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Abstract
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding or the provision of human milk a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention and The Joint Commission monitor breastfeeding practices in United States hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding. Efforts to improve breastfeeding rates must acknowledge existing disparities and the impact of racism in promoting equity in breastfeeding education, support, and services.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai, New York.,New York City Health+Hospitals Elmhurst
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252
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Abstract
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding, or the provision of human milk, a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention (CDC) and The Joint Commission monitor breastfeeding practices in US hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York.,New York City Health+Hospitals/Elmhurst
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253
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Crossing AE, Gumudavelly D, Watkins N, Logue C, Anderson RE. A Critical Race Theory of Psychology as Praxis: Proposing and Utilizing Principles of PsyCrit. JOURNAL OF ADOLESCENT RESEARCH 2022. [DOI: 10.1177/07435584221101930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Historically, psychological science has contributed to maintaining the hegemony of white normativity and a fallacious belief in objective science that speaks to one singular truth about race. Due to a widespread unfamiliarity with critical theories and research methods in the field, novel approaches to psychological scientific inquiry are warranted to support scholars in pursuing racially-just empirical inquiries with socially-just implications. This manuscript aims to (1) introduce an evolution from critical race theory in psychology to a set of principles to guide research praxis: PsyCrit and (2) demonstrate its utility through use in an exemplar qualitative study. Qualitative coding analysis of semi-structured interviews with four Black mothers and one Black father ( n = 5) participating in the Engaging, Managing, and Bonding through Race intervention was conducted to model the use of PsyCrit in practice and deepen our understanding of parent factors in Black families. This manuscript unpacks four aspects of the exemplar study utilizing four of the seven tenets of PsyCrit. The depth of analysis provided by the framework suggests that these principles may serve in guiding psychological researchers toward more nuanced investigations, especially as they relate to issues of race or racism.
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254
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Glass DJ, Geerkens JT, Martin MA. Psychosocial and energetic factors on human female pubertal timing: a systematized review. EVOLUTIONARY HUMAN SCIENCES 2022; 4:e28. [PMID: 37588922 PMCID: PMC10426011 DOI: 10.1017/ehs.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Childhood psychosocial stressors have been proposed to favour fast life history strategies promoting earlier puberty in females. However, studies demonstrating this association often do not elucidate causal mechanisms, nor account for greater childhood energetic availability - also known to promote rapid growth and earlier puberty. To assess the extent to which such confounding has been considered, we conducted a systematized review to identify studies examining measures of both prepubertal growth (e.g. weight, height) and psychosocial stressors (e.g. adversity, father absence) in relation to female pubertal timing. A total of 1069 non-duplicated studies were identified across five databases. Twenty studies met selection criteria for critical review following independent screening of titles, abstracts and manuscripts. Within these studies, measures indicative of rapid childhood growth were more consistently associated with earlier pubertal timing than were measures of psychosocial stress. We discuss future research directions to investigate the impact of psychosocial stress on pubertal timing more robustly, including methodological and mechanistic considerations, and contextualization of findings by socioecological environments.
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Affiliation(s)
- Delaney J. Glass
- University of Washington, Department of Anthropology, Seattle, Washington, USA
| | | | - Melanie A. Martin
- University of Washington, Department of Anthropology, Seattle, Washington, USA
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255
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Heneghan JA, Goodman DM, Ramgopal S. Demographic and Clinical Differences Between Applied Definitions of Medical Complexity. Hosp Pediatr 2022; 12:654-663. [PMID: 35652303 DOI: 10.1542/hpeds.2021-006432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify the degree of concordance and characterize demographic and clinical differences between commonly used definitions of multisystem medical complexity in children hospitalized in children's hospitals. METHODS We conducted a retrospective, cross-sectional cohort study of children <21 years of age hospitalized at 47 US Pediatric Health Information System-participating children's hospitals between January 2017 to December 2019. We classified patients as having multisystem complexity when using 3 definitions of medical complexity (pediatric complex chronic conditions, pediatric medical complexity algorithm, and pediatric chronic critical illness) and assessed their overlap. We compared demographic, clinical, outcome, cost characteristics, and longitudinal healthcare utilization for each grouping. RESULTS Nearly one-fourth (23.5%) of children hospitalized at Pediatric Health Information System-participating institutions were identified as meeting at least 1 definition of multisystem complexity. Children with multisystem complexity ranged from 1.0% to 22.1% of hospitalized children, depending on the definition, with 31.2% to 95.9% requiring an ICU stay during their index admission. Differences were seen in demographic, clinical, and resource utilization patterns across the definitions. Definitions of multisystem complexity demonstrated poor agreement (Fleiss' κ 0.21), with 3.5% of identified children meeting all 3. CONCLUSIONS Three definitions of multisystem complexity identified varied populations of children with complex medical needs, with poor overall agreement. Careful consideration is required when applying definitions of medical complexity in health services research, and their lack of concordance should result in caution in the interpretation of research using differing definitions of medical complexity.
