Sion Kim Harris

Harvard Medical School, Boston, MA, United States

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Publications (42)102.74 Total impact

  • Adolescent medicine: state of the art reviews 04/2014; 25(1):126-56.
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    ABSTRACT: BACKGROUND:: Caring for families is fundamental to pediatric nursing. However, existing measures do not capture parents' experiences with family-centered nursing care. OBJECTIVE:: The aim of this study was to describe the development and initial psychometric testing of the Family-Centered Care Scale, a seven-item instrument designed to measure a parent's experience of nursing care that embodies core principles of family-centered care. METHODS:: In Phase 1, 18 items describing what nurses do to engage parents of hospitalized children were derived from the literature describing mutuality. After establishing face validity, pretesting, and revision for clarity, the scale was administered to a convenience sample of 91 parents of hospitalized patients. In Phase 2, two items on parents' perceptions of being well-cared-for were added. The 20-item scale was administered to 564 parents of children recruited from all inpatient units in a children's hospital. In Phase 3, the scale was shortened to seven items and retested for validity among 454 additional parents. RESULTS:: Internal consistency reliability was high across all versions and testing phases. Confirmatory factor analysis with data from a subsequent sample supported the final factor structure, regardless of patient type and race. There was a linear association between the scale consistency scores and overall quality of care ratings, supporting predictive validity of the scale. DISCUSSION:: The Family-Centered Care Scale showed initial evidence of reliability and validity among parents with hospitalized children.
    Nursing research 01/2013; 62(3):160-168. · 1.80 Impact Factor
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    ABSTRACT: ABSTRACT Professional guidelines recommend annual screening, brief intervention, and referral to treatment (SBIRT) as part of health maintenance for all adolescents, but reported screening rates have been low and no report has documented the techniques being used. The objective of this study was to describe the results of a statewide questionnaire regarding adolescent substance use screening rates and techniques used by primary care physicians practicing in Massachusetts. A questionnaire was mailed to every licensed physician registered as practicing pediatrics (N = 2176), family medicine (N = 1335), or both (N = 8) in the Massachusetts Board of Medicine database. After eliminating physicians who did not provide care for adolescents, the survey response rate was 28% and the final analyzable sample consisted of 743 surveys. Less than half of respondents reported using a validated adolescent screening tool. The majority of respondents used ineffective screening practices for adolescent substance use. Further physician training is recommended to encourage the use of developmentally appropriate screening tools and interventions for adolescents.
    Substance Abuse 10/2012; 33(4):321-6. · 1.25 Impact Factor
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    ABSTRACT: Objectives. This study described a medical home model for adolescent mothers and their children, and their 1- and 2-year preventive care, repeat pregnancy, and psychosocial outcomes. Methods. In this prospective, single cohort demonstration project, adolescent mothers (14-18 years old) and their children received care in a medical home. Demographic, medical and social processes, and outcomes data were collected at enrollment through 24 months. Change over time and predictors of repeat pregnancy were analyzed. Results. A total of 181 adolescents enrolled, with 79.6% participating for 2 years. At 2 years, 90.2% of children were completely immunized. Children and adolescent mothers met standards for health care visits, and adolescent condom use improved. Rates of cumulative repeat pregnancy were 14.7% and 24.6%, school attendance 77.6% and 68.7%, and employment 21.2% and 32.3% at 1 and 2 years, respectively. Conclusions. A medical home model with comprehensive and integrated medical care and social services can effectively address the complex needs of adolescent parents and their children.
    American Journal of Public Health 08/2012; 102(10):1879-85. · 3.93 Impact Factor
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    ABSTRACT: Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief advice (cSBA) system. We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12- to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and "talking points" designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up. Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio [aRRR] = 0.54, 95% confidence interval 0.38-0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57-0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17-0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32-0.71). Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients.
