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Objective To describe the development process of a patient-centered initiative focused on improving primary care health outcomes of patients with intellectual and developmental disabilities (IDD) and needle-related anxiety using evidence-based practices and novel approaches that can be implemented in outpatient settings. The overall outcome of the program is to increase vaccine uptake and accessibility in the IDD population as well as improve needle-related procedures in primary care settings to be more humane and effective. Methods The development process occurred in the context of a large healthcare system serving a diverse patient population in the U.S. and was led by an expert committee made of an multidisciplinary team of physicians, psychologists, ambulatory and clinic nurses, pharmacists, and anesthesiologists committed to promoting quality healthcare for the IDD population. Committee members were recruited within the healthcare system based on their relevant expertise. The methodology included an iterative and collaborative process that took place over three development phases: ideation and design, literature review and synthesis, and expert engagement. The ideation and design phase included a series of planning meetings among the expert committee, in which committee members identified preliminary concerns based on their expertise in the field and background knowledge on the current procedures related to improving routine care for individuals with IDD and/or needle-related anxiety. The literature review and synthesis phase led to the development of an annotated bibliography of research and clinical guidelines that synthesized findings on needle anxiety in clinical care. The expert engagement phase included all Committee members meeting for a final discussion to establish a tiered approach to utilizing evidence-based strategies that could be implemented across clinics within the healthcare system.  Results The multidisciplinary team of experts developed a three-tier system, deployed sequentially as needed. The first tier focuses on training nurses in evidence-based behavioral modification strategies to implement as standard of care. The second tier uses the addition of a distraction device and topical analgesic to reduce anxiety in patients with slightly elevated procedural anxiety. The third tier involves a novel minimal sedation protocol using intranasal midazolam for patients with needle phobia that can be administered in an outpatient setting. Conclusion The Needle Anxiety Program eases the administration of needle-related medical procedures in the primary care setting for patients with IDD and needle-related anxiety. The use of evidence-based practices and a novel minimal sedation protocol for individuals with needle phobia assists in the completion of routine healthcare procedures, such as vaccinations and phlebotomy, in a patient-preferred setting. The purpose of delineating needle-related processes and procedures through the Needle Anxiety Program is to reduce health disparities for patients with IDD and promote uptake of the Needle Anxiety Program in similar healthcare settings.

Objective Patients with intellectual and developmental disabilities (IDD) experience needle phobia at greater rates than individuals in the general population. Needle phobia deters patients with IDD from receiving routine medical procedures, which impacts their physical health outcomes. The aim of this quality improvement study was to assess the feasibility of a minimal sedation protocol in an outpatient care setting for patients with IDD and needle phobia. Methods The sample included 18 patients characterized as having a diagnosis of IDD only or IDD and needle phobia compared to patients with only a diagnosis of needle phobia. Reasons for referral to intervention included routine lab work, therapeutic drug monitoring, and routine vaccination. The minimal sedation intervention involved intranasal administration of a benzodiazepine (midazolam) by a registered nurse. Outcomes of interest were administration of the sedation and administration of medical orders. Results Nearly a third of patients were children (33.3%, n=6), and 39% of patients were female (n=7). Individuals with IDD (including those both with and without needle phobias) comprised 72.2% of patients (n=13). Half of intervention encounters were successful in both administering the sedation and performing the medical orders (n=9). Among individuals with IDD, 38.4% successfully completed the intervention (n=5). Conclusion This pilot study assessed the feasibility of implementing a minimal sedation protocol in primary care outpatient care settings. The preliminary results suggest that the minimal sedation protocol may improve the uptake of needle-related medical procedures for patients with IDD and/or needle phobia. The minimal sedation protocol should be studied in a larger sample and among multiple outpatient settings to establish effectiveness of the intervention.