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Affiliation(s)
- Julia A Heneghan
- Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Sriram Ramgopal
- Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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256
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Warren MD, McLellan SE, Mann MY, Scott JA, Brown TW. Progress, Persistence, and Hope: Building a System of Services for CYSHCN and Their Families. Pediatrics 2022; 149:188220. [PMID: 35642873 DOI: 10.1542/peds.2021-056150e] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
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257
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Affiliation(s)
- Olakunle B Akintemi
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Kenneth B Roberts
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
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258
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Kuo DZ, Rodgers RC, Beers NS, McLellan SE, Nguyen TK. Access to Services for Children and Youth With Special Health Care Needs and Their Families: Concepts and Considerations for an Integrated Systems Redesign. Pediatrics 2022; 149:188217. [PMID: 35642871 DOI: 10.1542/peds.2021-056150h] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
Access to services for children and youth with special health care needs (CYSHCN) have typically emphasized coverage, service, timeliness, and capability. Yet families of CYSHCN continue to describe a fragmented health care system with significant unmet needs. For many years, the concept of access to services has focused on the services themselves, rather than starting with the needs of CYSHCN and their families. Meeting these needs should be grounded in health equity, address systemic racism and ableism, and emphasize the life course and journey of those with such needs and their families. In this paper, we start with the simple concept of asking that care is available for CYSHCN regardless of when, where, and how they need it. Access to services is built on relationships instead of a series of transactions. Opportunities for innovation include creating a single point of service entry; determining services based on need instead of diagnosis; and emphasizing service continuity, transition, and a place-based approach. The innovations reimagine access throughout the life course, centering care around a proactive, human-centered system that addresses health and all of its determinants. The landscape of antipoverty investments, cultural humility, workforce changes, technology, and human-centered thought in design have the potential to further transform the conceptual framework to improve access to services for CYSHCN and their families.
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Affiliation(s)
- Dennis Z Kuo
- Associate Professor and Division Chief of General Pediatrics, University at Buffalo, Buffalo, New York
| | - Rylin C Rodgers
- Disability Policy Advisor, Microsoft Accessibility, Washington, DC
| | | | - Sarah E McLellan
- Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
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259
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Durand TM, Skubel A. Narratives of Puerto Rican Middle School Students Regarding School Context and Identity: Contradictions and Possibilities. JOURNAL OF ADOLESCENT RESEARCH 2022. [DOI: 10.1177/07435584221096446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Puerto Rican students are a growing population in U.S. mainland schools, yet few recent studies have focused on the school contextual and identity-based experiences of Puerto Rican youth. Using stage-environment fit and LatCrit theories, this qualitative study examined seven Puerto Rican adolescent students’ perspectives on domains of school context, along with prominent aspects of how they defined “being Puerto Rican,” in two urban middle schools. Based on qualitative analyses of student interview and focus groups, findings revealed that students’ experiences with teachers, ethnic-racial climate, and sense of belonging were fundamentally contradictory, where examples of purported “equal treatment” were tempered by racialized experiences marked by stereotypes and the suppression of Spanish, especially among male students. However, dimensions of identity-based resiliency such as ethnic pride, sense of familismo with other Puerto Rican students, and being bilingual emerged as sources of strength. We discuss school-based possibilities for the delivery of critically conscious support and ethnic affirmation for students during this critical developmental period, based on our exploratory findings.
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260
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Achieving equity through science and integrity: dismantling race-based medicine. Pediatr Res 2022; 91:1641-1644. [PMID: 35383261 DOI: 10.1038/s41390-022-02041-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
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261
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Walker CJ, Williams CD, Winter M, Everhart R. African American Children's Racial Discrimination Experiences and Mental Health. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:1621-1629. [PMID: 37388712 PMCID: PMC10309156 DOI: 10.1007/s10826-022-02311-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 07/01/2023]
Abstract
The current study examined how African American children's experiences of perceived personal racial discrimination and perceived vicarious racial discrimination were linked with depressive and anxiety symptoms, and whether there were significant sex differences in these relations. The sample included 73 African American children (48% male), ranging from 7 to 12 years of age (M = 8.82, SD = 2.06). Models specified children's personal discrimination and vicarious discrimination as predictors of depressive and anxiety symptoms. Nested model comparisons were also used to examine whether associations varied as a function of children's sex. The current study hypothesized that both forms of discrimination would be associated with greater anxiety and depressive symptoms. Findings indicated that children's personal racial discrimination significantly predicted greater child anxiety symptoms for both boys and girls. No significant sex differences emerged. Neither personal nor vicarious discrimination significantly predicted depressive symptoms. Our findings highlight that racialized experiences occur early in childhood and have important implications for children's mental health.
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Affiliation(s)
- Chloe J Walker
- Department of Psychology, Virginia Commonwealth University; 806 W. Franklin St. Box 842018, Richmond, VA, 23284 USA
| | - Chelsea Derlan Williams
- Department of Psychology, Virginia Commonwealth University; 806 W. Franklin St. Box 842018, Richmond, VA, 23284 USA
| | - Marcia Winter
- Department of Psychology, Virginia Commonwealth University; 806 W. Franklin St. Box 842018, Richmond, VA, 23284 USA
| | - Robin Everhart
- Department of Psychology, Virginia Commonwealth University; 806 W. Franklin St. Box 842018, Richmond, VA, 23284 USA
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262
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McLellan SE, Mann MY, Scott JA, Brown TW. A Blueprint for Change: Guiding Principles for a System of Services for Children and Youth With Special Health Care Needs and Their Families. Pediatrics 2022; 149:188225. [PMID: 35642876 DOI: 10.1542/peds.2021-056150c] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 12/22/2022] Open
Abstract
Children and youth with special health care needs (CYSHCN) and their families continue to face challenges in accessing health care and other services in an integrated, family-centered, evidence-informed, culturally responsive system. More than 12 million, or almost 86%, of CYSHCN ages 1-17 years do not have access to a well-functioning system of services. Further, the inequities experienced by CYSHCN and their families, particularly those in under-resourced communities, highlight the critical need to address social determinants of health and our nation's approach to delivering health care. To advance the system and prioritize well-being and optimal health for CYSHCN, the Health Resources and Services Administration's Maternal and Child Health Bureau, with input from diverse stakeholders, developed a set of core principles and actionable strategies for the field. This article presents principles and strategies in the Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and Their Families (Blueprint for Change), which acknowledges the comprehensive needs of CYSHCN, a changing health care system, and the disparities experienced by many CYSHCN. Four critical areas drive the Blueprint for Change: health equity, family and child well-being and quality of life, access to services, and financing of services. Although discussed separately, these critical areas are inherently interconnected and intend to move the field forward at the community, state, and federal levels. Addressing these critical areas requires a concerted, holistic, and integrated approach that will help us achieve the goal that CYSHCN enjoy a full life from childhood through adulthood and thrive in a system that supports their families and their social, health, and emotional needs, ensuring their dignity, autonomy, independence, and active participation in their communities.
