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Objectives The Reach Out and Read program (ROaR) is associated with increased parent-child book reading and improved language development in children. Though children of adolescent parents may have an elevated risk of language delay, ROaR has never been specifically studied among adolescent-headed families. This pilot evaluated the feasibility and effectiveness of ROaR among adolescent mothers and their children. Methods This randomized controlled pilot followed thirty adolescent mothers with children aged 6-20 months in a teen-tot clinic in downtown Toronto. At each of three consecutive well child checkups, intervention families received a new children's book, reading-related anticipatory guidance customized to the mother's developmental stage, counselling from a librarian, and a public library card. Control families received routine care. At baseline and study completion, all mothers completed a survey on family reading patterns and the Beck Depression Inventory-Revised (BDI-IA). Results Though regression models were not statistically significant, bivariate analyses at study completion revealed that intervention mothers were significantly more likely than controls to report reading as one of the child's favorite activities (29 vs 0 %) and had significantly lower maternal depression scores (7.0 vs 12.5; [greater than or equal to]10 = clinically significant depression). Trends for all other variables, including time spent reading together and maternal enjoyment of reading, were also in the direction of benefit. This program was implemented at minimal cost and adopted permanently following study completion. Conclusions This feasible and developmentally appropriate intervention shows promise in promoting shared book reading and reducing maternal depression within adolescent-headed families, warranting investigation with larger trials., Author(s): Maya M. Kumar[sup.1] [sup.4] , Henry R. Cowan[sup.2] , Lauren Erdman[sup.3] , Miriam Kaufman[sup.1] , Katherine M. Hick[sup.1] Author Affiliations: (1) Division of Adolescent Medicine, Department of Paediatrics, The [...]

IN 2005, THE American Academy of Pediatrics (AAP) Board of Directors commissioned the Committee on Psychosocial Aspects of Child and Family Health, the Committee on Early Childhood, Adoption, and Dependent Care, the Committee on Adolescence, the Committee on State Government Affairs, the Committee on Federal Government Affairs, and the Section on Adoption and Foster Care to develop an analysis examining the effects of marriage, civil union, and domestic partnership statutes and amendments on the legal, financial, and psychosocial health and well-being of children whose parents are gay or lesbian. In developing this analysis, the involved committees and section held before them the AAP's core philosophy--that the family is the principal caregiver and the center of strength and support for children. Together with this philosophy, contributors recognized the reality that our gay and lesbian patients grow up to be gay and lesbian adults. Because many pediatricians are fortunate to care for 2 or more generations of a family, we are likely to encounter and remain involved with our patients, regardless of sexual orientation, as they mature and mark the milestones of establishing a committed partnership with another adult, deciding to raise a family, and entrusting the health and well-being of their own children to us. This analysis explores the unique and complex challenges that same-gender couples and their children face as a result of public policy that excludes them from civil marriage. In compiling this report it became clear to the contributing committees and section that the depth and breadth of these challenges are largely unknown to the general public and perhaps even to many pediatricians. As such, the AAP Board of Directors approved the broad dissemination of this analysis to assist pediatricians with addressing the complex issues related to same-gender couples and their children. www.pediatrics.org/cgi/doi/10.1542/peds.2006-1279 doi:10.1542/peds.2006-1279 Key Words civil marriage, same gender, gay, lesbian, rights Abbreviations AAP--American Academy of Pediatrics DOMA--Defense of Marriage Act APA--American Psychological Association, DEFINITIONS It is important to note at the outset the distinction in the types of marriages that exist in the United States and throughout the world, namely civil marriage and [...]

Abstract Background Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. Objectives We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention. Methods The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models). Discussion The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.

Twenty-seven lesbian mothers completed standardized tools chosen to assess current functioning, followed by a video-taped interview. Verbal children were also interviewed. Questions involved perceptions of the mothers' and children's experiences of being homosexual or being raised by homosexual parents, knowledge and fantasies about the donor/father, feelings regarding the role of fathers, parents' experiences of being fathered, legal issues, and development. All mothers were strongly lesbian identified and most were completely 'out.' All but one mother planned to or had told their children. All mothers planned to reveal donor information at an appropriate age. Many, especially parents of boys, had concerns about lack of a male role model, but none felt this would negatively affect the child's development. Mothers were open to having their child ask questions and even seek out the donor when older. Thirty-one percent of mothers reported a positive relationship with their own father, 42% a father who was present but unavailable or punitive and 27% a completely absent father for large parts of their childhood. Couples divided parenting work based on individual strengths and interests, work schedules and demands. Only two of the couples felt that one of them played a role typical of a father. An aggregate score was compiled for each mother based on the number of negative outcomes in the standardized tools. The mean number of negative outcomes for the mothers was 3.15 (SD = 1.85). Of the six women with 5 or more negative outcomes on the scales, three were single parents and one had lost her partner when her child was two months old. On the CESD, three mothers showed depression levels that were high. The Internal External scale showed 42% of mothers to have an external locus of control. Three mothers scored negatively on the Family Assessment Device. Ninety-two percent of women showed moderate to high self-esteem on the Rosenberg Self-Esteem scale, and the Parenting Stress Index found only 4 women showing enough stress to warrant follow-up. Mothers who reported very negative early experiences of coming out were more likely to report current depressive symptoms (p = .03). All but one child living in two-mother homes identified both mothers as part of their family. Our initial impression is that these are primarily strong families with a variety of parenting skills, stressors and philosophies. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website: ] KEYWORDS. Lesbian mothers, donor fathers, children of lesbian mothers, lesbian parents