IntroductionThe Maternal and Child Health (MCH) Pipeline Training Program, promotes development of a diverse health workforce by training undergraduate students from underrepresented minorities. We aimed to evaluate the success of this program based on three domains: (1) demographic characteristics, (2) academic and career development, and (3) attitudes towards the field of MCH and the training programs among graduates.MethodsThree domains of success were determined through a collaborative effort between current program directors and the funding agency project officers. The survey with questions related to the three domains was distributed via an online platform to graduates from seven sites (one former site and six current sites). Data were analyzed and presented utilizing descriptive statistics.ResultsThe survey was distributed to 550 graduates, 162 responded (37% response rate). Demographically, 78% were female, 54% were Black/African American, 22% were Latinx and 83% did not report any disability. Eighty percent of respondents applied to graduate/professional schools, 67% received admission. Graduates often continued to work in MCH fields (70%). Majority felt confident and knowledgeable in the field (89%) and agreed the faculty were supportive at their training sites (90%).ConclusionThe study highlights successes in recruiting from underrepresented minorities, particularly Black/African Americans and first-time college goers in the family into the MCH Pipeline Training Programs. Programs were successful in furthering academic and career development for most trainees. Attitudes towards MCH and the training programs were overwhelmingly positive. Continued support of these programs is critical in addressing health disparities and achieving health equity.

In the United States, autistic individuals experience disproportionate physical and mental health challenges relative to non-autistic individuals, including higher rates of co-occurring and chronic conditions and lower physical, social, and psychological health-related quality of life. The Autism Intervention Research Network on Physical Health (AIR-P) is an interdisciplinary, multicenter research network for scientific collaboration and infrastructure that aims to increase the life expectancy and quality of life for autistic individuals, with a focus on underserved or vulnerable populations. The current paper describes the development of the AIR-P Research Agenda. Development of the research agenda involved an iterative and collaborative process between the AIR-P Advisory Board, Steering Committee, and Autistic Researcher Review Board. The methodology consisted of 3 phases: (1) ideation and design, (2) literature review and synthesis; and (3) network engagement. Six core research priorities related to the health of autistic individuals were identified: (1) primary care services and quality, (2) community-based lifestyle interventions, (3) health systems and services, (4) gender, sexuality, and reproductive health, (5) neurology, and (6) genetics. Specific topics within each of these priorities were identified. Four cross-cutting research priorities were also identified: (1) neurodiversity-oriented care, (2) facilitating developmental transitions, (3) methodologically rigorous intervention studies, and (4) addressing health disparities. The AIR-P Research Agenda represents an important step forward for enacting large-scale health-promotion efforts for autistic individuals across the lifespan. This agenda will catalyze autism research in historically underrepresented topic areas while adopting a neurodiversity-oriented approach to health-promotion.

With an increase in the diagnosis of autism spectrum disorder in the United States, many of whom have higher intellectual ability, there is a predicted increase in the number of college-bound students. Affected young adults face a "Services Cliff" as they transition into adulthood. Our study examined a nationally represented sample of freshman students and found that academic achievements in autistic students are comparable to their peers when they first enter college. The students however have more mental health and physical health problems compared to their non-autistic peers. Poor health maybe a major contributing factor to the lower graduation rates among autistic students. College-bound autistic students may continue to require services through college for them to be successful and graduate.

Introduction Efforts to recruit and retain diverse Maternal and Child Health (MCH) professionals are of paramount public health significance. Culturally congruent mentorship strategies are key to supporting a successful transition from undergraduate to graduate studies. Methods This mixed-method study evaluated a culturally congruent mentorship training used by one of the MCH Pipeline Training programs and described mentorship practices and lessons learned from the six MCH Pipeline programs. A retrospective pre-test post-test survey assessed mentorship competency skills following a mentoring workshop. All MCH Pipeline program leaders completed a questionnaire to elicit responses about mentoring training practices, mentor evaluation strategies, and lessons learned. Results Maternal and Child Health Pipeline Training Programs supported 1890 undergraduate scholars at universities and institutions nationally. Scholars at six MCH Pipeline Programs participated in MCH education and mentored experiential leadership opportunities in clinical practice, research, and public health education. Qualitative program-level mentor survey themes indicated the importance of creating a reflective space and building mentorship teams. Mean mentor self-assessed improvement in mentor competencies was 14.4 points, 95% CI [10.5, 18.3], p < .001 following completion of a mentoring training workshop implemented by one of the MCH Pipeline programs. Discussion The Health Resources and Services Administration's Maternal and Child Health Bureau recognized the need to support the development of the next generation of diverse MCH leaders. Pipeline programs that included mentoring workshops and building culturally congruent mentorship teams are two strategies to increase and retain diverse scholars in graduate school and leaders in the public health workforce., Author(s): Harolyn M. E. Belcher [sup.1] [sup.2] , Nikeea Copeland-Linder [sup.1] [sup.2] , Jacqueline Stone [sup.1] [sup.2] , Catrina R. Waters [sup.3] , Alice Kuo [sup.4] , Victoria Moerchen [sup.5] [...]

