General Pediatrics and Adolescent Health Research
School Anti-Bullying Policies: What Factors Influence Student Bullying and Adjustment?
Students who bully or are bullied by others experience a host of adjustment problems. Yet schools have had difficulty gaining traction in attempts to address school bullying. This project examines how school anti-bullying policies and practices are related to student behavior. We are particularly interested in identifying school practices that are related to less bullying involvement by students and which protect targets of bullying from adjustment problems such as emotional distress or school disconnection. This project also examines aspects of school climate and policies that protect lesbian, gay, and bisexual (LGB) youth from bullying. We combine primary data collection of school anti-bullying policies and practices and school climate for LGB students with secondary data analysis of the 2013 Minnesota Student Survey, a state-wide survey of Minnesota youth in grades 8, 9, and 11. Results from this study will inform school policy creation and the development of prevention programs.
Mindfulness and Health in Homeless and Highly Mobile Children
Homelessness impacts over 5000 of Minnesota's children every year -- a rate that has been climbing since 2008. Living without a stable home puts enormous stress on families and youth, who deal with even more chronic health conditions than those who live in poverty but have a stable home. Direct help is sorely needed because asthma, insomnia, obesity, and emotional and behavioral problems are extraordinarily common in these children and significantly interfere with their lifelong development. Our transformative approach is to enhance homeless children’s resilience by building their skills in mindfulness to promote a healing response to the stress they face every day. With our collaborators at the University’s internationally-recognized Institute for Child Development, we have established research partnerships with several local non-profit shelters and supportive housing communities to highlight the magnitude of the problem and to demonstrate the feasibility of a novel mindfulness-based approach to insomnia among homeless young children. We have strong synergies with the closely-allied work of expert colleagues in the Division of General Pediatrics and Adolescent Health, the Clinical and Translational Sciences Institute, and the Center for Neurobehavioral Development. Future research will examine the preventive power of this intervention among a larger number, and wider age-range, of children.
Comfort and Self-Care Among Hospitalized Children
Persistent, impairing pain impacts 5-10% of hospitalized children, in spite of ongoing improvements to assess and adequately treat it. Children who are predisposed chronic pain tend to be more reactive to stress and require more opiate medications when hospitalized than children who have good pain relief, necessitating a complementary non-pharmacological approach to their treatment. Our innovative work aims to boost these children’s competence in self-soothing and internal comfort, using strategies such as mindfulness, self-hypnosis, and computerized biofeedback that are aimed at decreasing their stress reactivity and improving their responsiveness to support. Our current projects aim at revealing how novel child factors, such as the development of the brain’s capacity for executive function, can be viewed as targets for these kinds of pain interventions, building on our research team’s expertise in using these mind-body approaches with children. This work synergizes well with that of collaborators in Hematology-Oncology, Integrative Pediatrics, and Pediatric Surgery. Future research will include trials of adaptive interventions and tailored treatments for children suffering with chronic pain.
School-based risk and protective factors and peer-harassment of vulnerable youth
School bullying is one of the most significant public health concerns facing youth today. However, most U.S. school-based programs show no or modest improvements on students’ behavior. The long term goal of this project is to uncover new characteristics of schools and individuals that are associated with harassment experiences among students, in order to move the field forward with new approaches to prevention. In order to achieve this goal, our primary objective is to conduct secondary data analyses that examine school characteristics associated with harassment for all students as well as vulnerable subpopulations, using a very large and uniquely suitable statewide survey of youth in Minnesota.
This study includes the following research questions:
- What school characteristics are associated with victimization and perpetration of physical, relational, cyber and prejudice-driven harassment?
- What are the harassment experiences of particularly vulnerable youth populations, including those who identify as gay, lesbian or bisexual (GLB), are overweight or have a physical or mental disability, and how are school characteristics associated with this experience?
- Is the well-established relationship between harassment victimization and perpetration and emotional well-being (depressive symptoms, self-harm, suicide) modified by school-level characteristics or membership in a vulnerable group?
