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1.  Internet and Mobile Technology Use Among Urban African American Parents: Survey Study of a Clinical Population 
There is considerable potential for mobile technologies to empower pediatric patients and families by improving their communication with health professionals. National surveys suggest minority parents frequently communicate via mobile technology, but it is uncertain how amenable they are to receiving health care information in this format. Although the low cost and far reach characteristics of mobile health (mHealth) technology makes it advantageous for communication with minority parents, data on acceptance are needed.
The objective of the study was to determine utilization of mobile and Internet technology by African American parents in an urban, underserved population, and to assess their interest in receiving health information via text messaging or other technologies (eg, social media and the Internet).
A survey was administered to parents of children aged 1-12 years covered by public insurance receiving care at 3 pediatric primary care centers in Washington, DC.
The African American sample (N=302) was composed of primarily single (75.8%, 229/302) mothers. Almost half had more than a high school education (47.7%, 144/302) and incomes above US $25,000 per year (43.0%, 130/302). Most (97.0%, 293/302) reported owning a cell phone, of which 91.1% (275/302) used it to text and 78.5% (237/302) used it to access the Internet. Most had service plans with unlimited text and data, but 26.5% (80/302) experienced service interruptions in the previous year. Home Internet access was more prevalent among those with higher income (86.2%, 112/130), but it was still relatively pervasive among lower income families (66.9%, 83/124). In adjusted logistic regression models, African American mothers with income greater than US $25,000 annually were 4 times as likely to own a tablet computer than their lower income counterparts. Of the participants, 80.8% (244/302) used social networking, primarily Facebook, and 74.2% (224/302) were interested in joining a social networking group about a health topic concerning their child. Although relatively few African American mothers (17.9%, 54/302) shared health information via texting, there was strong interest in receiving health information via mobile phones (87.4%, 264/302). There was no significant difference in Internet/mobile device use or interest in using these outlets to send/receive information about their children’s health between parents of healthy children and parents of children with chronic health conditions.
Urban African American parents are active users of the Internet and mobile technology for social interactions, but they are less likely to use it for accessing or communicating health information. However, most parents expressed an interest in receiving health information or utilizing social networking to learn more about health topics. Mobile technology and social networks may be an underutilized method of providing health information to underserved minority populations.
PMCID: PMC3906691  PMID: 24418967
health communication; mobile phone; social networking, African Americans; pediatrics
2.  African American Parents’ Trust in their Child’s Primary Care Provider 
Academic pediatrics  2012;12(5):399-404.
Patients’ trust in their primary care providers has important implications in terms of health outcomes and, among minority patients, mitigating racial health disparities. This study aims to identify family, provider, and health care setting characteristics that predict African American parents’ trust in their child’s primary care provider and whether provider partnership building communication style explains this association.
Data were collected via retrospective telephone interviews completed 2 weeks after a child’s health care visit to one of seven pediatric primary care clinics in Washington, DC (3 community health centers, 3 private practices, and 1 hospital-based clinic). 425 self-identified African American parents of children 0–5 years of age participated. Parents completed several standard survey instruments about trust and provider communication style as well as demographic questionnaires about their family and their child’s provider.
A step-wise linear regression revealed significant independent effects of having a previous relationship with the provider and seeing a provider in a community health center (CHC) on higher trust. There was also evidence of mediation by provider communication style, suggesting that parents who take their child to a CHC report greater trust in their child’s provider because they have higher perceptions of provider partnership building.
African American parents’ trust in their child’s provider may be enhanced by continuity of care and greater use of a partnership building communication style by providers.
PMCID: PMC3455113  PMID: 22858071
parent-provider communication; trust in provider; African American
3.  Comparative Effectiveness of After-School Programs to Increase Physical Activity 
Journal of Obesity  2013;2013:576821.
Background. We conducted a comparative effectiveness analysis to evaluate the difference in the amount of physical activity children engaged in when enrolled in a physical activity-enhanced after-school program based in a community recreation center versus a standard school-based after-school program. Methods. The study was a natural experiment with 54 elementary school children attending the community ASP and 37 attending the school-based ASP. Accelerometry was used to measure physical activity. Data were collected at baseline, 6 weeks, and 12 weeks, with 91% retention. Results. At baseline, 43% of the multiethnic sample was overweight/obese, and the mean age was 7.9 years (SD = 1.7). Linear latent growth models suggested that the average difference between the two groups of children at Week 12 was 14.7 percentage points in moderate-vigorous physical activity (P < .001). Cost analysis suggested that children attending traditional school-based ASPs—at an average cost of $17.67 per day—would need an additional daily investment of $1.59 per child for 12 weeks to increase their moderate-vigorous physical activity by a model-implied 14.7 percentage points. Conclusions. A low-cost, alternative after-school program featuring adult-led physical activities in a community recreation center was associated with increased physical activity compared to standard-of-care school-based after-school program.