PurposeTo evaluate whether exposure to MyFamilyPlan-a web-based preconception health education module-changes the proportion of women discussing reproductive health with providers at well-woman visits.DesignCluster randomized controlled trial. One hundred thirty participants per arm distributed among 34 clusters (physicians) required to detect a 20% change in the primary outcome.SettingUrban academic medical center (California).ParticipantsEligible women were 18 to 45 years old, were English speaking, were nonpregnant, were able to access the Internet, and had an upcoming well-woman visit. E-mail and phone recruitment between September 2015 and May 2016; 292 enrollees randomized.InterventionIntervention participants completed the MyFamilyPlan module online 7 to 10 days before a scheduled well-woman visit; control participants reviewed standard online preconception health education materials.MeasuresThe primary outcome was self-reported discussion of reproductive health with the physician at the well-woman visit. Self-reported secondary outcomes were folic acid use, contraceptive method initiation/change, and self-efficacy score.AnalysisMultilevel multivariate logistic regression.ResultsAfter adjusting for covariates and cluster, exposure to MyFamilyPlan was the only variable significantly associated with an increase in the proportion of women discussing reproductive health with providers (odds ratio: 1.97, 95% confidence interval: 1.22-3.19). Prespecified secondary outcomes were unaffected.ConclusionMyFamilyPlan exposure was associated with a significant increase in the proportion of women who reported discussing reproductive health with providers and may promote preconception health awareness; more work is needed to affect associated behaviors.

OBJECTIVES:Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by challenges in social communication and interaction and restricted or repetitive behavior, interests, or activities. Although ASD symptoms generally manifest in early childhood, many individuals experience delays accessing an autism diagnosis and related services. In this study, we identify the individual, social, and structural factors that influence parents' experiences of children's ASD diagnosis. METHODS:Parents of 25 children with autism participated in 60- to 90-minute semistructured in-person interviews. Interviews were recorded and transcribed verbatim. Transcripts were analyzed using the method of grounded theory. This inductive method allowed analysts to identify key themes related to participants' experiences of children's ASD diagnosis. RESULTS:The process of ASD diagnosis reflects an odyssey that includes 3 key phases: the prediagnosis phase, in which "Making Sense of Child Difference" is a primary characteristic of participants' experiences; the during-diagnosis phase, when "Navigating Diagnosis" suggests systematic barriers that influence the timing of ASD diagnosis; and the postdiagnosis phase, when participants' experiences of "Connecting to Services" point to the important role that personal efforts play in gaining access to care. CONCLUSIONS:In this study, we highlight individual, social, and structural factors that influence parent experiences before, during, and after their child's autism diagnosis. Our findings indicate the need for more consistent and continuous support for autistic individuals and their families during the diagnostic odyssey, as well as resources that better represent the diversity of experiences and symptoms associated with autism across the life course.

Reducing health disparities is a national public health priority. Latinos represent the largest racial/ethnic minority group in the United States and suffer disproportionately from poor health outcomes, including cardiovascular disease risk. Academic training programs are an opportunity for reducing health disparities, in part by increasing the diversity of the public health workforce and by incorporating training designed to develop a skill set to address health disparities. This article describes the Training and Career Development Program at the UCLA Center for Population Health and Health Disparities: a multilevel, transdisciplinary training program that uses a community-engaged approach to reduce cardiovascular disease risk in two urban Mexican American communities. Results suggest that this program is effective in enhancing the skill sets of traditionally underrepresented students to become health disparities researchers and practitioners.

