"The Design and Acceptability of a Hip Hop Themed Integrated Nutrition Math Curriculum for Minoritized 5th Grade Students Using the Multisensory Multilevel Health Education Model".

Digital technology creates new opportunities to design multisensory learning experiences. Evidence suggests that digital innovation can greatly benefit health education, including nutrition programs. The COVID-19 pandemic disrupted the education sector, forcing schools to modify standard practices from exclusively in-person delivery to online or blended learning. Digitalized curriculums became particularly useful as an Emergency Remote Teaching tool. This article focuses on developing and implementing a multimedia, multisensory, and scalable Hip-Hop Healthy Eating and Living in Schools (H.E.A.L.S.) Nutrition-Math Curriculum (NMC). NMC comprises 20 lessons-music-based multimedia resources used in the classroom or at home. Fourteen lessons represent self-directed online modules (asynchronous learning) hosted on a Learning Management System (LMS) called "Gooru." The remaining six lessons are teacher-facilitated (in person or using Zoom) review sessions (synchronous learning). The article discusses (1) the development of NMC through the lens of the Multisensory Multilevel Health Education Model (MMHEM), (2) the high acceptability of NMC evaluated using a mixed-methods design among minoritized fifth-grade students attending an after-school program, and (3) the students' completion and mastery rates of the NMC modules based on LMS data. Multimedia nutrition education programs integrated with common core curriculum content, such as NMC, may be a promising avenue for disseminating health education to minoritized children living in New York City and similar high fast-food density cities.

Assessing the impact of a 6-year health sciences enrichment program for underrepresented minority youth on healthcare workforce diversity, career path, and public health.

Background: Improving the quality of care for a diverse population requires a diverse healthcare workforce which necessitates high educational attainment among underrepresented communities. Programs aimed to address healthcare workforce diversity gaps also serve as a public health intervention by offering avenues to improve the health of local communities by providing students with the knowledge and skills to promote healthy behaviors, foster scientific literacy, and inspire future public health professionals - who in turn serve their local communities to advance health outcomes. We interviewed alumni of the New York Presbyterian Hospital Lang Youth Medical Program (LYMP), a high school health sciences mentoring and enrichment program for underrepresented minority youth in Upper Manhattan, from graduating classes between 2012 and 2021 to explore their perspectives on what aspects of the program had the most impact on their academic and career paths. Method: This is a qualitative study using in-depth, semi-structured individual interviews. All interviews were analyzed using the constant comparative method for developing grounded theory, following a convenience sampling method. Results: 106 codes were organized into 24 themes, which were further arranged into 4 topic areas: demonstrated program success, intangible program drivers, improvement opportunities, and barriers to program participation. Topic areas captured participants' perspectives on how the program is designed to foster an environment of personal, academic, and professional development; ways aspects of the program organically worked together to provide unanticipated positive facilitators; opportunities for program improvements, and external factors that influenced decision-making. Conclusion: Through this study, we found that the LYMP had a positive influence in helping participants set and achieve personal, academic, and professional goals. Alumni reported activities and experiences offered by the program that foster key youth development constructs linked to healthier and more resilient communities. Importantly, the vast majority of participants described how the synergism between program features, staff support, family involvement, and professional development and networking created an environment of achievement that went beyond the scope of the program design. Findings from this study offer a blueprint for other organizations to craft a similarly successful enrichment program that improves health outcomes, reduces health disparities, and promotes overall population health.

Assessment of a Fruit and Vegetable Prescription Program in the Northern Manhattan Community.

PURPOSE: This study aimed to assess whether produce prescription redemption was associated with food insecurity (FI), sociodemographics, and nutrition-related health measures, and to identify factors affecting participation. DESIGN: Retrospective, cross-sectional study. Patients, equally divided between groups who redeemed and did not redeem prescriptions, completed a follow-up survey. SETTING: Northern Manhattan, NY. SUBJECTS: 242 patients referred to Nutrition at an academic medical center between June and November 2019. INTERVENTION: All patients referred to Nutrition received prescriptions for produce at local Greenmarkets (patients with FI received $20; other patients received $10). MEASURES: We assessed patient satisfaction and factors impacting participation. Sociodemographics and nutrition-related health measures were extracted from medical records. ANALYSIS: The χ2 test for categorical data and Student's t-test for continuous variables. RESULTS: Prescription redeemers were significantly more likely to be very satisfied with the program (P < .001), have FI (P < .01), and have elevated hemoglobin A1C than non-redeemers (6.3 vs 5.5%, P < .001). Distance, time constraints, and forgetting or losing the prescription were common barriers, while convenience and valuing healthy eating facilitated redemption. CONCLUSION: Higher FI and worse hemoglobin A1c in patients who redeemed prescriptions suggests that our program reaches the target audience: patients needing food assistance and a healthier diet. Awareness of barriers offers areas for improvement. This provides a feasible model for hospital investment to increase access to produce to improve health and health equity.

Integrating Nurse Care Managers in the Medical Home of Children with Special Health Care needs to Improve their Care Coordination and Impact Health Care Utilization.

PURPOSE: There is a rising number of children with special health care needs (CSHCN) in the pediatric medical home and their care coordination is complicated and challenging. We aimed to integrate nurse care managers to coordinate care for such patients, and then evaluate, if this improved health care utilization. DESIGN AND METHODS: This quality improvement project evaluated the impact on CSHCN of the integration of nurse care managers in the pediatric medical home. From October 2015 through February 2019, 673 children received longitudinal care coordination support from a care manager. Health care utilization for primary, subspecialty, emergency department (ED) and inpatient care was reviewed using pre and post design. RESULTS: Three medical home-based nurse care managers were integrated into four pediatric hospital affiliated practices in a large, urban center. The number of ED visits and inpatient admissions were statistically significantly decreased post-intervention (p < 0.05).There was also a decrease in the number of subspecialty visits, but it was close to the threshold of significance (p = 0.054). There was no impact noted on primary care visits. CONCLUSION: This quality improvement project demonstrates that nurse care managers who are integrated into the medical home of CSHCN can potentially decrease the utilization of ED visits and hospital admissions as well as subspecialty visits. PRACTICE IMPLICATIONS: Nurse care managers can play a pivotal role in medical home redesign for the care of CSHCN.

Effect of TSH on Non-Alcoholic Fatty Liver Disease (NAFLD) independent of obesity in children of predominantly Hispanic/Latino ancestry by causal mediation analysis.

BACKGROUND: Nonalcoholic Fatty Liver Disease (NAFLD) is a common co-morbidity of obesity. Elevated TSH levels (eTSH), also associated with obesity, may contribute to the dysmetabolic state that predisposes to NAFLD. OBJECTIVE: To assess the relationship between TSH levels and NAFLD in children with biopsy-proven NAFLD compared to controls. DESIGN AND METHODS: In this retrospective study of children with biopsy-proven NAFLD and age-matched controls, the association of eTSH with NAFLD was investigated and the role of TSH as a mediator between obesity and NAFLD was assessed. RESULTS: Sixty-six cases and 4067 controls (69.7 vs 59% Hispanic/Latino ancestry, p = 0.1) of the same age range seen in the same time duration at an urban Children's Hospital were studied. Children with NAFLD were more likely to be male (74.6 vs 39.4%, p < 0.001), have higher modified BMI-z scores (median 2.4 (IQR 1.7) vs 1.9 (IQR 1.7), p < 0.001), and abnormal metabolic parameters (TSH, ALT, HDL-C, non-HDL-C, and TG). Multivariate analyses controlling for age, sex and severity of obesity showed significant association between the 4th quartile of TSH and NAFLD. Causal mediation analysis demonstrates that TSH mediates 33.8% of the effect of modified BMI-z score on NAFLD. This comprises of 16.0% (OR = 1.1, p = 0.002) caused by the indirect effect of TSH and its interaction with modified BMI-z, and 17.7% (OR = 1.1, p = 0.05) as an autonomous effect of TSH on NAFLD. Overall, 33.8% of the effect can be eliminated by removing the mediator, TSH (p = 0.001). CONCLUSIONS: The association of eTSH and biopsy-proven NAFLD is demonstrated in children of Hispanic/Latino ancestry. Further, a causal mediation analysis implicates an effect of TSH on NAFLD, independent of obesity.

Zooming Toward a Telehealth Solution for Vulnerable Children with Obesity During Coronavirus Disease 2019.

Health inequities exist throughout the life course, resulting in racial/ethnic and socioeconomic disparities in obesity and obesity-related health complications. Obesity and its comorbidities appear to be linked to coronavirus disease 2019 (COVID-19) mortality. Approaches to reduce obesity in the time of COVID-19 closures are urgently needed and should start early in life. In New York City, a telehealth pediatric weight-management collaborative spanning NewYork-Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine was developed during COVID-19 with show rates from 76% to 89%. To stave off the impending exacerbation of health disparities related to obesity risk factors in the aftermath of the COVID-19 pandemic, effective interventions that can be delivered remotely are urgently needed among vulnerable children with obesity. Challenges in digital technology access, social and linguistic differences, privacy security, and reimbursement must be overcome to realize the full potential of telehealth for pediatric weight management among low-income and racial/ethnic-minority children.

Genetic Variants Associated With Obesity and Insulin Resistance in Hispanic Boys With Nonalcoholic Fatty Liver Disease.

BACKGROUND AND OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) disproportionately affects Hispanic boys. Further, obesity and insulin resistance are major risk factors for NAFLD. No gene localization studies had been performed on children with biopsy-proven NAFLD. This study aims to identify genomic variants associated with increased adiposity and insulin resistance in a population of children with varying histologic severity of NAFLD. METHODS: We conducted a genome-wide association scan (GWAS) including 624,297 single-nucleotide polymorphisms (SNPs) distributed among all 22 autosomal chromosomes in 234 Hispanic boys (up to 18 years of age) who were consecutively recruited in a prospective cohort study in the Nonalcoholic Steatohepatitis Clinical Research Network Studies. Traits were examined quantitatively using linear regression. SNPs with P value <10 and a minor allele frequency >5% were considered potentially significant. RESULTS: Evaluated subjects had a median age of 12.0 years, body mass index (BMI) of 31.4, and hemoglobin A1C (Hgb A1C) of 5.3. The prevalence of NAFL, borderline NASH, and definite NASH were 23%, 53%, and 22%, respectively. The GWAS identified 10 SNPs that were associated with BMI z score, 6 within chromosome 2, and 1 within CAMK1D, which has a potential role in liver gluconeogenesis. In addition, the GWAS identified 9 novel variants associated with insulin resistance: HOMA-IR (6) and HbA1c (3). CONCLUSIONS: This study of Hispanic boys with biopsy-proven NAFLD with increased risk for the metabolic syndrome revealed novel genetic variants that are associated with obesity and insulin resistance.

Evaluating the Impact of Information Technology Tools to Support the Asthma Medical Home.

This study aimed to evaluate the impact of information technology tools on the outcomes of children with asthma in the medical home. A registry was established for children aged 4 to 18 years with an ICD-9 code for asthma. Changes to the electronic health record included modifications to notes, care plans, and orders. A retrospective analysis of emergency department and in-patient utilization for a cohort of patients was conducted from July 2009 through June 2013. Of the study population (n = 1217), 65% had a classification of asthma severity and 63% were risk-stratified. Seventy percent had a control assessment at least once. Care plan use increased from 5% to 22% and enrollment in care coordination increased from 0.1% to 4%. After 3 years, there was a reduction of emergency department and inpatient admissions for asthma (P < .05 and P < .005, respectively). The implementation of information technology tools was associated with improved asthma outcomes.