Mark A. Schuster - US grants

DESCRIPTION (provided by applicant): An estimated 16,600 U.S. children (<18 years) were orphaned by AIDS in 1996, and there were over 120,000 children with parents receiving care for HIV in 1996-97. The population of children with HIV+ parents is growing because of demographic shifts in the epidemic and increases in life expectancy of HIV+ people. Although only a small percentage of the children are infected, virtually all will be affected by HIV. Parents living with HIV often have limited financial, social, and emotional resources. Parents may intermittently be too ill to take care of children, and if parents die, children will need to be permanently cared for by others. Prior studies provide valuable data on some topics related to these children, but there has been no prior national probability sample. We propose to study this population to gain a better understanding of important issues in the lives of HIV+ parents and their children. Our specific aims are to examine: (1) factors associated with HIV+ parents retaining, giving up, or losing custody of their children, and the effect custody arrangements have on parent and child, (2) what guardianship plans HIV+ parents have made in case of incapacitation or death, what factors influence planning, whether parents involve their children in planning, and what resources would help them address guardianship issues, (3) what factors influence parents to disclose their infection to children, reasons for disclosure and non-disclosure, and impact of disclosure on parent and child, and (4) how HIV affects parenting behaviors and the parent-child relationship, important stresses and challenges for parents and children, and the role of social support in helping parents take care of children. We propose a two-phase study to address the aims. In Phase I, we will analyze data on 848 parents with 1.635 children from the HIV Cost and Services Utilization Study (HICSUS), a nationally representative study of people receiving care for HIV in the U.S. In Phase II, we will conduct semi-structured interviews with a subsample of 108 parents and about 71 of their children (7-17 years old). We will stratify by respondent gender, race/ethnicity, age of children, and amount of contact respondent has with children. We will use the interviews to explore important patterns found in the quantitative analyses. We will also examine topics not covered in detail in the quantitative data (e.g., social supports) and topics not naturally amenable to survey research (e.g., decision-making processes related to disclosure of parental HIV to children and guardianship planning). We will compare the parent and child perspectives on the impact of HIV on families and, in particular, on children.

[unreadable] DESCRIPTION (provided by applicant): With NIMH funding, we developed Talking Parents, Healthy Teens, a worksite-based program to help parents of 6th-10th graders learn to communicate with their children and promote healthy sexual development and risk reduction. The skills-based program is administered in 8 weekly one-hour lunchtime sessions to groups of 15 parents at worksites. In a randomized controlled trial, intervention and control parents complete surveys pre-intervention and at 0, 3, & 9 months post-intervention. Youth do not attend sessions but complete mail surveys. We have conducted the program at 10 sites (430 parents, 541 youth) and are scheduled at 5 more sites (180 parents, 227 youth). Preliminary analyses show significant improvement in short-term parent-child communication outcomes, which have the potential to mediate longer-term sexual behavior outcomes. Most youth in our study have not reached the average age of intercourse initiation; so long-term follow-up is critical to evaluate the program's full impact. We are applying for continuation funds to follow parents and youth every 6 months for 4 more survey waves (15, 21,27, 33 months). If the program has the hypothesized effects on behavior, we will have provided strong evidence for a causal link between parenting practices and adolescent sexual health behaviors. Our specific aims are to: (1) determine whether the program reduces sexual risk over several years, (2) assess persistence of program effects on parenting behaviors, parent-child relationships, and communication, (3) determine whether key components of our behavior change model mediate changes over time in parent-child relationships and adolescent behaviors, (4) explore subgroup differences in program effectiveness over time, (5) determine program effects on behavior of youth who received a substantial amount of the intended parenting practices, (6) determine whether the program affects adolescents' communication with peers and romantic/sexual partners about sexual topics and affects their relationships with peers and partners. [unreadable] [unreadable]