Introduction: About one in six children in the US, about 17% of the population, have one or more intellectual or developmental disabilities. Increases in disability due to neurodevelopmental or mental health conditions have increased by 21% in the last decade. Early intervention based on developmental screening and provider-initiated monitoring can significantly improve long-term health and cognitive outcomes. This paper assesses whether differences in receipt of developmental screening or monitoring are associated with access to a highquality primary care medical home and having a provider who shows sensitivity to a family's customs and values among neurotypical children and children with intellectual and developmental disabilities (IDD). Methods: We used cross-sectional data from the National Survey of Children's Health (NSCH) from 2017 to 2019. The NSCH is a nationally representative, parent-completed annual survey of children under 18. Children between 9 months and 5 years with IDD (n = 2,385) and neurotypical children (n = 20,200) were included in the analysis. Results: Uptake of developmental screening/monitoring in neurotypical children and children with IDD conditions was associated with belonging to minority race/ethnic backgrounds, specifically Black, Asian, and AIAN/NHPI, and single-parent households with lower incomes, being publicly insured or uninsured and not having access to a high-quality medical home. Weighted regression models showed that the odds of neurotypical children receiving developmental monitoring/screening were 53% higher when their healthcare provider always or usually demonstrated cultural sensitivity to the family's values and customs (OR 1.53, 95% CI, 1.08-2.18, p < 0.05). For children with IDD, the odds of receipt of monitoring/screening increased by 2.1 times when the provider always/usually demonstrated an understanding of the family's cultural norms (95% CI, 0.99-4.43, p = 0.053). Being female was significantly associated with a lack of screening/surveillance (OR 0.73, 95% CI, 0.58-0.91, p < 0.05). Discussion: With the rising prevalence of children with IDD conditions, early identification of developmental delays and subsequent access to interventions are crucial steps in supporting children and children with IDD to receive preventive care, services, and reduce disparities in accessing quality care. Implementing culturally sensitive approaches can be a low-cost and effective intervention in improving rates of provider-initiated monitoring and parent-completed screening. [ABSTRACT FROM AUTHOR]

Researchers collaborated with undergraduate minority students to quantitatively and qualitatively investigate college students' mental health during the first year of the COVID-19 pandemic. Participants were two convenience samples of diverse college students surveyed in June (n = 128; M age = 21.7, SD = 1.7) and December (n = 242; M age = 20.3, SD = 1.7) of 2020. This study administered items from the California Health Interview Survey and open-ended qualitative items via Qualtrics. Across both waves, students reported significant mental health challenges and psychological distress. Students surveyed in December were three to four times more likely to report depression and anxiety. Female and older students reported heightened odds of mental health challenges. Qualitative findings elaborated on contributing factors. During the pandemic, college students have experienced pronounced mental health challenges, potentially exacerbated by academic, professional, relational, and environmental stressors and uncertainty. [ABSTRACT FROM AUTHOR]

ObjectiveLatinos are the largest racial and ethnic minority group in the United States and bear a disproportionate burden of obesity related chronic disease. Despite national efforts to improve dietary habits and prevent obesity among Latinos, obesity rates remain high. The objective of this study is to explore the relationship between self-rated dietary quality and dietary behavior among Latinos and how this may vary by socio-demographics to help inform future public health efforts aiming to improve eating habits and obesity rates.DesignCross-sectional study using a series of chi-square tests, the non-parametric Wilcoxon-Mann-Whitney test and logistic regression to explore self-rated eating habits.SettingTwo urban, low-income, predominantly Latino neighborhoods in Los Angeles County.Subjects1000 adults who self-identified as their household's primary food purchaser and preparer were interviewed from 2012 to 2013. Households were randomly selected based on their proximity to corner stores participating in a project to improve the food environment.ResultsMost respondents (59%) report "good" eating habits. Significant associations between "good" eating habits and overall health, fruit and vegetable consumption were observed (p

