Typescript. / Bibliography: leaves [89]-98. / vii, 98 l

Asthma is the most common chronic childhood disease (National Center for Health Statistics, 2004). In Hawaii, 28,600 children (9.7%) currently have asthma (State of Hawaii Department of Health, 2004). This study was designed to expand asthma awareness among freshmen students at a private high school in Hawaii through informative training sessions integrated into the mandatory Physical Education (PE) class and supportive coaching for students with asthma. Of 430 freshmen at the high school study site, 83 had asthma. A pre/posttest quasi-experimental design was utilized to assess enhanced knowledge after the intervention. Nearly 400 part-Hawaiian male and female students, aged 13-15, participated in the asthma training intervention. The study enrolled 270 students. Fifty-six students with asthma participated in the asthma coaching session. Participants with asthma were classified by national guidelines as mild intermittent to moderately severe. All participants completed the Asthma General Knowledge Questionnaire before and after a training session presented in PowerPoint format. Scores were analyzed by paired t-tests. Only students with asthma participated in small group coaching sessions utilizing a PowerPoint presentation specifically tailored for adolescents. These participants completed the Pediatric Asthma Quality of Life Questionnaire before the session, then again three months after the session. Scores were analyzed using paired t­ test and descriptive statistics. Asthma training significantly increased general asthma knowledge scores (p :S 0.001). Although asthma coaching improved the frequency of controller medication for 50% of the students (n=lO), the increase was not statistically significant. Self­ management improvements and quality of life scores differences were also not statistically significant. These results may be due to the small sample size and short study duration. For an adolescent population where the rate of asthma is nearly 20%, providing asthma training to the entire group was demonstrated to be an effective means of increasing asthma awareness. Asthma education offered in a peer group setting demonstrates an innovative intervention modality that is culturally and developmentally sensitive to the adolescent population. Further study is needed over a longer time period to explore avenues to improved self-management skills and enhanced quality of life for adolescents with asthma.

A diagnosis of cancer represents a significant crisis for the child and their family. As the treatment for childhood cancer has improved dramatically over the past three decades, most children diagnosed with cancer today survive this illness. However, it is still an illness which severely disrupts the lifestyle and typical functioning of the family unit. Most treatments for cancer involve lengthy hospital stays, the endurance of painful procedures and harsh side effects. Research has confirmed that to manage and adapt to such a crisis, families must undertake measures which assist their adjustment. Variables such as level of family support, quality of parents’ marital relationship, coping of other family members, lack of other concurrent stresses and open communication within the family have been identified as influences on how well families adjust to a diagnosis of childhood cancer. Theoretical frameworks such as the Resiliency Model of Family Adjustment and Adaptation (McCubbin and McCubbin, 1993, 1996) and the Stress and Coping Model by Lazarus and Folkman (1984) have been used to explain how families and individuals adapt to crises or adverse circumstances. Developmental theories have also been posed to account for how children come to understand and learn about the concept of illness. However more descriptive information about how families and children in particular, experience and manage a diagnosis of cancer is still needed. There are still many unanswered questions surrounding how a child adapts to, understands and makes meaning from having a life-threatening illness. As a result, developing an understanding of the impact that such a serious illness has on the child and their family is crucial. A new approach to examining childhood illness such as cancer is currently underway which allows for a greater understanding of the experience of childhood cancer to be achieved. This new approach invites a phenomenological method to investigate the perspectives of those affected by childhood cancer. In the current study 9 families in which there was a diagnosis of childhood cancer were interviewed twice over a 12 month period. Using the qualitative methodology of Interpretative Phenomenological Analysis (IPA) a semi-structured interview was used to explicate the experience of childhood cancer from both the parent and child’s perspectives. A number of quantitative measures were also administered to gather specific information on the demographics of the sample population. The results of this study revealed a number of pertinent areas which need to be considered when treating such families. More importantly experiences were explicated which revealed vital phenomena that needs to be added to extend current theoretical frameworks. Parents identified the time of the diagnosis as the hardest part of their entire experience. Parents experienced an internal struggle when they were forced to come to the realization that they were not able to help their child get well. Families demonstrated an enormous ability to develop a new lifestyle which accommodated the needs of the sick child, as the sick child became the focus of their lives. Regarding the children, many of them accepted their diagnosis without complaint or question, and they were able to recognise and appreciate the support they received. Physical pain was definitely a component of the children’s experience however the emotional strain of loss of peer contact seemed just as severe. Changes over time were also noted as both parental and child experiences were often pertinent to the stage of treatment the child had reached. The approach used in this study allowed for rich and intimate detail about a sensitive issue to be revealed. Such an approach also allowed for the experience of childhood cancer on parents and the children to be more fully realised. Only now can a comprehensive and sensitive medical and psychosocial approach to the child and family be developed. For example, families may benefit from extra support at the time of diagnosis as this was identified as one of the most difficult periods. Parents may also require counselling support in coming to terms with their lack of ability to help their child heal. Given the ease at which children accepted their diagnosis, we need to question whether children are more receptive to adversity. Yet the emotional struggle children battled as a result of their illness also needs to be addressed.

