Faculty Bibliography

PURPOSE: To describe how medical trainees report communication with Spanish-speaking patients, and to assess trainees' desire to improve their language skills and have those skills formally evaluated. METHOD: A questionnaire was mailed to all fourth-year medical students and non-first-year residents in family practice, pediatrics, medicine, medicine-pediatrics, emergency medicine, and obstetrics-gynecology at the University of Rochester School of Medicine and Dentistry in 2004 (N = 263). RESULTS: The response rate was 92% (241/263). Each respondent had at least one year of clinical experience at the hospital. Of the 83% (199/241) who reported less than conversational Spanish language skills, 53% had taken a history and/or provided medical advice directly to Spanish-speaking patients without any form of interpretation. When an interpreter was used, professional interpretation services were used less frequently than other forms of interpretation (42% versus 58%, p < .05). Analyses were performed on the 68% (164/241) who reported having at least rudimentary Spanish skills: 85% reported that they would probably or definitely participate in further individual language training, 70% expressed at least possible willingness to have their Spanish formally evaluated, and 80% predicted that it is at least possible that they will use their Spanish as attending physicians. CONCLUSIONS: At the time of this study, this hospital's medical students and residents from multiple specialties used inadequate Spanish language skills to provide direct medical care despite the availability of professional interpretation services. Most of these trainees were motivated to improve their Spanish and would welcome evaluation of their language skills

The dedication of the Robert J. Haggerty Child Health Services Research Laboratories at the University of Rochester (New York) Medical Center in October 2004 provided an opportunity to reflect on the current state of child health services research. Dr Haggerty had a grand vision for using the community in which children live as a laboratory for studying the varied medical, psychosocial, and behavioral morbidities that affect them. He believed that the diverse problems faced by children were best studied by a multidisciplinary team, including both academic and community pediatricians, epidemiologists, sociologists, policy makers, and community leaders. Research done in the community involving front-line providers allows investigation into the most challenging and relevant problems faced by children. To this end, Dr Haggerty made collaboration and cooperation between the community and the academic medical center a priority during his tenure at Rochester. His vision of community as laboratory continues through the child health services research emanating from the Haggerty Laboratories. Nevertheless, many barriers remain that need to be overcome for the sake of improving the lives of children in the United States and throughout the world

OBJECTIVE: To determine whether the processes through which parenting practices, maternal depression, neighborhood, and chronic poverty affect child behavioral problems are similar or different in minority and nonminority children in the United States. METHODS: Data from 884 white, 538 black, and 404 Latino families with children who were 6 to 9 years of age in the National Longitudinal Survey of Youth were analyzed. The outcome, child behavioral problems, was measured using the Behavior Problems Index externalizing and internalizing subscales. The effects of chronic poverty, neighborhood, maternal depression, and parenting on the outcome were analyzed using multigroup structural equation modeling. RESULTS: Chronic poverty affected child behavioral problems indirectly through the other variables, and parenting practices had direct effects in each racial/ethnic group. The effects of maternal depression were partially mediated through parenting in the white and Latino samples but were direct and unmediated through parenting practices in the black sample. Neighborhood effects were present in the white and black samples but were not significant for the Latino sample. CONCLUSIONS: Chronic poverty, neighborhood, maternal depression, and parenting practices have effects on child behavioral problems in white, black, and Latino children, but the processes and mechanisms through which they exert their effects differ among the groups. The differences may be related to social stratification mechanisms as well as sociocultural differences in family and childrearing practices

OBJECTIVE: To determine the relationship between maternal depressive symptoms and select prevention practices and parenting behaviors for older preschool children. METHODS: A telephone survey of mothers and female guardians of children entering kindergarten in Monroe County, New York, was administered to 400 eligible parents in 2001. The Mental Health Inventory-5 was used to determine maternal depressive symptoms. We examined the impact of maternal depression on well-child care, immunizations, routine dental care, tooth brushing, frequent reading, safe motor vehicle seating location, car seat or booster seat use, discipline consistency, and parenting confidence. RESULTS: A total of 17.7% of mothers had depressive symptoms, with increased rates among women who were poor, less educated, and single parents. Children of mothers with depressive symptoms were more likely to have not received routine dental care in the past year (21.1% vs 8.2%, P = .001), brush their teeth less than twice a day (37.1% vs 25.2%, P = .041), or be read to less than 3 times per week (31.0% vs 13.7%, P < .001) compared with children of mothers without depressive symptoms. In addition, mothers with depressive symptoms were more likely to describe inconsistent discipline practices (36.6% vs 20.1%, P = .005) and less confidence in their parenting (39.4% vs 18.5%, P < .001). All associations remained significant in multivariate analyses controlling for maternal race, ethnicity, education, income, age, and household structure. CONCLUSIONS: Maternal depressive symptoms are associated with diminished positive parenting behaviors including dental care, reading, and discipline consistency for older preschoolers. These findings have implications for clinical pediatrics as well as preventive public health efforts

