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This Month in Archives of Pediatrics and Adolescent Medicine
June 06, 2011

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Pediatr Adolesc Med. 2011;165(6):486. doi:10.1001/archpediatrics.2011.81
Effects of a Peer-Led Asthma Self-management Program for Adolescents

While self-management of chronic illness is a cornerstone of the chronic care model, insufficient effort has been directed toward developing and evaluating asthma self-management interventions for adolescents. This randomized controlled trial evaluated the effectiveness of a peer-led program implemented in a camp setting in improving asthma outcomes in 112 adolescents with asthma. The peer-led asthma program yielded greater improvement in attitudes and quality of life compared with the adult-led program. The study provides compelling empirical evidence that an asthma self-management program assisted by peer leaders is a viable and developmentally appropriate option for adolescents with asthma alternative to paternalistic models of asthma programs for adolescents.

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Effect of the intervention on quality of life in male (A) and female (B) adolescents.

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Use of a DASH Food Group Score to Predict Excess Weight Gain

The DASH (Dietary Approach to Stop Hypertension) diet emphasizes increased intakes of low-fat dairy products, fish, chicken, lean meats, fruits, vegetables, nuts, whole grains, and legumes. This study examined the effects of adherence to a DASH-style eating plan and its components on the change in body mass index (BMI) in a racially diverse sample of adolescent girls over a 10-year follow-up period. Those who consumed 2 or more servings of fruit per day had the smallest gain in BMI over time and the lowest BMI at the end of follow-up. Higher intake of low-fat dairy products led to lower BMI gains as well. There was no difference in BMI according to intake of vegetables. Greater consistency with the DASH eating plan resulted in lower excess weight gains among girls from early adolescence to young adulthood.

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Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) over 10 years associated with low-fat dairy products intake (mean servings per day).

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Effectiveness of a Citywide Patient Immunization Navigator Program

Immunization rates in adolescents remain low and disparities exist, with low-income and minority adolescents having poorer rates. This was a randomized controlled clinical trial in 8 urban practices in Rochester, New York, to evaluate the impact of tiered tracking, reminder/recall, and outreach on adolescent immunization and preventive health care visit rates. Immunization rates at the end of the study for individual vaccines and for all 3 vaccines combined (including human papillomavirus for girls) were 12 to 16 percentage points higher for the intervention group than for the control group. Preventive care visit rates for each age group were 9 to 17 percentage points higher for the intervention group. The intervention had greater effects on immunization rates for black or Hispanic adolescents than for white adolescents. These outcomes were accomplished primarily through telephone reminder/recall, with home visits for 12% of adolescents. The immunization navigator intervention cost was $3.81 per adolescent per month.

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Hospital-Based Comprehensive Care Programs for Children With Special Health Care Needs

Little is known to date about the effect of hospital-based programs focused on comprehensive care for children with special health care needs. This systematic review identified 17 programs for children with a single disease and 16 programs for those with multiple chronic illnesses. Improved outcomes most commonly reported were efficiency of care (64%), effectiveness of care (60%), and patient or family centeredness (53%). Outcomes less commonly evaluated were patient safety (9%), timeliness of care (6%), and equity of care (0%). Most studies of comprehensive hospital-based programs report positive results, but the quality of the evidence is modest overall. The evidence supporting the development of programs for children with special health care needs is restricted primarily to studies of children with categorical diseases and is limited by inadequate outcome measures.

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