ObjectiveThe aims of this study are to describe growth trajectories in the body mass index (BMI) among the major racial and ethnic groups of US children and to identify predictors of children's BMI trajectories.MethodsThe Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) was used to identify predictors of BMI growth trajectories, including child characteristics, maternal attributes, home practices related to diet and social behaviors, and family sociodemographic factors. Growth models, spanning 48 to 72 months of age, were estimated with hierarchical linear modeling via STATA/Xtmixed methods.ResultsApproximately one-third of 4-year-old females and males were overweight and/or obese. African-American and Latino children displayed higher predicted mean BMI scores and differing mean BMI trajectories, compared with White children, adjusting for time-independent and time-dependent predictors. Several factors were significantly associated with lower mean BMI trajectories, including very low birth weight, higher maternal education level, residing in a two-parent household, and breastfeeding during infancy. Greater consumption of soda and fast food was associated with higher mean BMI growth. Soda consumption was a particularly strong predictor of mean BMI growth trajectory for young Black children. Neither the child's inactivity linked to television viewing nor fruit nor vegetable consumption was predictive of BMI growth for any racial/ethnic group.ConclusionSignificant racial and ethnic differences are discernible in BMI trajectories among young children. Raising parents' and health practitioners' awareness of how fast food and sweetened-beverage consumption contributes to early obesity and growth in BMI-especially for Blacks and Latinos-could improve the health status of young children.

ObjectiveTo examine the associations of father-child feeding and physical interactions with dietary practices and weight status in children.MethodsA nationally representative sample of children, mothers, and fathers who participated in the Early Childhood Longitudinal Study Birth cohort study (N = 2441) was used to explore the relationship of father-child feeding and physical activity interactions with child dietary practices and weight status. Logistic multivariable regression analyses were adjusted for child, father, mother, and socio-demographic characteristics.ResultsApproximately 40% of fathers reported having a great deal of influence on their preschool child's nutrition and about 50% reported daily involvement in preparing food for their child and assisting their child with eating. Children had over 2 times the odds of consuming fast food at least once a week if fathers reported eating out with their child a few times a week compared to fathers who reported rarely or never eating out with their child (OR, 2.89; 95% CI, 1.94-4.29), adjusting for all covariates. Whether fathers reported eating out with their children was also significantly associated with children's sweetened beverage intake.ConclusionsPotentially modifiable behaviors that support healthy dietary practices in children may be supported by targeting fathers.

The Centers for Population Health and Health Disparities program promotes multilevel and multifactorial health equity research and the building of research teams that are transdisciplinary. We summarized 5 areas of scientific training for empowering the next generation of health disparities investigators with research methods and skills that are needed to solve disparities and inequalities in cancer and cardiovascular disease. These areas include social epidemiology, multilevel modeling, health care systems or health care delivery, community-based participatory research, and implementation science. We reviewed the acquisition of the skill sets described in the training components; these skill sets will position trainees to become leaders capable of effecting significant change because they provide tools that can be used to address the complexities of issues that promote health disparities.

The Pathways for Students into Health Professions program is one of four nationally funded programs by the Maternal and Child Health Bureau of the US Department of Health and Human Services to support the training of undergraduate students, particularly from under-represented minority groups to pursue maternal and child health professions. To assess the program's impact on student ratings, knowledge, and interest in maternal and child health professions. A baseline survey on student ratings and knowledge in maternal and child health topics and careers, public health topics, and career development topics was provided to 32 students at the beginning of their first year in the program and approximately 1 year after participation. Half of the students (16 students) in the program from 2009-2011 were from traditionally underrepresented minority groups. After participation, students reported significantly higher ratings of interest in maternal and child health topics and careers and in receiving adequate academic and career guidance. Students also reported significantly higher knowledge of public health, childhood and maternal morbidity and mortality, health care disparities, and life course health development. The program's didactic, experiential, and mentorship activities are changing student ratings and knowledge in a favorable direction toward maternal and child health careers and topics. Undergraduate training programs may be an important mechanism to strengthen the pipeline of a diverse healthcare workforce.

