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Narrative Story-Stem Tasks (NSST) assess young children's perceptions of close relationship qualities via the spontaneous narratives they create in response to story beginnings using doll-like figures. Most NSST research to date has focused on family relationships. This study extends this research to children's perceptions of relationships with teachers (caregiving and attachment) and peers (exploration, mutuality, and aggression) in school settings. Three new story-stems were created for this purpose. A racially and economically diverse sample (n = 39) was recruited from two school systems in the U.S. As predicted, girls were more likely to enact relational aggression in their narratives. Children attending the higher SES school were significantly more likely to enact representations of teachers as caregivers, and representations of parental and teacher caregiving were significantly associated. Parent-reported perceptions of their children's teachers were significantly associated with children's narrative representations of attachment behaviour directed toward teachers. Implications for policy and services are discussed.

IntroductionThe 15-minute work break provides an opportunity to promote health, yet few studies have examined this part of the workday. We studied physical activity and sedentary behavior among office workers and compared the results of the Booster Break program with those of a second intervention and a control group to determine whether the Booster Break program improved physical and behavioral health outcomes.MethodsWe conducted a 3-arm, cluster-randomized controlled trial at 4 worksites in Texas from 2010 through 2013 to compare a group-based, structured Booster Break program to an individual-based computer-prompt intervention and a usual-break control group; we analyzed physiologic, behavioral, and employee measures such as work social support, quality of life, and perceived stress. We also identified consistent and inconsistent attendees of the Booster Break sessions.ResultsWe obtained data from 175 participants (mean age, 43 y; 67% racial/ethnic minority). Compared with the other groups, the consistent Booster Break attendees had greater weekly pedometer counts (P < .001), significant decreases in sedentary behavior and self-reported leisure-time physical activity (P < .001), and a significant increase in triglyceride concentrations (P = .02) (levels remained within the normal range). Usual-break participants significantly increased their body mass index, whereas Booster Break participants maintained body mass index status during the 6 months. Overall, Booster Break participants were 6.8 and 4.3 times more likely to have decreases in BMI and weekend sedentary time, respectively, than usual-break participants.ConclusionFindings varied among the 3 study groups; however, results indicate the potential for consistent attendees of the Booster Break intervention to achieve significant, positive changes related to physical activity, sedentary behavior, and body mass index.

The spontaneous narratives of three brothers, ages 5, 8, and 11, in response to a structured story stem task were analysed for representations of positive and negative family interactions. The children had lived their entire lives with no permanent home, and often on the streets, in the care of their mother. The story stem task presented brief scenarios of parent and family conflict and a child's need for comfort. Analyses revealed children's understanding of basic family role structures; yet, their narratives were also characterized by emotional detachment, limited parental engagement, and self-centredness. Implications for young children's coping with great adversity are discussed.

The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) immunization for 11- to 12-year-old adolescents. In 2008, Louisiana required the school boards to distribute HPV vaccine information to parents or guardian of students in Grades 6 to 12. This article investigates the impact of this policy on HPV vaccination among 13- to 17-year-old female adolescents using National Immunization Survey-Teen (NIS-Teen) data. Drawing on the data from the 2008 to 2012 NIS-Teen, we compared the difference in proportions of females who have been vaccinated before and after the policy. Using difference-indifference estimation, we explored the change in vaccination rates before and after the policy implementation in Louisiana compared with Alabama and Mississippi, two states that did not have such a policy in place. The difference-in-differences estimates for HPV vaccination were not significant. Physician recommendation for HPV vaccination was significantly associated with vaccination among females in Louisiana and Alabama (adjusted odds ratio [aOR] = 7.74; 95% confidence interval [CI; 5.22, 11.5]), and for those in Louisiana and Mississippi (aOR = 7.05; 95% CI [4.6, 10.5]). Compared to the proportion of female adolescents who had received physician recommendation in Alabama or Mississippi, the proportion in Louisiana did not increase significantly in the postpolicy period. HPV vaccination rates did not increase significantly in Louisiana compared to Alabama or Mississippi following the implementation of the policy. Despite Louisiana's policy, physician recommendation remains the key determinant of HPV vaccination. HPV vaccine awareness does not necessarily result in HPV vaccination.

The central focus of this study was the perceptions of emotional security among 64 elementary school-aged children exposed to the hurricanes that affected the US Gulf Coast in 2005. Specifically, we examined the representational qualities of attachment, exploration, and caregiving as assessed with a narrative story-stem task in relation to parental reports of children's exposure to the hurricanes, their knowledge of hurricanes, and their teacher's exposure to the hurricanes. Knowledge of hurricanes was assessed with a new narrative method representing hurricane conditions wherein children were asked to tell stories about what hurricanes are and what damage they could do. Children's narrative representations of attachment, exploration, and caregiving were unrelated to parental reports of their children's exposure to the hurricanes but were significantly related to their knowledge of hurricanes, specifically the effects of hurricanes on people, and to teachers' reported loss of property related to the hurricanes. The findings suggest that a core component of children's representational models is the capacity for empathy for the experience of others.

