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.

No description available.

Background: In East Tennessee and Middle Appalachia, the epicenter of the opioid epidemic, approximately 15% of women give birth taking buprenorphine or methadone for opioid addiction (medical assisted therapy--MAT) or using other drugs illicitly and 5% of births are diagnosed with neonatal abstinence syndrome (NAS). A better understanding is needed of factors contributing to the severity of NAS. Objective: To identify maternal and infant characteristics associated with length of stay among newborns with neonatal abstinence syndrome. Design/Methods: Participants were 150 newborns systematically sampled from births diagnosed with NAS during the past 5 years at a single medical center. Data were obtained through abstraction of maternal prenatal records, infant delivery and infant medical charts. The abstraction included maternal and child demographic and clinical characteristics. Drug and other substance use/exposure histories were based on maternal history, and urine and cord tissue drug screening. Results: The infants’ average length of stay was 18.6 (s.d. = 11.9), 15% were low birthweight, and had an average gestational age of 38.8 (s.d. = 1.8); 62% were male; 49% were breast-fed. The mothers mean age was 27.5 (s.d. = 5.0); mean parity was 1.6 (s.d. = 1.4); 77% were unmarried; 75% had < HS education; and 89% had exposure at some time during pregnancy to other prescription (in addition to buprenorphine or methadone) or illicit opioids. In the least squares regression, which included important potential covariates such as infant sex, birth weight and gestational age, significant predictors of infant length of stay include: maternal benzodiazepine use (8.3 day longer LOS on average; p = 0.019), and infants whose mothers had a history of mental illness (3.9 day longer LOS on average, p = 0.040 ). While infants born to mothers smoking in the final 30 days of pregnancy had a 2.7 day longer LOS on average after adjustment for other significant predictors, this association was no longer significant in regression analysis (p = 0.293). Conclusion(s): Maternal use of prescription or illicit opioids leading to NAS is rooted in women’s’ life histories characterized by disadvantage, relationship instability, polysubstance use and mental illness. Efforts to reduce the incidence and severity of NAS among those on MAT during pregnancy should focus on preventing poly-substance misuse and providing supports for other maternal health needs including treating mental illness.

No description available.

Background: Especially important in the transition process is the role of the providers and parents shifting from that of a manager of health to more of a coach. In group work, as in healthcare management, there is the opportunity for social loafing to occur, which could impede one’s competence in performing the desired task. Social loafing is the reduction in motivation and effort when individuals work collectively compared with when they work individually. Specific to social loafing is the free rider effect —when a person lacks putting forth effort because they believe someone else will pick up the slack which has been demonstrated in parent-child and student-teacher relationships. Objective: In this study we examined the prevalence of social loafing as defined by whether youth report that they know how to perform specific transition readiness skills but report that others do the tasks for them (as opposed to doing it themselves). Design/Methods: We surveyed 161 youth from two different schools in South Central Appalachia about their transition readiness using anchors from the TRAQ with revised response categories. The response categories assessed 1) whether they know how to do the specific task or not and 2) whether youth perform the task themselves or if someone else does the task for them. Results: We were specifically interested in those who responded “No, someone else does it but I know how”. Of the 21 items on the TRAQ, the rate of endorsement of the “social loafing” response varied between 11% and 53%. For 14 of the 21 items, the rate of endorsement of the “social loafing” response was greater than 30%. Table 1 displays the rate of endorsement of the social loafing response for each TRAQ item. Conclusion(s): Our results demonstrate that although many youth “know” how to perform various transition related tasks, very frequently they allow someone else to perform the task for them. In order for transition to adulthood to be successful, youth should be challenged to accept responsibility for performing task with the support of adults—called scaffolding. This will enhance the youth’s competence and autonomy. Similarly, in healthcare settings, clinicians can implement a scaffolding approach to reduce social loafing and promote more autonomy and gain competence in managing their health.

No description available.

No description available.

No description available.