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263
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Calhoun A, Genao I, Martin A, Windish D. Moving Beyond Implicit Bias in Antiracist Academic Medicine Initiatives. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:790-792. [PMID: 34907963 DOI: 10.1097/acm.0000000000004562] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The concept of implicit bias has arguably laid the groundwork for uncomfortable discussions surrounding race in academic medicine, but its effectiveness in changing racist behavior and systems remains unclear. Terms like implicit bias, while perhaps more palatable than other concepts to some, may result in confusion and divert time from meaningful reconceptualization and creation of effective antiracism initiatives. This Invited Commentary contends that the term implicit bias is inadequate for addressing racism because it is too broad; does not necessarily lead to a change in racist behaviors; assumes that racism is unconscious, aggressor-centered, and individual-focused; and implies that everyone suffers equally in a racist system. The authors illustrate why terms like implicit bias are inadequate in combatting racism in medicine and suggest alternate terminology to use while engaging in antiracism work in academic medicine.
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Affiliation(s)
- Amanda Calhoun
- A. Calhoun is an adult/child psychiatry resident, Yale Child Study Center, New Haven, Connecticut
| | - Inginia Genao
- I. Genao is the graduate medical education director for diversity and inclusion and associate professor of medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Andrés Martin
- A. Martin is the Riva Ariella Ritvo Professor, Yale Child Study Center, and medical director, Children's Psychiatric Inpatient Service, Yale-New Haven Children's Hospital, New Haven, Connecticut
| | - Donna Windish
- D. Windish is associate professor of medicine and program director, General Internal Medicine Medical Education Fellowship, Yale School of Medicine, New Haven, Connecticut
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264
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Houtrow A, Martin AJ, Harris D, Cejas D, Hutson R, Mazloomdoost Y, Agrawal RK. Health Equity for Children and Youth With Special Health Care Needs: A Vision for the Future. Pediatrics 2022; 149:188222. [PMID: 35642875 DOI: 10.1542/peds.2021-056150f] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
Health equity is a key pillar in supporting a future in which CYSHCN enjoy a full life and thrive, as envisioned by experts and community partners who gathered in 2019 and 2020 to develop the Blueprint for Change: Guiding Principles for a System of Services for Children and Youth With Special Health Care Needs and Their Families. However, a variety of contextual factors impact health outcomes across the life course and intergenerationally and must be addressed to achieve this goal. For example, poverty and discrimination, including by some health care professionals and systems, are important, modifiable root causes of poor health outcomes. There are numerous barriers to achieving health equity, including political will, lack of resources, insufficient training, and limited cross-sector collaborations. Political, cultural, societal, and environmental interventions are necessary to eliminate health disparities and achieve health equity. The entities that serve CYSHCN should be equitably designed and implemented to improve health outcomes and address health disparities. Many entities that serve CYSHCN are taking positive steps through workforce development, policy changes, community engagement, and other means. The purpose of this article is to frame health equity for CYSHCN, detail their health disparities, review barriers to health equity, provide examples of strategies to advance health equity for them, and describe a path toward the future in which all CYSHCN have a fair and just opportunity to be as healthy as possible.
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Affiliation(s)
- Amy Houtrow
- Departments of Physical Medicine Rehabilitation.,Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison J Martin
- Oregon Center for Children and Youth with Special Health Needs, School of Public Health, Oregon Health and Science University-Portland State University, Portland, Oregon.,Institute on Development and Disability, Oregon Health and Science University, Portland, Oregon
| | - Debbi Harris
- The Arc of the United States, Washington, District of Columbia.,Family Voices of Minnesota, St. Paul, Minnesota
| | - Diana Cejas
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Carrboro, North Carolina
| | - Rachel Hutson
- Title V Maternal and Child Health, Colorado Department of Public Health and Environment
| | | | - Rishi K Agrawal
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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265
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Countering Educational Disparities Among Black Boys and Black Adolescent Boys from Pre-K to High School: A Life Course-Intersectional Perspective. THE URBAN REVIEW 2022; 54:183-206. [PMID: 34565917 PMCID: PMC8450170 DOI: 10.1007/s11256-021-00616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
Accounts of educational opportunity gaps for Black boys are overwhelmingly focused on later years of development. Achievement and discipline disparities are evident across their lifespan. Life course and intersectionality theories were used to develop a framework for understanding obstacles Black boys face during their preschool through high school years. Outlining the cumulative impact of threats and protective factors for their academic success provides insight for supporting Black boys at various developmental stages. Implications include tools for families, educators, and practitioners. This perspective will enhance the collective understanding of the resiliency of Black boys and support their educational success throughout the life course.
