Journal of Racial and Ethnic Health Disparities, 2015
Nutrition in early childhood can significantly impact physical and mental health outcomes for chi... more Nutrition in early childhood can significantly impact physical and mental health outcomes for children. However, research on broadly defined pre/postnatal nutrition interventions is sparse. The present study is a process and outcome evaluation of a primary care-based nutrition intervention targeting low-income Hispanic women. Pregnant women enrolled in the program were in their first trimester and received services through their 6-month well child check. The program provided vouchers for fruits and vegetables from the local farmers' market, nutrition classes, cooking classes, and lactation counseling. We conducted a prospective study of program participants (n=32) and a comparable group of women for whom the program was not available (n=29). Panel survey data measured maternal diet, exercise, stress, depression, social support, infant feeding practices, and demographics. Outcome measures obtained from medical records included pregnancy weight gain, infant weight at 6 and 12 months, and infant development at 9 months. Findings reveal that the program was not associated with infant weights. However, despite similar profiles at baseline, women in the intervention group were more likely than women in the comparison group to have significant improvements in diet, exercise, and depression (p≤.05). In addition, participants were more likely to breastfeed (p=.07) and their infants were more likely to pass the ages and stages developmental screen (p=.06) than women in the comparison group. The study was limited by a lack of random assignment and small samples. However, the breadth and size of the effects suggest pre/postnatal nutrition interventions integrated into primary care warrant additional investigation.
The nationwide epidemic of pediatric obesity is more prevalent among Hispanic children than white... more The nationwide epidemic of pediatric obesity is more prevalent among Hispanic children than white children. Recent literature suggests that obesity has early origins, leading scholars to call for interventions in pregnancy and infancy. However, there is little theoretical or empirical research to guide the development of early prevention programs for Hispanics. The present study seeks to identify risk factors for early childhood obesity among a lowincome, predominately Hispanic sample. Data were gathered to inform the design of a primary care childhood obesity prevention program targeting pregnancy through age 12 months. Baseline data were gathered on 153 women attending the clinic for prenatal care or for their child's 2, 6 or 12 month well-check. All women completed surveys on diet, exercise, social support, food security, stress, infant feeding practices, health, and demographics. For women with children (n = 66), survey data were matched with medical records data on infant weight. Results reveal that 55 % of women in the sample had an infant profiling in the 85th percentile or higher, confirming the need for an early childhood obesity intervention. While mothers exhibited several potential risk factors for childhood obesity (e.g. fast food consumption), only maternal consumption of sweets and sugar-sweetened beverages, stress, and SNAP (food stamp receipt) were associated with infant overweight. Findings further reveal that stress and SNAP relate to child overweight, in part, through mothers' sugar-sweetened beverage consumption. Results suggest that obesity prevention efforts must address specific individual choices as well as the external environment that shapes these consumption patterns.
Background.-Boston's Department of Health and Hospitals established the Boston Immunization Infor... more Background.-Boston's Department of Health and Hospitals established the Boston Immunization Information System (BIIS) as part of a citywide effort to raise immunization rates. Objectives.-Our objectives were 1) to assess the validity of data entry in one computerized immunization database within this system; 2) to identify the types of errors made in data entry; and 3) to assess the effectiveness of an intervention to improve the accuracy of information in this database. Methods.-Chart records were used as the gold standard in comparison with the computerized BIIS database. Children were considered up to date for immunizations if they had received 4 DTPs, 3 polios, and 1 MMR by their second birthday. In March of 1995, billing records were used to identify all children born between March 1, 1992, and September 1, 1994, in one urban health center. These children were between 6 months and 36 months of age at the time. We compared the computer record with the chart, looking for and correcting errors such as incorrect dates and missing immunization data. An intervention was then begun, including a system for reviewing the accuracy of the computerized data at all well-child visits. In October of 1996, the chart review was repeated on children born between March 1, 1992, and September 1, 1995. This age range included all the children in the original review plus those born in the subsequent 12 months. Immunization rates before and after chart reviews were compared for children 24 to 36 months of age. Results.-We initially reviewed 737 of 739 charts (99%). In the follow-up time period, we examined 881 of 943 charts (93%). During the first review, 333 of the 563 (59%) records contained at least one error in data entry, compared with 116 of 646 (18%) in the second review (P Ͻ .0001). During the second review, we also examined the type of errors. Thirty-eight percent of all errors represented vaccines that had not been entered into the computer. Before the study period, analysis of the computerized immunization record showed an immunization up-to-date rate of 24%. This increased to 41% after the initial chart review and to 75% after the intervention period (P Ͻ .0001). Conclusion.-Errors in data entry caused underestimates of immunization rates. Eliminating the errors increased immunization rates immediately through more accurate bookkeeping. Eighteen months later, immunization rates had continued to improve dramatically.
