It is becoming increasingly clear that infants’ and toddlers’ temperament may play a central role in their cognitive and linguistic functioning. Research has found, for example, that at 21 months of age, children’s “attentional focus” moderates the extent that environmental distractions prevent them from learning novel words or solving nonlinguistic problems. The purpose of the present investigation was to explore the extent that dimensions of temperament moderate the performance of 15-month-olds on two typical nonlinguistic problemsolving tasks in the presence of environmental distractions. Forty-two 15-month olds visited the lab and were presented two tasks: “feed bear” and “make a rattle.” Infants were familiarized with the two sets of props initially, and then were presented models of desired action sequences. Half the children experienced a distraction during the feed bear task, the remaining were distracted during make a rattle. For each task, four dependent variables were scored: number of target actions performed, variety of target actions performed, longest chain of target actions performed, and number of pairs of actions performed in order. Temperament was measured via maternal report using the Early Child Behavior Questionnaire. Multivariate analyses revealed that children’s performance varied as a function of task [F(5, 24) = 5.42, p = .001]. The distractions also attenuated the effects of the model for both feed bear [univariate Fs(1, 40) = 4.21 to 9.22, ps = .047 to .018] and make a rattle [univariate Fs (1, 40) = 4.08 to 6.08, ps = .050 to .018]. Interactions of these effects with temperament were many, but complex. For example, low intensity pleasure moderated distracter effects, but only for feed bear [Fs(1, 27) = 5.19 to 9.73, ps = .031 to .004]. In other analyses, toddlers low in perceptual sensitivity benefited more from the model than did children high on that dimension [F’s(1, 28) = 3.71 to 6.67, p’s = .064 to .015)]. A number of additional temperament related findings also obtained. There is considerable reason to continue explorations into potential roles that temperament may play in infants’ cognitive and language development. Results from the present study extend previous findings to the 15-month age period, which, to our knowledge, has not been investigated in previous research. The present results also suggest that roles played by temperament may be exceptionally complex, and highlight the multifaceted internal and external experiences through which children must navigate to become competent thinkers and communicators in an adult world.

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Purpose To describe: (1) development of ReadNPlay for a Bright Future with community stakeholders, (2) integration of a novel communicative tool, the ReadNPlay Baby Book, into infant-toddler well child visits, and (3) use of a quality improvement approach to monitor progress in promoting healthy active living in families with young children. Methods ReadNPlay for a Bright Future is funded by a grant from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee Chapter of the AAP. The setting for this project is in rural southern Appalachia, a U.S. region with a disproportionately high prevalence of obesity. During a community forum held in Northeast Tennessee in fall 2012, community stakeholders provided feedback to help finalize project materials and messages developed by the project team around four themes: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. A behavioral health consultant (BHC) assisted with provider training in brief motivational interviewing and behavioral counseling and project implementation in the clinic. An anonymous mothers’ survey was designed to identify opportunities for improving behaviors and monitor progress in promoting healthy active living during well child visits. Process measures and feedback will be obtained from provider surveys and focus groups with parents and providers. Results As of February 2013, the ReadNPlay Baby Book is being provided to families starting at the newborn visit. The book contains age-appropriate guidance and areas for parents to record their baby’s growth, milestones, eating habits, favorite books, and activities between birth and 18 months. Families are receiving small incentives for bringing it to each well child visit. A companion Healthy Active Living Tips booklet encourages healthy behaviors in the whole family. Use of social media, posters, and periodic community events provide reinforcement. A total of 80 mothers with infants 9-24 months of age are completing anonymous surveys during well child visits every 4-6 months (mostly Caucasian, 70% WIC recipients). Baseline surveys with mothers of younger infants (9-12 months of age) suggest: 60% of mothers are reading or looking at books with their infants on most days of the week; 80% of infants watch at least 30 minutes of television and 48.7% drink juice on a typical day; 82% of infants were ever-breastfed; 20% of mothers had sought care for their infants due to an injury; and 13.2% of infants routinely bed-share. Over 80% of all mothers wished that they themselves could get more exercise. Conclusion ReadNPlay for a Bright Future is using novel communication tools, community partnerships, and quality improvement methodology to encourage healthy active living during infant-toddler well child visits.