Objective: The purpose of this study was to document the development and testing costs of the Enhanced Alcohol Risk Management (eARM) intervention, a web enhanced training program to prevent alcohol sales to intoxicated bar patrons and to estimate its implementation costs in a "real world", non-research setting. Methods: Data for this study were obtained retrospectively from a randomized controlled trial of the eARM intervention, which was conducted across 15 communities in a Midwestern metropolitan area. Inputs and their costs were obtained from records maintained during the randomized controlled trial. Total development and testing costs were computed, and implementation costs were estimated with input from the research team. The average implementation cost per establishment was calculated by dividing the total estimated implementation cost by the number of establishments that participated in the study. This provides an estimate of the resources needed to support a broader dissemination of interventions such as eARM. Results: Direct development and testing costs were $484,904. Including the University's overhead cost rate of 51 percent, total development and testing costs were $732,205. Total estimated implementation costs were $179,999 over a 12 month period. The average cost per establishment was $1,588. Conclusions: Given the large damage liability awards faced by establishments that serve alcohol to drunk drivers, establishments or their insurance companies may be willing to pay the $1,588 estimated implementation cost in order to limit their exposure to these large damage awards. Therefore, making interventions such as eARM available could be an effective and sustainable policy for reducing alcohol-related incidents.

Background: Chronic disease accounts for the majority of healthcare costs. The Chronic Disease Self-Management Programme (CDSMP) has been shown to be effective in reducing the burden of chronic disease. Objectives: The objective of this study was to measure the cost of delivering the Chronic Disease Self-Management Programme (CDSMP) in order to determine whether it has the potential to produce a net cost saving among elderly residents of South Florida. Methods: Cost data were collected from four agencies participating in the delivery of CDSMP workshops in South Florida. Information on healthcare cost savings were obtained from the literature and updated to current dollars. Questionnaires were emailed to programme coordinators from agencies participating in the delivery of CDSMP workshops. Questionnaires were returned via email. Costs were computed from the perspective of the participating agencies. Results: Costs for implementation per programme participant were US$204. These average costs are below the US$1,381 healthcare cost reductions documented in the literature during the first year following programme participation. Conclusion: Results suggest the potential effectiveness of CDSMP in reducing healthcare costs among elderly residents of South Florida. This has implications for the further dissemination and sustainability of evidence-based programmes for seniors. An evaluation of outcomes among the South Florida population is needed.

Standardized clinical assessments from the point of view of children are rare. A standardized narrative assessment measure, developed to assess children's perceptions of their caregiving environments, the Narrative Story-Stem Technique (NSST), was used with two fraternal twins, age 8, with histories of severe maltreatment and multiple foster placements. Their responses to the NSST indicate that they perceived their caregiving environments as unstable and unpredictable, though in noticeably different ways. Representations of certain family strengths were also evident. The NSST can provide highly detailed information of great utility for treatment planning and intervention regarding children's perceptions of, and experiences in, their caregiving environments. (Contains 1 table.)

Despite an emergence of psychosocial treatments for adolescent ADHD, their long-term effects are unknown. We examine four-year outcomes of a randomized controlled trial (N = 218) comparing high-intensity (HI; 412 h, $4,373 per participant) versus low-intensity (LI; 24 h, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD at two secondary school transitions (6th/9th grade). Quantitative and qualitative analyses evaluated group×time and group×grade×time effects on 4-year outcomes. Relative to LI, a single dose of HI had modest but lasting effects on teen organization skills (d =.40) and ADHD symptoms (9th grade only: d =.27 to.31) at 4-year follow-up. There was no long-term incremental effect of HI (vs. LI) for parent-teen conflict, GPA, or parent use of contingency management. Treatment appeared most effective when delivered to older adolescents (i.e., 9th versus 6th grade), suggesting the long-term impact of ADHD treatment may increase with age. Qualitative data corroborated that the primary long-term benefit of HI (vs. LI) treatment was to organization skills; many of the remaining perceived benefits were to parent and teen psychological variables (i.e., increased self-esteem, self-awareness, parental optimism). HI offered no incremental benefit to long-term educational or clinical service utilization or costs. Modest therapeutic benefits of adolescent ADHD treatment are maintained long term. However, HI treatment did not impact outcomes that could defray the intervention's high costs ($4,373) compared to LI treatment ($97). [ABSTRACT FROM AUTHOR]