[unreadable] DESCRIPTION (provided by applicant): Children with special health care needs (CSHCN) make up 15% of all children and account for the majority of pediatric health expenditures. Parents of CSHCN experience greater work disruptions than other parents, largely due to episodic exacerbations of their children's chronic illnesses. Thus, for parents of CSHCN, the availability and type of family leave may be critical. In July 2004, the California (CA) Paid Family Leave Insurance (PFLI) program took effect, providing 6 weeks of paid leave for most employees and making CA the first state to legislate paid family leave. This controversial program markedly expands the current federal family leave law, which guarantees only unpaid family leave. Because the employment and leave-taking needs and behaviors of parents of CSHCN are not well understood, the effects of new policies are difficult to predict. Before PFLI began, we completed a baseline phone survey of 570 parents of CSHCN in CA and 572 in Illinois (which does not have PFLI). Preliminary analyses suggest major conflicts between child illness and parent employment, as well as the importance of family leave. We seek funds to conduct follow-up surveys of baseline parents (for longitudinal analyses) and surveys of a new cohort of parents (for successive cohort analyses) about three years after the baseline survey. Our study, the first to assess PFLI's effects on employment, leave-taking, and child and parent health among families with CSHCN, will provide critical information for researchers, parents, policy-makers, employers, and clinicians. Our specific aims are to: (1) examine how PFLI, child illness, and other factors affect employment and leave-taking among parents of CSHCN; and (2) assess how use of PFLI and other family leave options affect parents' ability to care for children, children's quality of life, parents' mental health, and parents' employment. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Over one-third of US adolescents are obese or overweight, and large racial/ethnic disparities exist in obesity/ overweight rates. In the racially/ethnically diverse Los Angeles Unified School District (LAUSD), the second largest US school district and the community partner for this application, obesity and overweight prevalence (46%) is higher than the national average, und Black and Latino students have the highest prevalence. We have partnered with LUUSD to translate obesity policy into practice through NlMHD's R24 community-based participatory research (CBPR) Planning and Intervention Grants, for which we developed, pilot tested, and conducted a randomized controlled trial of our middle-school-based obesity prevention intervention, Students for Nutrition and exercise (SNaX). In this Dissemination Phase application, we seek funds to transition the intervention from research to practice. SNaX is a multi-level intervention that includes changes to the school food environment (e.g., sliced fruit and vegetable offerings; informational signage; free water at lunchtime), peer advocacy, and school-wide multimedia promotion. Our RCT results showed that SNaX is both effective at increasing healthy eating and cost-effective, and thus meets criteria as an evidence-based program worthy of dissemination. The specific aims are to use a theory-driven strategy and CBPR principles: 1) to synthesize and disseminate information about adolescent obesity prevention in general and SNaX in particular to community and academic stakeholders; 2) to enhance the general organizational and program- specific capacity of LAUSD to implement SNaX and maintain delivery of SNaX beyond the project period; 3) to disseminate and implement the SNaX program in LAUSD middle schools; and 4) to evaluate the SNeX dissemination and implementation process, including the domains of program reach, recruitment, efficacy, adoption, retention, implementation fidelity, and maintenance. We plan to use an iterative process, in which we initially launch dissemination in LAUSD's North region. We will evaluate and refine the dissemination process using a validated framework that includes program facility checklists, debriefing interviews with staff and students, and analyses of cafeteria records and physical fitness data. After the dissemination test, LAUSD plans to implement SNaX in middle schools across the rest of the district. Ultimately, we intend to find ways to disseminate SNaX more broadly, using lessons learned from the LAUSD dissemination process to guide entry into other school districts. Our goal is to bring obesity prevention out of the research realm and into communities, and thereby achieve enduring real-world changes in public health through the reduction and eventual elimination of disparities.

DESCRIPTION (provided by applicant): We propose to establish the Children's Hospital Boston Collaborative Center for Community Health Research (the "Center"), which will build participatory community-academic research partnerships to improve child health research and community research capacity. Using principles of community-based participatory research (CBPR), the Center will bring together community practitioners and academic researchers in Boston in a partnership that has the potential to transform the way complex public health issues and racial/ethnic disparities are addressed in both research and public health practice. The foundation of the Center will be a partnership among 4 cornerstones of children's health and education in Boston that have a history of effective collaboration: Children's Hospital Boston/Harvard University, the Boston Public Health Commission (the public health department), the Boston Public Schools, and the Boston Conference of the Massachusetts League of Community Health Centers. The Center will be run collaboratively by a Director (and Principal Investigator) from Children's Hospital Boston, and a Community Research Associate (CRA) from the Boston Public Health Commission. It will be organized into 3 cores-Research, Education, and Dissemination-each of which will be co-led by a representative from the community and from Children's Hospital Boston. We will initially focus on four child health topics that emerged in a systematic community needs assessment conducted by Children's Hospital Boston in November, 2009: (a) asthma, (b) mental health, (c) obesity, and (d) unintended pregnancy and HIV/STIs. The specific aims of the Center are to: (1) build infrastructure to conduct outstanding community-partnered research that draws on a range of disciplines and methodologies to study issues related to the health and health care needs of Boston's children (0-18-years-old) and families;(2) design education strategies to train a new generation of academic and community members in principles of and skills for community-partnered research;and (3) promote dissemination of research findings to stakeholders and develop products that will benefit community partners, the greater Boston community, and beyond. PUBLIC HEALTH RELEVANCE: The proposed project aims to create a sustainable community-based participatory research (CBPR) center that brings together Boston community representatives and Children's Hospital Boston/Harvard University faculty and students. We seek to become a trusted and respected center of excellence for rigorous community- partnered research that improves the health and well-being of Boston's children and families and serves as a national model for community-academic partnerships.

DESCRIPTION (provided by applicant): Project Summary/Abstract Healthy Passages is a three site longitudinal study of adolescent health that focuses on risk and protective factors, health behaviors (e.g., dietary practices, physical inactivity, tobacco use, and violent activity), and health outcomes (e.g., diabetes, obesity, and sexually transmitted diseases) for a fifth grade cohort that is being followed biennially from ages 10 to 20 years. Healthy Passages is designed to advance the research literature on child and adolescent health in several ways. It collects data on a broad range of outcomes and a comprehensive, multilevel set of factors (e.g., biological, family, peer, school, and neighborhood) to function as predictors of the occurrence, maintenance, and change of health risk and protective behaviors across time. In addition, Healthy Passages provides biennial in-depth assessment of 5,147 youth (and their primary caregiver) over multiple years (from fifth grade through two years post high school) to collect data needed to characterize the primary influences on adolescent health risk and protective behaviors and health and educational outcomes. The overarching objective of Healthy Passages is to provide an empirical basis for effective policies and intervention programs to promote the health and optimal development of adolescents and young adults. To accomplish the project's goals, a two-staged probability sampling procedure was used to select and enroll 5,147 fifth grade students from schools in Birmingham, AL, Houston, TX, and Los Angeles, CA to ensure a sufficient sample size of African Americans, Hispanics, and non- Hispanic whites, to support precise statistical inferences. Data collection began in 2004 and is planned to continue for 10 years (and possibly beyond). Data collection for Wave 1 (grade 5) and Wave 2 (grade 7) was completed during the previous 5-year funding cycle. Wave 3 (grade 10) interviews began in January 2010 with the first half of the cohort. To complete the next stage of longitudinal research, we are currently seeking funding to continue Healthy Passages at the Los Angeles site for five more years from September 2010 to September 2015. The next five years of the project will be devoted to completing the Wave 3 (10th grade), Wave 4 (12th grade), and Wave 5 (one year post-high school) data collection;tracking of enrolled study participants to maintain up-to-date contact information between survey waves;continued scientific oversight, program management, and community collaboration;cleaning, preparing and managing data files;computing variables and running statistical analyses;analyzing data, writing papers, preparing presentations, and disseminating findings;and measurement development and planning for Waves 4 - 5 and beyond.