Evaluation of a workshop to improve residents' patient-centred obesity counselling skills.

BACKGROUND: Primary care physicians are being asked to counsel their patients on obesity and weight management. Few physicians conduct weight loss counselling citing barriers, among them a lack of training and confidence. Our objective was to pilot test the effectiveness of a 3-h interactive obesity-counselling workshop for resident physicians based on motivational interviewing (MI) techniques. DESIGN: This study used a pretest/post-test cross-sectional design. A convenience sample of resident physicians was invited to participate. Participating resident physicians completed a preintervention and postintervention questionnaire to assess their knowledge, beliefs and confidence in obesity counselling. MI techniques taught in the intervention were evaluated by audio recording interviews with a standardised patient (SP) pre intervention and post intervention. Audio recordings were transcribed and coded by two independent coders using a validated assessment tool. Paired t tests were used to assess preintervention and postintervention differences. RESULTS: Eight-six residents attended the workshop. At baseline, the majority (71%) felt that there is not enough time to counsel patients about obesity and only 24% felt that residency trained them to counsel. After the intervention, knowledge and confidence in counselling increased (p<0.001). Among the 55 residents with complete pre-post SP interview data, MI adherent statements increased from a mean of 2.88 to 5.42 while the MI non-adherent statements decreased from 6.73 to 2.33 (p<0.001). CONCLUSIONS: After a brief workshop to train physicians to counsel on obesity-related behaviours, residents improved their counselling skills and felt more confident on counselling patients. Future studies are needed to assess whether these gains are sustained over time.

Child development and pediatric sport and recreational injuries by age.

CONTEXT: In 2010, 8.6 million children were treated for unintentional injuries in American emergency departments. Child engagement in sports and recreation offers many health benefits but also exposure to injury risks. In this analysis, we consider possible developmental risk factors in a review of age, sex, and incidence of 39 sport and recreational injuries. OBJECTIVE: To assess (1) how the incidence of 39 sport and recreational injuries changed through each year of child and adolescent development, ages 1 to 18 years, and (2) sex differences. Design : Descriptive epidemiology study. SETTING: Emergency department visits across the United States, as reported in the 2001-2008 National Electronic Injury Surveillance System database. PATIENTS OR OTHER PARTICIPANTS: Data represent population-wide emergency department visits in the United States. Main Outcome Measure(s) : Pediatric sport- and recreation-related injuries requiring treatment in hospital emergency departments. RESULTS: Almost 37 pediatric sport or recreational injuries are treated hourly in the United States. The incidence of sport- and recreation-related injuries peaks at widely different ages. Team-sport injuries tend to peak in the middle teen years, playground injuries peak in the early elementary ages and then drop off slowly, and bicycling injuries peak in the preteen years but are a common cause of injury throughout childhood and adolescence. Bowling injuries peaked at the earliest age (4 years), and injuries linked to camping and personal watercraft peaked at the oldest age (18 years). The 5 most common causes of sport and recreational injuries across development, in order, were basketball, football, bicycling, playgrounds, and soccer. Sex disparities were common in the incidence of pediatric sport and recreational injuries. CONCLUSIONS: Both biological and sociocultural factors likely influence the developmental aspects of pediatric sport and recreational injury risk. Biologically, changes in perception, cognition, and motor control might influence injury risk. Socioculturally, decisions must be made about which sport and recreational activities to engage in and how much risk taking occurs while engaging in those activities. Understanding the developmental aspects of injury data trends allows preventionists to target education at specific groups.

Unintentional injury among low-income 5-year-olds with chronic health conditions.

BACKGROUND: Growing numbers of children suffer from chronic health conditions, and initial evidence suggests chronic illness may be associated with increased child injury risk. We examined injury risk among 5-year-olds with and without chronic health conditions. METHODS: Data from a diverse US sample of 7954 low-income 5-year-olds participating in the National Head Start/Public School Early Childhood Transition Demonstration Study were analysed. Mothers reported demographics, presence/absence of eight chronic health conditions, and whether children had experienced injuries requiring professional medical attention in the past year. Primary analyses used ordinal logistic regression. RESULTS: Asthma, bronchitis, recurrent ear infections, hay fever/allergies and speech problems associated with increased injury risk (OR range = 1.20-1.49 in bivariate ordinal logistic regression, ps < 0.01). Children with cerebral palsy had reduced injury risk (OR = 0.37, 95% CI = 0.15-0.91, p < 0.05). Most findings held after including demographic covariates in multivariate models. CONCLUSION: Because a range of chronic health conditions associated with increased injury risk, the causal mechanism behind relations between chronic illness and injury risk may not be disease-specific. Instead, factors related to having chronic medical conditions-not any particular condition-might contribute. Possible mediators include impaired family functioning, impaired peer relations, and familiarity with the health system/health-seeking behaviours.

