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Background: Measuring the acquisition of self-management and health care utilization skills are part of evidence based transition practice. The Transition Readiness Assessment Questionnaire (TRAQ) is a validated 20-question and 5-factor instrument with a 5-point Likert response set using a Stages of Change Framework. Objective: To improve the performance of the TRAQ and allow more precise measurement across the full range of transition readiness skills (from precontemplation to initiation to mastery). Design/Methods: On data from 506 previously completed TRAQs collected from several clinical practices we used MPlus v.7.4 to apply a graded response model (GRM), examining item discrimination and difficulty. New questions were written and added across all domains to increase the difficulty and discrimination of the overall scale. To evaluate the performance of new items and the resulting factor structure of the revised scale we fielded a new version of the TRAQ (with a total of 30 items) using an online anonymous survey of first year college students (in process). Results: We eliminated the five least discriminating TRAQ items with minimal impact to the conditional test information. After item elimination (k = 15) the factor structure of the instrument was maintained with good quality, ?2 (86) = 365.447, CFI = 0.977, RMSEA = 0.079, WRMR = 1.017. We also found that a majority of items could reliably discriminate only across lower levels of transition readiness (precontemplation to initiation) but could not discriminate at higher levels of transition readiness (action and mastery). Therefore we wrote 15 additional items intended to have higher difficulty. On the new 30 item TRAQ, confirmatory factor analysis, internal reliability and IRT results will be reported from a large sample of college students Conclusion(s): Using IRT and factor analyses we eliminated 5 of 20 TRAQ items that were poorly discriminating. We found that many of the items in the TRAQ could discriminate among those in the early stages of transition readiness, but could not discriminate among those in later stages of transition readiness. To have a more robust measure of transition readiness we added more difficult items and are evaluating the scale’s psychometric properties.

The word- and nonword-learning abilities of toddlers were tested under various conditions of environmental distraction, and evaluated with respect to children's temperamental attentional focus. Thirty-nine children and their mothers visited the lab at child age 21-months, where children were exposed to fast-mapping word-learning trials and nonlinguistic sequential learning trials. It was found that both word- and nonword-learning were adversely affected by the presentation of environmental distractions. But it was also found that the effect of the distractions sometimes depended on children's level of attentional focus. Specifically, children high in attentional focus were less affected by environmental distractions than children low in attentional focus when attempting to learn from a model, whereas children low in attentional focus demonstrated little learning from the model. Translationally, these results may be of use to child health-care providers investigating possible sources of cognitive and language delay.

The interplay between child characteristics and parenting is increasingly implicated as crucial to child health outcomes. Based on data from a national birth cohort, this study assessed the joint effects of children's temperamental characteristics and maternal sensitivity on the development of childhood obesity. Infant temperament, assessed by maternal report, was categorized into three types: easy, average, and difficult. Maternal sensitivity, assessed by observing maternal behaviors during mother-child semi-structured interaction, was categorized into two groups: sensitive and insensitive. Child's weight and height were measured longitudinally from age two years to Grade 6 and body mass index (BMI) was calculated. Obese (≥ the 95th percentile) and overweight-or-obese (≥ the 85th percentile) were defined based on sex and age specific BMI percentiles. Generalized estimating equations were used to analyze data. The proportions of children who were obese and overweight-or-obese increased as they got older, 5.47% and 15.58% at 2 years of age, to 18.78% and 34.34% at Grade 6. Children with easy temperament and under the care of a sensitive mother were at the lowest risks of obesity and overweight-or-obesity over childhood. The joint effects of children's temperament and maternal sensitivity on overweight-or-obesity largely depended on childhood phases. For instance, children with difficult temperament and under the care of an insensitive mother had much higher risks during school age but not during early childhood. In conclusion, parents may need to tailor their parenting strategies to particular child temperamental characteristics in order to prevent and control the development of childhood obesity.

One-third of the US Latino population is under the age of 18. Studies show a significant percentage of Latinos aged 12 or older use illegal substances. Acculturation, family relationships, and depression are contributing factors to this abuse. Previous studies concentrated on populations along the US-Mexico border. This study examined the relationship between illegal substance abuse, acculturation, family relationships, and depression in Latino adolescents aged 12 to 19 in Northeast Tennessee. The Pan American Youth Inventory was administered to 66 Latino youth. There was a significant relationship between substance abuse and depression, as well as substance abuse and lifetime suicide ideations.

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Research has shown that children who exhibit problem behaviors in early childhood will oftentimes continue to experience these issues into adolescence, leading to an increase in negative social and health outcomes such as substance abuse and delinquency. The Family Check Up (FCU) is a proven, targeted intervention that seeks to address these problems at a young age in order to reduce the risk of these negative behaviors continuing into adolescence. The intervention consists of 3 components: 1) an initial interview in which the behavioral health consultant gets to know the family; 2) an assessment that consists of questionnaires and videotaped family interactions; and 3) a feedback session during which the family is provided with feedback unique to their particular situation, as well as appropriate solutions to these issues. The FCU has been shown to be effective in school-based settings in past studies; this study represents the first to test the feasibility of offering the FCU in a pediatric primary care practice. The aims of the study are based upon the RE-AIM framework (Reach; Effectiveness; Adoption; Implementation; and Maintenance), a Decision and Implementation (DamdI) science model that will assist in the evaluation of the utility of the FCU in the pediatric primary care setting. This particular project is focusing on two elements of the framework, Reach and Adoption. The FCU was implemented at East Tennessee State University’s (ETSU) Pediatrics Clinic beginning on January 19th, 2015. The parents of patients between the ages of 4 and 5 years old are given the Pediatric Symptom Checklist (PSC-17), a screener which helps to identify children who may be at risk for emotional and behavioral problems. If a child scores 15 or higher on the PSC-17, they are invited to participate in the components of the FCU. Research is ongoing, with 23 out of 31 patients (74.2%) completing the PSC-17 at their well-child visit. The results of the screeners thus far show that with the average score on the PSC-17 is 6.57, with the lowest score being 0 and the highest score being 19. Only 1 patient scored ≥ 15 on the PSC-17 thus far, possibly indicating the need for an expansion of the inclusion criteria for the remainder of the study. The final results of the project will indicate the rate of Reach and Adoption within the ETSU Pediatrics Clinic as well as provide evidence as to the most successful way to reach a specific population with an evidence-based intervention.

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