Nancy Ryan-Wenger, PhD, RN, CPNP, FAAN, is the director of nursing research and an investigator at the Center for Innovation in Pediatric Practice at Nationwide Children’s Hospital in Columbus, Ohio. As a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), she was a lead investigator of the first-ever study to systematically elicit the views of hospitalized children and adolescents on the quality of their nursing care, and also the first to evaluate children’s perceptions of nurses’ behavior for evidence of any disparities across demographic groups. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

Have we asked the children?

That became a pressing question for me when I retired from academia after 30 years and joined the staff of Nationwide Children’s Hospital. I became aware of things that are highly important to hospitals, such as opinions of the quality of care. Yet when I saw the patient surveys at Nationwide, they were almost always completed by parents, and 80 percent of the questions were geared toward parents: Were they kept informed of their child’s condition? Did they have a comfortable place to sleep? Was their child treated kindly by staff member?

Those are important questions, certainly, but if you’re doing a patient survey, don’t you want to know what the patient thinks?

Have we asked the children?

Manish K. Sethi, MD, is a health policy associate at the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College and a Pilot Project Mini-Grant recipient and renowned orthopaedic trauma surgeon at Vanderbilt University’s Orthopaedic Institute Center for Health Policy. Sethi spoke this morning during the 2012-2013 Grand Rounds Series, sponsored by Meharry Medical College School of Medicine, on “Gun Violence in Nashville: Working Towards Community Based Solutions.”

Human Capital Blog: What is the violence prevention program you’re directing with the RWJF Center for Health Policy at Meharry?

Sethi: We are doing a youth violence intervention program via partnership with Nashville schools funded by the RWJF Center for Health Policy at Meharry.

All of the data demonstrates that educational intervention with this age group demonstrates positive results. Currently, no such program exists in Nashville schools.

HCB: What drove your interest in this topic?

Sethi: I am a trauma surgeon and have been seeing an inordinate number of gun violence injuries in African American teenagers. I grew up in Tennessee and left for my medical training, but during childhood I never saw violence to this degree. Almost every week I see a teenager who either loses his life, or suffers major trauma secondary to a gun violence injury. I care very deeply about the future of these children and of Tennessee and I just feel that we have to do something.

Jason M. Fletcher, PhD, MS, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2010-2012) and an associate professor of health policy at Yale School of Public Health.   Fletcher was recently lead author of the study, “How Social and Genetic Factors Predict Friendship Networks,” published October 17 in the journal PNAS (Proceedings of the National Academy of Sciences). Fletcher and his colleagues found that important interactions between genetics and the social environment help determine friendship formation during high school.

For our study, we used a national survey of adolescent friendships (Add Health, or the National Longitudinal Study of Adolescent Health) to follow up on and expand a study published last year that showed that specific genes, including a dopamine receptor gene (DRD2), may determine friendships among teens.

We found the idea of a biological basis for, in our view, the very sociologically driven outcomes of friendship formation to be too narrow and to not take into account the social and geographic constraints that underlie friendship links.  So in our research we show, using the same data as the previous study, that once we take account of schools and social environments, the previous genetic story is not confirmed by our data.

Indeed, we show that some schools produce friendships that are genetically similar, and others produce friendships that are genetically dissimilar.  And specific aspects of schools, like socioeconomic inequality, appear to partially determine the types of friendships that we observe school-by-school.

Kynna Wright-Volel, PhD, RN, MPH, PNP-BC, FAAN, an assistant professor at the University of California, Los Angeles and Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar alumna, recently won a five-year, $1.2 million grant funded jointly by the National Institutes of Health’s National Institute of Nursing Research and Office of Behavioral Social Science Research. She will use the grant to work with the Los Angeles Unified School District to launch Project SHAPE LA™, a coordinated school-health program designed to increase physical activity among youth in Los Angeles County schools.

Human Capital Blog: Please share your vision for Project Shape LA™, what its goals are and how many children and teens it will reach.

Kynna Wright-Volel: Project SHAPE LA™ targets 24 middle schools in underserved areas of Los Angeles and will touch nearly 12,000 students. With this grant, we want physical education teachers to ignite a passion for physical activity – to teach kids that by being active, they can be healthy and achieve their dreams. Anticipated outcomes from this program include: increased moderate to vigorous physical activity; increased scores on the California State Board of Education’s FitnessGram Test in the areas of aerobic fitness, body composition and muscular strength/endurance; and increased academic achievement, as evidenced by higher scores on the California standardized test.

HCB: Why is a project like this needed in your community?

Wright-Volel: According to the L.A. County Department of Public Health, one in five children in the Los Angeles Unified School District is considered obese. Health inequities exist as well; children who are racial and ethnic minorities and/or come from families with low incomes have higher rates of obesity.

In May, the U.S. Department of Housing and Urban Development (HUD) awarded a multi-year grant to an asthma prevention and treatment program run by 2008 Robert Wood Johnson Foundation Community Health Leader Ray Lopez of New York City. Lopez is the director of environmental health services at the Little Sisters of the Assumption Family Health Service in New York’s East Harlem. The grant award is shared with the New York Academy of Medicine.

Human Capital Blog: First, congratulations on the grant. Would you tell us about the project, please?

Ray Lopez: Our mission is to serve children in East Harlem by helping their families treat and prevent asthma incidents. Asthma rates are unusually high in New York City in general, and the problem’s even more acute in Harlem, the South Bronx and Central Brooklyn where there are all kinds of environmental factors in children’s homes. We’re focused on children in public housing, where there are a number of problems. A lot of the apartments have mold that has grown as a result of leaks, and they’ve also got a lot of cockroaches, and mice, which all contribute as well. What we do, and what this grant will help us do a lot more broadly, is to get treatment for the kids, but also to go into their apartments and get to work on reducing the environmental factors. Sometimes that means identifying moisture sources and safely cleaning the mold. Sometimes it means pressing the city’s housing authority to do major work. Sometimes it involves teaching the adults in the family about the safe use of pesticides and cleaning products. For each family we visit, we work with them to create an individualized service plan, and then we focus on remediating the asthma triggers.

Teaching is a major part of this, too, and the plan is to teach by showing and doing. Families are enrolled with us for a year, and by end of year, we hope they will have accumulated skills to manage these problems on their own in the long-term. It’s a three-year project, in all: two-plus years working with the families, and then a final phase that consists of data analysis and policy initiatives led by the New York Academy of Medicine.

HCB: And then what’s the plan with the data and the analysis?

Lopez: The plan is to build the business case for this kind of intervention, and then to persuade insurance companies and providers that it’s worth the investment to them to spend a little money up front to prevent asthma incidents, rather than paying for them in the emergency room.

In this month’s RWJF Clinical Scholars Health Policy Podcast former RWJF Clinical Scholar Donald Schwarz, M.D., M.B.A., (University of Pennsylvania, 1985-1987), Philadelphia Health Commissioner and Deputy Mayor for Health and Opportunity, discusses his work combating the childhood obesity epidemic in Philadelphia, touching on that effort’s controversial soda tax. In his conversation with podcast series host, Matthew Press, M.D., Schwarz also talks about the impact of health care reform at the city health level, and the learning curve required to transition from a career in academia to government service.

Read more about the RWJF Clinical Scholars program. For an overview of RWJF scholar and fellow opportunities, visit www.RWJFLeaders.org.