Thesis (MSocSc)--University of South Australia, 1997

Childhood overweight is a leading global public health issue. Chapter One of this thesis is a three part literature review of the evidence concerning the issue of childhood overweight and its management. Section One of the literature review describes this issue in terms of Australian and international prevalence rates and trends, health outcomes and aetiology. Sections Two and Three of the literature review examine the evidence to guide effective management of childhood overweight and analyse the thoroughness by which this evidence has been determined and translated into practice recommendations. The assumed cornerstones of child weight management are dietary change, increased physical activity, decreased sedentary behaviour, family support and behaviour modification. Recently, the role of parenting skills in the management of childhood overweight has been identified as a promising area of research. This thesis study examined the effect of the addition of parenting skills training to a parent-led, family-focussed healthy lifestyle intervention for the management of overweight in 5-9 year old children (The Parenting, Eating and Activity for Child Health (PEACH) Study). The methodology of the intervention is presented in Chapter Two. Families of overweight 5-9 year old children across two sites (three cohorts per site) were randomized to either a healthy lifestyle group program (HL) or a healthy lifestyle plus parenting group program (HL+P). Parents in both groups received eight 1.5hour group education sessions covering topics on child/family nutrition, physical activity and positive body image. Parents in the HL+P group were offered a four week parenting skills training program prior to this. All information was directed to parents and they were responsible for initiating and maintaining healthy lifestyle changes with their families. The intervention was delivered over a six month period and group differences were examined at this time point (intervention effect) and six months following with no further program contact (maintenance effect). The sample size (n=169) was calculated to demonstrate an estimated reduction in BMI z-score of 30% in the HL+P group and 10% in the HL group over 12 months, allowing for a drop out rate of one third (power=80%, significance=95%). Intention to treat analysis was conducted using ANCOVA. The effectiveness of the intervention was measured against a comprehensive evaluation plan consisting of: • primary outcome indicators (body mass index (BMI) z-score and waist circumference (WC) z-score) (Chapter Three), • secondary outcome indicators (health-related quality of life (HRQoL), body size dissatisfaction and height z-score) (Chapter Three), • impact evaluation indicators (children’s lifestyle behaviours and parent’s parenting practices) (Chapter Four), • process evaluation indicators (participant attendance and satisfaction and maintenance of program integrity across sites) (Chapter Four) and • qualitative evaluation of the factors external to the intervention that supported or inhibited families to achieve their healthy lifestyle goals (Chapter Five). Analysis of the primary outcomes (Chapter Three) found a significant group difference at the six month time point for BMI z-score (HL: -8%, HL+P: -13%, p=0.005), but not WC z-score (HL: -9%, HL+P: -11%, p=0.39). There were no group differences at the 12 month time point (six months following intervention end and with no further program contact). Application of the IOTF definition for childhood overweight and obesity to the full study sample found that 39 (23%) and 130 (77%) children were classified as overweight and obese respectively at baseline. By the six month time point (n=135), six (4%) children fell within the healthy weight range and 38% were classified as overweight and 58% as obese. At 12 months (n=123), 4% of children remained in the healthy weight range, 35% as overweight and 61% as obese. Children’s psychosocial health and linear growth were sustained during the intervention and maintenance periods. There were no between-group difference observed for any of the children’s lifestyle behaviours (dietary and activity behaviours) or parents’ parenting practices. However, the group as a whole exhibited significant improvements from baseline for scores of diet quality at the six month time point that were maintained during the following six month non-contact period (p&lt0.001 for 0-6mth and 0-12mth) (Chapter Four). Small screen usage significantly decreased for the full sample from 0-6 months and 0-12months (p&lt0.001 for both), however time spent being physically active did not change. Parents in both groups reported improvements in aspects of parenting over both time periods. Evaluation of process indicators showed that the intervention was well attended and accepted by families (Chapter Four). Seventy three percent (123) of subjects were retained to the 12 month time point and 44% (75) attended at least 75% of scheduled program sessions. Of the 131 parents who responded to a program satisfaction questionnaire, ninety four percent reported receiving the help they desired and 99% would recommend the program to others. The integrity of intervention sessions was upheld across sites providing reassurance that the program protocol was adhered to and demonstrating a good degree of generalisability. The thematic analysis of interviews conducted with parents at the 12month time point identified more references to barriers than facilitators of healthy lifestyle goal achievement (433 vs 375) (Chapter Five). This chapter highlights the contextual nature of family-based interventions and weight management strategies and the need to consider these during program planning and delivery. Chapter Six concludes the thesis by summarising its results and highlighting how they have contributed to the evidence base. Study strengths and limitations are described and implications of the findings on practice and future research are presented.

Thesis (D. Min.)--Southwestern Baptist Theological Seminary, 1987. / Includes bibliographical references (leaves 194-199).

Thesis (M.A.)--The Master's College, 2005. / Includes bibliographical references (leaves [119]-123).

Thesis (Ph. D.)--University of Nevada, Reno, 2007. / "August 2007." Includes bibliographical references (leaves 54-58). Online version available on the World Wide Web.

Dissertation (Ph.D.) -- The Institute for Clinical Social Work, 2002. / A dissertation submitted to the faculty of the Institute of Clinical Social Work in partial fulfillment for the degree of Doctor of Philosophy.

Thesis (Ph. D.)--University of Nevada, Reno, 2005. / "August, 2005." Includes bibliographical references. Online version available on the World Wide Web.