151
|
Gonzalves LC, Ferrer E, Robins RW, Guyer AE, Hastings PD. Psychosocial Predictors of Suicidal Thoughts and Behaviors in Mexican-Origin Youths: An 8-Year Prospective Cohort Study. Clin Psychol Sci 2023; 11:425-443. [PMID: 37197008 PMCID: PMC10184188 DOI: 10.1177/21677026221102924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/28/2022] [Indexed: 12/03/2022]
Abstract
Suicide is the second leading cause of death for youths in the United States. More Latino adolescents report suicidal thoughts and/or behaviors (STBs) than youths of most other ethnic communities. Yet few studies have examined multiple psychosocial predictors of STBs in Latino youths using multiyear longitudinal designs. In this study, we evaluated the progression of STBs in 674 Mexican-origin youths (50% female) from fifth grade (10 years old) to 12th grade (17 years old) and identified psychosocial predictors of changes in STBs across this period. Latent growth curve models revealed that being female and later-generation status were associated with increasing prevalence in STBs across adolescence. Family conflict and peer conflict predicted increased STBs, whereas greater familism predicted less STBs. Thus, interpersonal relationships and cultural values contribute to the development of STBs in Mexican-origin youths and may be key levers for decreasing suicidality in this understudied but rapidly growing portion of the U.S. adolescent population.
Collapse
Affiliation(s)
- Lauren C. Gonzalves
- Department of Psychology, University of California, Davis
- Center for Mind and Brain, University of California, Davis
| | - Emilio Ferrer
- Department of Psychology, University of California, Davis
| | | | - Amanda E. Guyer
- Center for Mind and Brain, University of California, Davis
- Department of Human Ecology, University of California, Davis
| | - Paul D. Hastings
- Department of Psychology, University of California, Davis
- Center for Mind and Brain, University of California, Davis
| |
Collapse
|
152
|
Rainer T, Lim JK, He Y, Perdomo J, Nash KA, Kistin CJ, Tolliver DG, McIntyre E, Hsu HE. Structural Racism in Behavioral Health Presentation and Management. Hosp Pediatr 2023; 13:461-470. [PMID: 37066672 PMCID: PMC10714315 DOI: 10.1542/hpeds.2023-007133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Nia is a first-grade student with a history of trauma who was brought in by ambulance to the pediatric emergency department for "out of control behavior" at school. This is the first of multiple presentations to the emergency department for psychiatric evaluation, stabilization, and management throughout her elementary and middle school years. Several of the visits resulted in admission to the inpatient pediatric service, where she "boarded" while awaiting transfer to an inpatient psychiatric facility. At times, clinical teams used involuntary emergency medications and physical restraints, as well as hospital security presence at the bedside, to control Nia's behavior. Nia is Black and her story is a case study of how structural racism manifests for an individual child. Her story highlights the impact of adultification bias and the propensity to mislabel Black youth with diagnoses characterized by fixed patterns of negative behaviors, as opposed to recognizing normative reactions to trauma or other adverse childhood experiences-in Nia's case, poverty, domestic violence, and Child Protective Services involvement. In telling Nia's story, we (1) define racism and discuss the interplay of structural, institutional, and interpersonal racism in the health care, education, and judicial systems; (2) highlight the impact of adultification bias on Black youth; (3) delineate racial disparities in behavioral health diagnosis and management, school discipline and exclusion, and health care's contributions to the school-to-prison pipeline; and finally (4) propose action steps to mitigate the impact of racism on pediatric mental health and health care.
Collapse
Affiliation(s)
- Tyler Rainer
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jamie K Lim
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ilinois
| | - Yuan He
- Division of General Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Joanna Perdomo
- Department of General Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Katherine A Nash
- Division of Pediatric Critical Care and Hospital Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Caroline J Kistin
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
| | | | | | - Heather E Hsu
- Boston Medical Center and Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
153
|
Anderson J, Devine PJ, Greenlee Q, Najera DB, Dominguez D. Racism: Eroding the health of Black communities. JAAPA 2023; 36:38-42. [PMID: 37097780 DOI: 10.1097/01.jaa.0000923552.50265.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
ABSTRACT Even in the context of major advances in medicine, racial minorities continue to suffer worse medical outcomes. Although race is defined as a social, nonscientific construct, researchers have continued to use it as proxy to explain genetic and evolutionary differences among patients. Poorer health outcomes among Black Americans are known to be related to the psychosocial and physiological stress of racism. Black communities experience premature health deterioration because of the cumulative effects of social, economic, and political oppression and marginalization. Additionally, recent assertions that racism is best seen as a chronic disease has added value to understanding the effect of racism on the health of Black people. Using evidence-based information to assess the health of Black patients is a key step to assist clinicians in promptly addressing this chronic threat to the health of Black patients.
Collapse
Affiliation(s)
- James Anderson
- James Anderson practices at Evergreen Treatment Services in Seattle, Wash. Patricia J. Devine is director of the University of Washington's HEALWA program in Seattle. Quanté Greenlee is an assistant teaching professor in the University of Washington's MEDEX Northwest PA program in Tacoma. Deanna Bridge Najera practices in the ED at MedStar Montgomery Medical Center and is PA advisor for policy and engagement for MedStar Emergency Physicians, both in Olney, Md.; is lead clinician in the Carroll County Health Department's Bureau of Nursing and Reproductive Health Clinic in Westminster, Md.; and is a psychiatric medical management clinician for TrueNorth Wellness Services in Hanover, Pa. Delilah Dominguez practices at Yale New Haven (Conn.) Hospital. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | | | | | |
Collapse
|
154
|
Karbeah J, Bensignor MO, Vajravelu ME. Multidimensional Approaches to Understanding Structural Racism's Impact on Type 1 Diabetes. Pediatrics 2023; 151:e2022060800. [PMID: 37096485 PMCID: PMC10158074 DOI: 10.1542/peds.2022-060800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 04/26/2023] Open
Affiliation(s)
- J’Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
- Center for Antiracism Research for Health Equity, University of Minnesota, Minneapolis, Minnesota
| | - Megan O. Bensignor
- Division of Pediatric Endocrinology and Diabetes
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minneapolis
| | - Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
155
|
Nelson LE, Reeves J, Lopez DJ. Integrative Antiracism and the Salience of Intersectional Assets for Black and Latinx LGBTQ Youth. J Adolesc Health 2023; 72:647-648. [PMID: 37062570 DOI: 10.1016/j.jadohealth.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 04/18/2023]
|
156
|
Foster C, Noreen P, Grage J, Kwon S, Hird-McCorry LP, Janus A, Davis MM, Goodman D, Laguna T. Predictors for invasive home mechanical ventilation duration in bronchopulmonary dysplasia. Pediatr Pulmonol 2023. [PMID: 37114844 DOI: 10.1002/ppul.26437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Children with bronchopulmonary dysplasia (BPD) who require invasive home mechanical ventilation (IHMV) are medically vulnerable and experience high caregiving and healthcare costs. Predictors for duration of IHMV in children with BPD remain unclear, which can make prognostication and decision-making challenging. METHODS A retrospective cohort study of children with BPD requiring IHMV was conducted from independent children's hospital records (2005-2021). The primary outcome was IHMV duration, defined as time from initial discharge home on IHMV until cessation of positive pressure ventilation (day and night). Two new variables were included: discharge age corrected for tracheostomy (DACT) (chronological age at discharge minus age at tracheostomy) and level of ventilator support at discharge (minute ventilation per kg per day). Univariable Cox regression was performed with variables of interest compared to IHMV duration. Significant nonlinear factors (p < 0.05) were included in the multivariable analysis. RESULTS One-hundred-and-nineteen patients used IHMV primarily for BPD. Patient median index hospitalization lasted 12 months (interquartile range [IQR] 8.0,14.4). Once home, half of the patients were weaned off IHMV by 36.0 months and 90% by 52.2 months. Being Hispanic/Latinx ethnicity (hazard ratio [HR] 0.14 (95% confidence interval [CI] 0.04, 0.53), p < 0.01) and having a higher DACT were associated with increased IHMV duration (HR 0.66 (CI 0.43, 0.98), p < 0.05). CONCLUSIONS Disparity in IHMV duration exists among patients using IHMV after prematurity. Prospective multisite studies that further investigate new analytic variables, such as DACT and level of ventilator support, and address standardization of IHMV care are needed to create more equitable IHMV management strategies.
Collapse
Affiliation(s)
- Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Digital Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Paige Noreen
- McGaw Medical Center, Northwestern University, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jennifer Grage
- McGaw Medical Center, Northwestern University, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Soyang Kwon
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Lindsey P Hird-McCorry
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Angela Janus
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Denise Goodman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Theresa Laguna
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
157
|
Herres J, Krauthamer Ewing ES, Levy S, Creed TA, Diamond GS. Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety. Front Psychiatry 2023; 14:1096291. [PMID: 37168081 PMCID: PMC10165080 DOI: 10.3389/fpsyt.2023.1096291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
Increases in adolescent anxiety over the past several years suggest a need for trauma-informed, culturally responsive interventions that help teens cope with environmental stressors like those associated with the COVID-19 pandemic. Although abundant evidence supports the efficacy of cognitive behavioral therapy (CBT) in treating adolescent anxiety, not all teens respond positively to CBT. CBT does not typically include strategies that address important family factors that may be impacting the teen's functioning, such as the attachment relationship. Attachment-based family therapy (ABFT) addresses the attachment relationship and other factors that contribute to the adolescent's anxiety and related distress. By enhancing positive parenting behaviors, such as acceptance and validation of the adolescent's distress and promotion of their autonomy, ABFT sessions may repair the attachment relationship and increase the family's ability and willingness to engage in CBT tasks aimed at reducing anxiety. This theoretical paper describes the ABFT model and proposes that implementing ABFT sessions prior to CBT could result in better clinical outcomes for adolescents with anxiety disorders by improving the context within which the anxiety symptoms and treatment are experienced. Given that ABFT is sensitive and responsive to family and other contextual factors, adolescents from marginalized communities and those from less individualistic cultures may find the model to be more acceptable and appropriate for addressing factors related to their anxiety. Thus, a combined ABFT+CBT model might result in better outcomes for adolescents who have not historically responded well to CBT alone.
Collapse
Affiliation(s)
- Joanna Herres
- Department of Psychology, The College of New Jersey, Ewing, NJ, United States
| | | | - Suzanne Levy
- Counseling and Family Therapy Department, Drexel University, Philadelphia, PA, United States
| | - Torrey A. Creed
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Guy S. Diamond
- Counseling and Family Therapy Department, Drexel University, Philadelphia, PA, United States
| |
Collapse
|
158
|
A Structural Lens Approach to Vaccine Hesitancy and Identity. Pediatr Clin North Am 2023; 70:271-282. [PMID: 36841595 DOI: 10.1016/j.pcl.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Vaccine hesitancy is an increasing global health threat, and to improve vaccine uptake, it is critical to account for identity-based considerations including racial and ethnic, religious, and contemporary socio-political identities. Using critical consciousness to create awareness of the diverse cultural viewpoints on vaccines can help providers have conversations that are identity aware, equity-focused, and linguistically sensitive with their patients. It is necessary to collaborate with patients, families, communities, and community leaders to share information about vaccines, their safety profiles, and on how to have vaccines readily accessible in each community, to protect children and adolescents against vaccine preventable illnesses.
Collapse
|
159
|
Abstract
PURPOSE OF REVIEW Social determinants of health play a major role in healthcare utilization and outcomes in patients with asthma. Continuing to understand how these complex and interwoven relationships interact to impact patient care will be crucial to creating innovative programmes that address these disparities. RECENT FINDINGS The current literature continues to support the association of substandard housing, urban and rural neighbourhoods, and race/ethnicity with poor asthma outcomes. Targeted interventions with community health workers (CHWs), telemedicine and local environmental rectifications can help improve outcomes. SUMMARY The link between social determinants and poor asthma outcomes continues to be supported by recent literature. These factors are both nonmodifiable and consequences of institutionalized racist policies that require innovative ideas, technologic equity and funding for groups most at risk for poorer outcomes.
Collapse
Affiliation(s)
- Andre E. Espaillat
- Divisions of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Michelle L. Hernandez
- Allergy & Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
- Children’s Research Institute, University of North Carolina, Chapel Hill, NC
| | - Allison J. Burbank
- Allergy & Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
- Children’s Research Institute, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
160
|
Mendoza FS. The 2022 Joseph W. St Geme, Jr, Leadership Award Address-Diversity and Social Justice: The Field of Pediatrics Can and Should Lead. Pediatrics 2023; 151:e2022059080. [PMID: 36970864 DOI: 10.1542/peds.2022-059080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 04/04/2023] Open
Abstract
The following is an address given by the 2022 recipient of the Joseph W. St. Geme, Jr. Leadership Award, presented by the Federation of Pediatric Organizations at the Pediatric Academic Societies meeting on April 22, 2022.
Collapse
|
161
|
Luke MJ, Vasan A. Understanding and Addressing Racial and Ethnic Inequities in Pediatric Length of Stay. Hosp Pediatr 2023; 13:e92-e94. [PMID: 36911918 PMCID: PMC10087104 DOI: 10.1542/hpeds.2023-007146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Michael J Luke
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditi Vasan
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
162
|
Falusi O, Chun-Seeley L, de la Torre D, Dooley DG, Baiyewu M, Gborkorquellie TT, Merrill CT, Davis E, Ward MC. Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11305. [PMID: 36999061 PMCID: PMC10043344 DOI: 10.15766/mep_2374-8265.11305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/05/2022] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Faculty are increasingly expected to teach about the impact of racism on health and to model the principles of health equity. However, they often feel ill-equipped to do so, and there is limited literature on faculty development on these topics. We developed a curriculum for faculty education on racism and actions to advance racial health equity. METHODS The curriculum design was based on a literature review and needs assessments. Implementation consisted of four live virtual 1-hour sessions incorporating interactive didactics, cases, reflection, goal setting, and discussion offered to a multidisciplinary group of pediatric faculty at a children's hospital. Topics included the history of racism, racism in health care, interacting with trainees and colleagues, and racial equity in policy. Evaluation consisted of pre- and postsurveys at the beginning and end of the curriculum and a survey after each session. RESULTS A mean of 78 faculty members attended each session (range: 66-94). Participants reported high satisfaction and increased knowledge at the end of each session. Qualitative themes included self-reflection on personal biases, application of health equity frameworks and tools, becoming disruptors of racism, and the importance of systemic change and policy. DISCUSSION This curriculum is an effective method for increasing faculty knowledge and comfort. The materials can be adapted for various audiences.
Collapse
Affiliation(s)
- Olanrewaju Falusi
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Associate Program Director, Pediatric Residency Program, Children's National Hospital; Medical Director of Advocacy Education, Child Health Advocacy Institute, Children's National Hospital
| | - Lin Chun-Seeley
- Program Lead, Advocacy Education and Community Affairs, Pediatric Resident Health Equity Education, Child Health Advocacy Institute, Children's National Hospital
| | - Desiree de la Torre
- Director, Community Affairs and Population Health Improvement, Child Health Advocacy Institute, Children's National Hospital
| | - Danielle G. Dooley
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Medical Director of Community Affairs, Child Health Advocacy Institute, Children's National Hospital
| | - Melissa Baiyewu
- Program Manager, Health Promotion and Disease Prevention Programs, Child Health Advocacy Institute, Children's National Hospital
| | - Theiline T. Gborkorquellie
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Assistant Director of Health Equity Education, Pediatric Residency Program, Children's National Hospital; Affiliate Faculty, Child Health Advocacy Institute, Children's National Hospital
| | - Chaya T. Merrill
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Director, Child Health Data Lab, Child Health Advocacy Institute, Children's National Hospital
| | - Elizabeth Davis
- Manager, Government Affairs, Child Health Advocacy Institute, Children's National Hospital
| | - Maranda C. Ward
- Assistant Professor and Director of Equity, Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences
| |
Collapse
|
163
|
Brochier A, Messmer E, Wexler MG, Rogers S, Cottrell E, Tripodis Y, Garg A. A cross-sectional study of relationships between social risks and prevalence and severity of pediatric chronic conditions. BMC Pediatr 2023; 23:115. [PMID: 36890502 PMCID: PMC9992899 DOI: 10.1186/s12887-023-03894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND To examine the differential relationships between seven social risk factors (individually and cumulatively) with the prevalence and severity of asthma, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and overweight/obesity in children. METHODS Using the 2017-2018 National Survey of Children's Health, we examined associations between social risk factors (caregiver education, caregiver underemployment, discrimination, food insecurity, insurance coverage, neighborhood support, and neighborhood safety) and the prevalence and severity of asthma, ADHD, ASD, and overweight/obesity. We used multivariable logistic regression to assess the relationship between individual and cumulative risk factors with each pediatric chronic condition, controlling for child sex and age. RESULTS Although each social risk factor was significantly associated with increased prevalence and/or severity of at least one of the pediatric chronic conditions we investigated, food insecurity was significantly associated with higher disease prevalence and severity for all four conditions. Caregiver underemployment, low social support, and discrimination were significantly associated with higher disease prevalence across all conditions. For each additional social risk factor a child was exposed to, their odds of having each condition increased: overweight/obesity (aOR: 1.2, 95% CI: [1.2, 1.3]), asthma (aOR: 1.3, 95% CI: [1.2, 1.3], ADHD (aOR: 1.2, 95% CI: [1.2, 1.3]), and ASD (aOR: 1.4, 95% CI: [1.3, 1.5]). CONCLUSIONS This study elucidates differential relationships between several social risk factors and the prevalence and severity of common pediatric chronic conditions. While more research is needed, our results suggest that social risks, particularly food insecurity, are potential factors in the development of pediatric chronic conditions.
Collapse
Affiliation(s)
- Annelise Brochier
- Department of Pediatrics, Boston Medical Center, 801 Albany St. Floor 2N, Boston, MA, 02119, USA.
| | - Emily Messmer
- Quality and Patient Experience, Mass General Brigham, 399 Revolution Dr., Somerville, MA, 02145, USA
| | - Mikayla Gordon Wexler
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., New York, NY, 10029, USA
| | - Stephen Rogers
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 9104, USA
| | - Erika Cottrell
- OCHIN, Inc., PO Box 5426, Portland, OR, 97228, USA.,Oregon Clinical & Translational Research Institute, Oregon Health & Science University, 3250 Southwest Sam Jackson Park Rd., Portland, OR, 97329, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave., 3rd Floor, Boston, MA, 02118, USA
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children's Medical Center, 55 N Lake Ave., Worcester, MA, 01655, USA
| |
Collapse
|
164
|
Heath ML, Keptner KM. Impact of belonging and discrimination on psychological well-being among transitioning adults: study using panel survey for income dynamics transition supplement. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
|
165
|
Stevens KE, Choma EG, Clarke JA, Walsh JM. Discussion of Identity and Implicit Bias: A Strategy to Address Racism and Social Justice in Pediatric Nursing Education. Nurs Educ Perspect 2023; Publish Ahead of Print:00024776-990000000-00102. [PMID: 36877737 DOI: 10.1097/01.nep.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
ABSTRACT Nurse educators must weave discussions of systemic racism, social justice, social determinants of health, and psychosocial influences throughout the curriculum. For an online pediatric course, an activity was developed to raise awareness of implicit bias. This experience interfused assigned readings from the literature, introspection of identity, and guided discussion. Framed by principles of transformative learning, faculty facilitated an online dialogue involving groups of 5 to 10 students through aggregated self-descriptors and open prompts. Ground rules for the discussion established psychological safety. This activity complements other schoolwide racial justice initiatives.
Collapse
Affiliation(s)
- Kristen E Stevens
- About the Authors The authors are faculty in the School of Nursing, George Washington University, Ashburn, Virginia. Kristen E. Stevens, MS, CPNP-PC, CNEcl, is a clinical education instructor. Elizabeth G. Choma, DNP, MSN, CPNP-PC, is a clinical assistant professor. Julia A. Clarke, MSN, RN, CNS, is a clinical education instructor. Jennifer M. Walsh, DNP, CPNP-PC, CNE, is a clinical assistant professor. The authors extend special thanks to Lisa Glazer, MSEd, Abigail Caldwell, MSN, APRN, and Angela McNelis, PhD, RN, CNE, ANEF, FAAN, for their support. For more information, contact Kristen E. Stevens at
| | | | | | | |
Collapse
|
166
|
Holaday LW, Tolliver DG, Moore T, Thompson K, Wang EA. Neighborhood Incarceration Rates and Adverse Birth Outcomes in New York City, 2010-2014. JAMA Netw Open 2023; 6:e236173. [PMID: 37000451 PMCID: PMC10066462 DOI: 10.1001/jamanetworkopen.2023.6173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 04/01/2023] Open
Abstract
Importance The US has high rates of adverse birth outcomes, with substantial racial disparities augmented by stress and neighborhood disadvantage. Black people are more likely to live in neighborhoods with high rates of incarceration, which is a source of both stress and neighborhood disadvantage and, thus, may contribute to adverse birth outcomes. Objective To determine whether neighborhoods with high incarceration rates also have higher rates of adverse birth outcomes compared with neighborhoods with lower rates. Design, Setting, and Participants This cross-sectional study used publicly available data from the New York City Department of Health (2010-2014). Censored Poisson regression, with the US Census tract as the unit of analysis, was used to examine the association of neighborhood incarceration rate and birth outcomes. Multivariable models included percentage of births aggregated to the Census tract by maternal factors (age, parity, singleton vs multiple birth, insurance, and race) and neighborhood factors (poverty, education, and violent crime). Analyses were performed between May 2021 and October 2022. Exposure Neighborhood incarceration rate, categorized into quintiles. Main Outcomes and Measures The primary outcome was the incidence rate ratio (IRR) of preterm birth and low birth weight. Secondary outcomes were IRRs of very preterm birth, extremely preterm birth, and very low birth weight. Hypotheses were formulated before data collection. Results Among 2061 Census tracts with 562 339 births, incarceration rates varied from 0 to 4545 people incarcerated per 100 000, and high-incarceration neighborhoods had more residents of Black race (54.00% vs 1.90%), living in poverty (32.30% vs 10.00%), and without a general educational development equivalent (28.00% vs 12.00%) compared with low-incarceration neighborhoods. In fully adjusted models, high-incarceration neighborhoods had a 13% higher IRR of preterm birth (IRR, 1.13; 95% CI, 1.08-1.18), 45% higher IRR of very preterm birth (IRR, 1.45; 95% CI, 1.24-1.71), 125% higher IRR of extremely preterm birth (IRR, 2.25; 95% CI, 1.59-3.18), 10% higher IRR of low birth weight (IRR, 1.10; 95% CI, 1.05-1.16), and 52% higher IRR of very low birth weight compared with low-incarceration neighborhoods (IRR, 1.52; 95% CI, 1.28-1.81). Conclusions and Relevance Neighborhood incarceration rate was positively associated with adverse birth outcomes, particularly those associated with infant mortality. Black people were significantly more likely to live in high-incarceration neighborhoods, suggesting that mass incarceration may contribute to racial disparities in birth outcomes.
Collapse
Affiliation(s)
- Louisa W. Holaday
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
- SEICHE Center for Health and Justice, Yale University, New Haven, Connecticut
- National Clinician Scholars Program, Yale University, New Haven, Connecticut
| | - Destiny G. Tolliver
- National Clinician Scholars Program, Yale University, New Haven, Connecticut
| | - Tiana Moore
- Center for Vulnerable Populations, University of California, San Francisco
| | - Keitra Thompson
- National Clinician Scholars Program, Yale University, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health. Yale University, New Haven, Connecticut
| | - Emily A. Wang
- SEICHE Center for Health and Justice, Yale University, New Haven, Connecticut
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| |
Collapse
|
167
|
Hammon L, Mondzelewski L, Robinson C, Milder E. Well-Child Care Disparities in U.S. Military Health System. Acad Pediatr 2023; 23:363-371. [PMID: 35918041 DOI: 10.1016/j.acap.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe adherence rates for well-child visits among military children in the first 15 months of life and identify any disparities in adherence in a universally insured population. METHODS A retrospective cohort analysis was conducted using the Military Health System data repository which included children who were born between October 2013 and September 2016 and were eligible for TRICARE (the military health insurance program). Children were followed from zero to fifteen months of life to assess adherence with a national Health Effectiveness Data and Information Set (HEDIS) metric of 6 well visits during this period. Differences in adherence rates were evaluated across select demographic characteristics including sponsor rank, race, age, service branch, patient sex, geographic region, number of enrollment sites and provider type. Fitted logistic regression models were used to determine the probability of adherence with the HEDIS metric and identify disparities. RESULTS The final cohort included 168,830 infants. Across all variables, the mean number of well visits was 6.7 with an overall adherence rate of 86%. Child beneficiaries of junior enlisted, Black, and Air Force military members had lower adherence with the HEDIS metric. Enrollment at a single site and having a pediatrician for a primary care manager was associated with higher rates of adherence. CONCLUSIONS Sponsor rank, race, and service branch, along with provider type and number of enrollment sites were significantly associated with the probability of adherence. Further research should evaluate barriers to care that affect a universally insured population.
Collapse
Affiliation(s)
- Laura Hammon
- Department of Pediatrics (L Hammon), Naval Hospital Rota, Spain.
| | - Lisa Mondzelewski
- Department of Pediatrics (L Mondzelewski), Naval Medical Center San Diego, Calif
| | - Camille Robinson
- Division of Adolescent Medicine (C Robinson), Naval Medical Center San Diego, Calif
| | - Edmund Milder
- Division of Pediatric Infectious Diseases (E Milder), Naval Medical Center San Diego, Calif
| |
Collapse
|
168
|
Slavich GM, Roos LG, Mengelkoch S, Webb CA, Shattuck EC, Moriarity DP, Alley JC. Social Safety Theory: Conceptual foundation, underlying mechanisms, and future directions. Health Psychol Rev 2023; 17:5-59. [PMID: 36718584 PMCID: PMC10161928 DOI: 10.1080/17437199.2023.2171900] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023]
Abstract
Classic theories of stress and health are largely based on assumptions regarding how different psychosocial stressors influence biological processes that, in turn, affect human health and behavior. Although theoretically rich, this work has yielded little consensus and led to numerous conceptual, measurement, and reproducibility issues. Social Safety Theory aims to address these issues by using the primary goal and regulatory logic of the human brain and immune system as the basis for specifying the social-environmental situations to which these systems should respond most strongly to maximize reproductive success and survival. This analysis gave rise to the integrated, multi-level formulation described herein, which transforms thinking about stress biology and provides a biologically based, evolutionary account for how and why experiences of social safety and social threat are strongly related to health, well-being, aging, and longevity. In doing so, the theory advances a testable framework for investigating the biopsychosocial roots of health disparities as well as how health-relevant biopsychosocial processes crystalize over time and how perceptions of the social environment interact with childhood microbial environment, birth cohort, culture, air pollution, genetics, sleep, diet, personality, and self-harm to affect health. The theory also highlights several interventions for reducing social threat and promoting resilience.
Collapse
Affiliation(s)
- George M Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Lydia G Roos
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Christian A Webb
- McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eric C Shattuck
- Institute for Health Disparities Research and Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Daniel P Moriarity
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jenna C Alley
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| |
Collapse
|
169
|
Migita D, Cooper A, Barry D, Bettinger B, Tieder A, Sharek PJ. Equity Dashboards: Data Visualizations for Assessing Inequities in a Hospital Setting. Pediatrics 2023; 151:190637. [PMID: 36751915 DOI: 10.1542/peds.2022-058848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 02/09/2023] Open
Affiliation(s)
- Darren Migita
- Seattle Children's, Seattle, Washington.,University of Washington, Seattle, Washington
| | | | | | | | | | - Paul J Sharek
- Seattle Children's, Seattle, Washington.,University of Washington, Seattle, Washington
| |
Collapse
|
170
|
Seeberger JM, Lucas C, Brawley A, Groff A, Kavanaugh M, Yirinec A, Moroco A, Zhu X, King TS, Olympia RP. Positive and Negative Themes Depicted in Television Shows Targeted Toward Adolescents. Clin Pediatr (Phila) 2023; 62:215-226. [PMID: 35982609 DOI: 10.1177/00099228221118401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The American Academy of Pediatrics has previously expressed concerns about the thematic content of television (TV) and the amount of time children spend viewing TV. The objective of this study was to determine the positive and negative themes depicted in a select number of TV shows targeted toward adolescents. We analyzed the thematic content depicted in the first season of 26 Netflix TV shows. The mean occurrences/h for positive and negative themes were 39.53 and 47.20, respectively. The most common positive themes were "encouragement from a friend/peer," "demonstrating honesty," and "staying true to oneself" (5.98, 5.38, and 3.72 mean occurrences/h, respectively). The most common negative themes were "dishonesty," "cursing," and "selfishness," (5.30, 4.96, and 4.85 mean occurrences/h, respectively). We suggest that health care providers become aware of TV thematic content and promote media education, and we encourage co-viewing and active mediation by parents/guardians with their children.
Collapse
Affiliation(s)
| | - Christy Lucas
- Penn State University College of Medicine, Hershey, PA, USA
| | - Amalia Brawley
- Penn State University College of Medicine, Hershey, PA, USA
| | - Andrew Groff
- Penn State University College of Medicine, Hershey, PA, USA
| | - Madison Kavanaugh
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Alison Yirinec
- Penn State University College of Medicine, Hershey, PA, USA
| | - Annie Moroco
- Penn State University College of Medicine, Hershey, PA, USA
| | - Xijun Zhu
- Penn State University College of Medicine, Hershey, PA, USA
| | - Tonya S King
- Department of Public Health Science, Penn State University College of Medicine, Hershey, PA, USA
| | - Robert P Olympia
- Department of Emergency Medicine and Pediatrics, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
171
|
Hospitalizations at United States Children's Hospitals and Severity of Illness by Neighborhood Child Opportunity Index. J Pediatr 2023; 254:83-90.e8. [PMID: 36270394 DOI: 10.1016/j.jpeds.2022.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/13/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the association between neighborhood opportunity measured by the Child Opportunity Index 2.0 (COI) and patterns of hospital admissions and disease severity among children admitted to US pediatric hospitals. STUDY DESIGN Retrospective, cross-sectional study of 773 743 encounters for children <18 years of age admitted to US children's hospitals participating in the Pediatric Health Information System database 7/2020-12/2021. RESULTS The proportion of children from each COI quintile was inversely related to the degree of neighborhood opportunity. The difference between the proportion of patients from Very Low COI and Very High COI ranged from +32.0% (type 2 diabetes mellitus with complications) to -14.1% (mood disorders). The most common principal diagnoses were acute bronchiolitis, respiratory failure/insufficiency, chemotherapy, and asthma. Of the 45 diagnoses which occurred in ≥0.5% of the cohort, 22, including type 2 diabetes mellitus, asthma, and sleep apnea had higher odds of occurring in lower COI tiers in multivariable analysis. Ten diagnoses, including mood disorders, neutropenia, and suicide and intentional self-inflicted injury had lower odds of occurring in the lower COI tiers. The proportion of patients needing critical care and who died increased, as neighborhood opportunity decreased. CONCLUSIONS Pediatric hospital admission diagnoses and severity of illness are disproportionately distributed across the range of neighborhood opportunity, and these differences persist after adjustment for factors including race/ethnicity and payor status, suggesting that these patterns in admissions reflect disparities in neighborhood resources and differential access to care.
Collapse
|
172
|
Williamson AA, Johnson TJ, Tapia IE. Health disparities in pediatric sleep-disordered breathing. Paediatr Respir Rev 2023; 45:2-7. [PMID: 35277358 PMCID: PMC9329494 DOI: 10.1016/j.prrv.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
Sleep-disordered breathing reflects a continuum of overnight breathing difficulties, ranging from mild snoring to obstructive sleep apnea syndrome. Sleep-disordered breathing in childhood is associated with significant adverse outcomes in multiple domains of functioning. This review summarizes the evidence of well-described ethnic, racial, and socioeconomic disparities in pediatric sleep-disordered breathing, from its prevalence to its treatment-related outcomes. Research on potential socio-ecological contributors to these disparities is also reviewed. Critical future research directions include the development of interventions that address the modifiable social and environmental determinants of these health disparities.
Collapse
Affiliation(s)
- Ariel A Williamson
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
173
|
Taylor MG, Joerger T, Anvari S, Li Y, Gerber JS, Palazzi DL. The Quality and Management of Penicillin Allergy Labels in Pediatric Primary Care. Pediatrics 2023; 151:e2022059309. [PMID: 36740967 PMCID: PMC10680064 DOI: 10.1542/peds.2022-059309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Penicillin allergy labels are the most common drug allergy label. The objective of this study was to describe the quality and management of penicillin allergy labels in the pediatric primary care setting. METHODS Retrospective chart review of 500 of 18 015 children with penicillin allergy labels born from January 1, 2010 to June 30, 2020 randomly selected from an outpatient birth cohort from Texas Children's Pediatrics and Children's Hospital of Philadelphia networks. Penicillin allergy risk classification ("not allergy," "low risk," "moderate or high risk," "severe risk," "unable to classify") was determined based on documentation within (1) the allergy tab and (2) electronic healthcare notes. Outcomes of allergy referrals and penicillin re-exposure were noted. RESULTS Half of penicillin allergy labels were "unable to classify" based on allergy tab documentation. Risk classification agreement between allergy tabs and healthcare notes was fair (Cohen's ĸ = 0.35 ± 0.02). Primary care physicians referred 84 of 500 (16.8%) children to an allergist, but only 54 (10.8%) were seen in allergy clinic. All children who were challenged (25 of 25) passed skin testing. Removal of allergy labels was uncommon (69 of 500, 13.8%) but occurred more often following allergy appointments (26 of 54, 48%) than not (43 of 446, 9.6%, P < .001). Children delabeled by primary care physicians were as likely to tolerate subsequent penicillin-class antibiotics as those delabeled by an allergist (94% vs 93%, P = .87). CONCLUSIONS Penicillin allergy documentation within the allergy tab was uninformative, and children were infrequently referred to allergists. Future quality improvement studies should improve penicillin allergy documentation and expand access to allergy services.
Collapse
Affiliation(s)
- Margaret G Taylor
- Division of Infectious Diseases
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Torsten Joerger
- Division of Infectious Diseases
- Division of Immunology, Allergy, and Retrovirology
| | - Sara Anvari
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
- Division of Immunology, Allergy, and Retrovirology
| | - Yun Li
- Division of Immunology, Allergy, and Retrovirology
- Pediatric IDEAS Research Group of the Center for Pediatric Clinical Effectiveness
- Department of Biostatistics, Epidemiology, and Informatics
| | - Jeffrey S Gerber
- Division of Infectious Diseases
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debra L Palazzi
- Division of Infectious Diseases
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
174
|
Monroe P, Campbell JA, Harris M, Egede LE. Racial/ethnic differences in social determinants of health and health outcomes among adolescents and youth ages 10-24 years old: a scoping review. BMC Public Health 2023; 23:410. [PMID: 36855084 PMCID: PMC9976510 DOI: 10.1186/s12889-023-15274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION With the recent emergence of the Healthy People 2030 goals there is a need to understand the role of SDOH on health inequalities from an upstream perspective. This review summarizes the recent body of evidence on the impact of SDOH across adolescence and youth health outcomes by race/ethnicity using the Health People 2030 Framework. METHODS A systematic, reproducible search was performed using PubMed, Academic Search Premier, PsychInfo, and ERIC. A total of 2078 articles were screened for inclusion. A total of 263 articles met inclusion criteria, resulting in 29 articles included for final synthesis. RESULTS Across the 29 articles, 11 were cross-sectional, 16 were cohort, and 2 were experimental. Across SDOH categories (economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context), 1 study examined self-efficacy, 6 educational attainment, 10 behavior, 5 smoking, 11 alcohol use, 10 substance use, and 1 quality of life. The majority of outcomes represented in this search included health behaviors such as health risk behavior, smoking, alcohol use, and substance use. Across the 29 articles identified, significant differences existed across outcomes by race/ethnicity across SDOH factors, however magnitude of differences varied by SDOH category. DISCUSSION SDOH differentially affect adolescents and youth across race/ethnicity. The lived adverse experiences, along with structural racism, increase the likelihood of adolescents and youth engaging in risky health behaviors and negatively influencing health outcomes during adolescence and youth. Research, public health initiatives, and policies integrating SDOH into interventions at early stage of life are needed to effectively reduce social and health inequalities at a population level.
Collapse
Affiliation(s)
- Patricia Monroe
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Jennifer A Campbell
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melissa Harris
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
175
|
Spencer AE, Sikov J, Adams WG, Jellinek M, Murphy JM, Garg A. Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic. Acad Pediatr 2023; 23:263-264. [PMID: 36351513 PMCID: PMC9637283 DOI: 10.1016/j.acap.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Andrea E Spencer
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago (AE Spencer), Chicago, Ill.
| | - Jennifer Sikov
- Department of Psychology, Florida International University (J Sikov), Miami, Fla
| | - William G Adams
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center (WG Adams), Boston, Mass
| | - Michael Jellinek
- Department of Psychiatry, Massachusetts General Hospital (M Jellinek and JM Murphy), Boston, Mass; Department of Psychiatry, Harvard Medical School (M Jellinek and JM Murphy), Boston, Mass
| | - J Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital (M Jellinek and JM Murphy), Boston, Mass; Department of Psychiatry, Harvard Medical School (M Jellinek and JM Murphy), Boston, Mass
| | - Arvin Garg
- Department of Pediatrics, Child Health Equity Center, UMass Chan Medical School, UMass Memorial Children's Medical Center (A Garg), Worcester, Mass
| |
Collapse
|
176
|
Adolescent experiences of the safe surgical checklist and surgical care processes. Pediatr Surg Int 2023; 39:108. [PMID: 36759361 DOI: 10.1007/s00383-023-05396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To explore the perceptions, satisfaction, and needs of adolescent surgical patients with their perioperative pathway, including consent, the Safe Surgical Checklist (SSC), and post-operative care. METHODS We used qualitative methodology to examine adolescent experiences with surgical consent, SSC, and post-operative care. We purposively recruited ten patients aged 13-17 undergoing emergency and elective surgery and obtained consent from parents and patients. Semi-structured interview scripts were co-developed with an adolescent patient advisor, and interviews were performed, recorded, and transcribed verbatim. Thematic analysis was based on grounded theory and Participants were recruited and interviewed until thematic saturation was achieved. RESULTS Four themes emerged in thematic analysis: (1) Autonomy and Inclusion-Adolescents desire to participate in the consent process, including signing their own consent when appropriate, (2) Value of Repetition-Adolescents value the repetition of information in the pre-operative check and feel safer when the team reinforces the information, (3) Importance of Caregiver Involvement - Adolescents valued their caregivers being involved in critical conversations and decision making, and (4) Importance of Transparency in Communication-Adolescents desire to be directly given information about their surgery post-operatively and not told to parents alone. CONCLUSION Adolescents are situated uniquely between childhood and adulthood. Adolescents desired to be directly involved in the decision-making process of their surgery, including participation in the SSC and discussion of post-operative complications.
Collapse
|
177
|
Harmon A, Jordan M, Platt A, Wilson J, Keith K, Chandrashekaran S, Schlichte L, Pendergast J, Ming D. Goal-Concordance in Children with Complex Chronic Conditions. J Pediatr 2023; 253:278-285.e4. [PMID: 36257348 DOI: 10.1016/j.jpeds.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To characterize delivery of goal-concordant end-of-life (EOL) care among children with complex chronic conditions and to determine factors associated with goal-concordance. STUDY DESIGN This was a retrospective review of goals of care discussions for 272 children with at least 1 complex chronic condition who died at a tertiary care hospital between January 1, 2014, and December 31, 2017. Goals of care and code status were assessed before and within the last 72 hours of life. Goals of care discussions were coded as full interventions; considering withdrawal of interventions (palliation); planned transition to palliation; or actively transitioning/transitioned to palliation. RESULTS In total, 158 children had documented goals of care discussions before and within the last 72 hours of life, 18 had goals of care discussions only >72 hours before death, 54 only in the last 72 hours of life, and 42 had no documented goals of care. For children with goals of care, EOL care was goal-concordant for 82.2%, discordant in 7%, and unclear in 10.8%. Black children had a greater than 8-fold greater odds of discordant care compared with White children (OR 8.34, P = .007). Comparison of goals of care and code status before and within the last 72 hours of life revealed trends toward nonescalation of care. Specifically, rates of active palliation increased from 11.7% to 63.0%, and code status shifted from 32.6% do not resuscitate to 65.2% (P < .001). CONCLUSIONS In this cohort, a majority of children had documented goals of care discussions and received goal-concordant EOL care. However, Black children had greater odds of receiving goal-discordant care. Goals of care and code status shifted toward palliation during the last 72 hours of life.
Collapse
Affiliation(s)
- Alexis Harmon
- Department of Pediatrics, McGaw Medical Center of Northwestern University, Chicago, IL
| | - Megan Jordan
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Alyssa Platt
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jonathon Wilson
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Kevin Keith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | | | - Jane Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - David Ming
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC.
| |
Collapse
|
178
|
Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 292] [Impact Index Per Article: 292.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
|
179
|
Postdischarge Racial and Ethnic Disparities in Pediatric Appendicitis: A Mediation Analysis. J Surg Res 2023; 282:174-182. [PMID: 36308900 DOI: 10.1016/j.jss.2022.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/11/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Significant racial and ethnic disparities exist for children presenting with acute appendicitis; however, it is unknown if disparities persist after initial management and hospital discharge. MATERIALS AND METHODS We performed a retrospective cohort study of children (aged < 18 y) who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals between 2017 and 2019. Primary outcomes were 30-d emergency department (ED) visits and 30-d inpatient readmission. Hierarchical multivariable logistic regression models were developed to determine the association of race and ethnicity on the primary outcomes. Inverse odds-weighted mediation analyses were used to estimate the degree to which complicated disease, insurance status, urbanicity, and residential socioeconomic status- mediated disparate outcomes. RESULTS A total of 67,303 patients were included. Compared with Non-Hispanic White children, Non-Hispanic Black (NHB) (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.23-1.59) and Hispanic/Latinx (HL) children (OR 1.55, 95% CI 1.44-1.67) had higher odds of ED visits. Only NHB children had higher odds of readmission (OR 1.43, 95% CI 1.30-1.57). On a multivariable analysis, NHB (adjusted OR 1.19, 95% CI 1.04-1.36) and HL (adjusted OR 1.19, 95% CI 1.09-1.31) children had higher odds of ED visits. Insurance, disease severity, socioeconomic status, and urbanicity mediated 61.6% (95% CI 29.7-100%) and 66.3% (95% CI 46.9-89.3%) of disparities for NHB and HL children, respectively. CONCLUSIONS Children of racial and ethnic minorities are more likely to visit the ED after treatment for acute appendicitis, but HL patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence. A lack of appropriate postdischarge education and follow-up may drive disparities in healthcare utilization after pediatric appendicitis.
Collapse
|
180
|
Rea KE, West KB, Dorste A, Christofferson ES, Lefkowitz D, Mudd E, Schneider L, Smith C, Triplett KN, McKenna K. A systematic review of social determinants of health in pediatric organ transplant outcomes. Pediatr Transplant 2023; 27:e14418. [PMID: 36321186 DOI: 10.1111/petr.14418] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre- and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods. METHODS Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases. RESULTS Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent. CONCLUSION This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities.
Collapse
Affiliation(s)
- Kelly E Rea
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Kara B West
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Dorste
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Debra Lefkowitz
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily Mudd
- Cleveland Clinic Children's, Center for Pediatric Behavioral Health, Wilmington, North Carolina, USA
| | - Lauren Schneider
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Courtney Smith
- Norton Children's, University of Louisville, Louisville, Kentucky, USA
| | - Kelli N Triplett
- Children's Health, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | |
Collapse
|
181
|
Child Health Advocacy: The Journey to Antiracism. Pediatr Clin North Am 2023; 70:91-101. [PMID: 36402474 DOI: 10.1016/j.pcl.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The last several years have seen accelerated activity and discourse directed at antiracism. Specifically following the 2020 murder of George Floyd, institutions across the country engaged in a range of introspective exercises and transparent reckonings examining their practices, policies, and history insofar as equity and racism is concerned. The authors of this article, both active protagonists in this domain, have been, and continue to be, part of ongoing national efforts and have learned much about the strategies and tactics necessary to initiate, engage, and sustain traction on the path to antiracism.
Collapse
|
182
|
Breuner CC, Alderman EM, Jewell JA. The Hospitalized Adolescent. Pediatrics 2023; 151:190499. [PMID: 36995186 DOI: 10.1542/peds.2022-060646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This policy statement is the first published statement in the United States on this topic and the authors aim to provide pediatricians with evidence-based information on the unique aspects required to care for hospitalized adolescents. Included in this policy statement is a description of the possible effects hospitalization may have on the developmental and emotional progress of adolescence, the role of the hospital setting, the importance of confidentiality, and issues related to legal/ethical matters and bias and institutional and systemic racism that may occur during hospitalization.
Collapse
Affiliation(s)
- Cora C Breuner
- Division of Adolescent Medicine, Departments of Pediatrics and Orthopedics and Sports Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
| | - Jennifer A Jewell
- The Barbara Bush Children's Hospital at Maine Medical Center, MaineHealth, Portland, Maine
| |
Collapse
|
183
|
Abstract
This clinical report provides pediatricians evidence-based information on the developmentally appropriate, comprehensive clinical care for hospitalized adolescents. Included in this report are opportunities and challenges facing pediatricians when caring for specific hospitalized adolescent populations. The companion policy statement, “The Hospitalized Adolescent,” includes detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital setting and design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.
Collapse
|
184
|
Perrin JM, Flanagan P, Katkin J, Barabell G, Price J. The Unique Value Proposition of Pediatric Health Care. Pediatrics 2023; 151:190498. [PMID: 36995185 DOI: 10.1542/peds.2022-060681] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This document provides a framework for the value proposition of pediatric health care. It is intended to provide a succinct set of principles for establishing this proposition that demonstrates the short- and long-term value to the child and family, the health care system, and society as a whole.
Collapse
Affiliation(s)
- James M Perrin
- MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Patricia Flanagan
- W. Alpert Medical School of Brown University/Hasbro Children's Hospital Department of Pediatrics, Providence, Rhode Island
| | - Julie Katkin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Jonathan Price
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
185
|
Nguyen-Truong CKY, Waters SF, Richardson M, Barrow N, Seia J, Eti DU, Rodela KF. An Antiracism Community-Based Participatory Research With Organizations Serving Immigrant and Marginalized Communities, Including Asian Americans and Native Hawaiians/Pacific Islanders in the United States Pacific Northwest: Qualitative Description Study With Key Informants. Asian Pac Isl Nurs J 2023; 7:e43150. [PMID: 36648292 PMCID: PMC9976990 DOI: 10.2196/43150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Asian American (AA) community leaders, Native Hawaiian/Pacific Islander (NH/PI) community leaders, and allies in the United States Pacific Northwest expressed concern that there are families and children from AA communities and NH/PI communities who experience and witness acts of xenophobia and racism. This can cause racial trauma. The long-time practice of aggregating AA and NH/PI data contributes to erasure and makes it challenging to advance health equity, such as allocating resources. According to AAPI Data's long-awaited report in June 2022, there are over 24 million AAs and 1.6 million NHs/PIs in the United States, growing by 40% and 30%, respectively, between 2010 and 2020. Philanthropic investments have not kept up with this substantive increase. The National Academies of Sciences, Engineering, and Medicine emphasized the need for effective partnerships to advance the health and well-being of individuals and communities in antiracism and system-level research. OBJECTIVE The aim of this community-based participatory research qualitative description study was to identify perceptions and experiences regarding racial discrimination, race-based stress, and racial trauma; intergenerational healing and resiliency; and sharing the body with science from key informants of an academic and community partnership to inform antiracism coalition work. This partnership includes academic researchers and community leaders from community-based organizations and a health care organization serving immigrant and marginalized communities, including AAs and NHs/PIs in the United States Pacific Northwest. METHODS In total, 10 key informants joined 1 of 2 participatory group discussions via videoconference for 2 hours in 2022. We used a semistructured and open-ended group interview guide. A qualitative participatory group-level assessment was conducted with the key informants and transcribed. Interpretations and meanings of the main points and the main themes were reflected upon, clarified, and verified with the key informants in real time. The field note-based data transcripts were manually coded using conventional content analysis. Reflexivity was used. RESULTS There were 6 main themes: prejudice plus power in racism definition and working in solidarity to counter lateral oppression/false sense of security, microaggression as multilayers, "not assimilationist by nature" and responding differently to white superiority, intergenerational- and identity-related trauma, what is healing among People of Color and through a lens of resiliency and intergenerational connection and knowledge, and mistrust and fear in the research and health care systems surrounding intentions of the body. CONCLUSIONS The themes highlight the importance of internal and intergenerational healing from racial trauma and the need for solidarity among communities of color to combat white supremacy and colonization. This work was foundational in an ongoing effort to dismantle racism and uplift the community voice through a cross-sector academic and community partnership to inform antiracism coalition work.
Collapse
Affiliation(s)
| | - Sara F Waters
- Human Development Department in Vancouver, College of Agricultural, Human, and Natural Resource Sciences, Washington State University, Vancouver, WA, United States
| | - Meenakshi Richardson
- Human Development Department in Vancouver, Washington State University, Vancouver, WA, United States
| | - Natasha Barrow
- College of Nursing, Health Sciences Spokane, Washington State University, Spokane, WA, United States
| | - Joseph Seia
- Lived Experience Coalition, Federal Way, WA, United States
| | - Deborah U Eti
- College of Nursing, Health Sciences Spokane, Washington State University, Spokane, WA, United States
| | | |
Collapse
|
186
|
Opel DJ, Brewer NT, Buttenheim AM, Callaghan T, Carpiano RM, Clinton C, Elharake JA, Flowers LC, Galvani AP, Hotez PJ, Schwartz JL, Benjamin RM, Caplan A, DiResta R, Lakshmanan R, Maldonado YA, Mello MM, Parmet WE, Salmon DA, Sharfstein JM, Omer SB. The legacy of the COVID-19 pandemic for childhood vaccination in the USA. Lancet 2023; 401:75-78. [PMID: 36309017 PMCID: PMC9605265 DOI: 10.1016/s0140-6736(22)01693-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing and Center for Health Incentives, University of Pennsylvania, Philadelphia, PA, USA; Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy Callaghan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jad A Elharake
- Yale Institute for Global Health, New Haven, CT, USA; Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
| | - Lisa C Flowers
- Department of Obstetrics & Gynecology, Emory University, Atlanta, GA, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | - Peter J Hotez
- Texas Children's Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA; Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA; James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA
| | - Jason L Schwartz
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | | | - Arthur Caplan
- New York University Langone School of Medicine, New York University, New York, NY, USA
| | - Renee DiResta
- Stanford Internet Observatory, Stanford University, Stanford, CA, USA
| | | | | | - Michelle M Mello
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA; Stanford Law School, Stanford, CA, USA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Wendy E Parmet
- Center for Health Policy & Law, Northeastern University, Boston, MA, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joshua M Sharfstein
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, CT, USA; Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale School of Nursing, Orange, CT, USA
| |
Collapse
|
187
|
Greenbaum J, Kaplan D, Young J, Asnes AG, Gavril AR, Gilmartin ABH, Girardet RG, Heavilin ND, Laskey A, Messner SA, Mohr BA, Nienow SM, Rosado N, Forkey H, Keefe R, Keeshin B, Matjasko J, Edward H, Stedt E, Linton J, Gutierrez R, Caballero T, Falusi O“LO, Giri M, Griffin M, Ibrahim A, Mukerjee K, Shah S, Shapiro A, Young J. Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients. Pediatrics 2023; 151:190310. [PMID: 36827522 DOI: 10.1542/peds.2022-060416] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
Exploitation and labor and sex trafficking of children and adolescents is a major public health problem in the United States and throughout the world. Significant numbers of US and non-US-born children and adolescents (including unaccompanied immigrant minors) are affected by this growing concern and may experience a range of serious physical and mental health problems associated with human trafficking and exploitation (T/E). Despite these considerations, there is limited information available for health care providers regarding the nature and scope of T/E and how providers may help recognize and protect children and adolescents. Knowledge of risk factors, recruitment practices, possible indicators of T/E, and common medical, mental, and emotional health problems experienced by affected individuals will assist health care providers in recognizing vulnerable children and adolescents and responding appropriately. A trauma-informed, rights-based, culturally sensitive approach helps providers identify and treat patients who have experienced or are at risk for T/E. As health care providers, educators, and leaders in child advocacy and development, pediatricians play an important role in addressing the public health issues faced by children and adolescents who experience exploitation and trafficking. Working across disciplines with professionals in the community, health care providers can offer evidence-based medical screening, treatment, and holistic services to individuals who have experienced T/E and assist vulnerable patients and families in recognizing signs of T/E.
Collapse
Affiliation(s)
- Jordan Greenbaum
- International Centre for Missing and Exploited Children, Alexandria, Virginia
| | - Dana Kaplan
- Department of Pediatrics, Staten Island University Hospital, Northwell Health Physician Partners, Staten Island, New York.,The Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Janine Young
- Department of Pediatrics, University of California, San Diego, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
188
|
Wilson RF, Afifi TO, Yuan K, Lyons BH, Fortson BL, Oliver C, Watson A, Self-Brown S. Child abuse-related homicides precipitated by caregiver use of harsh physical punishment. CHILD ABUSE & NEGLECT 2023; 135:105953. [PMID: 36403370 PMCID: PMC11163945 DOI: 10.1016/j.chiabu.2022.105953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Physical punishment (PP), which may involve the use of physical force, has been linked to negative effects in children and can escalate to abusive or harsh PP, resulting in injury or death. OBJECTIVE To examine characteristics associated with fatal abuse involving caregiver use of harsh PP. METHODS Data were from the National Violent Death Reporting System in 40 states, the District of Columbia, and Puerto Rico for years 2012-2018. Qualitative analysis was used to code textual material into categorial data, and logistic regression was used to examine associations between various characteristics and harsh PP. RESULTS Approximately 4 % (n = 87) of the 2414 abuse-related homicides were known to have been precipitated by caregiver use of harsh PP. In adjusted models, homicides had greater odds of being harsh PP-related when incidents involved mothers' male companions (versus fathers), victims had a previous nonfatal injury (versus no previous nonfatal injury), and another adult participated in the fatal incident or had awareness of prior abuse/neglect (versus those without this characteristic). Two common precipitators of caregivers' use of harsh PP were: 1) child had a bathroom-related accident/soiled clothes (23.0 %; n = 20), and 2) child disobeyed a directive given by the perpetrator (17.2 %; n = 15). CONCLUSIONS This study highlights characteristics associated with fatal abuse precipitated by caregiver use of harsh PP. Children were physically punished for developmentally normative behaviors. Ensuring caregivers are aware of and use effective parenting practices that focus on use of nonphysical discipline and promote healthy child development, may help decrease harsh PP and physical abuse-related homicides among children.
Collapse
Affiliation(s)
- Rebecca F Wilson
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, GA, USA.
| | | | - Keming Yuan
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA, USA
| | - Bridget H Lyons
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, GA, USA
| | - Beverly L Fortson
- Department of Defense, Sexual Assault Prevention and Response Office, Alexandria, VA, USA
| | - Christal Oliver
- Georgia State University, School of Public Health, Atlanta, GA, USA
| | - Ashley Watson
- Georgia State University, School of Public Health, Atlanta, GA, USA
| | | |
Collapse
|
189
|
Patchin JW, Hinduja S. Cyberbullying Among Asian American Youth Before and During the COVID-19 Pandemic. THE JOURNAL OF SCHOOL HEALTH 2023; 93:82-87. [PMID: 36221854 DOI: 10.1111/josh.13249] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Early in the COVID-19 pandemic, there was a concern that cyberbullying incidents would increase as youth were spending more time online. Additionally, reports emerged that Asian American citizens were being disproportionately targeted due to the purported origination of the disease. The current study explores whether cyberbullying incidents increased among adolescents overall-and Asian American youth in particular-since the onset of the coronavirus. METHODS Three unique national surveys of teens (aged 13-17, mean = 14.96) conducted in 2016 (N = 4742), 2019 (N = 4250), and 2021 (N = 2546) were analyzed to track experience over time with general cyberbullying, as well as cyberbullying based on race or color. Additionally, respondents were asked in 2021 whether they had been cyberbullied more or less since the start of the COVID-19 pandemic. RESULTS More youth have experienced cyberbullying since the beginning of the COVID-19 pandemic, with Asian American youth most likely to report increased victimization during the pandemic. For example, in 2021, 23.2% of youth reported experiencing cyberbullying compared to 17.2% in 2019 and 16.7% in 2016. Among Asian American youth, 23.5% said they were cyberbullied because of their race in 2021, compared to 7.4% in 2019 and 13.9% in 2016. CONCLUSIONS As more adolescents continue to spend more time online, cyberbullying victimization may increase across all racial groups. In the current politicized environment, Asian Americans may continue to be targeted because of their race. Schools and communities should augment existing implementations and pedagogy with more population-specific approaches that are culturally relevant, culturally sustaining, and that reflect the unique lived experiences of Asian American youth. IMPLICATIONS AND CONTRIBUTION The current study shows that more adolescents have experienced cyberbullying (both general and race-based) since the start of the COVID-19 pandemic. The increase in race-based victimization was highest among Asian American youth.
Collapse
Affiliation(s)
- Justin W Patchin
- Department of Political Science, University of Wisconsin-Eau Claire, 105 Garfield Avenue, Eau Claire, WI, 54702-4004
| | - Sameer Hinduja
- School of Criminology and Criminal Justice, Florida Atlantic University, 5353 Parkside Drive, Jupiter, FL, 33458-2906
| |
Collapse
|
190
|
Orr CJ, Turner AL, Ritter VS, Gutierrez-Wu J, Leslie LK. Pursuing a Career in Pediatrics: Intersection of Educational Debt and Race/Ethnicity. J Pediatr 2023; 252:162-170. [PMID: 35973445 DOI: 10.1016/j.jpeds.2022.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/25/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the associations among pediatric trainees' self-reported race/ethnicity, educational debt, and other factors for pursuing a pediatrics career. STUDY DESIGN Cross-sectional study using data from the American Board of Pediatrics In-training Examination Post-examination Survey years 2018-2020 of categorical pediatric interns. Independent variable of interest was race/ethnicity. Classifications used were White, Hispanic/Latinx, Black/African American, Asian, and other/multiracial. The primary dependent variable was educational debt; secondary dependent variables included the importance of personal, professional, and financial factors in selecting a pediatric career. Means with 95% CIs were computed to summarize scores regarding a factor's importance. Chi-square tests of homogeneity and one-way ANOVA F tests were used to compare proportions and means of dependent variables across levels of self-reported race/ethnicity. RESULTS A total of 11 150 (91.5%) completed the survey. Of the final analytical sample (7 943), approximately 6.3% self-identified as Black/African American, 8.2% as Hispanic/Latinx, 22% as Asian, and 55% as White; 44% reported >$200 000 of debt. Overall, 33% of those identifying as Black/African American had >$300 000 in educational debt. The highest ranked career factor was interest in a specific disease/patient population. The importance of educational debt in career choices was highest among those identifying as Black/African American, followed by Asians and Hispanic/Latinx. Among all races/ethnicities, the importance of mentorship decreased with higher educational debt. CONCLUSION Among individuals pursuing pediatrics, the intersection of race/ethnicity and debt may influence trainees' pursuit of pediatric careers. Educational debt negatively impacts the importance of mentorship.
Collapse
Affiliation(s)
- Colin J Orr
- Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - Victor S Ritter
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Gutierrez-Wu
- Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, NC; Tufts School of Medicine, Boston, MA
| |
Collapse
|
191
|
Vo H, Campelia GD, Olszewski AE. Addressing Racism in Ethics Consultation: An Expansion of the Four-Box Method. THE JOURNAL OF CLINICAL ETHICS 2023; 34:11-26. [PMID: 36940357 DOI: 10.1086/723322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
AbstractRacism is a pervasive issue in patient care and a key social determinant of health. Clinical ethicists, like others involved in patient care, have a duty to recognize and respond to racism on both individual and systems-wide levels to improve patient care. Doing so can be challenging and, like other skills in ethics consultation, may benefit from specialized training, standardized tools and approaches, and practice. Learning from existing frameworks and tools, as well as building new ones, can help guide clinical ethicists to systematically approach racism as it affects clinical cases. Here, we propose an expansion of the commonly used four-box method to clinical ethics consultation, where racism is considered as a potential factor in each of the four boxes. We apply this method to two clinical cases to highlight ethically salient information that might be missed using the standard formulation of the four boxes but captured with the expanded version. We argue that this expansion of an existing clinical ethics consultation tool is ethically justified insofar as it (a) creates a more just approach, (b) supports individual consultants and services, and (c) facilitates communication in contexts where racism impinges on effecting good patient care.
Collapse
|
192
|
Szoko N, Ragunanthan B, Radovic A, Garrison JL, Torres O. Antiracist Curriculum Implementation for Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231162986. [PMID: 37123077 PMCID: PMC10134181 DOI: 10.1177/23821205231162986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objectives Racism has been recognized as a public health crisis, with calls for greater focus on antiracism in medical training. We sought to evaluate a longitudinal antiracist curriculum among pediatric residents. Methods In 2020-2021, we delivered seven educational sessions to pediatric trainees in a single residency program. We administered pre-/post-surveys to assess changes in awareness of structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Awareness was measured with 27 Likert-type items spanning five conceptual domains (schools, healthcare, justice system, employment, and housing/transportation). We evaluated knowledge with 18 true/false or multiple-choice questions. Participants indicated comfort with clinical skills using 13 Likert-type items drawn from national toolkits and policy statements. Individual/institutional advocacy behaviors were measured with 14 items from the Antiracism Behavioral Inventory. McNemar or paired Wilcoxon signed-rank tests compared measures before and after implementation. Results Out of 121 residents, 79 (65%) completed pre-surveys, 47 (39%) completed post-surveys, and 37 (31%) were eligible for matching across responses. 78% of respondents were female and 68% identified as White. We found significant increases in awareness across several conceptual domains (schools: p = 0.03; healthcare: p = 0.004; employment: p = 0.003; housing/transportation: p = 0.02). Mean knowledge score increased after implementation (p = 0.03). Self-reported clinical skills improved significantly (p < 0.001). Individual advocacy behaviors increased (p < 0.001); there were no changes in institutional advocacy. Conclusion We demonstrate improvements in several educational constructs with a novel antiracist curriculum. Efforts to scale and sustain this work are ongoing, and additional teaching and evaluation methodologies may be incorporated in the future.
Collapse
Affiliation(s)
- Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Nicholas Szoko, Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Avenue, Second Floor, Pittsburgh PA, 15213, USA.
| | | | - Ana Radovic
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica L. Garrison
- Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Orquidia Torres
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
193
|
Wittman SR, Yabes JG, Sabik LM, Kahn JM, Ray KN. Patient and Family Factors Associated with Use of Telemedicine Visits for Pediatric Acute Respiratory Tract Infections, 2018-2019. Telemed J E Health 2023; 29:127-136. [PMID: 35639360 PMCID: PMC9918348 DOI: 10.1089/tmj.2022.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Pediatric acute respiratory tract infections (ARTIs) were a common reason for commercial direct-to-consumer (DTC) telemedicine use before the COVID-19 pandemic, but the factors associated with this use are unknown. Objective: To identify child and family factors associated with use of commercial DTC telemedicine for ARTIs in 2018-2019. Methods: We performed a retrospective cohort analysis of claims data from the Optum Clinformatics® Data Mart Database. Among children with ARTI visits, we fitted logit models to examine child and family characteristics associated with DTC telemedicine use. Results: Of 660,725 children with ARTI visits, 12,944 (2.0%) had ≥1 commercial DTC telemedicine encounter. The odds of DTC telemedicine use were higher for children with age ≥12 years, lower parent educational attainment, higher household income, white non-Hispanic race/ethnicity, and residency in the West South Central census division. Conclusion: In 2018-2019, commercial DTC telemedicine use varied with child age, child race/ethnicity parent educational attainment, household income, and geography.
Collapse
Affiliation(s)
- Samuel R. Wittman
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan G. Yabes
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lindsay M. Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jeremy M. Kahn
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kristin N. Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
194
|
Structural racism is associated with adverse postnatal outcomes among Black preterm infants. Pediatr Res 2022:10.1038/s41390-022-02445-6. [PMID: 36577795 PMCID: PMC9795138 DOI: 10.1038/s41390-022-02445-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/03/2022] [Accepted: 11/28/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Structural racism contributes to racial disparities in adverse perinatal outcomes. We sought to determine if structural racism is associated with adverse outcomes among Black preterm infants postnatally. METHODS Observational cohort study of 13,321 Black birthing people who delivered preterm (gestational age 22-36 weeks) in California in 2011-2017 using a statewide birth cohort database and the American Community Survey. Racial and income segregation was quantified by the Index of Concentration at the Extremes (ICE) scores. Multivariable generalized estimating equations regression models were fit to test the association between ICE scores and adverse postnatal outcomes: frequent acute care visits, readmissions, and pre- and post-discharge death, adjusting for infant and birthing person characteristics and social factors. RESULTS Black birthing people who delivered preterm in the least privileged ICE tertiles were more likely to have infants who experienced frequent acute care visits (crude risk ratio [cRR] 1.3 95% CI 1.2-1.4), readmissions (cRR 1.1 95% CI 1.0-1.2), and post-discharge death (cRR 1.9 95% CI 1.2-3.1) in their first year compared to those in the privileged tertile. Results did not differ significantly after adjusting for infant or birthing person characteristics. CONCLUSION Structural racism contributes to adverse outcomes for Black preterm infants after hospital discharge. IMPACT STATEMENT Structural racism, measured by racial and income segregation, was associated with adverse postnatal outcomes among Black preterm infants including frequent acute care visits, rehospitalizations, and death after hospital discharge. This study extends our understanding of the impact of structural racism on the health of Black preterm infants beyond the perinatal period and provides reinforcement to the concept of structural racism contributing to racial disparities in poor postnatal outcomes for preterm infants. Identifying structural racism as a primary cause of racial disparities in the postnatal period is necessary to prioritize and implement appropriate structural interventions to improve outcomes.
Collapse
|
195
|
Shahidullah JD, Petts R, Broder-Fingert S. Toward Antiracism Pediatric Practice: The Role of System Navigation in the Medical Home. J Dev Behav Pediatr 2022; 43:537-539. [PMID: 36115018 DOI: 10.1097/dbp.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Rachel Petts
- Fairleigh Dickinson University, Teaneck, NJ; and
| | | |
Collapse
|
196
|
Luff D, Buscher SW, Ward VL, Ballal SA, Holden P, Pierre R, Won P, Yu EJ, Toomey SL. Understanding Racial, Ethnic, and Socioeconomic Differences in the Ambulatory Care Experience. Pediatrics 2022; 150:189912. [PMID: 36336649 DOI: 10.1542/peds.2021-056001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Racial and ethnic and socioeconomic differences in patient experience are prevalent and can negatively impact health outcomes. Our objective was to examine differences in family experience of care in the pediatric ambulatory setting. METHODS We conducted interviews with parents of patients from different demographic groups who had received care at 1 of 3 clinics at a quaternary children's hospital. Multidisciplinary team conducted inductive and deductive thematic analysis of transcribed interviews. Sentiments and recurring themes were compared within and between racial and ethnic groups, insurance status, and language. RESULTS Eighty parents were interviewed. Three primary themes were identified: (1) mitigation of system issues: parents' mixed experiences with staff or clinicians mitigating system issues impacted their overall perceptions of care; (2) pivotal role of personal interactions: clinicians' interactions positively influenced family-clinician relationships and offset negative experiences; (3) effective explanations: clinicians' clear and thorough explanations were crucial in enhancing parent confidence in care. As an overarching theme, discrimination and disrespect by staff undermined trust in care, affecting all aspects of experience. With the exception of explanations, a higher proportion of publicly-insured parents reported negative experiences across all themes compared to those with private insurance. Asian parents with public insurance had the highest proportion of interviews that were mainly negative in sentiment. CONCLUSIONS Our findings offer nuanced insights into differences in the experience of ambulatory care. Insurance status emerged as an important marker of differential perceptions of care. Our study points to areas for improvement and highlights family-clinician interactions as vital to overall positive experience.
Collapse
Affiliation(s)
- Donna Luff
- Simulator Program (SIMPeds).,Harvard Medical School, Boston, Massachusetts
| | | | - Valerie L Ward
- Office of Health Equity and Inclusion, Department of Radiology.,Harvard Medical School, Boston, Massachusetts
| | - Sonia A Ballal
- Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Sara L Toomey
- Division of General Pediatrics.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
197
|
Ming DY, Jones KA, White MJ, Pritchard JE, Hammill BG, Bush C, Jackson GL, Raman SR. Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics. Matern Child Health J 2022; 26:2407-2418. [PMID: 36198851 PMCID: PMC10026355 DOI: 10.1007/s10995-022-03543-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare differences in healthcare utilization and costs for Medicaid-insured children with medical complexity (CMC) by race/ethnicity and rurality. METHODS Retrospective cohort of North Carolina (NC) Medicaid claims for children 3-20 years old with 3 years continuous Medicaid coverage (10/1/2015-9/30/2018). Exposures were medical complexity, race/ethnicity, and rurality. Three medical complexity levels were: without chronic disease, non-complex chronic disease, and complex chronic disease; the latter were defined as CMC. Race/ethnicity was self-reported in claims; we defined rurality by home residence ZIP codes. Utilization and costs were summarized for 1 year (10/1/2018-9/30/2019) by complexity level classification and categorized as acute care (hospitalization, emergency [ED]), outpatient care (primary, specialty, allied health), and pharmacy. Per-complexity group utilization rates (per 1000 person-years) by race/ethnicity and rurality were compared using adjusted rate ratios (ARR). RESULTS Among 859,166 Medicaid-insured children, 118,210 (13.8%) were CMC. Among CMC, 36% were categorized as Black non-Hispanic, 42.7% White non-Hispanic, 14.3% Hispanic, and 35% rural. Compared to White non-Hispanic CMC, Black non-Hispanic CMC had higher hospitalization (ARR = 1.12; confidence interval, CI 1.08-1.17) and ED visit (ARR = 1.17; CI 1.16-1.19) rates; Hispanic CMC had lower ED visit (ARR = 0.77; CI 0.75-0.78) and hospitalization rates (ARR = 0.79; CI 0.73-0.84). Black non-Hispanic and Hispanic CMC had lower outpatient visit rates than White non-Hispanic CMC. Rural CMC had higher ED (ARR = 1.13; CI 1.11-1.15) and lower primary care utilization rates (ARR = 0.87; CI 0.86-0.88) than urban CMC. DISCUSSION Healthcare utilization varied by race/ethnicity and rurality for Medicaid-insured CMC. Further studies should investigate mechanisms for these variations and expand higher value, equitable care delivery for CMC.
Collapse
Affiliation(s)
- David Y Ming
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michelle J White
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA
| | - Jessica E Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - George L Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
198
|
Fiori KP, Oyeku SO. Addressing Racial, Ethnic, and Socioeconomic Differences in Real-World Practice. Pediatrics 2022; 150:189911. [PMID: 36336641 DOI: 10.1542/peds.2022-058243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kevin P Fiori
- Department of Family and Social Medicine.,Division of Academic General Pediatrics, Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
| | - Suzette O Oyeku
- Division of Academic General Pediatrics, Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
199
|
Hoskins K, Linn KA, Ahmedani BK, Boggs JM, Johnson C, Heintz J, Marcus SC, Kaminer I, Zabel C, Wright L, Quintana LM, Buttenheim AM, Daley MF, Elias ME, Jager-Hyman S, Lieberman A, Lyons J, Maye M, McArdle B, Ritzwoller DP, Small DS, Westphal J, Wolk CB, Zhang S, Shelton RC, Beidas RS. Equitable implementation of S.A.F.E. Firearm: A multi-method pilot study. Prev Med 2022; 165:107281. [PMID: 36191653 PMCID: PMC10013361 DOI: 10.1016/j.ypmed.2022.107281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 02/08/2023]
Abstract
Attention to health equity is critical in the implementation of firearm safety efforts. We present our operationalization of equity-oriented recommendations in preparation for launch of a hybrid effectiveness-implementation trial focused on firearm safety promotion in pediatric primary care as a universal suicide prevention strategy. In Step 1 of our process, pre-trial engagement with clinican partners and literature review alerted us that delivery of a firearm safety program may vary by patients' medical complexity, race, and ethnicity. In Step 2, we selected the Health Equity Implementation Framework to inform our understanding of contextual determinants (i.e., barriers and facilitators). In Step 3, we leveraged an implementation pilot across 5 pediatric primary care clinics in 2 health system sites to study signals of inequities. Eligible well-child visits for 694 patients and 47 clinicians were included. Our results suggested that medical complexity was not associated with program delivery. We did see potential signals of inequities by race and ethnicity but must interpret with caution. Though we did not initially plan to examine differences by sex assigned at birth, we discovered that clinicians may be more likely to deliver the program to parents of male than female patients. Seven qualitative interviews with clinicians provided additional context. In Step 4, we interrogated equity considerations (e.g., why and how do these inequities exist). In Step 5, we will develop a plan to probe potential inequities related to race, ethnicity, and sex in the fully powered trial. Our process highlights that prospective, rigorous, exploratory work is vital for equity-informed implementation trials.
Collapse
Affiliation(s)
- Katelin Hoskins
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kristin A Linn
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Jennifer M Boggs
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Christina Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan Heintz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabelle Kaminer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Celeste Zabel
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Leslie Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - LeeAnn M Quintana
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Marisa E Elias
- Department of Pediatrics, Henry Ford Health, Detroit, MI, USA
| | - Shari Jager-Hyman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adina Lieberman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Lyons
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Bridget McArdle
- Department of Pediatrics, Henry Ford Health, Detroit, MI, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Dylan S Small
- Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Shiling Zhang
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rinad S Beidas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
200
|
Williams DR, Braddock A, Houser M, Blair G, Browne N. Review of upstream social factors contributing to childhood obesity. OBESITY PILLARS 2022; 4:100040. [PMID: 37990668 PMCID: PMC10662005 DOI: 10.1016/j.obpill.2022.100040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/23/2023]
Affiliation(s)
- Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA
| | - Amy Braddock
- Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
| | - Marcella Houser
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Giselle Blair
- The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA
- Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Nancy Browne
- The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA
- Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| |
Collapse
|