Education in Pediatrics Across the Continuum (EPAC)
Rationale: The current four-year time-based curriculum in UME resulted from the Flexner report of 1910. Despite reports indicting the current system and calling for widespread change medical education remains time- and tradition-based. Competency-based education holds promise for addressing the suggested reforms but few have attempted to test a time-variable educational pathway in the formation of a physician. This pilot project seeks to do just that.
Brief Project Plan: Four pilot schools were chosen for demographic diversity and commitment to education. Each site will select 4-5 students/year identifying pediatrics as their specialty choice early in medical school. These students will be guaranteed a residency position at the same institution. They will advance through the medical school and residency clinical curricula based primarily on demonstrated competence. At the University of Minnesota, we will be enrolling students in a pediatrics-focused longitudinal clerkship in May 2015 based at the University of Minnesota Children's Hospital. This clerkship will meet the requirements of all of their core clerkships and allow for meaningful longitudinal relationships with patients, faculty, and multidisciplinary staff.
Local EPAC team:
Patty Hobday, Course Director
John Andrews, Project Director
Emily Borman-Shoap, GME Director
Katherine (Betsy) Murray, UME Director
Food Access & Adequacy Project: Maternal health prior to, and during, pregnancy are critical for fetal and infant health. Past research has shown that depression and anxiety increases women's risk for health problems during pregnancy and affect infants' development as well; however, studies have not been focused on incarcerated women, who are at increased risk for these vulnerabilities. This study aims to identify concerns of incarcerated women of reproductive age regarding food access and adequacy, determine the feasibility of administering daily food diaries to this population, and test whether women's perceptions of food access and adequacy are associated with depressive symptoms and identify whether this association is similar for pregnant, compared to non-pregnant women, or reproductive age.
Isis Rising: Isis Rising is a prison‐based pregnancy, birth, and parenting program provided to incarcerated women at the prison in Shakopee, Minnesota. The program includes a weekly support group facilitated by trained and experienced doulas, as well as individualized support for expectant incarcerated mothers. Through a generous pilot grant from the University of Minnesota’s Clinical and Translational Science Institute and the Program in Health Disparities Research, we are currently evaluating Isis Rising.
Observational Jail Studies: Children of incarcerated parents are at risk for cognitive delays, internalizing (e.g., depression) and externalizing problems (e.g., delinquency). Visits during the parent’s incarceration have the potential to reduce these risks. One research project at the University of Wisconsin observed and assessed these interactions between children and their jailed parents; however it focuses exclusively on younger children (2-6 years). Through funding from the UMN Office of the Vice President for Research, I will adapt the observational protocol for older children and adolescents (7-17 years), examine the visit quality as a potential protective factor, and study associations between children’s developmental outcomes and characteristics of their jailed parents.
In a second study, jointly funded by the University of Minnesota Clinical & Translational Science Institute and University of Wisconsin Institute for Clinical & Translational Research, an intervention utilizing the Little Children, Big Challenges: Incarceration materials designed for children of incarcerated parents will be implemented during jail visits. The proposed intervention will be evaluated for efficacy and impact on children’s short-term outcomes. More information
Sesame Street Dissemination Project: children who have an incarcerated parent through the use of interactive and age-appropriate (3-8 years) resources. Each kit contains a Sesame Street DVD featuring a muppet story, a guide for parents and caregivers, and a children’s storybook. An overview of the pilot program is available here and additional online resources can be accessed on the Sesame Street website.
Little Children, Big Challenges: Incarceration is designed to:
- Support, comfort, and reduce anxiety, sadness, and confusion that young children may experience during the incarceration of a parent,
- Provide at-home caregivers with strategies, tips, and age-appropriate language they can use to help communicate with their children about incarceration, and
- Inform incarcerated parents themselves that they can parent from anywhere, and provide them with simple parenting tips highlighting the importance of communication.
Arkansas, California, Florida, Illinois, New York, Oklahoma, Texas, Virginia, and Wisconsin are the other states involved in piloting the new program. More information