Sticker charts: a method for improving adherence to treatment of chronic diseases in children.

Poor adherence is a common problem and may be an underlying cause of poor clinical outcomes. In pediatric populations, positive reinforcement techniques such as sticker charts may increase motivation to adhere to treatment regimens. To review the use of sticker charts to improve adherence in children with chronic disease, Medline and PsycINFO searches were conducted using the key words "positive reinforcement OR behavior therapy" and "adherence OR patient compliance" and "child." Randomized controlled retrospective cohort or single-subject-design studies were selected. Studies reporting adherence to the medical treatment of chronic disease in children using positive reinforcement techniques were included in the analysis. The systematic search was supplemented by identifying additional studies identified through the reference lists and authors of the initial articles found. Positive reinforcement techniques such as sticker charts increase adherence to medical treatment regimens. In several studies, this effect was maintained for months after the initial intervention. Better adherence correlated with better clinical outcomes in some, but not all, studies. Few studies examining the use of sticker charts were identified. Although single-subject-design studies are useful in establishing the effect of a behavioral intervention, larger randomized controlled trials would help determine the precise efficacy of sticker chart interventions. Adherence to medical treatments in children can be increased using sticker charts or other positive reinforcement techniques. This may be an effective means to encourage children with atopic dermatitis to apply their medications and improve clinical outcomes.

Skewed riskscapes and gentrified inequities: environmental exposure disparities in Seattle, Washington.

OBJECTIVES: Few studies have considered the sociohistorical intersection of environmental injustice and gentrification; a gap addressed by this case study of Seattle, Washington. This study explored the advantages of integrating air toxic risk screening with gentrification research to enhance proximity and health equity analysis methodologies. It was hypothesized that Seattle's industrial air toxic exposure risk was unevenly dispersed, that gentrification stratified the city's neighborhoods, and that the inequities of both converged. METHODS: Spatial characterizations of air toxic pollution risk exposures from 1990 to 2007 were combined with longitudinal cluster analysis of census block groups in Seattle, Washington, from 1990 to 2000. RESULTS: A cluster of air toxic exposure inequality and socioeconomic inequity converged in 1 area of south central Seattle. Minority and working class residents were more concentrated in the same neighborhoods near Seattle's worst industrial pollution risks. CONCLUSIONS: Not all pollution was distributed equally in a dynamic urban landscape. Using techniques to examine skewed riskscapes and socioeconomic urban geographies provided a foundation for future research on the connections among environmental health hazard sources, socially vulnerable neighborhoods, and health inequity.

Skewed riskscapes and environmental injustice: a case study of metropolitan St. Louis.

This article presents a case study of Toxics Release Inventory (TRI) air pollution exposure risks across metropolitan St. Louis. The first section critically reviews environmental justice research and related barriers to environmental risk management. Second, the paper offers a conventional analysis of the spatial patterns of TRI facilities and their surrounding census block group demographics for metropolitan St. Louis. Third, the article describes the use of an exposure risk characterization for 319 manufacturers and their air releases of more than 126 toxic pollutants. This information could lead to more practical resolutions of urban environmental injustices. The analysis of TRIs across metropolitan St. Louis shows that minority and low-income residents were disproportionately closer to industrial pollution sources at nonrandom significance levels. Spatial concentrations of minority residents averaged nearly 40% within one kilometer of St. Louis TRI sites compared to 25% elsewhere. However, one-fifth of the region's air pollution exposure risk over a decade was spatially concentrated among only six facilities on the southwestern border of East St. Louis. This disproportionate concentration of some of the greatest pollution risk would never be considered in most conventional environmental justice analyses. Not all pollution exposure risk is average, and the worst risks deserve more attention from environmental managers assessing and mitigating environmental injustices.