    PEDIATRICS 05/2012; 129(6):1072-82. · 4.47 Impact Factor
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    ABSTRACT: To (1) assess the reliability of the newly developed Fears of Stranger Danger (FSD) scale, (2) examine measurement invariance and identify demographic variation in FSD, and (3) examine associations of FSD with physical activity, screen time, and body mass index (BMI) z score. Cross-sectional survey with test-retest. Neighborhoods with various socioeconomic characteristics and walkability in San Diego, Boston, and Cincinnati. Parent-adolescent pairs (n = 171), and parents of children (n = 116). Response rate was 47% for Survey 1, and 69% were retained for Survey 2. Data analyses included test-retest reliability and internal consistency for FSD, tests of differential functioning for measurement invariance, t-test for associations between FSD and demographic variables, and partial correlation for associations of FSD with physical activity, screen time, and BMI z score. The FSD scale had moderate to substantial test-retest reliability (intraclass correlation coefficient = .65-.85) and excellent internal consistency (Cronbach α = .88-.94). Measurement invariance was established across gender, race/ethnicity, and income. FSD was higher regarding younger children, females, nonwhites, and lower-income youth. FSD was positively associated with restrictive parental rules for playing outside (partial r = .28-.33), and negatively associated with children's outdoor physical activity in the neighborhood (partial r = -.27), but not associated with other measures of physical activity, screen time, or BMI z score. The new measure of FSD had good evidence of reliability and measurement invariance, but there were inconsistent associations of FSD with youth physical activity.
    American journal of health promotion: AJHP 01/2012; 26(3):189-95. · 2.37 Impact Factor
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    ABSTRACT: Previous studies have suggested that adolescent mothers with higher social support have lower depressive symptoms. This is a longitudinal study of adolescent mothers to examine the association of social support and depressive symptoms over one year postpartum. This was a prospective study of adolescent mothers (N at baseline = 120, N at 1 year = 89; age < 19 years) enrolled in a teen tot program. Participants completed the Center for Epidemiological Studies Depression Scale for children (CES-DC) and the Duke-UNC Functional Social Support Questionnaire at baseline, 12 weeks, and 1 year. A score of ≥ 16 on the CES-DC was suggestive of major depression. The mean CES-DC scores of the adolescent mothers were ≥ 16 points at all three time points (baseline: mean = 18.7 ± 10.3; 53% ≥ 16; 12 weeks: mean = 18.4 ± 11.4, 57% ≥ 16; one year: mean = 20.0 ± 11.4; 57% ≥ 16). Social support had a significant, inverse association with depressive symptoms for all participants from baseline to 12 weeks with a stronger association for those with more depressive symptoms (score ≥ 16) at baseline (beta = -0.030 ± 0.007; P < 0.001) than for those with fewer depressive symptoms (score < 16) at baseline (beta = -0.013 ± 0.006; P = 0.021). From 12 weeks to one year, increased social support was only significantly associated with decreased depressive symptoms for those with a higher baseline level of depressive symptoms (beta = - 0.039 ± 0.009; P < 0.001). Depressive symptoms were prevalent among adolescent mothers. For more depressed adolescent mothers, higher levels of social support were associated with less depressive symptoms over the 1 year follow-up. Effective long-term interventions are needed to lessen depression and enhance social support.
    Maternal and Child Health Journal 05/2011; 16(4):894-901. · 2.24 Impact Factor
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    ABSTRACT: OBJECTIVES: To determine (1) reliability of new food environment measures; (2) association between home food environment and fruit and vegetable (FV) intake; and (3) association between community and home food environment. METHODS: In 2005, a cross-sectional survey was conducted with readministration to assess test-retest reliability. Adolescents, parents of adolescents, and parents of children (n = 458) were surveyed in San Diego, Boston, and Cincinnati. RESULTS: Most subscales had acceptable reliability. Fruit and vegetable intake was positively associated with availability of healthful food (r = 0.15-0.27), FV (r = 0.22-0.34), and ratio of more-healthful/less-healthful food in the home (r = 0.23-0.31) and was negatively associated with less-healthful food in the home (r = -0.17 to -0.18). Home food environment was associated with household income but not with community food environment. CONCLUSIONS AND IMPLICATIONS: A more healthful home food environment was related to youth FV intake. Higher income households had more healthful food in the home. The potential influence of neighborhood food outlets warrants further study.
