Background: The percentage of children with obesity and type II diabetes in the United States has increased over the past two decades, particularly in the rural Southeast. Schools are a proposed setting for prevention initiatives. Purpose: The purpose of this study was to gain a better understanding of school personnel perceptions of child obesity and diabetes prevention. This understanding will facilitate a unique collaboration between a regional university, a hospital system, community organizations, and schools in making healthy changes in policy, curricula, and environments in elementary and middle schools. The approach will be modeled after the Coordinated School Health Program (CSHP). Methods: The study was approved by the university Institutional Review Board. Key personnel from six school systems in Northeast Tennessee were invited to participate in a written survey that included questions about nutrition, physical activity, and obesity. Results: All school systems participated, with a total of 32 administrators and teachers completing the survey. Sixty-five percent of respondents believed that the amount of student physical activity at their school was too little. All respondents felt that to be healthy, 2008 Appalachian Student Research Forum Page 51 students needed a total of 30 minutes of physical activity at school each day in every grade level. Eightyfour percent of respondents thought that the nutritional quality of foods and drinks consumed by students at school was fair, good, or very good. Most teachers did agreed that schools should not sell unhealthy snacks as fundraisers and that classroom parties should include mostly healthy foods and drinks. Eightytwo percent of personnel were either extremely or very concerned about child obesity in their school community. Over ninety percent agreed that schools should do more to promote physical activity and healthy nutrition among both children and teachers. All respondents felt that parents needed to be more involved in this effort with their children. Conclusion: School personnel from this Northeast Tennessee sample were concerned about child obesity and seemed willing to implement changes in their schools to promote physical activity and healthy nutrition. The next phase of this study will test whether a program modeled after and implemented in conjunction with Tennessee CSHP is effective in producing changes in school policies, curricula, and environments that will promote physical activity and healthier nutrition.

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Childhood overweight and obesity rates have grown immensely in recent years in the United States, especially in rural areas. The current study evaluated health care providers’ perceptions of training and implementation of a cluster-randomized clinical trial, Parent-Led Activity and Nutrition (PLAN) for Healthy Living, for treatment of overweight and obesity in children 5-11 years of age. Five physicians (3 in a pediatric clinic and 2 in a family medicine clinic) were trained in (1) brief motivational interviewing techniques for individual visits with parents, and (2) the National Institutes of Health (NIH) We Can! (Ways to Enhance Children’s Activity and Nutrition) Curricula to lead group sessions with these same parents aimed at providing them with the tools necessary to aid in changing their family’s eating and physical activity behaviors. Upon completion of the 10-week intervention, physicians (N = 4) participated in focus groups with research staff to discuss their experiences with the study. Based on the individual visit training in brief motivational interviewing, the principle of supporting self-efficacy was used by all providers during individual visits and was determined to be of most help. One physician commented that individual sessions would likely be more effective with families that are well-known by the provider, and several physicians believed that longer-term follow-up visits conducted by a registered dietician or nurse are feasible. Findings revealed that physician preparation time for a group session with parents was within the range of 15-90 minutes, with all providers believing this time was well-spent. The provider ratings of group session effectiveness were very high, approximately a 6 on a 7 point scale. Several providers felt the group visits were more effective than the individual visits. Additionally, some providers suggested continuing the group sessions on a monthly basis for long-term support. The collective data suggests that physicians view PLAN as an acceptable and feasible approach to the treatment of child overweight and obesity.

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Human papilloma virus (HPV) is the most common viral infection of the reproductive tract and a well-established cause of cervical, anal, and oropharyngeal cancers in both women and men worldwide. Despite data that supports HPV vaccine as an effective measure to prevent such cancers, vaccine uptake has not been optimal in many countries. In the United States (US) for example, rates have stagnated over the past few years and only one-third of adolescents are fully immunized, in contrast to other adolescent vaccines such as Tdap and meningococcal that have double the rates of uptake. Current approaches to HPV vaccine education and delivery have not been successful at improving immunization rates. In this article we propose the implementation of a child rights, social justice, and health equity-based approach to HPV vaccine policy. This approach would promote youth’s participation in medical decision-making and advance policies that allow for independent consent to HPV vaccination. We postulate that by empowering youth to be involved in issues pertaining to their health and well-being, they will be more likely to explore and discuss information about HPV with others, and be able to make informed decisions related to HPV vaccine.

INTRODUCTION: One out of every 100 deaths from an obesity-related disease is caused by sugary drink consumption. The National Center for Health Statistics reported in 2010, sugary beverages like soda, fruit drinks, sports drinks, sweet tea, and energy drinks accounted for 46% of all added sugars in the American diet. According to the Youth Risk Behavior Surveillance in 2013, 27% of teens drank one or more soda per day, 19% drank two or more, and 11% drank three or more. Research has shown each additional 12 ounce soda a child consumes each day, attributes to an increased 60% chance of becoming obese during one and a half years of follow up time. Sugary drink consumption, childhood obesity, and low socio-economic status have been linked to increased likelihood of obesity during adulthood. Woman, Infants, and Children (WIC) is a special supplemental nutrition program hoping to improve the health of low income pregnant, postpartum, and breastfeeding mothers and their infants and children up to the age of 5. WIC provides food, nutrition education, breastfeeding promotion and referrals to health services at no charge. The WIC program is designed to supplement the participant’s diet. According to food packages in Tennessee, mothers are allowed to buy 100% fruit juice in the form of two 64 ounce bottles, 48 ounces shelf stable or frozen reconstitute, three 48 ounce bottles, or one 96 ounce bottle. This study compares sugary drink consumption of WIC-participating infants and mothers to non WIC participants and aims to identify any disparities. METHODS: Data were obtained through ReadNPlay for a Bright Future, a program advocating for healthy active living among families with young children. Surveys were generated to assess the health and demographics of mothers and their children living in the area. A convenience sample was utilized by voluntary and anonymous submission of surveys by mothers with babies aged 9-24 months, who visited a local pediatric clinic. Collection of 320 surveys was achieved during four separate time frames within 2013-2015. The association between sugary drink consumption in children and WIC is being examined using linear regression. RESULTS: Preliminary data analysis revealed 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. Mothers reported their infants consumed an average of 4.6 ounces of sugary drinks daily (range 1-15 ounces). 66.4% of mothers reported consuming at least one sugary drink daily, while 27.1% reported consuming 3 or more daily. CONCLUSION: The American Academy of Pediatrics recommends infants and children should be given milk or water instead of 100% fruit juice to reduce the amount of unneeded calories and sugar. If juice is given it is recommended to limit consumption to 4-6 ounces per day. Some types of 100% fruit juice, such as grape juice, have more sugar per ounce than soda. The results of this analysis may help to evaluate the healthfulness of the current WIC food package and identify high risk groups for counseling on sugary drink consumption.

Objective: The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these settings. Methods: A 61-item healthcare provider questionnaire assessing current practices, attitudes, perceived barriers, and skill levels in managing childhood overweight and obesity was distributed to physicians in four primary care clinics. Questionnaires were obtained from 36 physicians. Results: Physicians' practices to address childhood overweight and obesity were limited, despite the fact that most physicians shared the attitude that childhood overweight and obesity need attention. While 71% of physicians reported talking about eating and physical activity habits with parents of overweight or obese children, only 19% reported giving these parents the tools they needed to make changes. Approximately 42% determined the parents' readiness to make small changes for their overweight or obese children. Physicians' self-perceived skill level in managing childhood overweight and obesity was found to be a key factor for childhood overweight- and obesity- related practices. Conclusion: Primary care physicians in southern Appalachia currently play a limited role in the prevention or intervention of childhood overweight and obesity. Training physicians to improve their skills in managing childhood overweight and obesity may lead to an improvement in practice.

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Purpose ReadNPlay for a Bright Future develops a variety of projects aimed at promoting healthy living in families with young children in Appalachian Tennessee. The purposes of this research are 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 and 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. Methods Anonymous clipboard surveys were administered to attendees of regional community events during July of 2014. 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. Results 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). Conclusion 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 use in conjunction with infant-toddler well child visits.