PMCID: PMC3747626  PMID: 23984052
4.  Health Protective Behaviors among Young People Living with HIV/AIDS 
Journal of AIDS & clinical research  2012;Suppl 1(13):7348.
Young people living with HIV/AIDS (YPLH) in the post-HAART era have the potential to manage their HIV as a chronic illness rather than as an almost inevitable terminal disease. However, little is known about behaviors YPLH can engage in to promote or protect health beyond taking anti-retroviral (ARV) medicines. The current study fills an important gap in existing research by identifying correlates of Health Protective Behaviors (HPB) within an urban sample of YPLH. Participants (n=134) were recruited from two pediatric clinics serving adolescents living with HIV who met the following criteria: HIV-infected and aware of their status, 13–24 years old, residing in the Washington, DC metropolitan area, currently prescribed ARV or due to begin ARV within 3 months, and able to understand and sign a written consent form. Each participant was interviewed via Audio computer-assisted self-interview (ACASI) and reported the percentage of possible time they engaged in six HPB during the prior month using a 10-point scale (e.g., 5=50%). Results indicate that most patients engaged in the measured health protective behaviors more than half the time, although patients 18 and older engaged in all HPB less frequently than their younger counterparts. Patients with adherence > 90% were far more likely to engage in HPB than those with poorer adherence. The age differences in HPB highlight a need for broader scaffolding in the transition to independent living and adult health care. Given the relationship between adherence and HPB, the establishment and maintenance of healthy lifestyle practices early in adolescence can translate into positive long-term health outcomes.
PMCID: PMC3535443  PMID: 23293748
HIV; Youth; Health behaviors; Adherence
5.  African American Parents' Perceptions of Partnership with their Child's Primary Care Provider 
The Journal of pediatrics  2011;159(2):262-267.
This study aimed to identify family, provider and healthcare setting characteristics associated with African American (AA) parents' perceptions of partnership with their child's primary care provider.
Study design
Data were collected via a telephone survey of 425 AA parents of 0-5 year-old children who had presented for a health visit 1-2 weeks prior at participating pediatric primary care practices in Washington, DC. Parents' perceptions of the level of partnership building by their child's provider were assessed using Street's Provider Communication Style instrument.
Multivariate logistic regression models indicated that, after adjusting for other family and provider/setting characteristics, parents seen in community health centers (CHCs) were more likely to report high partnership building compared with parents seen at private or hospital-based practices. Parents with at least a college level of education and those who described their child's provider's race as ‘other’ were most likely to report moderate partnership building.
Future studies should examine elements of care delivery at CHCs that may lead to better partnerships between parents and providers in private and hospital based practice setting.
PMCID: PMC3128207  PMID: 21429513
provider communication; primary care; parents
6.  Outbreak of Pneumonia in the Setting of Fatal Pneumococcal Meningitis among US Army Trainees: Potential Role of Chlamydia pneumoniae Infection 
BMC Infectious Diseases  2011;11:157.
Compared to the civilian population, military trainees are often at increased risk for respiratory infections. We investigated an outbreak of radiologically-confirmed pneumonia that was recognized after 2 fatal cases of serotype 7F pneumococcal meningitis were reported in a 303-person military trainee company (Alpha Company).
We reviewed surveillance data on pneumonia and febrile respiratory illness at the training facility; conducted chart reviews for cases of radiologically-confirmed pneumonia; and administered surveys and collected nasopharyngeal swabs from trainees in the outbreak battalion (Alpha and Hotel Companies), associated training staff, and trainees newly joining the battalion.
Among Alpha and Hotel Company trainees, the average weekly attack rates of radiologically-confirmed pneumonia were 1.4% and 1.2% (most other companies at FLW: 0-0.4%). The pneumococcal carriage rate among all Alpha Company trainees was 15% with a predominance of serotypes 7F and 3. Chlamydia pneumoniae was identified from 31% of specimens collected from Alpha Company trainees with respiratory symptoms.
Although the etiology of the outbreak remains unclear, the identification of both S. pneumoniae and C. pneumoniae among trainees suggests that both pathogens may have contributed either independently or as cofactors to the observed increased incidence of pneumonia in the outbreak battalion and should be considered as possible etiologies in outbreaks of pneumonia in the military population.