    Journal of nutrition education and behavior 04/2011; · 1.36 Impact Factor
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    ABSTRACT: To describe pediatrician experiences collaborating with psychiatrists when caring for children with attention deficit hyperactivity disorder (ADHD), depression, and anxiety. A random sample of Massachusetts primary care pediatricians completed a mailed self-report survey. Response rate was 50% (100/198). Most pediatricians preferred psychiatrists to initiate medications for anxiety (87%) or depression (85%), but not ADHD (22%). Only 14% of respondents usually received information about a psychiatry consultation. For most (88%), the family was the primary conduit of information from psychiatrists, although few (14%) believed the family to be a dependable informant. Despite this lack of direct communication, most pediatricians reported refilling psychiatry-initiated prescriptions for ADHD (88%), depression (76%), and anxiety (72%). Pediatricians preferred closer collaboration with psychiatrists for managing children with anxiety and depression, but not ADHD. The communication gap between psychiatrists and pediatricians raises concerns about quality of care for children with psychiatric conditions.
    Clinical Pediatrics 01/2011; 50(1):37-43. · 1.27 Impact Factor
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    ABSTRACT: The purpose of this study was to describe the cost burden of congenital heart disease (CHD) and the associated social impact as experienced by families. Qualitative methods were used to collect and interpret data. Semi-structured interviews were conducted with parents of children with various degrees of CHD complexity and socioeconomic status currently admitted for congenital heart surgery at a large tertiary care regional center. The meaning of cost burden as defined by participants resulted in the emergence of two major categories, lifestyle change and uncertainty. Cost was described beyond monetary terms and as a result, data in each category were further clustered into three underlying subcategories labeled financial, emotional, and family burden. The child's disease complexity and parent's socioeconomic status seem to be linked to higher levels of stress experienced in terms of finances, emotional drain, and family member burden. Prenatal diagnosis was noted to trigger early discussion of financial uncertainty, often resulting in altered personal spending prior to birth. The cost experienced by parents of children with complex CHD was described as both life-changing and uncertain. Informing families of these types of additional stressors may allow issues of finances to be considered early in the overall preparation of caring for a child with complex CHD.
    Journal of Pediatric Health Care 09/2010; 24(5):318-25. · 1.76 Impact Factor
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    ABSTRACT: Clinical observations suggest that nonverbal children with severe intellectual disability exhibit pain in a wide variety yet uniquely individual ways. Here, we investigate the feasibility and describe the initial psychometrics properties of the Individualized Numeric Rating Scale (INRS), a personalized pain assessment tool for nonverbal children with intellectual disability based on the parent's knowledge of the child. Parents of 50 nonverbal children with severe intellectual disability scheduled for surgery were able to complete the task of describing then rank ordering their child's usual and pain indicators. The parent, bedside nurse and research assistant (RA) triad then simultaneously yet independently scored the patient's post-operative pain using the INRS for a maximum of two sets of pre/post paired observations. A total of 170 triad assessments were completed before (n=85) and after (n=85) an intervention to manage the child's pain. INRS inter-rater agreement between the parents and research nurse was high (ICC 0.82-0.87) across all ratings. Parent and bedside nurse agreement (ICC 0.65-0.74) and bedside nurse and research nurse agreement (ICC 0.74-0.80) also suggest good reliability. A moderate to strong correlation (0.63-0.73) between INRS ratings and NCCPC-PV total scores provides evidence of convergent validity. These results provide preliminary data that the INRS is a valid and reliable tool for assessing pain in nonverbal children with severe intellectual disability in an acute care setting.
    Pain 04/2010; 150(2):231-6. · 5.64 Impact Factor
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    ABSTRACT: Primary care visits provide an opportunity to screen adolescents for substance use and offer early intervention, but little is known about follow-up plans. The objective of this study was to determine recommendations by PCPs and assess the relationship between their diagnostic impressions of substance use severity and plans for intervention. Data were collected through a prospective observational study conducted at 7 primary care practices in New England. Patients aged 12 to 18 years completed an interview, which included sociodemographic characteristics and the CRAFFT substance abuse screen. PCPs received screen results, noted their diagnostic impression of participants' substance use severity, and recorded follow-up plans. Follow-up plans other than "periodic screening" alone were defined as "active intervention." We examined the relationship of provider impressions with follow-up recommendations by using the chi(2) test. For 2034 adolescents, PCPs recommended no plan for 369 patients, periodic screening for 1557 patients, a return visit for 98 patients, and referral to counseling for 44 patients. PCPs' diagnostic impressions identified 97 (4.8%) patients with problem use and 19 (0.01%) patients with abuse or dependence. Recommendations for active intervention were more likely with patients' higher severity of use. However, 1 in 5 patients thought to have problem use did not receive a recommendation for an active intervention. Parent notification was planned for only 13 patients. When concerned about substance use, PCPs recommend a return visit to their office more than twice as often as referral to counseling, and rarely planned to engage parents. PCPs need enhanced training and strategies for delivery of office-based interventions.
