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Purpose To describe outcomes of community partnerships for promoting healthy active living among families with young children in the ReadNPlay for a Bright Future Project. Methods ReadNPlay for a Bright Future was developed through grant support from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee AAP Chapter. ReadNPlay is a coordinated, multi-level, multi-component initiative promoting healthy active living among families with young children during infant-toddler health supervision visits and in childcare and other community settings. The project site is located in rural southern Appalachia, an area of the country with a high prevalence of obesity. Materials and messages developed by the project team were finalized during a community forum with stakeholders held in Northeast Tennessee in fall 2012. Four themes emerged as a focus for the initiative: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. Partnerships with the regional children's hospital, childcare providers, health department, public libraries, and farmers' markets were supported through on-going communication via email, social media, and individual meetings. Availability of two $750 pediatric resident mini-grants and structure afforded by the residency program's existing community pediatrics rotation facilitated development and implementation of community initiatives for this project. Results Project posters displayed in community settings, use of social media, and periodic community events are reinforcing efforts to promote healthy active living in the clinical setting. A new event for families with infants/toddlers was added to the children's hospital annual Kids Run, involving over 120 families during the first year. Walk N' Rollers received free Reach Out and Read books and were surprised at the sugar content of juice and other beverages displayed in sippy cups as part of a “Sugar Quiz.” Information disseminated through regional child care centers will promote participation in a summer Walk N' Roll program in addition to this annual event. At a regional childcare provider conference, ReadNPlay workshops with over 100 infant-toddler teachers and 40 families were conducted and information on Tennessee's “Gold Sneaker” designation for compliance with state nutrition and physical activity policies was shared (only 6% of local centers are designated). During summer 2013, 75 families are being provided with $10 farmers' market vouchers at their 12-15 month well child visit to encourage consumption of fruits and vegetables. 18-month statistics on social media reach, walking program participation, new Gold Sneaker designations, and farmers' market program participation will be presented. Conclusion This presentation will illustrate how pediatric residency programs and practitioners may partner with existing community organizations and initiatives to promote healthy active living in families with young children.

Despite known associated benefits of breastmilk, such as protection against infection, decreased risk for asthma, and decreased risk for obesity, breastfeeding rates in Tennessee fail to obtain nationally set benchmark goals. According to 2014 CDC data, in Tennessee 74.9% of infants were ever breastfed, and by six and twelve months only 40.7% and 20.9% of infants were breastfed, respectively. The targets set by Healthy People 2020 are 81.9% for initiation, 60.6% at 6 months, and 34.1% at 12 months. Moreover, infants from low-income families are less likely to receive breastmilk compared to infants from higher income families. Federal resources such as Women, Infants, Children (WIC) which provides women of low economic status with supplemental food, nutrition education, and breastfeeding support. Breastfeeding rates among WIC recipients historically have been lower than those among non-WIC recipients. Recently, Tennessee WIC has improved their food package for breastfeeding mothers and increased peer counselor and breastfeeding support an attempt to address this disparity. This study aims to assess the rates of breastfeeding in Northeast Tennessee and explore whether or not differences exist in breastfeeding rates between WIC-recipients and non-WIC recipients. This study was conducted as part of the Read and Play for a Bright Future program which aims to improve health and wellness in families with young children, in part through improved breastfeeding counseling in primary care as well as expansion of breastfeeding support groups and events for local families. A survey was constructed which evaluated social and health demographics of patients in a local pediatric clinic. Using convenience sampling method, anonymous surveys were obtained from mothers of 9-24 month infants during 2013 to 2015 on four separate occasions. Preliminary data analysis estimates that 69.3% of the total sample (n=226) was enrolled in WIC. 89% of mothers reported having a high school degree during the most recent data collection. Results suggested that 72.4% of mothers had ever breastfed their infant. This number declined to 57.1% after one month, 26.6% after six months, and 6.7% after twelve months. Factors associated with breastfeeding are being explored using univariate and multi-variate analyses. While rates of breastfeeding in this Appalachian Tennessee sample are below Healthy People 2020 targets, rates of breastfeeding continuation may be higher than in the state as a whole. However, the significant decline in breastfeeding rates of 30.5% between the ages of one month and six months sug

Objectives: The purpose of the study was to examine potential differences between two approaches to defining adolescent weight misperception. Specifically, weight status perception was compared with self-reported weight status and actual weight status (based on body mass index percentiles calculated from self-reported and actual weights and heights, respectively). Furthermore, the accuracy of assigning weight status based on body mass index percentiles calculated from self-reported weights and heights was assessed by comparing them with actual weight status. Methods: Data were extracted from Team Up for Healthy Living, an 8-week, school-based obesity prevention program in southern Appalachia. Participants (N = 1509) were predominately white (93.4%) and ninth graders (89.5%), with approximately equivalent representation of both sexes (50.7% boys). Results: The study revealed significant differences between the approaches to defining weight misperception (χ2 = 16.2; P = 0.0003). Conclusions: Researchers should interpret study findings with awareness of potential differences based on the method of calculating weight misperception.

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The purpose of this study was to discover a theory on how women decide to deliver their babies by cesarean section instead of experiencing a trial of labor and expected vaginal delivery when it is appropriate. The specific goals are to answer the research questions: What is the decision-making process by which healthy, low-risk women choose to deliver their babies by cesarean delivery in the absence of medical indications? What antecedents occur to influence a pregant woman's decision to undergo a maternal request cesaren section? Seven women from the surrounding Knoxville area underwent in-depth interviews. To qualify for the study, the women had to be healthy and low-risk, had an elective cesarean section within the last two years, be 18 years or older and reside in the East Tennessee area. Symbolic interactionism and feminism were utilized to provide a theoretical framework for the study. The grounded theory methodology by Strauss and Corbin (1990) was used to develop the core category, context, antecedents, intervening factors and consequences. From the data, a substantive theory was identified, "Having an elective c-section: Doing what's best." The antecedents of the women's decision were being scared and perceiving a cesarean section as an easier way to give birth. Women made this choice after gathering information and seeking support from health care providers, friends and family within the context of progressing through the pregnancy. Once the decision was made and the cesarean section was performed, the women voiced happiness with their decision and in having a good outcome. The findings of this study may assist office nurses, public health nurses, midwives, advanced practice nurses, childbirth educators and other women's health nurses to educate women on their childbirth options and hopefully to reduce the rate of maternal request cesarean deliveries.

The results of this study indicate that two groups of mothers share a relatively similar socioeconomic status, knowledge of health and hygiene, and have similar health-seeking behaviors. The mothers' lack of knowledge and their local view of illnesses seemed to embody questionable newborn care related to breastfeeding practices and oil applications to newborns. Three psychosocial factors that appeared to contribute to the mother's health-seeking behaviors were attitudinal factors (this consisted of favorable or unfavorable perceptions toward services based on the mother's prior experiences or familiarity with service), social pressures (opinions from others and the mother's competing responsibilities), and self-efficacies accessibility, availability, and affordability). In addition, the external factor of poverty in the slum settlements was also a significant factor which determined the mother's health seeking behaviors. The implications of these findings are discussed in further detail, which are then followed by a set of recommendations for future health interventions designed to reduce the risk of sepsis neonatorum in urban communities. This study underscores the benefits of integrating the perspectives of anthropology and public health to further the understanding of the neonatal health problem. Finally, the need for future studies is addressed as it is necessary to further understand the existing local practices and beliefs in relation to the risks of sepsis neonatorum.

Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.