Nutrition in early childhood can significantly impact
physical and mental health outcomes for chi... more Nutrition in early childhood can significantly impact physical and mental health outcomes for children. However, research on broadly defined pre/postnatal nutrition interventions is sparse. The present study is a process and outcome evaluation of a primary care-based nutrition intervention targeting low-income Hispanic women. Pregnant women enrolled in the program were in their first trimester and received services through their 6-month well child check. The program provided vouchers for fruits and vegetables from the local farmers’ market, nutrition classes, cooking classes, and lactation counseling.We conducted a prospective study of program participants (n=32) and a comparable group of women for whom the program was not available (n=29). Panel survey data measured maternal diet, exercise, stress, depression, social support, infant feeding practices, and demographics. Outcome measures obtained from medical records included pregnancy weight gain, infant weight at 6 and 12 months, and infant development at 9 months. Findings reveal that the program was not associated with infant weights. However, despite similar profiles at baseline, women in the intervention group were more likely than women in the comparison group to have significant improvements in diet, exercise, and depression (p≤.05). In addition, participants were more likely to breastfeed (p=.07) and their infants were more likely to pass the ages and stages developmental screen (p=.06) than women in the comparison group. The study was limited by a lack of random assignment and small samples. However, the breadth and size of the effects suggest pre/postnatal nutrition interventions integrated into primary care warrant additional investigation.
Journal of Racial and Ethnic Health Disparities, 2015
Nutrition in early childhood can significantly impact physical and mental health outcomes for chi... more Nutrition in early childhood can significantly impact physical and mental health outcomes for children. However, research on broadly defined pre/postnatal nutrition interventions is sparse. The present study is a process and outcome evaluation of a primary care-based nutrition intervention targeting low-income Hispanic women. Pregnant women enrolled in the program were in their first trimester and received services through their 6-month well child check. The program provided vouchers for fruits and vegetables from the local farmers' market, nutrition classes, cooking classes, and lactation counseling. We conducted a prospective study of program participants (n=32) and a comparable group of women for whom the program was not available (n=29). Panel survey data measured maternal diet, exercise, stress, depression, social support, infant feeding practices, and demographics. Outcome measures obtained from medical records included pregnancy weight gain, infant weight at 6 and 12 months, and infant development at 9 months. Findings reveal that the program was not associated with infant weights. However, despite similar profiles at baseline, women in the intervention group were more likely than women in the comparison group to have significant improvements in diet, exercise, and depression (p≤.05). In addition, participants were more likely to breastfeed (p=.07) and their infants were more likely to pass the ages and stages developmental screen (p=.06) than women in the comparison group. The study was limited by a lack of random assignment and small samples. However, the breadth and size of the effects suggest pre/postnatal nutrition interventions integrated into primary care warrant additional investigation.
The nationwide epidemic of pediatric obesity is more prevalent among Hispanic children than white... more The nationwide epidemic of pediatric obesity is more prevalent among Hispanic children than white children. Recent literature suggests that obesity has early origins, leading scholars to call for interventions in pregnancy and infancy. However, there is little theoretical or empirical research to guide the development of early prevention programs for Hispanics. The present study seeks to identify risk factors for early childhood obesity among a lowincome, predominately Hispanic sample. Data were gathered to inform the design of a primary care childhood obesity prevention program targeting pregnancy through age 12 months. Baseline data were gathered on 153 women attending the clinic for prenatal care or for their child's 2, 6 or 12 month well-check. All women completed surveys on diet, exercise, social support, food security, stress, infant feeding practices, health, and demographics. For women with children (n = 66), survey data were matched with medical records data on infant weight. Results reveal that 55 % of women in the sample had an infant profiling in the 85th percentile or higher, confirming the need for an early childhood obesity intervention. While mothers exhibited several potential risk factors for childhood obesity (e.g. fast food consumption), only maternal consumption of sweets and sugar-sweetened beverages, stress, and SNAP (food stamp receipt) were associated with infant overweight. Findings further reveal that stress and SNAP relate to child overweight, in part, through mothers' sugar-sweetened beverage consumption. Results suggest that obesity prevention efforts must address specific individual choices as well as the external environment that shapes these consumption patterns.
Background.-Boston's Department of Health and Hospitals established the Boston Immunization Infor... more Background.-Boston's Department of Health and Hospitals established the Boston Immunization Information System (BIIS) as part of a citywide effort to raise immunization rates. Objectives.-Our objectives were 1) to assess the validity of data entry in one computerized immunization database within this system; 2) to identify the types of errors made in data entry; and 3) to assess the effectiveness of an intervention to improve the accuracy of information in this database. Methods.-Chart records were used as the gold standard in comparison with the computerized BIIS database. Children were considered up to date for immunizations if they had received 4 DTPs, 3 polios, and 1 MMR by their second birthday. In March of 1995, billing records were used to identify all children born between March 1, 1992, and September 1, 1994, in one urban health center. These children were between 6 months and 36 months of age at the time. We compared the computer record with the chart, looking for and correcting errors such as incorrect dates and missing immunization data. An intervention was then begun, including a system for reviewing the accuracy of the computerized data at all well-child visits. In October of 1996, the chart review was repeated on children born between March 1, 1992, and September 1, 1995. This age range included all the children in the original review plus those born in the subsequent 12 months. Immunization rates before and after chart reviews were compared for children 24 to 36 months of age. Results.-We initially reviewed 737 of 739 charts (99%). In the follow-up time period, we examined 881 of 943 charts (93%). During the first review, 333 of the 563 (59%) records contained at least one error in data entry, compared with 116 of 646 (18%) in the second review (P Ͻ .0001). During the second review, we also examined the type of errors. Thirty-eight percent of all errors represented vaccines that had not been entered into the computer. Before the study period, analysis of the computerized immunization record showed an immunization up-to-date rate of 24%. This increased to 41% after the initial chart review and to 75% after the intervention period (P Ͻ .0001). Conclusion.-Errors in data entry caused underestimates of immunization rates. Eliminating the errors increased immunization rates immediately through more accurate bookkeeping. Eighteen months later, immunization rates had continued to improve dramatically.