    PEDIATRICS 08/2009; 124(1):144-50. · 4.47 Impact Factor
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    ABSTRACT: Few studies have explored barriers to physical activity in parks and streets among children, adolescents, and their parents. The purpose of this article is to evaluate the psychometric properties of a new survey of barriers to physical activity in neighborhood parks and streets. Adolescents and parents of children and adolescents completed surveys twice. Two barrier subscales (environment and safety) emerged that applied to both locations and all participant groups. Results generally supported acceptable, internal consistency as well as construct validity, but test-retest reliabilities were lower than desired. These scales may be used to improve understanding of perceptions of barriers to physical activity in neighborhood parks and streets, but further development is needed.
    Pediatric exercise science 03/2009; 21(1):86-99. · 1.57 Impact Factor
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    ABSTRACT: Developed for use in health research, the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) consists of brief measures of a broad range of religiousness and spirituality (R/S) dimensions. It has established psychometric properties among adults, but little is known about its appropriateness for use with adolescents. We assessed the psychometric properties of the BMMRS among adolescents. We recruited a racially diverse (85% non-White) sample of 305 adolescents aged 12-18 years (median 16 yrs, IQR 14-17) from 3 urban medical clinics; 93 completed a retest 1 week later. We assessed internal consistency and test-retest reliability. We assessed construct validity by examining how well the measures discriminated groups expected to differ based on self-reported religious preference, and how they related to a hypothesized correlate, depressive symptoms. Religious preference was categorized into "No religion/Atheist" (11%), "Don't know/Confused" (9%), or "Named a religion" (80%). Responses to multi-item measures were generally internally consistent (alpha > or = 0.70 for 12/16 measures) and stable over 1 week (intraclass correlation coefficients > or = 0.70 for 14/16). Forgiveness, Negative R/S Coping, and Commitment items showed lower internal cohesiveness. Scores on most measures were higher (p < 0.05) among those who "Named a religion" compared to the "No religion/Atheist" group. Forgiveness, Commitment, and Anticipated Support from members of one's congregation were inversely correlated with depressive symptoms, while BMMRS measures assessing negative R/S experiences (Negative R/S Coping, Negative Interactions with others in congregation, Loss in Faith) were positively correlated with depressive symptoms. These findings suggest that most BMMRS measures are reliable and valid for use among adolescents.
    Journal of Religion and Health 12/2008; 47(4):438-57. · 1.02 Impact Factor
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    ABSTRACT: Pediatricians are in an ideal position to screen parents of their patients for alcohol use. The objective of this study was to assess parents' preferences regarding screening and intervention for parental alcohol use during pediatric office visits for their children. A descriptive multicenter study that used 3 pediatric primary care clinic sites (rural, urban, suburban) was conducted between June 2004 and December 2006. Participants were a convenience sample of consecutively recruited parents who brought children for medical care. Parents completed an anonymous questionnaire that contained demographics; 2 alcohol-screening tests (TWEAK and Alcohol Use Disorders Identification Test); and items that assessed preferences for who should perform alcohol-screening, acceptance of screening, and preferred interventions if the screening result was positive. A total of 929 of 1028 eligible parents agreed to participate, and 879 of 929 completed surveys that yielded sufficient data for analysis. Most participants were mothers. A total of 101 of 879 parents screened positive on either the TWEAK or the Alcohol Use Disorders Identification Test. Parents with a negative alcohol screen (alcohol-negative) were more likely than parents with a positive alcohol screen (alcohol-positive) to report that they would agree to being asked about their alcohol use. There were no significant differences in preferences within alcohol-positive and alcohol-negative groups for screening by the pediatrician or computer-based questionnaire. Most preferred interventions for the alcohol-positive group were for the pediatrician to initiate additional discussion about drinking and its effect on their child, give educational materials about alcoholism, and refer for evaluation and treatment. Alcohol-positive men were more accepting than alcohol-positive women of having no intervention. A majority of parents would agree to being screened for alcohol problems in the pediatric office. Regardless of their alcohol screen status, parents are accepting of being screened by the pediatrician, a computer-based questionnaire, or a paper-and-pencil survey. Parents who screen positive prefer that the pediatrician discuss the problem further with them and present options for referral.
