college women's preferred HIV prevention message mediums: mass media versus interpersonal relationships.

One quarter of HIV cases occur in women ages 15-44 years. We investigated preferential HIV prevention message mediums among college women (18-21 years of age) and their association with parent and partner communication. A nonexperimental cross-sectional survey assessed factors associated with parent and partner communication among 626 single female students who were sexually active in the previous 6 months and attending a 4-year public university in Florida. Women who perceived themselves to be at elevated risk of acquiring HIV were more likely to communicate with their parents (p < .05), but not their partners. In multivariable analysis, students were more likely to communicate about sexual risk behavior with their parents when mothers were younger and when less influenced by their peers. Reading items on the Internet about intravenous drug use and HIV were independently associated with higher parent and partner communication, respectively. Findings can guide future HIV prevention communication interventions.

Childhood obesity: Can electronic medical records customized with clinical practice guidelines improve screening and diagnosis?

PURPOSE: The purpose of this project was to determine if customization of the electronic medical record (EMR) using evidence-based practice guidelines developed by the National Association of Pediatric Nurse Practitioners and the Expert Panel recommendations for the prevention, screening, and treatment of childhood and adolescent overweight and obesity would improve the rate of screening and diagnosis of obesity in children, 7 to 18 years of age. DATA RESOURCES: A retrospective review of encounters before and after implementation of customized EMR was conducted in a community health center. Data collected were compared for documentation of body mass index (BMI), completion of growth charts, scoring of risk questionnaire, and diagnosis of overweight or obesity. CONCLUSIONS: There was a clear increase in the frequency of recording BMI, completing BMI growth charts, and scoring questionnaires between written and electronic medical records. The number of children diagnosed with overweight or obesity increased with customized EMR but still remains well below the rates of obesity for this community. IMPLICATIONS FOR PRACTICE: Customizing EMR with clinical practice guidelines improved adherence to recommendations for screening and identification of childhood overweight and obesity. Increased recognition and diagnosis will lead to improved interventions and improve outcomes for childhood obesity.

Strengthening families program (10-14): effects on the family environment.

This study examined whether parent-youth dyads participating in the Strengthening Families Program 10-14 (SFP 10-14) would demonstrate greater postprogram family cohesion, communication, involvement, and supervision and if youth would report less alcohol, tobacco, and other drugs involvement in contrast to a comparison group. From 16 randomly selected schools, we recruited 167 parent-youth dyads: 86 from intervention and 81 from comparison schools. The intention-to-treat analysis found one significant change in family environment. Considering dose, it was found that among dyads receiving a full dose, all the outcomes were in the expected direction and effect sizes were moderate. Among dyads receiving a partial dose, 10 of 18 outcomes were in the direction opposite that expected. Youth participation in alcohol, tobacco, and other drugs was very low and did not differ postprogram. Although the expected outcomes were not realized, findings descriptive of dosage effects make a valuable contribution to the field. Study of factors that distinguish intervention completers from noncompleters is recommended.

Evaluating content validity and test-retest reliability of the children's health risk behavior scale.

OBJECTIVE: Describe the instrument development process and report the validity and reliability of the Children's Health Risk Behavior Scale (CHRBS), a scale designed to screen for health risk behaviors among youth aged 10-13 Years. METHODS: Domain identification and item generation using the Youth Risk Behavior Surveillance Survey from the Centers for Disease Control and Prevention and testing relevance and test-retest reliability among a target audience sample of 77 fifth graders in their classrooms in two separate public school districts. RESULTS: Youth performed their tasks as expert item reviewers effectively. Twenty-one items comprise the CHRBS with a reading level determined to be at the third grade. CONCLUSIONS: We have developed a reliable and valid measure to assess late elementary youth's participation in health risk behavior.

Race, urban community stressors, and behavioral and emotional problems of children with special health care needs.

OBJECTIVES: This study examined the relationship of community-level stressors to behavioral and emotional problems among African-American and white children with special health care needs. METHODS: The authors interviewed 257 low-income caregivers of children with special health care needs in an urban Midwestern city who brought their child for a primary health care visit to a community health center between September 2001 and May 2002. Sociodemographic characteristics as well as information about the children's behavioral and emotional problems, the health status of the children, perceptions of urban community stress, access to health care, and satisfaction with health care were collected to determine racial differences in the impact of urban stress on behavioral and emotional problems. RESULTS: Urban community stressors, race, and child's health status were significantly associated with behavioral and emotional problems among children with special health care needs. The association between urban stress and total behavioral problems did not differ by race. CONCLUSIONS: When caring for children with special health care needs, especially those with emotional or behavioral problems, primary care providers may be better able to identify important aggravating factors if they also assess urban stress. Systems of care are needed that can assist in addressing urban community-level stressors.

Enhancing survey data collection among youth and adults: use of handheld and laptop computers.

Tobacco use, alcohol and other drug use, early sexual behavior, dietary practices, physical inactivity, and activities that contribute to unintentional and intentional injuries are a significant threat to the health of young people. These behaviors have immediate and long-term consequences and contribute to diminished health, educational, and social outcomes. Research suggests that health risk behaviors exhibited during adolescence and adulthood have their origins earlier in childhood and preventive interventions are less successful after the risk behaviors have begun. Therefore, efforts to prevent health risk behaviors are best initiated in late childhood or early adolescence. However, to document the efficacy of these efforts, reliable, valid, and parent/child-friendly systems of data collection are required. Computerized data collection for research has been found to improve privacy, confidentiality, and portability over the paper-and-pencil method, which, in turn, enhances the reliability of sensitive data such as alcohol use or sexual activity. We developed programming tools for the personal computer and a handheld personal data assistant to offer a comprehensive set of user interface design elements, relational databases, and ample programming languages so that adults could answer 261 items and youth 346 items. The purpose of the article was to describe an innovative handheld computer-assisted survey interview method of collecting sensitive data with children aged 9 to 11. The method was developed as part of a large multisite, national study to prevent substance use.

Behavioral and mental health problems in low-income children with special health care needs.

This study examined caregiver perceptions of mental health problems and counseling needs in low-income children with special health care needs (CSHCN). Interviewers collected data from 257 caregivers of CSHCN (61% males; 60% African American; Mean age = 8.4 years) attending six Midwestern inner-city health clinics. Measures included the Child Behavior Checklist (CBCL) and an investigator-designed questionnaire. CBCL T-scores indicated that 38% of CSHCN had a behavioral or mental health problem, but only 26% of caregivers perceived the need for treatment or counseling. CSHCN should be assessed and referred appropriately for behavioral and mental health problems during routine health care visits.