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266
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Shonkoff JP, Boyce WT, Bush NR, Gunnar MR, Hensch TK, Levitt P, Meaney MJ, Nelson CA, Slopen N, Williams DR, Silveira PP. Translating the Biology of Adversity and Resilience Into New Measures for Pediatric Practice. Pediatrics 2022; 149:187008. [PMID: 35535547 DOI: 10.1542/peds.2021-054493] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
As the science of adversity and resilience advances, and public awareness of the health consequences of stress grows, primary care providers are being increasingly asked to address the effects of adverse experiences on child wellbeing. Given limited tools for assessing these effects early in life, the authors explore how enhanced capacity to measure stress activation directly in young children could transform the role and scope of pediatric practice. When employed within a trusted relationship between caregivers and clinicians, selective use of biological measures of stress responses would help address the documented limitations of rating scales of adverse childhood experiences as a primary indicator of individual risk and strengthen the ability to focus on variation in intervention needs, assess their effectiveness, and guide ongoing management. The authors provide an overview of the potential benefits and risks of such expanded measurement capacity, as well as an introduction to candidate indicators that might be employed in an office setting. The ultimate value of such measures for both pediatricians and parents will require vigilant attention to the ethical responsibilities of assuring their correct interpretation and minimizing the harm of inappropriate labeling, especially for children and families experiencing the hardships and threats of racism, poverty, and other structural inequities. Whereas much work remains to be done to advance measurement development and ensure its equitable use, the potential of validated markers of stress activation and resilience to strengthen the impact of primary health care on the lives of young children facing significant adversity demands increased attention.
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Affiliation(s)
- Jack P Shonkoff
- Center on the Developing Child.,Harvard Graduate School of Education.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - W Thomas Boyce
- University of California, San Francisco, San Francisco, California
| | - Nicole R Bush
- Departments of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences.,Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, San Francisco, California
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | - Takao K Hensch
- Center on the Developing Child.,Conte Center for Basic Mental Health Research.,Center for Brain Science, Harvard University, Cambridge, Massachusetts.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Pat Levitt
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael J Meaney
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore, Republic of Singapore
| | - Charles A Nelson
- Center on the Developing Child.,Harvard Graduate School of Education.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Natalie Slopen
- Center on the Developing Child.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - David R Williams
- Center on the Developing Child.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Patricia Pelufo Silveira
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
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267
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Miller AL, Stein SF, Sokol R, Varisco R, Trout P, Julian MM, Ribaudo J, Kay J, Pilkauskas NV, Gardner-Neblett N, Herrenkohl TI, Zivin K, Muzik M, Rosenblum KL. From zero to thrive: A model of cross-system and cross-sector relational health to promote early childhood development across the child-serving ecosystem. Infant Ment Health J 2022; 43:624-637. [PMID: 35638583 DOI: 10.1002/imhj.21996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/30/2021] [Indexed: 11/05/2022]
Abstract
Early relational health between caregivers and children is foundational for child health and well-being. Children and caregivers are also embedded within multiple systems and sectors, or a "child-serving ecosystem", that shapes child development. Although the COVID-19 pandemic has made this embeddedness abundantly clear, systems remain siloed and lack coordination. Fostering relational health amongst layers of this ecosystem may be a way to systematically support young children and families who are facing adversity. We integrate theory, examples, and empirical findings to develop a conceptual model informed by infant mental health and public health frameworks that illustrates how relational health across the child-serving ecosystem may promote child health and well-being at a population level. Our model articulates what relational health looks like across levels of this ecosystem from primary caregiver-child relationships, to secondary relationships between caregivers and child-serving systems, to tertiary relationships among systems that shape child outcomes directly and indirectly. We posit that positive relational health across levels is critical for promoting child health and well-being broadly. We provide examples of evidence-based approaches that address primary, secondary, and tertiary relational health, and suggest ways to promote relational health through cross-sector training and psychoeducation in the science of early development. This model conceptualizes relational health across the child-serving ecosystem and can serve as a template for promoting child health and well-being in the context of adversity.
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Affiliation(s)
- Alison L Miller
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sara F Stein
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebeccah Sokol
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Rachel Varisco
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Phoebe Trout
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan M Julian
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie Ribaudo
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Joshua Kay
- University of Michigan Law School, Ann Arbor, Michigan, USA
| | | | | | - Todd I Herrenkohl
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Kara Zivin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Maria Muzik
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine L Rosenblum
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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268
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Cooper SM, Hurd NM, Loyd AB. Advancing scholarship on anti-racism within developmental science: Reflections on the special section and recommendations for future research. Child Dev 2022; 93:619-632. [PMID: 35596641 DOI: 10.1111/cdev.13783] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To date, theoretical and conceptual scholarship on anti-racism has been advanced through leading contributions from several disciplines (e.g., sociology, education, psychology). Still, there remain fewer empirical studies on anti-racism constructs, and we know little about the development of anti-racism among diverse youth across key stages of development. In this special section of Child Development, we sought to address this gap by highlighting scholarship in developmental science that attends to the development of anti-racism in children across contexts (e.g., families, schools) and developmental stages (e.g., early childhood through emerging adulthood). In our introduction to the special section, we review the collective contributions of included studies and outline recommendations for future research in the development of anti-racism in youth.