Importance:The prevalence of psychological distress among mothers of children with autism spectrum disorder (ASD) suggests a need for interventions that address parental mental health during the critical period after the child's autism diagnosis when parents are learning to navigate the complex system of autism services.Objective: To investigate whether a brief cognitive behavioral intervention, problem-solving education (PSE), decreases parenting stress and maternal depressive symptoms during the period immediately following a child's diagnosis of ASD.Design, Setting, and Participants: A randomized clinical trial compared 6 sessions of PSE with usual care. Settings included an autism clinic and 6 community-based early intervention programs that primarily serve low-income families. Participants were mothers of 122 young children (mean age, 34 months) who recently received a diagnosis of ASD. Among mothers assessed for eligibility, 17.0%declined participation. We report outcomes after 3 months of follow-up (immediate postdiagnosis period).INTERVENTIONS Problem-solving education is a brief, cognitive intervention delivered in six 30-minute individualized sessions by existing staff (early intervention programs) or research staff without formal mental health training (autism clinic).Main Outcomes and Measures: Primary outcomeswere parental stress and maternal depressive symptoms.RESULTS: Fifty-nine mothers were randomized to receive PSE and 63 to receive usual care. The follow-up rate was 91.0%. Most intervention mothers (78.0%) received the full PSE course. At the 3-month follow-up assessment, PSE mothers were significantly less likely than those serving as controls to have clinically significant parental stress (3.8% vs 29.3%; adjusted relative risk [aRR], 0.17; 95%CI, 0.04 to 0.65). For depressive symptoms, the risk reduction in clinically significant symptoms did not reach statistical significance (5.7%vs 22.4%; aRR, 0.33; 95%CI, 0.10 to 1.08); however, the reduction in mean depressive symptoms was statistically significant (Quick Inventory of Depressive Symptomatology score, 4.6 with PSE vs 6.9 with usual care; adjusted mean difference, -1.67; 95%CI, -3.17 to -0.18).Conclusions and Relevance: The positive effects of PSE in reducing parenting stress and depressive symptoms during the critical postdiagnosis period, when parents are asked to navigate a complex service delivery system, suggest that itmay have a place in clinical practice. Furtherwork will monitor these families for a total of 9 months to determine the trajectory of outcomes..

BackgroundThe Nutrition Facts label can facilitate healthy dietary practices. There is a dearth of research on Latinos' utilization and comprehension of the Nutrition Facts label.ObjectiveTo measure use and comprehension of the Nutrition Facts label and to identify correlates among Latinos in East Los Angeles, CA.DesignCross-sectional interviewer-administered survey using computer-assisted personal interview software, conducted in either English or Spanish in the participant's home.Participants/settingEligibility criteria were: living in a household within the block clusters identified, being age 18 years or older, speaking English or Spanish, identifying as Latino and as the household's main food purchaser and preparer. Analyses were based on 269 eligible respondents.Statistical analyses performedχ(2) test and multivariate logistic regression analysis assessed the associations among the main outcomes and demographics. Multiple imputations addressed missing data.ResultsSixty percent reported using the label; only 13% showed adequate comprehension of the label. Utilization was associated with being female, speaking Spanish, and being below the poverty line. Comprehension was associated with younger age, not being married, and higher education. Utilization was not associated with comprehension.ConclusionsLatinos who are using the Nutrition Facts label are not correctly interpreting the available information. Targeted education is needed to improve use and comprehension of the Nutrition Facts label to directly improve diet, particularly among males, older Latinos, and those with less than a high school education.

Despite higher risk for school failure, few school-based mentoring (SBM) studies have focused on low-income at-risk Latino children. We describe the development and evaluation of the Youth Empowerment Program (YEP), a sustainable, high-quality, SBM program among urban Latino students. Based on evidence from work in other communities, YEP was created as a partnership between the 4th and 5th grades at a Los Angeles Title I elementary school and university undergraduates. We tested the feasibility of applying a previously validated relationship quality assessment tool in this population. Since 2008, 61 mentor and mentee pairs have participated in YEP, with an average relationship length of 1.5 years. Through 2010, over 95 % of pairs had relationships lasting at least 1 year, while 47 % lasted 2 or more years. Seventy-percent of mentees and 85 % of mentors were female, and an increased trend for early relationship termination was observed among male mentees. Through 2011, relationships lasted under 1 year among 29 % of male mentees compared to 7 % of female mentees (p = 0.15). A previously validated relationship quality assessment tool was easily incorporated into YEP, with relationships exhibiting youth-centeredness, emotional engagement and low dissatisfaction. After 5 years, YEP has become a feasible and sustainable SBM program providing long-term relationships for low-income Latino children. These relationships may improve youth health through fewer risky behaviors and attitude improvements. Future work should focus on supporting male mentors and mentees.

