents of children with food allergy (3 groups), physicians (3 groups), and the general public (2 groups). A constant comparative method was used to identify the emerging themes which were then grouped into key domains of food allergy knowledge, attitudes, and beliefs. Results Parents of children with food allergy had solid fundamental knowledge but had concerns about primary care physicians' knowledge of food allergy, diagnostic approaches, and treatment practices. The considerable impact of children's food allergies on familial quality of life was articulated. Physicians had good basic knowledge of food allergy but differed in their approach to diagnosis and advice about starting solids and breastfeeding. The general public had wide variation in knowledge about food allergy with many misconceptions of key concepts related to prevalence, definition, and triggers of food allergy. Conclusion Appreciable food allergy knowledge gaps exist, especially among physicians and the general public. The quality of life for children with food allergy and their families is significantly affected.