Background: Measuring the acquisition of self-management and health care utilization skills are part of evidence based health care transition practice. Youth with Spina Bifida (SB) have significant demands for self-management and high self-care burden. To complement HCT skills assessed in the TRAQ, we developed an 11 item SB-TRAQ to assess self-management skills specific to Spina Bifida. Similar to the TRAQ, the SB-TRAQ uses a 5-point Likert responses using Stages of Change. Objective: To develop and assess the reliability and validity of a questionnaire to measure independence and skill acquisition for youth with SB. Design/Methods: Working with a multidisciplinary team of experts in the care of youth with SB we developed a twelve item questionnaire specific to the main facets of SB self-care and -management including urine and stool continence, prevention of skin breakdown and awareness of signs of shunt malfunction. The items were reviewed and revised through several iterations by healthcare providers and patients. The SB-TRAQ was fielded in an SB Specialty Clinic participating in the National Spina Bifida Patient Registry (NSBPR). Ninety youth with SB completed the 20-item TRAQ and the 12-item SB-TRAQ. Item response means, and distributions were assessed. A principal component analysis (PCA) was conducted with oblique rotation (promax). We also assessed criterion validity by examining the correlation of the SB-TRAQ supplement with the TRAQ and age. Results: Sample characteristics and scale information for the TRAQ and SB-TRAQ supplements are displayed in Table 1, including a Cronbach alpha of 0.9 for the SB-TRAQ. The item characteristics are provided in Table 2. Results of the factor analysis show eleven items loaded onto one factor, with almost all items loadings > 0.7 . One item did not load, resulting in an 11 item solution. The primary factor explained 62% of the variance. Intraclass correlations of the SB-TRAQ supplement with the TRAQ overall scale and subscales demonstrated good criterion validity (TRAQ overall ICC = .74; ICCs varied among the subscales and the SB-TRAQ). Additionally, the SB-TRAQ, as hypothesized, was significantly and positively correlated with age (Pearson correlation .29, p<.01). Conclusion(s): Results of our analyses demonstrate that the SB-TRAQ had good internal reliability and excellent criterion validity as demonstrated by strong correlation with age and the validated TRAQ. The SB-TRAQ can be a useful tool to help youth with SB achieve independence and self-management.

Purpose Breastfeeding rates in Northeast Tennessee are much lower than national rates and the Healthy People 2020 targets. The purpose of this research was to develop and evaluate a high school breastfeeding education intervention. Methods Literature review and interviews with regional stakeholders informed development of an educational intervention for high school students aimed at increasing breastfeeding rates in this southern Appalachian region. An interactive educational game was developed based on the Theory of Planned Behavior (TPB) to provide age-appropriate information about breastfeeding. Health science classes from two regional high schools participated. Prior to the game, the students were given a 35-question pre-survey to assess knowledge, attitudes, subjective norms, perceived behavioral control, and intentions, the tenets of the TPB. Education was delivered during a single class session and included information about related health careers. A post-survey was given two weeks after the educational intervention and compared to the pre-test results using t-tests and Cohen’s d to assess changes in mean summary scores of measures of the TPB tenets. Results Surveys were completed by 107 students (75% female, 68% freshman/sophomores). Intention to breastfeed in the future significantly increased from 47.6% to 66.3% following the intervention. Measures of knowledge, attitudes, and perceptions of subjective norms related to breastfeeding were all significantly improved after the intervention. Levels of breastfeeding knowledge were low at baseline and demonstrated the largest improvement of all of the TPB tenets following the intervention (Cohen’s d = 1.6). Results were not found to vary significantly based on gender or grade level. Conclusion Breastfeeding education is not common in middle and high schools and published research evaluating the effects of breastfeeding education in schools is limited. While this study did not assess the impact of the intervention on breastfeeding rates, the changes observed suggest that an educational intervention based on the TPB may have the potential to increase the breastfeeding rates in the future. Limitations of the study include only having one session of education and a short follow-up period of only two weeks.