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Affiliation(s)
- Shauna M Cooper
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Noelle M Hurd
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
| | - Aerika Brittian Loyd
- Department of Psychology, University of California, Riverside, Riverside, California, USA
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269
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Sullivan J, Wilton L, Apfelbaum EP. How age and race affect the frequency, timing, and content of conversations about race with children. Child Dev 2022; 93:633-652. [PMID: 35587879 DOI: 10.1111/cdev.13787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 01/22/2023]
Abstract
Anti-racist efforts require talking with children about race. The present work tested the predictors of U.S. adults' (N = 441; 52% female; 32% BIPOC participants; Mage = 35 years) conversations about race with children across two timepoints in 2019. Approximately 60% of adult participants talked to their children (3-12 years) about race during the preceding week; only 29% talked to other adults about race during the same period. This paper describes the content and predictors of conversations about race, revealing how conversations differ depending on the participant's race, a child's age, and whether the conversation occurs with children or another adult. These data have important implications for theorizing about when, why, and how adults actually talk about race with children and adults.
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Affiliation(s)
- Jessica Sullivan
- Department of Psychology, Skidmore College, Saratoga Springs, New York, USA
| | - Leigh Wilton
- Department of Psychology, Skidmore College, Saratoga Springs, New York, USA
| | - Evan P Apfelbaum
- Boston University, Questrom School of Business, Boston, Massachusetts, USA
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270
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Thomas K. Early relational health - A promising approach for equitable systems change in pediatrics: A commentary. Infant Ment Health J 2022; 43:507-514. [PMID: 35579363 DOI: 10.1002/imhj.21984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/11/2022]
Abstract
Pediatric primary care plays a critical role in supporting the healthy development of young children. Wisdom and research suggest that every developmental domain is shaped by the quality of close relationships, particularly the caregiver-child relationship. Therefore, pediatric primary care has a unique opportunity to support and nurture early relationships using the Early Relational Health (ERH) framework and its applications Early Relational Health Screen, and Early Relational Health Conversations. ERH and its applications recognize years of innovation focused on the promotion of the wellbeing of caregiver-child relationships, and children's long-term development. Central to enhancing and elevating pediatric practice is intentional effort in using diversity-informed, anti-racist, equitable systems of care frameworks. This Commentary offers a call to action for pediatric primary care to create more equitable and inclusive practice via ERH. The call to action includes deepening self and institutional awareness; allocating resources for systems change, including infusing greater equity into departmental structures; and, building authentic relationships with patients, families, and communities. This will result in intentional systems change centered on equitable practice.
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271
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Condon MC, Charlot-Swilley D, Rahman T. At the feet of storytellers: Equity in early relational health conversations. Infant Ment Health J 2022; 43:390-409. [PMID: 35579361 DOI: 10.1002/imhj.21979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/16/2021] [Indexed: 11/08/2022]
Abstract
Early Relational Health (ERH) focuses attention on family-baby relationships during the first 1000 days of life. Positive ERH enhances child health and development and family wellbeing. Universal, early identification of RH and vulnerability could add value to care. How to screen, when, where, and with whom is the question. Tools and models for screening are practitioner-centered. Bias can affect family engagement and outcomes. This may be problematic for African American families. Authors present findings of a discourse analysis and phenomenological study of experiences of African American families' and HealthySteps Specialists' (HSS) of color with screening ERH in Washington, D.C., USA (N = 13). Findings indicate relevance, acceptance and utility may be influenced by positionality, cultural context, issues of equity, and engagement in mutual reflection. A family-centered approach that opened space for non-dominant knowledge about ERH made positive differences in engagement and utility for families and practioners alike. Health and vulnerability were detected reliably using this approach. Outcomes include new theories about ERH-focused visits with African American families and infants, and a new model for centering ERH in pediatric practice, entitled Early Relational Health Conversations. ERH-C is a family reflection model, not necessarily dyadic. It may have value for other populations. Future directions in ERH-C research are suggested.
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Affiliation(s)
| | - Dominique Charlot-Swilley
- Early Childhood Innovation Network, Washington, D.C. (ECIN), USA.,Children's National Primary Care, Children's Health Center - Anacostia, Washington, D.C., USA
| | - Tininka Rahman
- Early Childhood Innovation Network, Washington, D.C. (ECIN), USA.,Children's National Primary Care, Children's Health Center - Anacostia, Washington, D.C., USA
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272
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Quinn ED, Cotter K, Kurin K, Brown K. Conducting a Community Engagement Studio to Adapt Enhanced Milieu Teaching. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1095-1113. [PMID: 35007426 PMCID: PMC9567404 DOI: 10.1044/2021_ajslp-21-00100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/11/2021] [Accepted: 09/25/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE Barriers to implementing evidence-based practices occur at various levels. Stakeholder input is required to identify challenges specific to clinical practice settings, client populations, and service delivery approaches. The purpose of this project was to solicit feedback from stakeholders on the telepractice service delivery and implementation strategies proposed for a future study of enhanced milieu teaching (EMT) in rural counties. METHOD A Community Engagement Studio was conducted with 11 caregivers of children with language delays living in rural counties. Caregivers and the researchers discussed early intervention service delivery for children with language delays in rural Oregon and the proposed telepractice EMT procedures. Researchers gathered feedback on three intervention components: session frequency and schedule, implementation strategies to encourage caregivers' use of EMT, and performance feedback techniques to teach caregivers. RESULTS Findings from the Community Engagement Studio led to four primary modifications to the telepractice EMT study protocol. The principal investigator increased available days and times for intervention sessions and added text-message reminders for parents. A survey was also added for caregivers to identify their preferences for additional implementation strategies (e.g., tip sheets, checklist, e-mailed session summaries) and graphic representations of performance feedback (e.g., bar graph, radial graph, mountain climber infographic). CONCLUSION Community Engagement Studios are a promising method for increasing community engagement in clinical research and soliciting stakeholder feedback on evidence-based intervention adaptations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.17774819.
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Affiliation(s)
- Emily D. Quinn
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Kathleen Cotter
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Kim Kurin
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Kim Brown
- Community Outreach, Research, and Engagement, Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland
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273
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Bergmann KR, Nickel A, Hall M, Cutler G, Abuzzahab MJ, Bretscher B, Lammers S, Watson D, Hester GZ. Association of Neighborhood Resources and Race and Ethnicity With Readmissions for Diabetic Ketoacidosis at US Children's Hospitals. JAMA Netw Open 2022; 5:e2210456. [PMID: 35511179 PMCID: PMC9073568 DOI: 10.1001/jamanetworkopen.2022.10456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
Importance The Child Opportunity Index 2.0 (COI) assesses neighborhood resources and conditions that influence health. It is unclear whether the COI scores are associated with health outcomes by race and ethnicity among children with type 1 diabetes (T1D). Objective To determine whether COI categories are associated with diabetes-related outcomes by race and ethnicity, including readmissions for diabetic ketoacidosis (DKA) and co-occurring acute kidney injury (AKI) or cerebral edema (CE). Design, Setting, and Participants This cross-sectional study included children discharged with a primary diagnosis of T1D with DKA between January 1, 2009, and December 31, 2018. Merged data were obtained from the Pediatric Health Information System and COI. Participants included children and adolescents younger than 21 years with an encounter for DKA. Data were analyzed from April 29, 2021, to January 5, 2022. Exposures Neighborhood opportunity, measured with the COI as an ordered, categorical score (where a higher score indicates more opportunity), and race and ethnicity. Main Outcomes and Measures The primary outcome was readmission for DKA within 30 and 365 days from an index visit. Secondary outcomes included the proportion of encounters with AKI or CE. Mixed-effects logistic regression was used to generate probabilities of readmission, AKI, and CE for each quintile of COI category by race and ethnicity. Results A total of 72 726 patient encounters were identified, including 38 924 (53.5%) for girls; the median patient age was 13 (IQR, 9-15) years. In terms of race and ethnicity, 600 (0.8%) of the encounters occurred in Asian patients, 9969 (13.7%) occurred in Hispanic patients, 16 876 (23.2%) occurred in non-Hispanic Black (hereinafter Black) patients, 40 129 (55.2%) occurred in non-Hispanic White (hereinafter White) patients, and 5152 (7.1%) occurred in patients of other race or ethnicity. The probability of readmission within 365 days was significantly higher among Black children with a very low COI category compared with Hispanic children (risk difference, 7.8 [95% CI, 6.0-9.6] percentage points) and White children (risk difference, 7.5 [95% CI, 5.9-9.1] percentage points) at the same COI category. Similar differences were seen for children with very high COI scores and across racial groups. The COI category was not associated with AKI or CE. However, race and ethnicity constituted a significant factor associated with AKI across all COI categories. The probability of AKI was 6.8% among Black children compared with 4.2% among Hispanic children (risk difference, 2.5 [95% CI, 1.7-3.3] percentage points) and 4.8% among White children (risk difference, 2.0 [95% CI, 1.3-2.6] percentage points). Conclusions and Relevance These results suggest that Black children with T1D experience disparities in health outcomes compared with other racial and ethnic groups with similar COI categories. Measures to prevent readmissions for DKA should include interventions that target racial disparities and community factors.
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Affiliation(s)
- Kelly R. Bergmann
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis
| | - Amanda Nickel
- Department of Research and Sponsored Programs, Children’s Minnesota, Minneapolis
| | - Matt Hall
- Department of Analytics, Children’s Hospital Association, Overland Park, Kansas
| | - Gretchen Cutler
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis
| | | | - Brianna Bretscher
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis
| | - Shea Lammers
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis
| | - Dave Watson
- Department of Research and Sponsored Programs, Children’s Minnesota, Minneapolis
| | - Gabrielle Z. Hester
- Department of Value and Clinical Excellence, Children’s Minnesota, Minneapolis
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274
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Hotez E, Berghaus M, Verbiest S, Russ S, Halfon N. Proposal for Life Course Intervention Researcher Core Competencies. Pediatrics 2022; 149:186918. [PMID: 35503320 PMCID: PMC9847407 DOI: 10.1542/peds.2021-053509f] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Affiliation(s)
- Emily Hotez
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Departments of Medicine,Address correspondence to Emily Hotez, PhD, 911 Broxton Ave, 2 Floor, Los Angeles, CA 90024. E-mail:
| | - Mary Berghaus
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Pediatrics, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sarah Verbiest
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shirley Russ
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Pediatrics, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Neal Halfon
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Pediatrics, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California,Department of Health Policy and Management, Fielding School of Public Health,Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
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275
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Argabright ST, Visoki E, Moore TM, Ryan DT, DiDomenico GE, Njoroge WFM, Taylor JH, Guloksuz S, Gur RC, Gur RE, Benton TD, Barzilay R. Association Between Discrimination Stress and Suicidality in Preadolescent Children. J Am Acad Child Adolesc Psychiatry 2022; 61:686-697. [PMID: 34425231 PMCID: PMC8917360 DOI: 10.1016/j.jaac.2021.08.011] [Citation(s) in RCA: 12] [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: 02/11/2021] [Revised: 07/17/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Youth suicide rates in the United States have been increasing in recent years, especially in Black Americans, the reasons for which are unclear. Environmental adversity is key in youth suicidality; hence there is a need to study stressors that have a disproportionate impact on Black youths. We aimed to disentangle the unique contribution of racial/ethnic discrimination from other adversities associated with childhood suicidal ideation and attempts (suicidality). METHOD We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, which included a large, diverse sample of US children (N = 11,235, mean age 10.9 years, 20.2% Black), assessed for multiple environmental adversities including discrimination. Multivariate regression models tested the association of self-reported racial/ethnic discrimination with suicidality, covarying for multiple confounders including other discrimination types (toward non-US-born individuals, sexual orientation-based, and weight-based). Matched analyses contrasted effects of racial/ethnic discrimination and racial identity on suicidality. RESULTS Black youths reported more discrimination and higher suicidality rates than non-Black youths. High racial/ethnic discrimination was positively and significantly associated with suicidality, adjusting for other discrimination types (odds ratio = 2.6, 95% CI = 2.1-3.2). Findings remained significant after adjusting for multiple suicidality risk factors. Once experienced, racial/ethnic discrimination was similarly associated with suicidality in White, Black, and Hispanic youths. Matched analyses revealed that racial/ethnic discrimination was associated with suicidality (relative risk = 2.7, 95% CI = 2-3.5), whereas Black race was not (relative risk = 0.9, 95% CI = 0.7-1.2). CONCLUSION Racial/ethnic discrimination is disproportionately experienced by Black children, and is associated with preadolescent suicidality, over and above other adversities. Findings highlight the need to address discrimination as part of suicide prevention strategies. Cross-sectional design hampers causal inferences.
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Affiliation(s)
- Stirling T Argabright
- Children's Hospital of Philadelphia, Pennsylvania; Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania
| | - Elina Visoki
- Children's Hospital of Philadelphia, Pennsylvania; Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania
| | - Tyler M Moore
- Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dallas T Ryan
- Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania
| | - Grace E DiDomenico
- Children's Hospital of Philadelphia, Pennsylvania; Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania
| | - Wanjikũ F M Njoroge
- Children's Hospital of Philadelphia, Pennsylvania; Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jerome H Taylor
- Children's Hospital of Philadelphia, Pennsylvania; Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sinan Guloksuz
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, the Netherlands; Yale University School of Medicine, New Haven, Connecticut
| | - Ruben C Gur
- Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raquel E Gur
- Children's Hospital of Philadelphia, Pennsylvania; Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tami D Benton
- Children's Hospital of Philadelphia, Pennsylvania; Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ran Barzilay
- Children's Hospital of Philadelphia, Pennsylvania; Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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276
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Chun TH, Schnadower D, Casper TC, Sapién R, Tarr PI, O'Connell K, Roskind C, Rogers A, Bhatt S, Mahajan P, Vance C, Olsen CS, Powell EC, Freedman SB. Lack of Association of Household Income and Acute Gastroenteritis Disease Severity in Young Children: A Cohort Study. Acad Pediatr 2022; 22:581-591. [PMID: 34274521 PMCID: PMC10130956 DOI: 10.1016/j.acap.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To determine if low household income is associated with disease severity following emergency department (ED) discharge in children with acute gastroenteritis (AGE). METHODS We conducted a secondary analysis employing data collected in 10 US-based tertiary-care, pediatric EDs between 2014 and 2017. Participants were aged 3 to 48 months and presented for care due to AGE. Income status was defined based on 1) home ZIP Code median annual home income and 2) percentage of home ZIP Code households below the poverty threshold. The primary outcome was moderate-to-severe AGE, defined by a post-ED visit Modified Vesikari Scale (MVS) score ≥9. Secondary outcomes included in-person revisits, revisits with intravenous rehydration, hospitalization, and etiologic pathogens. RESULTS About 943 (97%) participants with a median age of 17 months (interquartile range 10, 28) completed follow-up. Post-ED visit MVS scores were lower for the lowest household income group (adjusted: -0.60; 95% confidence interval [CI]: -1.13, -0.07). Odds of experiencing an MVS score ≥9 did not differ between groups (adjusted odds ratio: 0.91; 95% CI: 0.54, 1.52). No difference in the post-ED visit MVS score or the proportion of participants with scores ≥9 was observed using the national poverty threshold definition. For both income definitions, there were no differences in terms of revisits following discharge, hospitalizations, and intravenous rehydration. Bacterial enteropathogens were more commonly identified in the lowest socioeconomic group using both definitions. CONCLUSIONS Lower household income was not associated with increased disease severity or resource use. Economic disparities do not appear to result in differences in the disease course of children with AGE seeking ED care.
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Affiliation(s)
- Thomas H Chun
- Department of Emergency Medicine and Pediatrics, Hasbro Children's Hospital, Brown University (TH Chun), Providence, RI
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine (D Schnadower), Cincinnati, Ohio
| | - T Charles Casper
- Department of Pediatrics, University of Utah (TC Casper), Salt Lake City, Utah
| | - Robert Sapién
- Department of Emergency Medicine, University of New Mexico Health Sciences Center (R Sapién), Albuquerque, NM
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine (PI Tarr), St. Louis, Mo
| | - Karen O'Connell
- Division of Emergency Medicine, Department of Pediatrics, Children's National Hospital, The George Washington School of Medicine and Health Sciences (K O'Connell), Washington, DC
| | - Cindy Roskind
- Department of Emergency Medicine, Columbia University College of Physicians & Surgeons (C Roskind), New York, NY
| | - Alexander Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan (A Rogers and P Mahajan), Ann Arbor, Mich
| | - Seema Bhatt
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine (S Bhatt), Cincinnati, Ohio
| | - Prashant Mahajan
- Departments of Emergency Medicine and Pediatrics, University of Michigan (A Rogers and P Mahajan), Ann Arbor, Mich; Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan Wayne State University (P Mahajan), Detroit, Mich
| | - Cheryl Vance
- Departments of Pediatrics and Emergency Medicine, University of California, Davis, School of Medicine (C Vance), Sacramento, Calif
| | - Cody S Olsen
- Department of Pediatrics, University of Utah (CS Olsen), Salt Lake City, Utah
| | - Elizabeth C Powell
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (EC Powell), Chicago, Ill
| | - Stephen B Freedman
- Divisions of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary (SB Freedman), Calgary, Alberta, Canada..
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277
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Umaretiya PJ, Vinci RJ, Bona K. A Structural Racism Framework to Guide Health Equity Interventions in Pediatric Oncology. Pediatrics 2022; 149:186711. [PMID: 35490282 DOI: 10.1542/peds.2021-054634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology.,Division of Population Sciences.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Robert J Vinci
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine Boston, Massachusetts
| | - Kira Bona
- Department of Pediatric Oncology.,Division of Population Sciences.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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278
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Tolliver DG, Lee LK, Patterson EE, Monuteaux MC, Kistin CJ. Disparities in School Referrals for Agitation and Aggression to the Emergency Department. Acad Pediatr 2022; 22:598-605. [PMID: 34780998 DOI: 10.1016/j.acap.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Describe the demographic and clinical characteristics of children presenting to the emergency department (ED) for agitation and aggression from school versus other sites. METHODS We performed a retrospective cross-sectional study of children 5 to 18 years old who were evaluated in an urban tertiary care pediatric ED with a chief complaint of agitation or aggression. We examined demographics, disposition, and payments for children presenting from school versus other sites. We conducted multivariable logistic regression to identify predictors of referral site (school versus all other sites, school versus home) and discharge status (home versus higher level of psychiatric care). RESULTS Of the 513 included children, 147 (29%) presented from school. Children were more likely to present from school versus other sites if they were Black (adjusted odds ratio [aOR] 2.26, 95% confidence interval [CI] 1.32, 3.88), Latinx (aOR 2.91, 95% CI 1.42, 5.97), or had special educational needs (aOR 2.55, 95% CI 1.64, 3.97). These associations persisted in the analysis of school versus home referrals. Children presenting from school versus all other sites were more likely to be discharged home (aOR 1.60, 95% CI 1.05, 2.44), although this difference did not persist when comparing school versus only home referral. A total of $154,269 (median $367 per encounter) was paid for school referrals to the ED. CONCLUSIONS Children with agitation and aggression referred from school were more likely to be Black, Latinx, or have special educational needs. Future efforts should identify and address root causes of this disparity to decrease ED referrals, reduce healthcare spending, and address inequities.
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Affiliation(s)
- Destiny G Tolliver
- Department of Pediatrics (DG Tolliver), Boston Children's Hospital, Boston, Mass.
| | - Lois K Lee
- Division of Emergency Medicine (LK Lee, EE Patterson, and MC Monuteaux), Boston Children's Hospital, Boston, Mass
| | - Emma E Patterson
- Division of Emergency Medicine (LK Lee, EE Patterson, and MC Monuteaux), Boston Children's Hospital, Boston, Mass
| | - Michael C Monuteaux
- Division of Emergency Medicine (LK Lee, EE Patterson, and MC Monuteaux), Boston Children's Hospital, Boston, Mass
| | - Caroline J Kistin
- Division of General Pediatrics (CJ Kistin), Boston Medical Center, Boston, Mass
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279
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Browne NT, Hodges EA, Small L, Snethen JA, Frenn M, Irving SY, Gance-Cleveland B, Greenberg CS. Childhood obesity within the lens of racism. Pediatr Obes 2022; 17:e12878. [PMID: 34927392 DOI: 10.1111/ijpo.12878] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate inequity and disparity in the context of childhood obesity. The National Institute of Minority Health and Health Disparities' Research Framework guides the explication of structurally racist mechanisms that influence health disparities and contribute to childhood obesity: biologic and genetic, health behaviours, chronic toxic stress, the built environment, race and cultural identity, and the health care system. Strategies and interventions to combat structural racism and its effects on children and their families are reviewed along with strategies for research and implications for policy change. From our critical review and reflection, the subtle and overt effects of societal structures sustained from years of racism and the impact on the development and resistant nature of childhood obesity compel concerted action.
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Affiliation(s)
| | - Eric A Hodges
- UNC-Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Leigh Small
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Julia A Snethen
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin, USA
| | - Marilyn Frenn
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | - Sharon Y Irving
- Pediatric Nursing, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Pediatric Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Cindy Smith Greenberg
- College of Health and Human Development, California State University, Fullerton, California, USA
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280
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Buka SL, Beers LS, Biel MG, Counts NZ, Hudziak J, Parade SH, Paris R, Seifer R, Drury SS. The Family is the Patient: Promoting Early Childhood Mental Health in Pediatric Care. Pediatrics 2022; 149:186907. [PMID: 35503309 PMCID: PMC9847420 DOI: 10.1542/peds.2021-053509l] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Advances in developmental psychology, child psychiatry, and allied disciplines have pointed to events and experiences in the early years as the origin of many adult mental health challenges. Yet, children's mental health services still largely lack a developmental or prevention-focused orientation, with most referrals to mental health professionals occurring late, once problems are well established. An early childhood mental health system rooted in the principles of life-course health development would take a very different approach to designing, testing, and implementing prevention and intervention strategies directed toward early child mental health. