Explore the vast range of titles available.

The outcome of flourishing and its predictors have not been well documented among US children, especially those who face adversity. Using data for 2016 and 2017 from the National Survey of Children's Health, we determined the prevalence and predictors of flourishing among US children ages 6-17. A three-item index included indicators of flourishing: children's interest and curiosity in learning new things, persistence in completing tasks, and capacity to regulate emotions. The national prevalence of flourishing was 40.3 percent (29.9-45.0 percent across states). At each level of adverse childhood experiences, household income, and special health care needs, the prevalence of flourishing increased in a graded fashion with increasing levels of family resilience and connection. Across the sectors of health care, education, and human services, evidence-based programs and policies to increase family resilience and connection could increase flourishing in US children, even as society addresses remediable causes of childhood adversity.

Background Exposure to adverse childhood experiences (ACEs) and being female are distinct risk factors for having a major depressive episode (MDE) or an anxiety disorder (AD) in adulthood, but it is unclear whether these two risk factors are synergistic. The purpose of this study was to determine whether exposure to ACEs and being female are more than additive (synergistic) in their association with MDE and AD in US adults. Methods We pooled cross-sectional survey data in the Midlife in the United States study from two nationally-representative cohorts of English-speaking US adults. Data from the first cohort were collected in 2004–2006 and from the second in 2011–2014. Data from both cohorts included the 12-month prevalence of MDE and AD (generalized anxiety disorder or panic disorder) assessed with the Composite International Diagnostic Interview Short Form, gender (here termed female and male), and the count of five categories of exposure to ACEs: physical, sexual, or emotional abuse; household alcohol or substance abuse; and parental separation or divorce. Results Of the 5834 survey respondents, 4344 (74.5%) with complete data on ACEs were included in the analysis. Mean (SD) age was 54.1 (13.8) years and 53.9% were female. The prevalences of MDE, AD, and exposure to 3–5 categories of ACEs were 13.7, 10.0, and 12.5%, respectively. After adjusting for covariates (age, race, and current and childhood socioeconomic disadvantage), for those with both risk factors (female and 3–5 ACEs) the prevalence of MDE was 26.9%. This was 10.2% (95% CI: 1.8, 18.5%) higher than the expected prevalence based on the additive associations of the two risk factors. The adjusted prevalence of AD among females with 3–5 ACEs was 21.9%, which was 11.4% (95% CI: 4.0, 18.9%) higher than the expected prevalence. Conclusions For both MDE and AD, there was synergy between the two risk factors of exposure to ACEs and being female. Identification and treatment of MDE and AD may benefit from understanding the mechanisms involved in the synergistic interaction of gender with ACEs.

Background The prevalence of obesity among preschool-aged children has increased, especially among those in low-income households. Two promising behavioral targets for preventing obesity include limiting children’s portion sizes and their intake of foods high in solid fats and/or added sugars, but these approaches have not been studied in low-income preschoolers in the home setting. The purpose of this study was to understand the contextual factors that might influence how low-income mothers felt about addressing these behavioral targets and mothers’ aspirations in feeding their children. Methods We recruited 32 English-speaking women in Philadelphia, Pennsylvania who were eligible for the Supplemental Nutrition Assistance Program and who were the biologic mothers of children 36 to 66 months of age. Each mother participated in 1 of 7 focus groups and completed a brief socio-demographic questionnaire. Focus group questions centered on eating occasions, foods and drinks consumed in the home, and portion sizes. Each focus group lasted 90 minutes and was digitally recorded and transcribed verbatim. Three authors independently identified key themes and supporting quotations. Themes were condensed and modified through discussion among all authors. Results Thirty-one mothers identified themselves as black, 15 had a high school education or less, and 22 lived with another adult. Six themes emerged, with three about aspirations mothers held in feeding their children and three about challenges to achieving these aspirations. Mothers’ aspirations were to: 1) prevent hyperactivity and tooth decay by limiting children’s sugar intake, 2) use feeding to teach their children life lessons about limit setting and structure, and 3) be responsive to children during mealtimes to guide decisions about portions. Especially around setting limits with sweets and snacks, mothers faced the challenges of: 1) being nagged by children’s food requests, 2) being undermined by other adults in the family, and 3) having bad memories from childhood that made it hard to deny children’s food requests. Conclusions Although the primary aspirations of low-income mothers in feeding their preschool-aged children were not focused on children’s weight, these aspirations were compatible with obesity prevention strategies to limit children’s portion sizes and their intake of solid fats and/or added sugars.

We describe the Life Experiences Curriculum (LEC), which attempts to integrate medical student well-being with trauma-informed medical education. The long-term goal of LEC is to help medical students flourish with adversity and trauma, where flourishing refers to having a sense of purpose that arises from awareness of one’s strengths and limitations, shaped by life experiences. The short-term goal of LEC is to develop students’ relatiol capacities, such as acceptance and awareness of self and others, while building and maintaining students’ psychological safety. We describe the conceptual ratiole for these goals and the curriculum’s development, implementation, evaluation, and limitations. The curriculum extends over four years and involves a preclinical semir and students’ individual and group reflection sessions with LEC faculty. The semir addresses the coexistence of trauma and flourishing across life experiences, as well as how safety in relationships is impaired by traumatic experiences and must be restored for healing and growth. The physician faculty have no role in student evaluation and co-lead all LEC activities. LEC is intended to provide students with new language for understanding the process of trauma and flourishing in both individuals and systems and to build and sustain students’ relatiol capacities. There are ongoing efforts to re-imagine self-care as commul-care in which care and support are given and received in a community of students and faculty. Such a model may help build the relatiol capacities needed to deliver trauma-informed care and also promote flourishing with adversity in healers and in those seeking to be healed.

The prevalence of obesity has increased in both children and adults. 1 , 2 The medical illnesses associated with obesity 3 usually occur in adulthood, but adults rarely achieve sustained weight loss. 4 Therefore, prevention of obesity in childhood and effective treatment of overweight children are essential. Although several studies have tracked fatness from childhood to adulthood, 5 – 11 only one study contained data on subjects' height and weight throughout childhood. 11 Whether parental obesity alters the probability that a child will become an obese adult is not known. The purpose of this study was to determine the probability of obesity in young adulthood in relation . . .

Objectives. This study examined the patterns and correlates of maternal smoking before, during, and after pregnancy. Methods. We examined socioeconomic, demographic, and clinical risk factors associated with maternal smoking in a nationally representative cohort of women (n = 8285) who were surveyed 17 ± 5 months and again 35 ± 5 months after delivery. Results. Smoking rates among women with a college degree decreased 30% from before pregnancy to 35 months postpartum but did not change among the least educated women. Risk factors clustered, and a gradient linked the number of risk factors (0, 2, 4) to the percentage smoking (6%, 31%, 58%, P < .0001). Conclusions. The period of pregnancy and early parenthood is associated with worsening education-related disparities in smoking as well as substantial clustering of risk factors. These observations could influence the targeting and design of maternal smoking interventions.

Turnover of early childhood education (ECE) professionals negatively impacts program costs, staff morale, and relationships with children. We determined whether the presence of work as a calling was associated with less intention to leave the ECE field. From an online survey administered to 265 ECE professionals in Pennsylvania, a calling score based on the Calling and Vocation Questionnaire was used to create sample-defined tertiles of low (< 38), medium (38–44), and high (> 44) presence of calling. Those intending to leave the ECE field reported that, given the option, they would most likely “find a position or get training in a completely different field,” or “stop work, stay home, or retire.” Analysis was restricted to 194 respondents currently employed in ECE and under age 60, of whom 94.8% were female and 53.9% were non-Hispanic White. After adjusting for race/ethnicity and workplace stress, the prevalence (95% CI) of intention to leave decreased as calling increased, from low (28.6% [17.8%, 38.4%]) to medium (12.2% [4.3%, 20.1%]) to high (9.1% [1.5%, 16.6%]). The presence of call was associated with less intention to leave the ECE field. Identifying, building, and sustaining call among ECE professionals may decrease turnover.

In this study, women with children were enabled to move from poor neighborhoods to neighborhoods with lower poverty rates. The moves were associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes. Many observational studies have shown that neighborhood attributes such as poverty and racial segregation are associated with increased risks of obesity and diabetes, even after adjustment for observed individual and family-related factors. 1 – 4 In response, the U.S. surgeon general has called for efforts to “create neighborhood communities that are focused on healthy nutrition and regular physical activity, where the healthiest choices are accessible for all citizens.” 5 Previous studies have suggested several pathways through which neighborhoods might influence health. Changes in the built environment (e.g., the addition of grocery stores or spaces where residents can exercise) might affect health-related behaviors and . . .

Turnover in the US early childhood education (ECE) workforce is associated with worse outcomes for children. Greater workplace spirituality, or the perception of meaningful work, sense of community, and alignment with organizational values, is associated with reduced turnover. However, this association has not been examined in ECE professionals. We administered an online survey to 265 ECE professionals in Pennsylvania (US) in the spring of 2021. Respondents were asked about their intention to stay in their current program, if given the option to leave. Workplace spirituality was measured with a 21-item scale assessing the dimensions of meaningful work, sense of community, and alignment with organizational values. The survey was completed by 246 (92.8%), and data were analyzed for 232 respondents. Of these, 94.8% were female, 54.4% were non-Hispanic White, and 70.7% had a bachelor’s or graduate degree. The prevalence of intention to stay was 33.2%. After adjusting for all covariates, including gender, age, race/ethnicity, education, job position, workplace stress, and economic hardships, the prevalence (95% confidence interval [CI]) of intention to stay increased across tertiles of workplace spirituality from low to medium to high: 16.4% (7.9%, 24.9%) to 38.6% (28.4%, 48.8%) to 43.7% (32.1%, 55.3%), respectively. ECE professionals who perceived greater workplace spirituality were more likely to report they intended to stay in their current program. Turnover in the ECE workforce could potentially be reduced through efforts to increase a sense of meaning and community at work and to align the values of ECE programs with those who work in them.

Given the large influence of social conditions on health, physicians may be more effective if they are trained to identify and address social factors that impact health. Despite increasing interest in teaching the social determinants of health in undergraduate medical education, few models exist. We present a 9-month pilot course on the social determinants of health for medical and other health professional students, which is based at Puentes de Salud, Philadelphia, PA, USA, a community health center serving a Latino immigrant population. This service-learning course, called the Health Scholars Program (HSP), was developed and implemented by volunteer medical and public health faculty in partnership with the community-based clinic. The HSP curriculum combines didactic instruction with service experiences at Puentes de Salud and opportunities for critical reflection. The HSP curriculum also includes a longitudinal project where students develop, implement, and evaluate an intervention to address a community-defined need. In our quantitative evaluation, students reported high levels of agreement with the HSP meeting stated course goals, including developing an understanding of the social determinants of health and working effectively with peers to implement community-based projects. Qualitative assessments revealed students' perception of learning more about this topic in the HSP than in their formal medical training and of developing a long-term desire to serve vulnerable communities as a result. Our experience with the HSP suggests that partnerships between academic medical centers and community-based organizations can create a feasible, effective, and sustainable platform for teaching medical students about the social determinants of health. Similar medical education programs in the future should seek to achieve a larger scale and to evaluate both students' educational experiences and community-defined outcomes.