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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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Thesis (M.S.)--Brandeis University, 2009. / Title from PDF title page (viewed on May 29, 2009). Includes bibliographical references.

Background/Rationale: The American Academy of Pediatrics recommends universal surveillance of social determinants of health in primary care. Addressing these determinants is likely crucial to reducing extant health disparities. Such screening in urban pediatric primary care has been shown to increase access to relevant resources for families when combined with provider training in using a community resource binder (Garg et al., 2007). However, resources in more rural areas are often scarce and helping families navigate a complex resource system often requires a more individualized approach. Additionally, in an increasingly screener heavy pediatric environment, social determinant screeners that are comprehensive but brief are needed to reduce the burden on both patients and providers. Methods/Results: A brief TEAM Care social determinants screener protocol was developed to meet the needs of families presenting to ETSU Pediatrics. Our clinic serves primarily low income families, many of which live in ruralareas. During the first eight months of data collection, 2043 TEAM Care screeners were administered at annual well child checks. The prevalence of caregiver endorsed concerns was as follows: financial concerns impacting ability to pay for food, housing, or utilities (7%), transportation problems (4%), caregiver depression (4%), concerns about caregiver drug/alcohol use (2%), domestic violence (1%), and literacy problems (1%). 13.4% of caregivers endorsed at least one concern on the screener. Caregivers who endorsed a concern were provided individualized resources via a warm handoff or phone call by integrated social work interns. Interns were available on an ongoing basis to check in with families, adjust resource recommendations as needed, and coordinate care with the child’s primary care physician. Our poster will report on an anticipated 3000 TEAM Care screeners collected during the first year of administration. Conclusion: Last year at CFHA, we reported the initiation of the TEAM Care Screener, modeled after the WE CARE Screener (Garg et al., 2007) and designed to screen for social determinants of health in pediatric primary care via six items. Previous preliminary reports of this study included data from approximately 1000 screeners. A one year report of the TEAM Care screener will be completed in September 2017, making it ideal timing to present at CFHA in October 2017. We anticipate reporting prevalence data from 3000 screeners and incorporating results from a provider satisfaction survey of the screener process. The TEAM Care screener process was designed to maximize efficiency for families and providers, and the addition of social work interns ensures that families who endorse needs receive individualized help. A future goal is to more systematically follow up with families to determine how many were connected to recommended resources.

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Background: The Central Appalachian region of the United States is disproportionately burdened with high prevalence of tobacco use and tobacco-induced diseases. Efforts to address tobacco use in the region have become complicated with uptake of Electronic Nicotine Products (ENPs), including e-cigarettes, among adolescents and young adults. The high prevalence of tobacco use, and the history of tobacco production have created a high-risk environment for the use of tobacco and ENP among adolescents in the region. However, research on how susceptibility to use e-cigarettes among school-going adolescents translates to usage is sparse. This study aimed to explore the association between susceptibility to use e-cigarette and e-cigarette use in school-going adolescents in Appalachian Tennessee. Methods: Data (N=399) was collected from high school students in an Appalachian Regional Commission (ARC)-designated distressed County in Appalachian Tennessee. We ascertain the study’s outcomes (current e-cigarette use), the exposure (susceptibility to use e-cigarette) and co-variates (grade, sex, age at first use of tobacco, perception of the danger of smoking, parental counseling) using validated questions. Descriptive statistics and multi-variable logistics analyses were performed. The Odds Ratios (ORs) along with Confidence Intervals (CI) have been reported. Results: 15.5% of the population were current e-cigarette users and 25.93% were identified as susceptible to use e-cigarettes. Susceptibility to use e–cigarette was associated with increased odds of the current use of e-cigarette (OR=6.40, CI=4.18–9.77). In addition, age at first use of tobacco (OR = 0.42, 95%CI =0.32 – 0.56) was associated with reduced odds of the current use of e-cigarette, while intention to smoke e-cigarette (OR =6.46, CI =3.63 -11.49) was associated with increased odds of the current use of e-cigarette. Conclusion: Susceptibility to use e-cigarette was positively associated with the current use of e-cigarette among school going adolescents. Future longitudinal studies with large sample size are warranted to confirm the association.