Using community--academic partnerships and a comprehensive school-based program to decrease health disparities in activity in school-aged children.

Many underserved school-age children do not meet the recommended guidelines for physical activity. While children ultimately depend on parents, they also look to schools for their access to developmentally appropriate physical activity. The present randomized controlled trial study utilized a community-academic partnered participatory research approach to evaluate the impact of a culturally sensitive, comprehensive, school-based, program, Kids N Fitness(©), on body mass index (BMI), and child physical activity behavior, including: daily physical activity, team sports participation, attending PE class, and TV viewing/computer game playing, among underserved children ages 8-12 (N = 251) in Los Angeles County. All measures were collected at baseline, 4 and 12 months post-intervention. Students who participated in the KNF program had significant decreases in BMI Z-score, TV viewing, and an increase in PE class attendance from baseline to the 12 month follow-up. Our study shows the value of utilizing community-academic partnerships and a culturally sensitive, multi-component, collaborative intervention.

Impact of a nurse-directed, coordinated school health program to enhance physical activity behaviors and reduce body mass index among minority children: a parallel-group, randomized control trial.

BACKGROUND: Underserved children, particularly girls and those in urban communities, do not meet the recommended physical activity guidelines (>60min of daily physical activity), and this behavior can lead to obesity. The school years are known to be a critical period in the life course for shaping attitudes and behaviors. Children look to schools for much of their access to physical activity. Thus, through the provision of appropriate physical activity programs, schools have the power to influence apt physical activity choices, especially for underserved children where disparities in obesity-related outcomes exist. OBJECTIVES: To evaluate the impact of a nurse directed, coordinated, culturally sensitive, school-based, family-centered lifestyle program on activity behaviors and body mass index. DESIGN, SETTINGS AND PARTICIPANTS: This was a parallel group, randomized controlled trial utilizing a community-based participatory research approach, through a partnership with a University and 5 community schools. Participants included 251 children ages 8-12 from elementary schools in urban, low-income neighborhoods in Los Angeles, USA. METHODS: The intervention included Kids N Fitness(©), a 6-week program which met weekly to provide 45min of structured physical activity and a 45min nutrition education class for parents and children. Intervention sites also participated in school-wide wellness activities, including health and counseling services, staff professional development in health promotion, parental education newsletters, and wellness policies for the provision of healthy foods at the school. The Child and Adolescent Trial for Cardiovascular Health School Physical Activity and Nutrition Student Questionnaire measured physical activity behavior, including: daily physical activity, participation in team sports, attending physical education class, and TV viewing/computer game playing. Anthropometric measures included height, weight, body mass index, resting blood pressure, and waist circumference. Measures were collected at baseline, completion of the intervention phase (4 months), and 12 months post-intervention. RESULTS: Significant results for students in the intervention, included for boys decreases in TV viewing; and girls increases in daily physical activity, physical education class attendance, and decreases in body mass index z-scores from baseline to the 12 month follow-up. CONCLUSIONS: Our study shows the value of utilizing nurses to implement a culturally sensitive, coordinated, intervention to decrease disparities in activity and TV viewing among underserved girls and boys.

Improving healthy dietary behaviors, nutrition knowledge, and self-efficacy among underserved school children with parent and community involvement.

BACKGROUND: University­community partnerships through coordinated school health programs (CSHP) can play a key role in decreasing child obesity. The main objective of this study was to measure over a 1-year period whether a CSHP with parental, school, and home-based components to promote optimal nutrition will reduce BMI percentiles and z-scores and improve dietary behaviors in a sample of low-income, school-aged children. METHODS: The intervention included, Kids Nutrition and Fitness, a 6-week nutrition, physical activity educational after-school program, and school activities, including creation of an Advisory Committee that made wellness policies. A randomized controlled pilot study evaluated the effectiveness of the intervention that contrasts 251 (n = 251) predominantly Mexican-American 8 to 12 year olds from low-income Los Angeles­based schools. A mixed model of repeated measures analysis assessed changes in BMI percentiles and z-scores, dietary behaviors, food preferences, knowledge, and self-efficacy measured by a reliable/valid questionnaire. These data were collected at baseline and at 4 and 12 months postintervention. Process measures, collected via focus groups with parents, evaluated parent/community involvement. RESULTS: At the 12-month follow-up, children in the intervention group decreased their BMI on average by 2.80 (p = 0.04) and BMI z-scores on average by 0.48 (p = 0.03) and they increased their daily dietary intake of vegetables on average by 1.51 (p = 0.03), fruit on average by 2.00 (P = 0.001), and 100% fruit juice by 1.12 (p = 0.05). An increase of 1.02 (p = 0.03) was seen in self-efficacy of healthy food choices (p = 0.03). Parent (P = 0.04) and community (p = 0.001) involvement significantly increased to 100% participation by the 12-month follow-up. CONCLUSIONS: A CSHP using parent and community involvement was effective in reducing the risk of obesity in school-aged Mexican- American children attending low-income schools. The findings need to be examined in a larger, more diverse sample of children.