How do mothers and fathers influence pediatric injury risk in middle childhood?

OBJECTIVES: Parental influences are among the strongest behavioral correlates to unintentional injury outcome in early childhood, but are less well understood as children develop. We implemented a prospective research design to study how parenting style, parent-child relationships, and parental mental health influence injury during middle childhood. We also considered the roles of parent and child gender. METHODS: Parental influences were assessed from a sample of 584 first graders, plus their mothers and fathers. Injuries requiring medical treatment were assessed regularly over the subsequent 5 years. Logistic regression models examined how maternal and paternal parenting factors predicted injury among all children, just boys, and just girls. RESULTS: Fathers who reported more positive relationships with their children had children protected from injury. This was particularly true of father-son relationships. No maternal traits predicted injury. CONCLUSIONS: A positive father-child, and especially a positive father-son relationship, may protect children from injury during middle childhood.

Brief report: unintentional injury risk among children with sensory impairments.

OBJECTIVE: Pediatric injuries result from a multifaceted process involving a range of individual, interpersonal, and environmental influences. One risk that remains poorly understood is the role of children's perception and perceptual disabilities. METHODS: Injury counts (parent-report of injuries requiring professional medical treatment over the past year) in three groups of children were compared: those without vision or hearing sensory impairments, those with deficits who use eyeglasses or hearing aids, and those with deficits who do not use aids as recommended. A national sample of 7391 5-year-olds in the National Head Start/Public School Early Childhood Transition Demonstration Study was studied. RESULTS: Injury counts over the past year were higher among children with sensory impairments, and higher still among children with sensory impairments who did not use prescribed sensory aids. CONCLUSIONS: Awareness of increased injury risk among children with hearing and vision impairment could help professionals protect children from injury.

Injury risk in children with asthma.

BACKGROUND: Asthma is the most common chronic illness in American children. Injury is the most common acute medical condition and also the leading cause of mortality. Previous research examining possible links between pediatric asthma and injury is inconclusive. OBJECTIVE: This study investigates the relationship between pediatric asthma and injury. METHODS: Asthma diagnosis and multiple child, parent, and family characteristics were assessed from 878 families when children were 54 months. Parents reported child injuries regularly over the next 2.5 years. RESULTS: Children with asthma had more injuries than children without asthma, even after controlling for child, parent, and environmental covariates. CONCLUSIONS: Four-year-old children diagnosed with asthma appear to have increased risk of injury over their peers as they enter the early elementary school years, and the authors discuss the possible causes of this relationship.

Language acculturation and pediatric injury risk.

The number of immigrant children in the US continues to grow rapidly, but pediatric immigrant health remains a poorly understood domain. Previous research suggests immigrant children have reduced risk for injury, but the reason for that finding remains unknown. One leading hypothesis is cultural-less acculturated children in the United States appear to be protected from injury-but the combined influence of immigrant status and acculturation is unclear. This study examines the roles of immigration and language acculturation on pediatric injury risk. Samples of 8,526 children and 4,010 adolescents included in the 2003 California Health Interview Survey were studied. The primary analytic technique was Poisson regressions predicting incidents of injury requiring professional medical attention. Predictor variables included demographic characteristics, health insurance availability, birthplace (US vs. other), and language acculturation. Both birthplace and language acculturation were related to children's and to adolescent's risk for unintentional injury, but language acculturation emerged as the stronger univariate predictor and only multivariate predictor of injury in both models. Possible interpretations of the results are discussed.

Chronic maternal depression and children's injury risk.

OBJECTIVE: A substantial number of mothers of young children suffer from depression. One understudied consequence of maternal depression is how it affects toddlers' injury risk. This study examined links between chronic maternal depression and child injury. METHODS: A national sample of 1,364 American children was studied. RESULTS: Chronic levels of severe maternal depression placed children at increased risk of concurrent injury from birth to age 3. The relation between chronic, severe maternal depression and child injury risk held even after controlling for variance from family SES, child sex, child temperament and externalizing behavior, and parenting. Chronic maternal depression during infancy and toddlerhood did not influence children's subsequent risk for injury, between age 3 and first grade. Less severe symptoms of chronic maternal depression were unrelated to concurrent or future child injury. CONCLUSIONS: Chronic, severe levels of maternal depression are linked to concurrent child injury risk during infancy and toddlerhood.

Nocturnal awakenings and pediatric injury risk.

OBJECTIVE: This study was designed to examine relations between nocturnal awakenings and unintentional injury risk among toddlers. METHODS: A nationally representative sample of 799 children was followed longitudinally from birth through 36 months. Patterns of nocturnal awakening were assessed by parent-report at ages 6, 15, 24 and 36 months, and injury events were reported at quarterly intervals over the same time period. A range of external covariates, including positive and negative affect and externalizing behavior; maternal stress, maternal depression, and parenting style; and family socioeconomic status were measured. RESULTS: A persistent pattern of very mild nocturnal awakening was related to increased risk of injury during the toddler years, and that relation held after controlling for a range of potential covariates. CONCLUSIONS: A pattern of persistent nocturnal awakening appears to be related to unintentional injury risk in toddlers.

Does time spent in child care influence risk for unintentional injury?

OBJECTIVE: To investigate the effect of quantity and quality of early child care on children's risk for unintentional injury. METHODS: A diverse cohort of 1,225 children was recruited from several sites in the United States and followed from birth until first grade. Quantity and quality of child care from birth until entry into kindergarten were used to predict unintentional injuries from age 6 months until first grade. Measures from an evaluation at 6 months of age were tested as covariates. RESULTS: Children who spent more time in nonparental childcare environments were at slightly reduced risk for unintentional injury after controlling for child (gender, temperament), family [socioeconomic status (SES)], parent (positive parenting), and child care (quality of care) characteristics. CONCLUSIONS: We discuss possible explanations for the results, including the possibilities that childcare center environments are safer than the homes of most preschoolers or that attendance in child care is nonrandom.

Injury risk among children of low-income U.S.-born and immigrant mothers.

The number of immigrants in the United States is at an all time high, yet psychologists have largely ignored the domain of immigrant health. This article considers 1 aspect of immigrant health, risk for pediatric injury. A sample of over 5,000 5-year-old children from impoverished families was studied; approximately 13% had immigrant mothers. Children of immigrants had a significantly lower rate of injury in the prior year. This was particularly true of non-White children of immigrants. Three possible mediators for this finding--assistance with parenting, parenting style, and health care accessibility--were considered, but none explained the difference. The need for further research on the topic and implications of results for injury prevention are discussed.

Interactions between child behavior patterns and parenting: implications for children's unintentional injury risk.

OBJECTIVES: Two factors were considered as predictors of children's risk for unintentional injury: (a) children's temperamentally difficult behavior patterns and (b) parenting. Along with hypotheses to replicate previous univariate effects, it was hypothesized that active, involved parents with sufficient time resources might reduce injury risk among temperamentally at-risk children. METHODS: Study 1 used a retrospective design with a diverse sample of over 10,000 5-year-olds. Study 2 replicated Study 1 using a prospective design and behavioral data from a sample of over 1,000 children followed from 6 to 36 months of age. RESULTS: In Study 1, male gender, child hyperactivity, and family poverty predicted injury in a univariate manner. In Study 2, male gender and lack of positive parenting predicted injury in a univariate manner. Interaction effects also emerged: in Study 1 the interaction between child hyperactivity and parental time resources protected children from injury, and in Study 2 the interaction between child's difficult temperament and positive parenting protected children from injury. CONCLUSIONS: Children at increased risk for injury, i.e., those with hyperactive and difficult behavior patterns, might be protected in the environment of positive parenting. Theoretically, results suggest that researchers should consider Temperament x Environment interactions along with univariate predictors of outcome behavior. From an applied perspective, results have implications for the design of injury prevention campaigns: Parents who spend positive time with temperamentally difficult children might protect them from injury.

The role of fathers in toddlers' unintentional injury risk.

OBJECTIVES: Previous work suggests that maternal parenting and supervision reduces risk for children's unintentional injuries, but very little research has examined the role of fathers in children's unintentional injury risk. The role of fathers in protecting children from unintentional injury was considered. METHODS: A prospective longitudinal design predicted injury risk in 181 toddlers from the ages of 6 to 36 months. Predictor variables included child gender and temperament, individual difference factors of the mother and father, and parenting factors of the mother and father. RESULTS: Hierarchical regression models suggested that fathers' report of gains to the family from their employment was the strongest predictor of risk of children's unintentional injury. Several other paternal and maternal factors were also modestly related to injury risk. CONCLUSIONS: Data indicate the need to consider the role of fathers in protecting children from unintentional injuries.