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Patient reported outcome measures (PROM) can engage patients and clinicians to improve health outcomes. Their population health impact may be limited by systematic barriers inhibiting access to completion. In this analysis we evaluated the association between individual parent/child characteristics and clinic factors with parental completion of a locally developed PROM, the Early Healthy Lifestyles (EHL) questionnaire. Participants included parent-child dyads who presented at 14 pediatric clinics for regularly scheduled well-child visits (WCV) prior to age 26 months. EHL items include feeding practices, diet, play time, screen exposure, and sleep. Completion was categorized at patient- (i.e., parent-child dyad) and clinic-levels. Parents completed the 15-item EHL in the patient portal before arrival or in the clinic; ninety-three percent of EHL questionnaires were completed in the clinic vs. 7% in the patient portal. High-completers completed EHL for half of WCVs; low-completers completed at least once; and non-completers never completed. Clinics were classified by EHL adoption level (% high completion): High-adoption: >50%; Moderate-adoption: 10%-50%; and Low-adoption: <10%. Individual-level factors had negligible impact on EHL completion within moderate/low EHL adoption sites; high-adoption sites were used to evaluate infant and maternal factors in association with EHL completion using hierarchical logistic regression. Noncompletion of EHL was significantly associated (p < 0.05) with infant use of public insurance (OR = 1.92 [1.42, 2.59]), >1 clinic site for WCV (OR = 1.83 [1.34, 2.50]), non-White birth mother (OR = 1.78 [1.28, 2.47]), and body weight <2,500 grams or gestational age <34 weeks (OR = 1.74 [1.05, 2.90]). The number of WCVs, a proxy for clinic size, was evaluated but was not associated with completion. Findings indicate potential disparities between populations exposed to, completing, and benefitting from these tools.

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INTRODUCTION: Acute respiratory infection is a major cause of death for under-5 children in Bangladesh. We aimed to analyze the effect of immunonutritional status, healthcare factors, and lifestyle on the incidence of acute respiratory infection among under-5 children taking individual-level and contextual-level risk factors into consideration. METHODS: This study recruited 200 children suffering from acute respiratory infection and 100 healthy controls matched by age, sex, and sociodemographic profile. Serum antioxidant vitamin A (retinol), vitamin C (ascorbic acid), and vitamin E (α-tocopherol) were assessed along with the impact of vaccination, socioeconomic factors, and Z-score on the incidence of acute respiratory infection. RESULTS: Serum antioxidant vitamins were significantly lower in the acute respiratory infection children compared to the non-acute respiratory infection group. Vitamin A was found to be significantly high in acute respiratory infection children who were breastfed for more than 1 year. Vitamin E levels were found to be significantly higher in the acute respiratory infection children who were immunized. Compared to the children living in tin-shed house or huts, serum vitamin E level increased in those acute respiratory infection children who resided in apartments. Vitamin A level was significantly high in those acute respiratory infection children whose height-for-age was -2 SD and above (Z-score), and vitamin C levels were also significantly high in those acute respiratory infection children whose weight-for-height was -2 SD and below (Z-score). CONCLUSION: Deficiencies of antioxidant vitamins along with healthcare and lifestyle factors have a significant influence on the incidence of acute respiratory infection among under-5 children in Bangladesh.

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PURPOSE: The study purpose was to examine demographic, healthcare, and contextual correlates of smoking among sexual minority women (SMW). METHODS: Data were from the Chicago Health and Life Experiences of Women study (2010-2012, N = 726). RESULTS: The rate of current smoking was 29.6%, with 29.5% and 40.9% former or nonsmokers, respectively. A history of ever smoking was associated with lower educational levels, having a partner who smokes, heavy drinking, illicit drug use, and a bisexual identity. Statistically significant correlates of former versus current smoker included higher education, having a nonsmoking partner, being from the newest recruited cohort, and less illicit drug use. A past-year quit attempt among current smokers was associated with higher levels of illicit drug use, longer time until first cigarette, and being from the original cohort. CONCLUSION: The study results highlight key correlates of smoking behaviors among SMW and make an important contribution to the literature on smoking disparities. Additional research is needed to inform smoking cessation prevention and control efforts to reduce known and persistent smoking disparities among SMW.

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PURPOSE/OBJECTIVES: To understand the relationship between mammography history and current thoughts about obtaining a mammogram among Latinas and examine the mediation effects of several healthcare factors.
. DESIGN: Cross-sectional survey.
. SETTING: Federally qualified health centers (Sea Mar Community Health Centers) in western Washington.
. SAMPLE: 641 Latinas nonadherent and adherent with screening mammography.
. METHODS: Baseline survey data from Latinas with a mammography history of never, not recent (more than two years), or recent (less than two years) were analyzed. Preacher and Hayes methods were used to estimate the mediation effect of healthcare factors.
. MAIN RESEARCH VARIABLES: The survey assessed mammography history, sociodemographic and healthcare factors, and current thoughts about obtaining a mammogram.
. FINDINGS: Latinas' thoughts about obtaining a mammogram were associated with mammography history. Having had a clinical breast examination mediated 70% of differences between Latinas with a never and recent mammography history. Receipt of a provider recommendation mediated 54% of differences between Latinas with and without a recent mammography history.
. CONCLUSIONS: These findings emphasize the importance of the patient-provider relationship during a clinic visit and help inform how nurses may be incorporated into subsequent screening mammography interventions tailored to Latinas.
. IMPLICATIONS FOR NURSING: As providers, health educators, and researchers, nurses have critical roles in encouraging adherence to screening mammography guidelines among Latinas.

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