As part of the ReadNPlay for a Bright Future initiative, an online survey was conducted to determine the preferences of parents and caregivers in regards to receiving health information and support and to identify opportunities to improve existing support groups in Northeast Tennessee. An anonymous online survey with ten closed-ended questions was designed on Survey Monkey and posted on social media sites of the ReadNPlay project, BABE Regional Breastfeeding Coalition, and local mothers’ support groups. After a two-week period, during which a reminder of the survey was posted, the results of the survey were summarized using Survey Monkey and Excel. A total of 39 surveys were collected. Of the 39 participants, all identified themselves as either a mother (97.44%) or other female caregiver (2.56%). Sixty three percent of mothers and caregivers wanted to receive support or health information through face-to-face support group meetings compared to 78.95% who wanted to receive the same information through social media and 68.42% who wanted to receive information via email. Less popular options for receiving health information and support include community events (60.53%), classes (44.74%), text messages (36.84%), childcare centers/schools (34.21%), handouts from healthcare providers (28.95%), and snail mail (21.05%). Forty six percent of respondents have attended support group meetings several times, 41.03% have never attended a support group meeting, and 15.38% have only attended a support group meeting once. Mothers and other caregivers identified the greatest barriers to participation in a support group as inconvenient timing (47.22%), lack of time (50%), inconvenient locations (47.22%), and lack of information about time and location (25%). Respondents were interested in receiving the following health and parenting information: learning/development (83.78%) breastfeeding (75.68%), active play (75.68%), behavior (72.97%), nutrition (64.86%), safety (45.95%), and prevention (40.54%). Mothers and other caregivers were interested in receiving the following types of support when they attend group meetings: socialization with other parents (81.58%), activities sponsored by community organization (78.95%), information about community resources (65.79%), parenting tips (63.16%), health information (44.74%), and food and supplies (34.21%).Additionally, when respondents were asked to identify preferred locations for support group meetings, the most popular option was a kid-friendly location (97.37%) followed by a community center (57.89%). The results obtained above are being used to improve existing support groups by providing parents and caregivers with child-friendly environments in which to socialize and receive a variety of parenting information, including information on learning and development.

Introduction: Breastfeeding has numerous benefits for babies, mothers, and families. It is well established that mothers perceptions of embarrassment, convenience, and social support related to breastfeeding affect whether they choose to breastfeed and for how long . Tennessee falls well below national statistics and goals for breastfeeding initiation and continuation. Effective and efficient promotional tools that can be incorporated into clinical care are needed. Objectives: This study evaluated the effectiveness of a video intervention to improve perceptions of breastfeeding among pregnant women presenting for a prenatal visit in an obstetrics and gynecology (OB/GYN) clinic in northeast Tennessee. Specifically, the project sought to determine whether watching the video with the babys father, a friend, or family member (supportive others) would be more beneficial than watching it alone, a previously unanswered question. Methods: The investigative team established a relationship with an OB/GYN clinic that serves a high volume of pregnant women. A 15 minute video addressing issues of embarrassment, convenience and support related to breastfeeding was shown in the clinic waiting room. The video had been previously developed and evaluated by the Mississippi Department of Health. Pregnant women visiting the clinic during 8 days in 2009 were invited to complete an anonymous written survey immediately before and after viewing the video. The survey included items on demographics, perceptions of breastfeeding, and intention to breastfeed. Descriptive statistics were calculated. The proportion of women reporting improved perceptions of breastfeeding was compared between subgroups using chi-square testing. Mean breastfeeding perception scores were compared between subgroups and changes in womens intention to breastfeed were evaluated. Results: Of the 77 participants, 38.9% reported previously breastfeeding a child, 51.3% planned to breastfeed, and 25% were undecided. After viewing the video, perceptions of embarrassment, convenience, and social support related to breastfeeding improved in a range of 39-44.2%, 37-40%, 39-63% of women, respectively. Mothers who watched the video with a supportive other were more likely to report improved perceptions of embarrassment than mothers who watched the video alone (chi2 = 12.01, p = .002). Of the mothers who reported being undecided about breastfeeding prior to watching the video, 57.9% reported being more likely to breastfeed after watching the video (chi2=10.22, df=2, p=0.006). Discussion: The findings suggest this video intervention is an effective means of addressing barriers to breastfeeding in the clinical setting. Furthermore, this study addressed previously unanswered questions about the impact of pregnant mothers watching the video with supportive others; results indicate that its efficacy is significantly improved if pregnant women view it with a supportive other.

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ReadNPlay for a Bright Future develops a variety of projects aimed at promoting healthy living in families with young children in Northeast Tennessee. The purposes of this research are: (1) to collect parents’ and caregivers’ perspectives on healthy eating for the purpose of designing a new book in the ReadNPlay children’s book series to be entitled A Farmers Market Adventure (2) to collect the preferences of parents and guardians related to website and mobile application (app) usage to help shape the development of a new ReadNPlay My Baby Book app. Anonymous clipboard surveys were administered to attendees of regional community events during July of 2013. Survey items asked parents about healthy eating in the context of their families and the role of parenting websites and mobile apps in their families. The results from these surveys were summarized using Excel. A total of 100 surveys were collected. It was found that when parents were asked to identify barriers to healthy eating, the most common responses were picky eaters in the household (30%) followed by lack of time (22%). When asked to identify things that have helped parents to encourage healthy eating in their families, the three most common responses were good recipes (20%), good role models (16%), and farmers markets (16%). Twenty-eight percent of parents surveyed do not use websites or apps for parenting, while those who do use parenting websites or apps identified advice from experts (20%) and advice from other parents (18%) to be the two features most commonly desired in such a resource. When asked what they do not like about website and app usage, 20% of parents indicated that these tools are “too complicated.” However, when parents are told that our group of pediatricians was developing a free mobile application for families designed to help them keep track of their baby’s growth, development, and eating habits, 75% of parents said such an app would be very helpful to them (25% said a little helpful). These results will inform a new ReadNPlay children’s book themed around healthy eating behaviors, overcoming pickiness, and shopping with families at farmers markets and a new ReadNPlay mobile app for families to be use in conjunction with infant-toddler well child visits.

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