Despite a mandated 1-month rotation in developmental-behavioral pediatrics (DBP), pediatric residents report inadequate training in behavioral health care. As a first step in much needed curriculum development in this area, this study sought to assess learner experiences regarding the management of behavioral health problems during residency. Four focus groups were conducted for residents in years 1-3 of training in 2 residency programs in a northeastern state. Transcripts were analyzed and coded by researchers through qualitative classical content analysis. The exploratory analysis revealed 9 key themes: time requirements, rapport building, resources and referrals for behavioral health, psychiatric medications, diagnosis vs. treatment, working with families, the importance of behavioral health, fears of working with a pediatric population, and training issues. These qualitative data further identify gaps in the behavioral health training of pediatric residents and may inform future innovations in training curricula.

No description available.

Technology is a promising means for increasing rural individuals’ access to behavioral healthcare. However, the range of technology use in rural areas is currently unknown. The aims of this study were to examine the use of technology in rural areas, the relationship between technology use and willingness to access pediatric mental health services via videoconferencing, and this relationship within the context of other critical variables linked to service uptake. Data were collected at 2 pediatric primary care clinics. While no significant relationship was found between technology use and willingness to use videoconferencing, a significant relationship emerged between previous service seeking and willingness to use videoconferencing. These findings indicate the need for more research examining other variables’ relationships to willingness to seek help via technology, such as general help-seeking attitudes, unfamiliarity with videoconferencing services, or other variables included in previously established models of technology adoption.

Purpose: Coordinated school health programs (CSHPs), a type of health promoting school (HPS) program adopted by Canada and the USA, were developed to provide a comprehensive approach to school health in the USA. Community partnerships are central to CSHP and HPS efforts, yet the quality of collaboration efforts is rarely assessed. The purpose of this paper is to use Himmelman’s strategies for working together to assess the types of partnerships that are being formed by CSHPs and to explore the methodological usefulness of this framework. The Himmelman methodology describes four degrees of partnering interaction: networking, coordinating, cooperating, and collaborating, with each degree of interaction signifying a different level of partnership between organizations. Design/methodology/approach: Data were collected as part of the 2008-2009 and 2009-2010 CSHP annual Requests for Proposal from all 131 public school systems in Tennessee. Thematic analysis methods were used to assess partnerships in school systems. Descriptive analyses were completed to calculate individual collaboration scores for each of the eight CSHP components (comprehensive health education, physical education/activity, nutrition services, health services, mental health services, student, family, and community involvement, healthy school environment, and health promotion of staff) during the two data collection periods. The level of collaboration was assessed based on Himmelman’s methodology, with higher scores indicating a greater degree of collaboration. Scores were averaged to obtain a mean score and individual component scores were then averaged to obtain statewide collaboration index scores (CISs) for each CSHP component. Findings: The majority of CSHPs partnering activities can be described as coordination, level two in partnering interaction. The physical activity component had the highest CISs and scored in between coordinating and cooperating (2.42), while healthy school environment had the lowest score, scoring between networking and coordinating (1.93), CISs increased from Year 1 to Year 2 for all of the CSHP components. Applying the theoretical framework of Himmelman’s methodology provided a novel way to quantify levels of collaboration among school partners. This approach offered an opportunity to use qualitative and quantitative methods to explore levels of collaboration, determine current levels of collaboration, and assess changes in levels of collaboration over the study period. Research limitations/implications: This study provides a framework for using the Himmelman methodology to quantify partnerships in a HPS program in the USA. However, the case study nature of the enquiry means that changes may have been influenced by a range of contextual factors, and quantitative analyses are solely descriptive and therefore do not provide an opportunity for statistical comparisons. Practical implications: Quantifying collaboration efforts is useful for HPS programs. Community activities that link back to the classroom are important to the success of any HPS program. Himmelman’s methodology may be useful when applied to HPSs to assess the quality of existing partnerships and guide program implementation efforts. Originality/value: This research is the first of its kind and uses a theoretical framework to quantify partnership levels in school health programs. In the future, using this methodology could provide an opportunity to develop more effective partnerships in school health programs, health education, and public health.

No description available.

On behalf of the Appalachia Funders Network (AFN), with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago conducted a study to analyze the current burden of obesity and chronic disease in central Appalachia and identify promising practices and strategies that are having a positive impact on the reduction of obesity in the region. Central Appalachia consists of parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. Regional recommendations to reduce childhood obesity and improve the overall population’s health were developed based on a review of current literature, a survey, and focus groups with both community groups and funders.

On behalf of the Appalachia Funders Network (AFN), with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago conducted a study to analyze the current burden of obesity and chronic disease in central Appalachia and identify promising practices and strategies that are having a positive impact on the reduction of obesity in the region. Central Appalachia consists of parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. Regional recommendations to reduce childhood obesity and improve the overall population’s health were developed based on a review of current literature, a survey, and focus groups with both community groups and funders.

Research Objective: On behalf of the Appalachian Funders Network, with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago documented the current burden of obesity, diabetes, and chronic disease mortality in central Appalachia. An analysis of county-level data was conducted in order to provide a picture of the health condition of the region. This study identified both the magnitude of obesity-related health problems in central Appalachia as well as promising practices, policies and strategies aimed at reducing obesity rates, especially among children. Study Design: A mixed methods approach was used to assess the policies and practices that have a positive impact on the reduction of childhood obesity and chronic disease in central Appalachia (TN, VA, KY, WV, NC, and OH). Along with a literature review and analysis of national and regional health data, the study included surveys and focus groups of community members, practitioners and funders to identify the region’s current obesity prevention efforts. Activities were broken into (1) healthy eating, including promotion of policies and/or changes to the built environment and promotion of healthy food; and (2) physical activity. Population Studied: The central Appalachian region ranks amongst the highest in the nation for percentage of obese high school students. There, children are disproportionately affected by rates of obesity by location; specifically, rural children differ from urban children, 16.5% to 14.4%, respectively, in prevalence of obesity. Focus groups comprising community members, practitioners and funders were held to obtain internal stakeholder input and secure community buy-in. Principal Findings: Across central Appalachia, participants in the surveys and focus groups identified a number of recommendations to advance regional efforts to reduce obesity and improve the overall population’s health. Survey results indicate the most promising and prevailing nutritional practices comprise community-based, locally led support strategies spanning multisector approaches to endorse schools' feeding programs, community and school gardens, and farmers' market SNAP programs via co- investment and funding. Concurrently, promising physical activity promotion practices include stepping up community walkability, enhancing physical education requirements, expanding and revitalizing trails, tracks, playgrounds, gyms and other exercise opportunities within built environments. Conclusions: This study provides evidence-based, promising practices to address obesity in rural communities. For long-term changes to occur programs that are successful need to be evaluated rigorously and shared widely. Implications for Public Health Policy or Practice: Improving the local food and physical activity environment in a community requires participation of many dedicated partners. Government, the health care system, schools, private businesses and community organizations all have critical roles to play in this effort. Cross-sector collaboration creates local ownership leading to more sustainable programs that are valued not only by the foundations and grantees but also by the larger community.

Research Objective: On behalf of the Appalachian Funders Network, with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago documented the current burden of obesity, diabetes, and chronic disease mortality in central Appalachia. An analysis of county-level data was conducted in order to provide a comprehensive picture of the health condition of the region. Contributing factors, such as physical inactivity and food environment, were also investigated to determine how the built environment impacts obesity. Study Design: Several secondary data sources were utilized, including the County Health Rankings, CDC Diabetes Interactive Atlas, USDA Food Environment Atlas, and mortality data from the CDC National Center for Health Statistics, National Vital Statistics System. Variables analyzed included: adult obesity prevalence, adult diabetes prevalence, food insecurity, access to exercise opportunities, physical inactivity, and premature chronic disease mortality. The mortality analyses focused on four of the leading causes of death: heart disease, stroke, diabetes, and chronic lower respiratory disease, for persons age 25 to 64 from 2009 to 2013. When available, county-level estimates were used to create maps of the region, documenting the disparities compared to the rest of the nation. Population Studied: Health disparities were documented within the counties of central Appalachia, consisting of parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. Principal Findings: More than two-thirds (68.6%) of the 234 counties in central Appalachia have an adult obesity prevalence above the national median of 30.9% (defined as BMI over 30). Over 85% of the counties in central Appalachia have a percentage of physically inactive adults higher than the national median of 26.4% (defined as not participating in physical activity or exercise in the past 30 days). When analyzing the combined chronic disease mortality for heart disease, stroke, diabetes and chronic lower respiratory disease, the combined national mortality rate is 93.0 deaths per 100,000 population. Nearly 90% of central Appalachian counties have a higher combined morality rate, and the state mortality rate for the Appalachian region of all six states is higher than the national rate. The disparity is more pronounced in rural communities, as the rural counties of central Appalachia have a higher mortality rate than urban counties within central Appalachia and rural counties across the United States. The combined mortality rate for these four diseases is 74% higher in rural central Appalachia than urban counties nationally. Conclusions: Compared to the rest of the country, people in central Appalachia are more likely to experience and prematurely die from obesity-related chronic disease, including diabetes and heart disease. Residents of rural central Appalachia face even more significant disparities as compared to urban residents within the region and nationally. Implications for Policy or Practice: Obesity and chronic disease in central Appalachia are significant public health concerns that must be addressed in order to improve the health of the region.

No description available.