Elinor Graham - Academia.edu (original) (raw)

Papers by Elinor Graham

Psychology of Addictive Behaviors, 2002

The relationships between perceived stress, depressive symptoms, concern about weight gain and sm... more The relationships between perceived stress, depressive symptoms, concern about weight gain and smoking dependence were examined among 83 European American and 175 African American female smokers bringing children to pediatric clinics serving a low-income population. Among African American women, but not European American women, greater stress and more depressive symptoms predicted greater smoking dependence, and less concern about weight gain predicted greater smoking dependence. Multivariate analyses confirmed the bivariate relationships among stress, depressive symptoms, and smoking dependence among African American women but reduced the relationship between weight concern and smoking dependence. The stronger relationships among stress, depressive symptoms, and smoking dependence among African American women may be indicative of smoking patterns more associated with affect regulation than are the smoking patterns of European American women.

The Journal of Pediatrics, 1996

Increased zinc protoporphyrin/heme (ZPP/H) ratio has been used in pediatrics to screen for iron d... more Increased zinc protoporphyrin/heme (ZPP/H) ratio has been used in pediatrics to screen for iron deficiency and lead poisoning. This study was conducted to determine whether common hereditary hemoglobin disorders (alpha- and beta-thalassemia traits, hemoglobin E) found in U.S. minority groups are associated with an increase in the ZPP/H ratio in an iron-sufficient population. The database was compiled from hemoglobinopathy screens performed between 1987 and 1993 at a regional referral laboratory in Washington State. ZPP/H ratio and hemoglobin type were obtained for 326 subjects between the ages of 15 and 49 years of age who were iron sufficient (serum ferritin levels > or = 50 micrograms/L). The mean ZPP/H ratio was significantly higher (p < 0.01) for subjects with beta-thalassemia trait (87 +/- 32 micromol/mol), (alpha-thalassemia trait (73 +/- 37 micromol/mol), and hemoglobin E disorders (73 +/- 24 micromol/mol) than for subjects with normal hemoglobin values (60 +/- 8 micromol/mol). Fifty-one percent of subjects with beta-thalassemia trait, 22% with hemoglobin E, and 20% with alpha-thalassemia trait had elevated ZPP/H ratios (> 80 micromol/mol), compared with only 1.5% with normal hemoglobin values. The ZPP/H ratio is elevated in common hereditary hemoglobin disorders that mimic the microcytic anemia of iron deficiency, even in individuals without associated nutritional iron deficiency. For children who are treated for presumed iron deficiency, failure of the ZPP/H ratio to return to normal after adequate iron treatment, especially if microcytosis persists, indicates that a hereditary hemoglobin disorder may be present.

Journal of Developmental & Behavioral Pediatrics, 2004

is a 4-year-old Puerto Rican boy diagnosed with high-functioning autism. His mother, who speaks S... more is a 4-year-old Puerto Rican boy diagnosed with high-functioning autism. His mother, who speaks Spanish and knows little English, has brought him in to see you, his new bilingual pediatrician. She felt that Jose's former pediatrician did not provide her son with adequate treatment and services because ''the doctor doesn't speak my language and didn't seem to understand my culture.'' Jose's mother also is concerned because she believes he is in a regular, English-only mainstream classroom at school and worries that he is not receiving appropriate services in the school.

Archives of Pediatrics & Adolescent Medicine, 2003

Archives of Pediatrics & Adolescent Medicine, 2003

Continued high rates of smoking among socioeconomically disadvantaged women lead to increases in ... more Continued high rates of smoking among socioeconomically disadvantaged women lead to increases in children's health problems associated with exposure to tobacco smoke. The pediatric clinic is a "teachable setting" in which to provide advice and assistance to parents who smoke. To evaluate a smoking cessation intervention for women. Two-arm (usual care vs intervention) randomized trial. Pediatric clinics serving an ethnically diverse population of low-income families in the greater Seattle, Wash, area. During the clinic visit, women received a motivational message from the child's clinician, a guide to quitting smoking, and a 10-minute motivational interview with a nurse or study interventionist. Women received as many as 3 outreach telephone counseling calls from the clinic nurse or interventionist in the 3 months following the visit. Self-identified women smokers (n = 303) whose children received care at participating clinics. Self-reported abstinence from smoking 12 months after enrollment in the study, defined as not smoking, even a puff, during the 7 days prior to assessment. Response rates at 3 and 12 months were 80% and 81%. At both follow-ups, abstinence rates were twice as great in the intervention group as in the control group (7.7% vs 3.4% and 13.5% vs 6.9%, respectively). The 12-month difference was statistically significant. A pediatric clinic smoking cessation intervention has long-term effects in a socioeconomically disadvantaged sample of women smokers. The results encourage implementation of evidence-based clinical guidelines for smoking cessation in pediatric practice.