PMCID: PMC3121612  PMID: 21635754
Pneumonia; pneumococcal; Chlamydophila; pneumoniae; Military Personnel
7.  Maternal Distress Explains the Relationship of Young African American Mothers’ Violence Exposure With Their Preschoolers’ Behavior 
Journal of interpersonal violence  2010;26(3):580-603.
Adolescent mothers and their children are particularly susceptible to witnessing or directly experiencing violence. Such violence exposure predicts maternal distress, parenting, and child behavior problems. The current study examined how mothers’ depressive symptoms, aggression, harsh disciplinary practices, and home environment independently explain the association between mothers’ violence exposure and children’s externalizing and internalizing behavior, controlling for their children’s violence exposure. Data were collected from 230 African American mothers living in Washington, DC who gave birth as adolescents and whose children were 3 to 5 years old. Path analysis revealed that the effect of mothers’ experienced violence on children’s externalizing and internalizing behavior was mediated by mothers’ depressive symptoms and aggression. However, neither harsh discipline nor stimulation in the home environment acted as significant mediators, and there were no direct or indirect effects of mothers’ witnessed violence on child behavior. This study builds on previous work by identifying an association between maternal violence exposure and children’s behavior, independent of children’s own violence exposure that is explained by mothers’ increased distress but not their parenting. These findings suggest that a potential means of preventing behavior problems in minority children born to adolescent mothers is to identify mothers who have been directly exposed to violence and treat their depressive symptoms and aggressive behaviors.
PMCID: PMC3104723  PMID: 20448236
intergenerational transmission of trauma; mental health and violence; violence exposure; youth violence
8.  Stress among Fathers of Young Children with Type 1 Diabetes 
Although fathers’ stress has been shown to have important implications for children’s health and well-being, few studies of children with type 1 diabetes have considered paternal parenting stress. The current study contributes to the literature by exploring correlates of fathers’ pediatric parenting stress in a sample of young children with type 1 diabetes. Forty-three fathers of children 2–6 years old with type 1 diabetes completed self-report questionnaires examining pediatric parenting stress, child behavior, participation in diabetes management tasks, and parental psychological resources. Results of multiple regression show that fathers’ pediatric parenting stress is positively associated with state anxiety and mother-reported difficult child behavior. These findings suggest that fathers may experience parenting stress differently than mothers, and that their experiences may have implications not only for their own level of anxiety, but also for their children’s behavior.
PMCID: PMC2853761  PMID: 20047355
fathers; parenting stress; type 1 diabetes; early childhood
9.  Identification of P1 Variants of Mycoplasma pneumoniae by Use of High-Resolution Melt Analysis▿  
Journal of Clinical Microbiology  2009;47(12):4117-4120.
Mycoplasma pneumoniae is a leading cause of community-acquired pneumonia. Although two genetically distinct types of M. pneumoniae are known, variants of each also exist. We used a real-time PCR high-resolution melt genotyping assay to identify clinical variants which may provide greater insight into the genetic distribution of M. pneumoniae strains.
PMCID: PMC2786687  PMID: 19828737
10.  Violence Exposure and the Association between Young African American Mothers’ Discipline and Child Problem Behavior 
Academic pediatrics  2009;9(3):157-163.
Children of adolescent mothers are at increased risk of violence exposure and behavior problems, which have been linked to mothers’ disciplinary practices. This study examines how the effect of young African American mothers’ discipline on their preschool-age children’s externalizing and internalizing behavior varies by mother and child violence exposure.
Participants and Methods
A sample of 230 African American mothers who gave birth as adolescents and their 3- to 6-year-old children were recruited from community-based day care and primary health care sites in the Washington, DC metropolitan region. In-person interviews were conducted by trained research assistants using standard survey instruments.
Hierarchical regression models revealed an interaction effect such that adolescent mothers’ harsh disciplinary practices, specifically physical discipline strategies, were positively associated with young children’s internalizing and externalizing behavior in the context of high or moderate but not low maternal violence exposure.
As compared to less violence-exposed mothers, the harsh disciplinary practices of young African American mothers who have been exposed to high levels of violence are more strongly associated with their children’s problem behavior. Practitioners should screen mothers for violence exposure in order to address potential issues of discipline and behavior problems.
PMCID: PMC2730742  PMID: 19450775
violence exposure; child behavior; adolescent mothers; harsh discipline
11.  Mexican American Mothers and Fathers’ Prenatal Attitudes and Father Prenatal Involvement: Links to Mother-Infant Interaction and Father Engagement 
Sex roles  2009;60(7-8):510-526.