    PEDIATRICS 12/2008; 122(5):e1022-9. · 4.47 Impact Factor
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    ABSTRACT: To develop and test the validity and reliability of the Withdrawal Assessment Tool-1 for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Prospective psychometric evaluation. Pediatric critical care nurses assessed eligible at-risk pediatric patients for the presence of 19 withdrawal symptoms and rated the patient's overall withdrawal intensity using a Numeric Rating Scale where zero indicated no withdrawal and 10 indicated worst possible withdrawal. The 19 symptoms were derived from the Opioid and Benzodiazepine Withdrawal Score, the literature and expert opinion. Two pediatric intensive care units in university-affiliated academic children's hospitals. Eighty-three pediatric patients, median age 35 mos (interquartile range: 7 mos-10 yrs), recovering from acute respiratory failure who were being weaned from more than 5 days of continuous infusion or round-the-clock opioid and benzodiazepine administration. Repeated observations during analgesia and sedative weaning. A total of 1040 withdrawal symptom assessments were completed, with a median (interquartile range) of 11 (6-16) per patient over 6.6 (4.8-11) days. Generalized linear modeling was used to analyze each symptom in relation to withdrawal intensity ratings, adjusted for site, subject, and age group. Symptoms with high redundancy or low levels of association with withdrawal intensity ratings were dropped, resulting in an 11-item (12-point) scale. Concurrent validity was indicated by high sensitivity (0.872) and specificity (0.880) for Withdrawal Assessment Tool-1 > 3 predicting Numeric Rating Scale > 4. Construct validity was supported by significant differences in drug exposure, length of treatment and weaning from sedation, length of mechanical ventilation and intensive care unit stay for patients with Withdrawal Assessment Tool-1 scores > 3 compared with those with lower scores. The Withdrawal Assessment Tool-1 shows excellent preliminary psychometric performance when used to assess clinically important withdrawal symptoms in the pediatric intensive care unit setting. Further psychometric evaluation in diverse at-risk groups is needed.
    Pediatric Critical Care Medicine 10/2008; 9(6):573-80. · 2.35 Impact Factor
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    ABSTRACT: Competency in pediatric resuscitation is an essential goal of pediatric residency training. Both the exigencies of patient care and the Accreditation Council for Graduate Medical Education require assessment of this competency. Although there are standard courses in pediatric resuscitation, no published, validated assessment tool exists for pediatric resuscitation competency. The purpose of this work was to develop a simulation-based tool for the assessment of pediatric residents' resuscitation competency and to evaluate the tool's reliability and preliminarily its validity in a pilot study. We developed a 72-question yes-or-no questionnaire, the Tool for Resuscitation Assessment Using Computerized Simulation, representing 4 domains of resuscitation competency: basic resuscitation, airway support, circulation and arrhythmia management, and leadership behavior. We enrolled 25 subjects at each of 5 different training levels who all participated in 3 standardized code scenarios using the Laerdal SimMan universal patient simulator. Performances were videotaped and then reviewed by 2 independent expert raters. The final version of the tool is presented. The intraclass correlation coefficient between the 2 raters ranged from 0.70 to 0.76 for the 4 domain scores and was 0.80 for the overall summary score. Between the 2 raters, the mean percent exact agreement across items in each domain ranged from 81.0% to 85.1% and averaged 82.1% across all of the items in the tool. Across subject groups, there was a trend toward increasing scores with increased training, which was statistically significant for the airway and summary scores. In this pilot study, the Tool for Resuscitation Assessment Using Computerized Simulation demonstrated good interrater reliability within each domain and for summary scores. Performance analysis shows trends toward improvement with increasing years of training, providing preliminary construct validity.