BACKGROUND: Childhood iron deficiency is associated with behavioral and cognitive delays. Few studies have explored the relationship between prolonged bottle-feeding and iron-deficiency anemia among toddlers. OBJECTIVE: To examine the association between prolonged bottle-feeding and iron deficiency in a nationally representative sample of children ages 1 to 3 years. DESIGN AND METHODS: The National Health and Nutrition Examination Survey III provides data on the feeding practices of children 1 to 3 years old and contains measures of iron status including transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin. The prevalence of iron deficiency and duration of bottle-feeding were determined for black, white, and Mexican American toddlers. Bivariate and multivariate analyses were performed to examine the association between bottle-feeding duration and iron deficiency. RESULTS: Among 2121 children ages 1 to 3 years, the prevalence of iron deficiency was 6% among whites, 8% among blacks, and 17% among Mexican Americans (P< .001). With increasing duration of bottle-feeding, the prevalence of iron deficiency among all children increased (3.8%, bottle-fed < or =12 months; 11.5%, bottle-fed 13-23 months; and 12.4%, bottle-fed 24-48 months [P< .001]). At 24 to 48 months of age, 36.8% of Mexican American children were still bottle-fed, compared with 16.9% of white and 13.8% of black children. In multivariate analyses, bottle-feeding for 24 to 48 months and Mexican ethnicity were associated with iron deficiency (odds ratio, 2.8; 95% confidence interval, 1.3-6.0; and odds ratio, 2.9; 95% confidence interval, 1.5-5.6, respectively). CONCLUSIONS: Children with prolonged bottle-feeding and Mexican American children are at higher risk for iron deficiency. Screening practices and nutritional counseling should be targeted at these high-risk groups

CONTEXT: Both maternal smoking and depression are common and can adversely impact child health and functioning, yet few studies have explored their co-occurrence among mothers. OBJECTIVE: To determine the prevalence and associations of depression and smoking among mothers in the United States. DESIGN: Random-digit-dial national telephone survey of 1530 households conducted in 2002. Respondents were asked about their sociodemographic characteristics, smoking status, and their children's receipt of Medicaid. A validated 3-item depression screen was administered. Bivariate and multiple regression analyses for maternal smoking and a positive depression screen were performed. SETTING: National sample. PARTICIPANTS: Seven hundred two mothers with children aged less than 19 years living in their homes. RESULTS: The response rate was 61%. Among mothers, 24.3% were smokers, 24.4% had a positive depression screen, 8.1% had both, and 40.6% were smokers and/or had a positive depression screen. All rates were greater among mothers whose children receive Medicaid (37.6%, 47.5%, 20.6%, and 64.5%) than those whose children do not receive Medicaid (21.1%, 19.0%, 4.8%, and 35.3%) (P < .001) for each. In multivariate analyses, maternal smoking was independently associated with a 70% increased risk of depressive symptoms (odds radio, 1.7; 95% confidence interval, 1.1-2.6). CONCLUSIONS: This study highlights both the frequency and the co-occurrence of maternal smoking and maternal depressive symptoms, two negative influences on children's health and development, as well as their increased prevalence among mothers whose children receive Medicaid, thereby highlighting the economic disparities associated with both. These findings have significant implications for our nation's children, health care clinicians, and health care payers

BACKGROUND: The metabolic syndrome predicts future coronary artery disease and type II diabetes and often emerges in childhood. Tobacco smoke potentially contributes to insulin resistance in this syndrome. This study evaluates the association of environmental tobacco smoke (ETS) exposure and active smoking with the prevalence of the metabolic syndrome in US adolescents. METHODS AND RESULTS: Data from 2273 subjects 12 to 19 years of age were examined from the National Health and Nutrition Examination Survey III (NHANES III, 1988 to 1994). Serum cotinine levels, presence of household smokers, and self-report of smoking were used to determine ETS exposure and active smoking. The metabolic syndrome was defined as having > or =3 criteria from the National Cholesterol Education Panel definition. Bivariate and multivariable analyses were conducted. Among adolescents, 5.6% met the criteria for metabolic syndrome, and prevalence increased with tobacco exposure: 1.2% for nonexposed, 5.4% for those exposed to ETS, and 8.7% for active smokers (P<0.001). In adolescents at risk for overweight and overweight adolescents (body mass index above the 85th percentile), a similar relationship was observed: 5.6% for nonexposed, 19.6% for those exposed to ETS, and 23.6% for active smokers (P=0.01). In multivariable logistic regression analyses among all adolescents, ETS exposure was independently associated with the metabolic syndrome (ETS exposure: odds ratio, 4.7, 95% CI, 1.7 to 12.9; active smoking: odds ratio, 6.1; 95% CI, 2.8 to 13.4). CONCLUSIONS: Considering that tobacco and obesity are the 2 leading causes of preventable death in the United States, these findings of a dose-response, cotinine-confirmed relationship between tobacco smoke and metabolic syndrome among adolescents may have profound implications for the future health of the public

PURPOSE: To evaluate factors that independently predict counseling for diet, exercise, sexually transmitted diseases (STDs), pregnancy, smoking, and injuries at adolescent well visits, and compare these rates to the frequency of counseling at adolescent acute visits. METHODS: The 1997-2000 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys were combined for patients aged 11-21 years. Acute visits were identified by ICD-9 code for: sexual health, obesity, asthma, injury, and well care. Bivariate analyses were used to determine differences in relevant counseling provided at acute visits compared with well visits. Logistic regression was used to assess factors that predict counseling on each of the above topics at well adolescent visits. RESULTS: Of 23,378 adolescent ambulatory visits, 1508 (6.5%) were for well care. Only 0.8% of visits were for obesity, 3.7% for sexual health, 2.6% for asthma, and 13% for injuries. Counseling was more frequent at acute than well visits for diet (72% vs. 28%), exercise (52% vs. 23%), human immunodeficiency virus/sexually transmitted diseases (HIV/STD; 14% vs. 6.2%), and family planning (FP) (24% vs. 10%), (all p values < .05). Pediatric clinicians were more likely than other specialists to provide counseling for diet (OR 2.3), HIV/STD (OR 2.7), FP (OR 2.9), tobacco use (OR 2.8), and injury prevention (OR 4.7). Blacks received less exercise counseling than Whites (OR 0.4), and counseling about sensitive issues (STDs, family planning) occurred more often in older adolescents (OR 1.3). CONCLUSIONS: Despite recommendations, more counseling occurs at acute rather than well visits, and still does not reach all those adolescents in need. There remains much room for improvement in physicians' adherence to national guidelines for adolescent care