Ambulatory Pediatrics, 2007

The health status of many people in developing countries is often dismal compared with the norms ... more The health status of many people in developing countries is often dismal compared with the norms in industrialized countries. Increasingly, medical practitioners in the United States and other industrialized countries have become interested in global health issues, an interest that often takes the form of short-term international medical trips. We discuss several ethical issues associated with participation in such trips and use our experiences in developing the Children's Health International Medical Project of Seattle (CHIMPS) to outline and illustrate a set of 7 guiding principles for making these trips. CHIMPS is a resident-run, faculty-supported international medical program founded in 2002 by pediatric residents at the University of Washington in Seattle. Members of CHIMPS work with a rural community in El Salvador to support ongoing public health interventions there and provide sustainable medical care in collaboration with the community and a local nongovernmental organization. The 7 principles developed as a result of this work-mission, collaboration, education, service, teamwork, sustainability, and evaluation-can be used as a model for health practitioners as they develop or select international medical trips. The importance of partnering with the community and working within the existing medical and public health infrastructure is emphasized. Many of the challenges of doing international medical work can be overcome when efforts are guided by a few specific principles, such as those we have outlined.

Maternal & Child Nutrition, 2010

The objective of this study was to explore Somali mothers' beliefs and practices around infant fe... more The objective of this study was to explore Somali mothers' beliefs and practices around infant feeding and education, towards developing a culturally informed infant nutrition curriculum for health providers. Four focus groups were conducted to explore: (1) beliefs about infant feeding, hunger and ideal weight; (2) feeding practices; (3) nutrition education approaches; and (4) provider/mother interactions. Thirty-seven Somali mother participants identified the following themes within these topics: (1) strategies for assessing hunger, satiety and when to feed; shared beliefs that plump babies are healthy, leading to worry about infant weight; (2) context of breast milk adequacy, difficulties breastfeeding and environmental and cultural barriers to breastfeeding, leading to nearly universal early supplementation with formula; (3) preferred education approaches include provider visits with interpreters, Somali language educational materials and advice from older, experienced family members; and (4) desired health provider skills include: listening, explaining, empathy, addressing specific concerns, repeating important information, offering preventive advice and sufficient visit time. This study presents knowledge about Somali beliefs and practices that can directly guide discussions with these families. Given that these infants appear on a trajectory towards obesity, influencing infant feeding practices in the Somali community is a good upstream approach to preventing obesity. These findings will underpin a new infant nutrition curriculum for health providers.

Psychology of Addictive Behaviors, 2002

The relationships between perceived stress, depressive symptoms, concern about weight gain and sm... more The relationships between perceived stress, depressive symptoms, concern about weight gain and smoking dependence were examined among 83 European American and 175 African American female smokers bringing children to pediatric clinics serving a low-income population. Among African American women, but not European American women, greater stress and more depressive symptoms predicted greater smoking dependence, and less concern about weight gain predicted greater smoking dependence. Multivariate analyses confirmed the bivariate relationships among stress, depressive symptoms, and smoking dependence among African American women but reduced the relationship between weight concern and smoking dependence. The stronger relationships among stress, depressive symptoms, and smoking dependence among African American women may be indicative of smoking patterns more associated with affect regulation than are the smoking patterns of European American women.

The Journal of Pediatrics, 1996

Increased zinc protoporphyrin/heme (ZPP/H) ratio has been used in pediatrics to screen for iron d... more Increased zinc protoporphyrin/heme (ZPP/H) ratio has been used in pediatrics to screen for iron deficiency and lead poisoning. This study was conducted to determine whether common hereditary hemoglobin disorders (alpha- and beta-thalassemia traits, hemoglobin E) found in U.S. minority groups are associated with an increase in the ZPP/H ratio in an iron-sufficient population. The database was compiled from hemoglobinopathy screens performed between 1987 and 1993 at a regional referral laboratory in Washington State. ZPP/H ratio and hemoglobin type were obtained for 326 subjects between the ages of 15 and 49 years of age who were iron sufficient (serum ferritin levels > or = 50 micrograms/L). The mean ZPP/H ratio was significantly higher (p < 0.01) for subjects with beta-thalassemia trait (87 +/- 32 micromol/mol), (alpha-thalassemia trait (73 +/- 37 micromol/mol), and hemoglobin E disorders (73 +/- 24 micromol/mol) than for subjects with normal hemoglobin values (60 +/- 8 micromol/mol). Fifty-one percent of subjects with beta-thalassemia trait, 22% with hemoglobin E, and 20% with alpha-thalassemia trait had elevated ZPP/H ratios (> 80 micromol/mol), compared with only 1.5% with normal hemoglobin values. The ZPP/H ratio is elevated in common hereditary hemoglobin disorders that mimic the microcytic anemia of iron deficiency, even in individuals without associated nutritional iron deficiency. For children who are treated for presumed iron deficiency, failure of the ZPP/H ratio to return to normal after adequate iron treatment, especially if microcytosis persists, indicates that a hereditary hemoglobin disorder may be present.