    PEDIATRICS 04/2008; 121(3):e597-603. · 4.47 Impact Factor
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    ABSTRACT: Bullying perpetration is an increasingly recognized problem in schools and is associated with poor psychosocial functioning, lower academic achievement, substance use, and violent behavior. Bully-victims, perpetrators of bullying who are also victims themselves, may represent a group at particularly high risk. Using self-report data collected in 2003 from a multiethnic sample of 418 9th-11th grade students (56.9 % female, 31% Latino, 26% black, 16% white, 22% other race/ethnicity) in two urban high schools, we examined the health risk profiles for bullies and bully-victims. Multivariable logistic models controlled for sex, race/ethnicity, grade, and school. Compared to students with no bullying involvement, perpetrators of bullying reported lower school connectedness and greater sexual assault victimization, substance use, and eating disorder symptoms. Within the subgroup of students reporting having bullied others, bully-victims were at higher risk across a range of domains. Compared to students who were bullies only, bully-victims were more likely to report depressive symptoms (OR 2.7; 95% CI 1.2-6.4), skipping school because they felt unsafe (OR 6.4; 95% CI 1.3-32.4), having been a victim of forced sexual contact (OR 2.7; 95% CI 1.0-7.3), using drugs other than alcohol or marijuana (OR 4.0; 95% CI 1.3-12.6), and eating disorder symptoms (OR 3.8; 95% CI 1.3-11.1). Bully-victims are a distinct subgroup of bullying perpetrators with a particularly poor health risk profile. While bullies are often referred to the school disciplinary system for intervention, understanding the unique vulnerabilities of bully-victims may be important for developing effective school-based interventions.
    135st APHA Annual Meeting and Exposition 2007; 11/2007
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    ABSTRACT: Background: Most U.S. adolescents do not meet recommended levels for physical activity. Few studies have examined the role of the availability and access to school equipment and playing fields in promoting physical activity among youth. Objective: To investigate the psychometric properties of measures of school equipment access and policies and their relationship to youth physical activity and TV watching. Methods: A diverse sample of adolescents in 3 cities (N = 174, mean age = 14.6) completed surveys twice two weeks apart. Items assessed school equipment availability (6 items), field/equipment access and supervision (2) and physical activity homework (2). Physical activity and TV viewing (hrs/wk) were self-reported for a typical week. Results: Test-retest reliability was high for school equipment availability (ICC=0.70), moderate for field/equipment access and supervision (ICC= 0.50) and low for physical activity homework (ICC=0.39). Inter-item consistency for all subscales was moderate to high (alpha range= 0.61 - 0.75). Field/equipment access and supervision was significantly correlated with higher physical activity (r=0.164, p=0.037). After controlling for demographics, school equipment availability and field/equipment access and supervision scores were marginally associated with physical activity (p=0.054 and p=0.066 respectively). Homework promoting physical activity and reducing sedentary behavior was not related to TV watching or physical activity. Conclusion: Initial testing of a new 10-item measure of school environment and policies for children's physical activity demonstrated good reliability and some evidence of validity. Further testing of the instrument is needed. Schools could promote student physical activity by making physical activity equipment accessible after school with supervision.
    135st APHA Annual Meeting and Exposition 2007; 11/2007
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    ABSTRACT: To identify barriers to adolescent substance abuse screening in primary care. Focus groups were held at six primary care sites with a total of 38 providers. Providers brainstormed a list of barriers, collectively grouped similar barriers, and voted to produce a final ranked list. Two investigators qualitatively analyzed field notes and transcripts to triangulate findings, ranked the barriers across all sites by the number of groups identifying the barrier, then calculated a mean ranking (MR) for each. The most commonly identified barrier was insufficient time (MR 1.8). Lack of training in how to manage a positive screen was ranked second (MR 1.7), but was linked to the first. Providers reported they had enough time to administer a short screen, but insufficient time to manage a positive result during the well care visit. The need to triage competing problems (MR 3.0), lack of treatment resources (MR 3.3), tenacious parents who would not leave the room for a confidential discussion (MR 2.5), and unfamiliarity with screening tools (MR 3.0) were also noted by more than one group. Insufficient time and lack of training in how to manage positive screens are the greatest barriers to screening adolescents for substance abuse. This suggests that some providers might differentially avoid screening youth who they suspect will screen positive, yet these patients would benefit most from early recognition. More research is needed on effective ways to manage positive substance abuse screens in primary care.
    Journal of Adolescent Health 06/2007; 40(5):456-61. · 2.97 Impact Factor