Nutrition in early childhood can significantly impact
physical and mental health outcomes for chi... more Nutrition in early childhood can significantly impact physical and mental health outcomes for children. However, research on broadly defined pre/postnatal nutrition interventions is sparse. The present study is a process and outcome evaluation of a primary care-based nutrition intervention targeting low-income Hispanic women. Pregnant women enrolled in the program were in their first trimester and received services through their 6-month well child check. The program provided vouchers for fruits and vegetables from the local farmers’ market, nutrition classes, cooking classes, and lactation counseling.We conducted a prospective study of program participants (n=32) and a comparable group of women for whom the program was not available (n=29). Panel survey data measured maternal diet, exercise, stress, depression, social support, infant feeding practices, and demographics. Outcome measures obtained from medical records included pregnancy weight gain, infant weight at 6 and 12 months, and infant development at 9 months. Findings reveal that the program was not associated with infant weights. However, despite similar profiles at baseline, women in the intervention group were more likely than women in the comparison group to have significant improvements in diet, exercise, and depression (p≤.05). In addition, participants were more likely to breastfeed (p=.07) and their infants were more likely to pass the ages and stages developmental screen (p=.06) than women in the comparison group. The study was limited by a lack of random assignment and small samples. However, the breadth and size of the effects suggest pre/postnatal nutrition interventions integrated into primary care warrant additional investigation.
Uploads
Papers by Louis Appel
physical and mental health outcomes for children. However,
research on broadly defined pre/postnatal nutrition interventions
is sparse. The present study is a process and outcome
evaluation of a primary care-based nutrition intervention
targeting low-income Hispanic women. Pregnant women enrolled
in the program were in their first trimester and received
services through their 6-month well child check. The program
provided vouchers for fruits and vegetables from the local
farmers’ market, nutrition classes, cooking classes, and lactation
counseling.We conducted a prospective study of program
participants (n=32) and a comparable group of women for
whom the program was not available (n=29). Panel survey
data measured maternal diet, exercise, stress, depression, social
support, infant feeding practices, and demographics. Outcome
measures obtained from medical records included pregnancy
weight gain, infant weight at 6 and 12 months, and
infant development at 9 months. Findings reveal that the program
was not associated with infant weights. However, despite
similar profiles at baseline, women in the intervention
group were more likely than women in the comparison group
to have significant improvements in diet, exercise, and depression
(p≤.05). In addition, participants were more likely to
breastfeed (p=.07) and their infants were more likely to pass
the ages and stages developmental screen (p=.06) than women
in the comparison group. The study was limited by a lack of
random assignment and small samples. However, the breadth
and size of the effects suggest pre/postnatal nutrition interventions
integrated into primary care warrant additional
investigation.
physical and mental health outcomes for children. However,
research on broadly defined pre/postnatal nutrition interventions
is sparse. The present study is a process and outcome
evaluation of a primary care-based nutrition intervention
targeting low-income Hispanic women. Pregnant women enrolled
in the program were in their first trimester and received
services through their 6-month well child check. The program
provided vouchers for fruits and vegetables from the local
farmers’ market, nutrition classes, cooking classes, and lactation
counseling.We conducted a prospective study of program
participants (n=32) and a comparable group of women for
whom the program was not available (n=29). Panel survey
data measured maternal diet, exercise, stress, depression, social
support, infant feeding practices, and demographics. Outcome
measures obtained from medical records included pregnancy
weight gain, infant weight at 6 and 12 months, and
infant development at 9 months. Findings reveal that the program
was not associated with infant weights. However, despite
similar profiles at baseline, women in the intervention
group were more likely than women in the comparison group
to have significant improvements in diet, exercise, and depression
(p≤.05). In addition, participants were more likely to
breastfeed (p=.07) and their infants were more likely to pass
the ages and stages developmental screen (p=.06) than women
in the comparison group. The study was limited by a lack of
random assignment and small samples. However, the breadth
and size of the effects suggest pre/postnatal nutrition interventions
integrated into primary care warrant additional
investigation.