Journal of Developmental & Behavioral Pediatrics, 2004

is a 4-year-old Puerto Rican boy diagnosed with high-functioning autism. His mother, who speaks S... more is a 4-year-old Puerto Rican boy diagnosed with high-functioning autism. His mother, who speaks Spanish and knows little English, has brought him in to see you, his new bilingual pediatrician. She felt that Jose's former pediatrician did not provide her son with adequate treatment and services because ''the doctor doesn't speak my language and didn't seem to understand my culture.'' Jose's mother also is concerned because she believes he is in a regular, English-only mainstream classroom at school and worries that he is not receiving appropriate services in the school.

Archives of Pediatrics & Adolescent Medicine, 2003

Archives of Pediatrics & Adolescent Medicine, 2003

Continued high rates of smoking among socioeconomically disadvantaged women lead to increases in ... more Continued high rates of smoking among socioeconomically disadvantaged women lead to increases in children's health problems associated with exposure to tobacco smoke. The pediatric clinic is a "teachable setting" in which to provide advice and assistance to parents who smoke. To evaluate a smoking cessation intervention for women. Two-arm (usual care vs intervention) randomized trial. Pediatric clinics serving an ethnically diverse population of low-income families in the greater Seattle, Wash, area. During the clinic visit, women received a motivational message from the child's clinician, a guide to quitting smoking, and a 10-minute motivational interview with a nurse or study interventionist. Women received as many as 3 outreach telephone counseling calls from the clinic nurse or interventionist in the 3 months following the visit. Self-identified women smokers (n = 303) whose children received care at participating clinics. Self-reported abstinence from smoking 12 months after enrollment in the study, defined as not smoking, even a puff, during the 7 days prior to assessment. Response rates at 3 and 12 months were 80% and 81%. At both follow-ups, abstinence rates were twice as great in the intervention group as in the control group (7.7% vs 3.4% and 13.5% vs 6.9%, respectively). The 12-month difference was statistically significant. A pediatric clinic smoking cessation intervention has long-term effects in a socioeconomically disadvantaged sample of women smokers. The results encourage implementation of evidence-based clinical guidelines for smoking cessation in pediatric practice.

Ambulatory Pediatrics, 2007

The health status of many people in developing countries is often dismal compared with the norms ... more The health status of many people in developing countries is often dismal compared with the norms in industrialized countries. Increasingly, medical practitioners in the United States and other industrialized countries have become interested in global health issues, an interest that often takes the form of short-term international medical trips. We discuss several ethical issues associated with participation in such trips and use our experiences in developing the Children's Health International Medical Project of Seattle (CHIMPS) to outline and illustrate a set of 7 guiding principles for making these trips. CHIMPS is a resident-run, faculty-supported international medical program founded in 2002 by pediatric residents at the University of Washington in Seattle. Members of CHIMPS work with a rural community in El Salvador to support ongoing public health interventions there and provide sustainable medical care in collaboration with the community and a local nongovernmental organization. The 7 principles developed as a result of this work-mission, collaboration, education, service, teamwork, sustainability, and evaluation-can be used as a model for health practitioners as they develop or select international medical trips. The importance of partnering with the community and working within the existing medical and public health infrastructure is emphasized. Many of the challenges of doing international medical work can be overcome when efforts are guided by a few specific principles, such as those we have outlined.

Maternal & Child Nutrition, 2010

The objective of this study was to explore Somali mothers' beliefs and practices around infant fe... more The objective of this study was to explore Somali mothers' beliefs and practices around infant feeding and education, towards developing a culturally informed infant nutrition curriculum for health providers. Four focus groups were conducted to explore: (1) beliefs about infant feeding, hunger and ideal weight; (2) feeding practices; (3) nutrition education approaches; and (4) provider/mother interactions. Thirty-seven Somali mother participants identified the following themes within these topics: (1) strategies for assessing hunger, satiety and when to feed; shared beliefs that plump babies are healthy, leading to worry about infant weight; (2) context of breast milk adequacy, difficulties breastfeeding and environmental and cultural barriers to breastfeeding, leading to nearly universal early supplementation with formula; (3) preferred education approaches include provider visits with interpreters, Somali language educational materials and advice from older, experienced family members; and (4) desired health provider skills include: listening, explaining, empathy, addressing specific concerns, repeating important information, offering preventive advice and sufficient visit time. This study presents knowledge about Somali beliefs and practices that can directly guide discussions with these families. Given that these infants appear on a trajectory towards obesity, influencing infant feeding practices in the Somali community is a good upstream approach to preventing obesity. These findings will underpin a new infant nutrition curriculum for health providers.