Influence of body mass index, gender, and Hispanic ethnicity on physical activity in urban children.

PURPOSE: This community-based participatory research study examined the association between overweight status and activity among Hispanic urban, school-age children. DESIGN AND METHODS: In a sample of 140 children, activities were assessed using the Youth Risk Behavior Survey's questions about physical activity (PA) and team sports. RESULTS: Thirty-nine percent were overweight (body mass index [BMI] >85%). Normal-weight children had higher levels of PA and team sports. Females had lower levels of PA and team sports. Significant associations included BMI and sports team participation, and BMI and Hispanic ethnicity. PRACTICE IMPLICATIONS: Nurses should be aware that Hispanic urban children are at risk for lower activity.

Correlates of adult assault among homeless women.

The purpose of this study was to assess predictors of sexual and physical assault among homeless women. A multivariate, correlation design was utilized to identify independent correlates of adult physical and sexual assault. The sample consisted of 202 homeless women residing in shelters or living on the street in the Skid Row area of Los Angeles. Respondents reporting a history of child sexual abuse were almost four times more likely to report being sexually assaulted as adults and were almost two and one third times more likely to report being physically assaulted as adults. A range of factors increase homeless women's risk of adult physical and sexual victimization, including child sexual abuse, substance use, lifetime sex trade activity, and previous incarceration. It is important for homeless service providers to develop an individual risk profile for homeless women and to intervene in order to decrease their risk of re-victimization.

The Healthy African American Families' risk communications initiative: using community partnered participatory research to address preterm birth at the local level.

Preterm birth is the leading cause of infant death for African Americans and is significantly associated with lifelong morbidity. Primary prevention efforts using medical strategies to reduce the rates of preterm birth have been unsuccessful. Using community partnered participatory processes, the Healthy African American Families project in Los Angeles developed a multilevel, risk communications strategy to promote awareness about preterm birth in the local community. Participants included community members, community-based organizations, local government, healthcare providers, and national-level advocates. The initiative focused on increasing social support for pregnant women, providing current information on preterm birth risks, and improving quality of health services. The initiative includes components addressing community education, mass media, provider education, and community advocacy. Products include 100 Intentional Acts of Kindness toward a Pregnant Woman, a doorknob brochure on signs and symptoms of preterm labor, and an education manual on preterm birth and other African American health issues. Cooperation, affiliation, and community self-help were key aspects of the planning process and the health promotion products. Additional community benefits included increased leadership and skills development. The process and products described here may be useful in other communities and for addressing other health outcomes in communities of color.

One Hundred Intentional Acts of Kindness toward a Pregnant Woman: building reproductive social capital in Los Angeles.

This article describes the development of an innovative community-based program, One Hundred Intentional Acts of Kindness toward a Pregnant Woman (100 Acts), which seeks to increase reproductive social capital for pregnant women in south and central Los Angeles communities. Reproductive social capital includes features such as networks, norms, and social trust that facilitate optimal reproductive health within a community. 100 Acts was designed and developed by the Healthy African American Families project, using community participatory methods, to increase local community and social network support for pregnant women. Dialog groups with pregnant women identified specific actions that families, friends, and strangers might do to support pregnancies. Participants primarily wanted emotional and instrumental support from family and friends. From strangers, they wanted respect for personal space and common courtesy. Based on these results, the 100 Acts was created for use in the Los Angeles community. 100 Acts encourages and engages active participation from community members in promoting healthy pregnancies. By seeking to increase community-level reproductive social capital, 100 Acts shifts the provision of social support during pregnancy from a high-risk approach to a population approach. 100 Acts also establishes new social norms about how pregnant women are valued, treated and respected.

Where is the F in MCH? Father involvement in African American families.

OBJECTIVES: To: 1) review the historical contexts and current profiles of father involvement in African American families; 2) identify barriers to, and supports of, involvement; 3) evaluate the effectiveness of father involvement programs; and 4) recommend directions for future research, programs, and public policies. METHODS: Review of observational and interventional studies on father involvement. RESULTS: Several historical developments (slavery, declining employment for Black men and increasing workforce participation for Black women, and welfare policies that favored single mothers) led to father absence from African American families. Today, more than two thirds of Black infants are born to unmarried mothers. Even if unmarried fathers are actively involved initially, their involvement over time declines. We identified multiple barriers to, and supports of, father involvement at multiple levels. These levels include intrapersonal (eg, human capital, attitudes and beliefs about parenting), interpersonal (eg, the father's relationships with the mother and maternal grandmother), neighborhoods and communities (eg, high unemployment and incarceration rates), cultural or societal (eg, popular cultural perceptions of Black fathers as expendable and irresponsible, racial stratification and institutionalized racism), policy (eg, Earned Income Tax Credit, Temporary Assistance for Needy Families, child support enforcement), and life-course factors (eg, father involvement by the father's father). We found strong evidence of success for several intervention programs (eg, Reducing the Risk, Teen Outreach Program, and Children's Aid Society - Carrera Program) designed to prevent formation of father-absent families, but less is known about the effectiveness of programs to encourage greater father involvement because of a lack of rigorous research design and evaluation for most programs. CONCLUSION: A multi-level, life-course approach is needed to strengthen the capacity of African American men to promote greater involvement in pregnancy and parenting as they become fathers.

A roadmap for authentic community/academic engagement for developing effective community preterm birth education.

Evidence-based care, behavioral interventions, and new technologies applied during the perinatal period are insufficient by themselves to reduce or eliminate racial/ethnic disparities in infant mortality. Traditional health and behavioral interventions, and the structures through which they are delivered, do not facilitate adherence to behavioral or health recommendations at home or in the community. The translation of research into practice in the absence of community involvement often results in interventions that are irrelevant to community needs, insensitive to existing culture, inconsistent with the resources available, and strain existing community assets. Using a community-partnered participatory research (CPPR) process, the Healthy African American Families project in Los Angeles developed a multilevel, risk communications strategy to promote awareness about preterm birth in the local community. This paper provides a roadmap, giving insight into the CPPR model and processes involved in the development of the risk communications strategy.

Closing the Black-White gap in birth outcomes: a life-course approach.

In the United States, Black infants have significantly worse birth outcomes than White infants. Over the past decades, public health efforts to address these disparities have focused primarily on increasing access to prenatal care, however, this has not led to closing the gap in birth outcomes. We propose a 12-point plan to reduce Black-White disparities in birth outcomes using a life-course approach. The first four points (increase access to interconception care, preconception care, quality prenatal care, and healthcare throughout the life course) address the needs of African American women for quality healthcare across the lifespan. The next four points (strengthen father involvement, systems integration, reproductive social capital, and community building) go beyond individual-level interventions to address enhancing family and community systems that may influence the health of pregnant women, families, and communities. The last four points (close the education gap, reduce poverty, support working mothers, and undo racism) move beyond the biomedical model to address the social and economic inequities that underlie much of health disparities. Closing the Black-White gap in birth outcomes requires a life course approach which addresses both early life disadvantages and cumulative allostatic load over the life course.

Disparities and predictors of emergency department use among California's African American, Latino, and White children, aged 1-11 years, with asthma.

OBJECTIVES: The purpose of this study was to determine factors associated with use of emergency departments by African American, Latino, and White children aged 1-11 years in California. METHODS: I conducted a secondary analysis of parental reports of emergency department use by children with asthma (defined as doctor's diagnosis of asthma). An overall sample of 1313 children with asthma was identified from the California Health Interview Survey, 2001. RESULTS: African American children were 1.82 times (95% CI 1.23-1.25) and Latino children were 1.23 times (95% CI 1.21-1.25) more likely than White children to visit the ED for asthma symptoms. Severity of symptoms, having private health insurance, being from a single-family home, and childhood disability factors were also associated with emergency department use. CONCLUSIONS: Health insurance type, being from a single-parent home, and asthma severity and disability predict the use of emergency department use for African American, Latino, and White children with asthma in California.

Examining racial and ethnic disparities and predictors of medication use among California's African-American, Latino, and White children with asthma.

The purpose of this study was to determine the factors that are associated with the use of prescription medication to control asthma in California's African-American, Latino, and White children from 1 to 11 years of age. This was a secondary analysis of parental reports of the use of prescription medication by children with current asthma symptoms (defined as MD diagnosis of asthma). These children were identified from a cross-sectional survey called the California Health Interview Survey (CHIS), 2001. An overall sample of 1,313 children with current asthma was used in the study. It was found that African-American children were 1.85 times (95% CI: 1.82, 1.88) more likely than White children were and 1.87 times (95% CI: 1.86, 1.90) more likely than Latino children to use prescription medication to control their asthma. Multivariate analysis showed an association with severity (mild, moderate, and severe symptoms), two childhood disability factors, and medication use. Asthma severity and disability (defined as affects to social role function) predicts the use of medications for African-American, Latino, and White children with asthma in California.