Lessons learned from a pilot study on the health status of children from itinerant populations

The Acceptability of Biobehavioral Research With Latino Youth in the United States

In this study, we explored Latinx adolescents’ knowledge and perceptions of biobehavioral research and their willingness to participate in such studies. We conducted four focus groups in the summer of 2014 with Latinx adolescents in Texas between the ages of 12 and 17 years ( n = 17; 53% male; M age = 14.6 years [ SD = 1.66]) who were recruited from a community-based clinic. Five themes emerged from our content analysis: (a) protection of human subjects is important to participants, (b) comfort with providing different types of biological data varies depending on different factors, (c) engagement in biobehavioral research should be grounded in a cultural lens, (d) providing bilingual research staff is essential, and (e) adolescents have various motivations for participating. Findings highlighted how various factors could serve as both barriers and facilitators to participation. Our study provides insight into strategies for conducting biobehavioral research with Latinxs, who are the fastest growing group of adolescents in the United States and experience disparities in health-risk behaviors that can be better understood through research approaches that integrate biological and psychological measures. Without considering the perspectives of historically marginalized or understudied populations, we jeopardize the quality and validity of research findings, and risk harming participants.

Prevalence and Determinants of Overweight and Obesity in Children and Adolescents from Migrant and Seasonal Farmworker Families in the United States-A Systematic Review and Qualitative Assessment

Overweight and obesity (OW/OB) is a pressing health concern among migrant and seasonal farmworker (MSFW) families in the US. The limited number of previously reported research on MSFW families suggests that their unique sociodemographic characteristics and lifestyle predispose them to poor health outcomes including OW/OB. We aimed to synthesize and assess available data on the prevalence and modifiable health determinants of OW/OB in MSFW children and adolescents. Literature search, study selection, data extraction and synthesis, and qualitative assessment of selected studies were performed independently by two authors. Ten cross-sectional studies met the inclusion criteria: articles or dissertations investigating prevalence and association between health determinants and OW/OB in MSFW children and adolescents (<20 years) in the US. The prevalence of OW, OB, and OW/OB ranged from 10%–33%, 15%–37%, and 31%–73%, respectively. Children’s education, household food insecurity, parents’ weight status, parents’ distorted perception of their children’s weight status, and parents’ participation in the federal nutrition assistance program were significantly associated with the children’s and adolescents’ risk of OW/OB. Promotion of culturally relevant public health programs and implementation of a systematic health surveillance plan for MSFWs and their children should be emphasized to combat OW/OB among MSFW children and adolescents.

The Impact of Head Start Enrollment Duration on Migrant Children's Health Outcomes

The purpose of this study is to examine whether family characteristics and the length of children's enrollment in Migrant Head Start affects children's health treatment. Children in the Michigan Migrant Head Start were classified depending on years of enrollments: One year (n = 638), two years (n = 293), and three or more years (n = 426). Logistic regression analyses were conducted to examine whether the probability of children receiving health treatment differed depending on years of enrollment. There is a higher health treatment rate among children who attended Head Start for multiple years than for those who attended for one year. Children's special needs status, of siblings, ethnicity, parental educational level, and marital status were related to preventative dental and physical health treatment outcomes. Although the primary goal of Head Start is school readiness rather than health improvement, migrant and seasonal farmworker children are likely to receive more health treatment if they attend more years of comprehensive intervention, such as Head Start, for positive physical and dental health.

Migrant farmworker mothers talk about the meaning of food

PURPOSE

To describe the meaning of food in the family life of migrant farmworker mothers; specifically to describe their understanding of the relationship of dietary intake to health, the environmental contributors to their families' dietary intake, and the use of foods in the commemoration of family occasions.

METHODS

The PRECEDE-PROCEED self-management model guided the qualitative research study, which used short, guided interviews conducted at Midwest migrant camps. A sample of 43 Mexican mothers answered three interview questions, the answers to which were transcribed verbatim, read, sorted, and arranged into categories and then themes. Thematic analysis was used to analyze the data.

RESULTS

The themes identified from the interviews were a) meal cost, b) lack of preparation time, c) distance to store locations, d) the importance of traditional ethnic foods, and e) limited knowledge of healthy food choices.

CLINICAL IMPLICATIONS

Pediatric nurses should remember that before they dispense nutritional anticipatory guidance, situational and cultural assessments are needed. Because vulnerable populations such as migrant farmworkers have limited resources to follow nurses' teachings, nurses need to become knowledgeable about what is available in the community to support these families. In addition, facility appointment times may need to be expanded to accommodate their long work hours, and modes of transportation need to be evaluated. Recommendations for anticipatory guidance, prescriptions, treatments, and over-the-counter items need to consider cost and ease in purchase, and cultural acceptability.

Pilot testing of a multicomponent home care intervention for older adults with heart failure: an academic clinical partnership

BACKGROUND

Heart failure (HF) has clinically significant psychological and physical consequences for older persons, and hospitalization for HF is frequent and costly to the Medicare program. As HF is the most common primary Medicare home care diagnosis, there is a critical need to develop home care services that improve heath-related outcomes for this population. The primary aim of this pilot study was to develop, implement, and test the initial feasibility and potential efficacy of the Home-Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities (HEART) trial, a nurse-directed multicomponent home care intervention. Observed outcomes were quality of life (QOL), depressive symptoms, and 90-day hospitalization.

METHODS

Twenty-four patients with a primary diagnosis of HF were assigned to the intervention (n = 12) or control group (n = 12) according to geographical location in a large multibranch Medicare-certified home health agency. Intervention group patients received 8 structured nurse education visits using evidence-based protocols designed in previous trials to teach HF self-management and to prevent/reduce depression, as well as a telemonitoring system. Control group patients received usual care and telemonitoring. Quality of life was assessed using the Minnesota Living With Heart Failure questionnaire. Depressive symptoms were assed using the Patient Health Questionnaire 9 at baseline and 90-day study end point.

RESULTS

Study protocols and instrumentation were found to be feasible and effective. Examination of enrollment data led to a reevaluation of eligibility criteria. Patients participating in the HEART intervention demonstrated significantly improved QOL (F = 8.99, P = .007) and significantly reduced depressive symptoms (F = 35.10, P = .001) in comparison to control group patients at the study end point. There was a trend toward lower hospital readmission rates in the intervention group (16% vs 25%), but this was not statistically significant.

CONCLUSION

This pilot study suggests that a full-scale trial of the HEART intervention is feasible.

Patterns and correlates of nutrition among migrant farm-worker children

Past research has demonstrated a higher incidence of overweight children in migrant farm-worker (MFW) families than in the general U.S. population. This study provided descriptive data on MFWs' acculturation, household food security, and general self-efficacy, and children's food patterns and body mass index. Convenience samples of 60 parent-child dyads were obtained from six MFW camps in two Midwest states. Acculturation and food security were low, higher general self-efficacy was associated with low acculturation, and the majority of children did not meet their U.S. Food Guide Pyramid recommendations. It was noteworthy that 48% of the sample, including siblings (excluded from data analysis), was overweight or obese. The knowledge learned concerning the food patterns and correlates of nutrition in this descriptive phase of the DINE study will direct counseling to MFW mothers on the purchase and preparation of affordable, nutritious, and culturally acceptable foods to achieve healthy weight in their children.

Food security and dietary intake in midwest migrant farmworker children

This article is a descriptive cross-sectional study with Latino migrant farmworker (MFW) families in Ohio. A demographic questionnaire, the U.S. Household Food Security Survey (USHFSS), and the Food Frequency Questionnaire were self-administered. Participants (N = 50) were primarily mothers of children with ages 2 to 13 years. USHFSS was 30% high, 18% marginal, 44% low, and 8% very low. Only 22% of the children met the minimum MyPyramid daily recommended food-group servings for age and gender. Knowledge gained from these data will influence development of culturally appropriate nutrition interventions to help Latino MFW families achieve healthier nutrition and weight in their children.

Health status in an invisible population: carnival and migrant worker children

One goal of Healthy People 2010 (2003) is to close the gap of disparities in access to care and health. The purpose of this descriptive exploratory study was to evaluate health status indicators in the children of itinerant carnival and migrant farmworkers aged birth to 12 years. Health status outcomes (immunization records, well-child examinations, dental health status, and growth parameters) were compared between the two groups and to national averages to identify health disparities. All forms were available in Spanish and English. A total of 97 children were recruited for this study: 45 carnival children and 52 migrant farmworker children.