The present study examines the associations between Mexican American mothers’ and fathers’ pregnancy intentions, fathers’ participation in prenatal activities and mother-infant interactions and father engagement with 9 month-old infants in a nationally representative sample of 735 infants and their parents participating in the Early Childhood Longitudinal Study – Birth Cohort. After controlling for a host of variables, multiple regressions revealed that when mothers wanted the pregnancy, fathers engaged in more literacy and caregiving activities than when mothers did not want the pregnancy. When couples disagreed about wanting the pregnancy, fathers engaged in more literacy activities and showed more warmth than when they agreed. Relationship quality significantly moderated the effects of parents’ wantedness on mother-infant interactions and fathers’ engagement in literacy activities.
PMCID: PMC2839246  PMID: 20300483
pregnancy intentions; mother-child interactions; parent involvement
12.  Exploring Gender Differences in the Association Between Young African American Mothers’ Reports of Preschoolers’ Violence Exposure and Problem Behavior 
The prevalence of children’s violence exposure, particularly among ethnic minorities living in urban areas, is troubling. Gender differences in the rates and effects of violence exposure on behavior have been found for older children, and the current study extends this research to preschool-age children. We draw on data collected from a sample of 3- to 5-year-olds born to 230 adolescent African American mothers living in Washington, DC. Girls and boys were exposed to comparable levels of witnessed and directly experienced violence. In contrast to findings from studies of older children, preschool-age boys’ and girls’ externalizing and internalizing behavior were comparably associated with directly experienced and witnessed violence. These findings highlight the importance of further developmental research to differentiate the effects of violence exposure as children grow older.
PMCID: PMC2829725  PMID: 20183643
13.  An Exploratory Study of Fathers’ Parenting Stress and Toddlers’ Social Development in Low-Income African American Families 
Fathering  2009;7(3):201-225.
The present study tested Abidin’s (1992) parenting stress model in a sample of low-income African American fathers and their toddlers, specifically examining the mediation effect of fathers’ engagement (self-report and observed) on the association between parenting stress and children’s social competence and problem behavior. We found that fathers reported moderate levels of parenting stress, but we found no evidence of a direct effect of stress on children’s social development. However, parenting stress predicted more engagement in management, which predicted children’s increased problem behaviour. These findings highlight the effect of fathering stress on specific forms of father engagement that affect toddlers’ social development.
PMCID: PMC2828951  PMID: 20190875
low-income; minority; parenting stress; engagement; social development
14.  Low-Income Nonresident Father Involvement with their Toddlers: Variation by Fathers' Race and Ethnicity 
Using data from a racially and ethnically diverse sample of low-income mothers of two-year-old children participating in the Early Head Start Research and Evaluation Project (N = 883), fathers' education and employment, mother-father relationship, and mothers' relationships with kin in the household were examined to explain variation in nonresident father involvement across racial and ethnic groups. Nonresident White fathers were less involved with their children than African-American and Latino fathers. This difference was explained by the status of mother-father relationships. White nonresident fathers were less likely than minority nonresident fathers to maintain romantic relationships with their child's mother. Mothers in the White father group were also more likely to re-partner, which negatively related to biological fathers' involvement. These findings suggest that approaches to strengthen nonresident father involvement in children's lives need to consider how father ethnicity and mother-father relations are associated with differential patterns of father involvement.
PMCID: PMC2819146  PMID: 18729678
Nonresident Fathers; Father Involvement; Racial and Ethnic Variation in Fathering; Low-Income Fathers; Predictors to Father Involvement; Mother-Father Relationship
15.  Genotyping of Chlamydophila psittaci by Real-Time PCR and High-Resolution Melt Analysis▿  
Journal of Clinical Microbiology  2008;47(1):175-181.
Human infection with Chlamydophila (Chlamydia) psittaci can lead to psittacosis, a disease that occasionally results in severe pneumonia and other medical complications. C. psittaci is currently grouped into seven avian genotypes: A through F and E/B. Serological testing, outer membrane protein A (ompA) gene sequencing, and restriction fragment length polymorphism analysis are currently used for distinguishing these genotypes. Although accurate, these methods are time-consuming and require multiple confirmatory tests. By targeting the ompA gene, a real-time PCR assay has been developed to rapidly detect and genotype C. psittaci by light-upon-extension chemistry and high-resolution melt analysis. Using this assay, we screened 169 animal specimens; 98 were positive for C. psittaci (71.4% genotype A, 3.1% genotype B, 4.1% genotype E, and 21.4% unable to be typed). This test may provide insight into the distribution of each genotype among specific hosts and provide epidemiological and epizootiological data in human and mammalian/avian cases. This diagnostic assay may also have veterinary applications during chlamydial outbreaks, particularly with respect to identifying the sources and tracking the movements of a particular genotype when multiple animal facilities are affected.
PMCID: PMC2620869  PMID: 19005152
16.  Evaluation of Three Real-Time PCR Assays for Detection of Mycoplasma pneumoniae in an Outbreak Investigation▿  
Journal of Clinical Microbiology  2008;46(9):3116-3118.
We compared the performances of three recently optimized real-time PCR assays derived from distinct genomic regions of Mycoplasma pneumoniae during an outbreak. Comprehensive evaluation established that a newly described toxin gene represents a superior target for detecting M. pneumoniae DNA in clinical specimens, although use of multiple targets may increase testing confidence.
PMCID: PMC2546712  PMID: 18614663
17.  Fgfr4 is required for effective muscle regeneration in vivo: Delineation of a MyoD-Tead2-Fgfr4 transcriptional pathway 
The Journal of biological chemistry  2005;281(1):429-438.
Fgfr4 has been shown to be important for appropriate muscle development in chick limb buds, however, Fgfr4 null mice show no phenotype. Here, we show that staged induction of muscle regeneration in Fgfr4 null mice becomes highly abnormal at the time point when Fgfr4 is normally expressed. By 7 days of regeneration, differentiation of myotubes became poorly coordinated and delayed by both histology and embryonic myosin heavy chain staining. By 14 days, much of the muscle was replaced by fat and calcifications. To begin to dissect the molecular pathways involving Fgfr4, we queried the promoter sequences for transcriptional factor binding sites, and tested candidate regulators in a 27 time point regeneration series. The Fgfr4 promoter region contained a Tead protein binding site (M-CAT 5′-CATTCCT-3′), and Tead2 showed induction during regeneration commensurate with Fgfr4 regulation. Co-transfection of Tead2 and Fgfr4 promoter reporter constructs into C2C12 myotubes showed Tead2 to activate Fgfr4, and mutation of the M-CAT motif in the Fgfr4 promoter abolished these effects. Immunostaining for Tead2 showed timed expression in myotube nuclei consistent with the mRNA data. Query of the expression timing and genomic sequences of Tead2 suggested direct regulation by MyoD, and, consistent with this, MyoD directly bound to two strong E-boxes in the first intron of Tead2 by chromatin immunoprecipitation assay. Moreover, co-transfection of MyoD and Tead2 intron reporter constructs into 10T1/2 cells activated reporter activity in a dose dependent manner. This activation was greatly reduced when the two E-boxes were mutated. Our data suggest a novel MyoD-Tead2-Fgfr4 pathway important for effective muscle regeneration.
PMCID: PMC1892582  PMID: 16267055
Muscle regeneration; Tead; TEF; Fgfr; MyoD; Microarray
18.  Inter-Platform comparability of microarrays in acute lymphoblastic leukemia 
BMC Genomics  2004;5:71.
Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy and has been the poster-child for improved therapeutics in cancer, with life time disease-free survival (LTDFS) rates improving from <10% in 1970 to >80% today. There are numerous known genetic prognostic variables in ALL, which include T cell ALL, the hyperdiploid karyotype and the translocations: t(12;21)[TEL-AML1], t(4;11)[MLL-AF4], t(9;22)[BCR-ABL], and t(1;19)[E2A-PBX]. ALL has been studied at the molecular level through expression profiling resulting in un-validated expression correlates of these prognostic indices. To date, the great wealth of expression data, which has been generated in disparate institutions, representing an extremely large cohort of samples has not been combined to validate any of these analyses. The majority of this data has been generated on the Affymetrix platform, potentially making data integration and validation on independent sample sets a possibility. Unfortunately, because the array platform has been evolving over the past several years the arrays themselves have different probe sets, making direct comparisons difficult.
To test the comparability between different array platforms, we have accumulated all Affymetrix ALL array data that is available in the public domain, as well as two sets of cDNA array data. In addition, we have supplemented this data pool by profiling additional diagnostic pediatric ALL samples in our lab. Lists of genes that are differentially expressed in the six major subclasses of ALL have previously been reported in the literature as possible predictors of the subclass.
We validated the predictability of these gene lists on all of the independent datasets accumulated from various labs and generated on various array platforms, by blindly distinguishing the prognostic genetic variables of ALL. Cross-generation array validation was used successfully with high sensitivity and high specificity of gene predictors for prognostic variables. We have also been able to validate the gene predictors with high accuracy using an independent dataset generated on cDNA arrays.
Interarray comparisons such as this one will further enhance the ability to integrate data from several generations of microarray experiments and will help to break down barriers to the assimilation of existing datasets into a comprehensive data pool.
PMCID: PMC522810  PMID: 15387886

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