Background and objectivePediatricians are encouraged to engage in community child health activities, yet practice constraints and personal factors may limit involvement. The objective was to compare community involvement in 2004 and 2010 and factors associated with participation in the past year.MethodsAnalysis of 2 national mailed surveys of pediatricians (2004: n = 881; response rate of 58%; 2010: n = 820; response rate of 60%). Respondents reported personal characteristics (age, gender, marital status, child ≤5 years old, underrepresented in medicine), practice characteristics (type, setting, full-time status, time spent in general pediatrics), formal community pediatrics training, and community pediatrics involvement and related perspectives. We used χ2 statistics to measure associations of personal and practice characteristics, previous training, and perspectives with involvement in the past 12 months. Logistic regression assessed independent contributions.ResultsFewer pediatricians were involved in community child health in 2010 (45.1% in 2004 vs. 39.9% in 2010) with a higher percentage participating as volunteers (79.5% vs. 85.8%; both P = .03). In 2010, fewer reported formal training at any time (56.1% vs. 42.9%), although more reported training specifically in residency (22.0% vs. 28.4%; both P < .05). Factors associated with participation in 2010 included older age, not having children ≤5 years old, practice in rural settings, practice type, training, and feeling moderately/very responsible for child health. In adjusted models, older age, practice setting and type, feeling responsible, and training were associated with involvement (P < .05).ConclusionsFormal training is associated with community child health involvement. Efforts are needed to understand how content, delivery, and timing of training influence involvement.

The objectives describe a curriculum to support parent-provider communication about child development, and to demonstrate its impact and effectiveness when delivered by staff from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). A curriculum was developed by a university-WIC partnership for a WIC center-based health education class to teach parents about child development and how to talk to their child's doctor about development. During a 90-min training session, university pediatricians used this curriculum and trained WIC paraprofessionals to conduct a 20-30 min center-based education session. WIC paraprofessionals completed an on-line survey to obtain their demographic characteristics, and their attitudes and perceptions about the training sessions and their experiences teaching the center-based health education session to parents. Approximately 500 WIC paraprofessionals received the 90-min training session across 60 centers in the Public Health Foundation Enterprises WIC Program in Southern California. About 250 WIC paraprofessionals completed the on-line survey and over 80 % of WIC staff reported that they had learned new information about child development as a result of the training, and 87 % of the WIC staff reported that the training was sufficient to feel comfortable teaching the class content to parents. We demonstrated the ability to build WIC paraprofessional capacity to promote parental participation in child developmental surveillance and communication with their child's doctor. With appropriate training, WIC staff are interested in supporting population-based efforts to improve parent-physician communication about child development that can complement WIC's existing maternal and child health topics.

Timing of the first introduction of solid food during infancy may have potential effects on life-long health. To understand the characteristics that are associated with the timing of infants' initial exposure to solid foods. The 2000 National Survey of Early Childhood Health (NSECH) was a nationally representative telephone survey of 2,068 parents of children aged 4-35 months, which profiled content and quality of health care for young children. African-American and Latino families were over-sampled. Analyses in this report include bivariate tests and logistic regressions. 62% of parents reported introducing solids to their child between 4-6 months of age. African-American mothers (OR=0.5 [0.3, 0.9]), English-speaking Latino mothers (OR=0.4 [0.2, 0.7]), White mothers with more than high school education (OR=0.5 [0.2, 1.0]), and mothers who breastfed for 4 months or longer (OR=0.4 [0.3, 0.7]) were less likely to introduce solids early. Most parents (92%) of children 4-9 months of age reported that their pediatric provider had discussed introduction of solids with them since the child's birth, and provider discussion of feeding was not associated with the timing of introduction of solids. Although most parents recall discussing the introduction of solid foods with their child's physician, several subgroups of mothers introduce solid foods earlier than the AAP recommendation of 4-6 months. More effective discussion of solid food introduction linked to counseling and support of breastfeeding by the primary health care provider may reduce early introduction of solids.