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Postpartum Depression (PPD) occurs in 10-20% of new mothers. PPD can lead to serious health risks to both the mother and infant, increase the risk of complications during birth, and cause lasting effects on the development and wellbeing of the child. Many mothers suffering from PPD do not receive treatment due to fear of being stigmatized, lack of education, or not being able to access mental health services. High prevalence of PPD, along with the negative and lasting effects it can cause point to the importance of developing an effective and feasible method of assessing and treating this disorder. A pediatric primary care office may be an opportune setting to screen for PPD since mothers often accompany their children to regularly scheduled well child visits. While some studies have examined PPD screening within the pediatric primary care setting, few have explored the addition of an on-site Behavioral Health Consultant to provide brief interventions for depressed mothers as part of a stepped care model. The primary aim of the current study is assess the feasibility of implementing a stepped care protocol that assesses PPD and provides brief interventions and referrals for depressed mothers within a pediatric primary care clinic. The protocol consists of several phases including: 1) distribution of the Edinburgh Postpartum Depression Screener to every mother arriving for a well child visit during the first six months of their child’s life; 2) appropriate documentation in the clinic’s electronic health record (EHR) of the Edinburgh score and resulting plan of action; 3) a brief same day intervention by the on-site Behavioral Health Consultant and referral to outside provider, if applicable; and 4) phone call follow up with the mother and referred provider, if applicable. Research assistants will monitor the EHR to determine the clinic’s fidelity to the protocol (e.g., if the Edinburgh is being administered properly). Data will also be collected from the EHR to determine if a correlation exists between Edinburgh scores and number of Emergency Room visits made by the child, immunizations administered to the child, and number of well child checks the child attended. Data collected throughout the month of March showing the Edinburgh uptake, consistency with protocol, and any correlation between Edinburgh scores and other variables will be presented.

Introduction. Previous research shows overweight children report poorer health-related quality of life (HRQoL), primarily in the areas of physical health and social functioning. These relations may be especially important to understand in rural populations characterized by poorer health behaviors and limited access to healthcare resources. Objective. The purpose of the current study was to investigate the relation between HRQoL (overall, physical, and social) and weight perception as well as actual weight status in middle school students residing in Southern Appalachia. Methods. 397 middle school students participating in Winning with Wellness, a school-based obesity prevention study, completed a written survey including the Pediatric Quality of Life Inventory. Results from a question on self-perceived weight were used to assign students to 1 of 4 weight-perception groups (underweight, healthy weight, overweight, or obese). Actual body mass index (BMI) percentile data collected by the schools was available for a subset of 152 students and used to classify students’ actual weight status according to Centers for Disease Control and Prevention guidelines. Results. Students who perceived them self to be overweight or obese reported significantly lower overall as well as lower physical and social HRQoL compared to students who perceived them self as a healthy weight. In the sub-sample with actual weight data, students whose actual weight status was obese reported significantly lower overall HRQoL than students whose weight status was in the healthy weight range. Conclusion. Our findings with students in Southern Appalachia are consistent with previous research documenting poorer HRQoL in overweight children and substantiate the need for more inclusive programs that target psychosocial well-being. The understanding of the role of weight perception in addition to actual weight may also inform future efforts at prevention and intervention.

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IntroductionThe STARx Questionnaire was designed with patient and provider input, to measure self-management and transition skills in adolescents and young adults (AYA) with chronic health conditions. With proven reliability and an empirically-based factor structure, the self-report STARx Questionnaire requires further validation to demonstrate its clinical and research utility. In this study we examine the concurrent, predictive, and discriminant validity of the STARx Questionnaire.MethodsTo examine concurrent validity, the STARx Questionnaire was compared to two other published transition readiness tools. Predictive validity was examined using linear regressions between the STARx Total Score and literacy, medication adherence, quality of life, and health services use. Discriminant validity was examined by comparing the performance of three chronic illness conditions on the STARx Total Score and associated subscales.ResultsThe STARx Questionnaire and its subscales positively correlated with the scores for both transition readiness tools reflecting strong concurrent validity. The STARx Questionnaire also correlated positively with the literacy, self-efficacy, and adherence measures indicating strong predictive validity; however, it did not correlate with either quality of life or health care utilization. The performance of AYA across three different clinical conditions was not significant, indicating the clinical utility of this HCT tool for a variety of chronic health conditions.ConclusionThe strong validity of the STARx Questionnaire, in tandem with its strong reliability, indicated adequate psychometric properties for this generic self-report measure. These strong psychometric properties should contribute to the STARx being a viable measure of health care transition for both research and clinical purposes.

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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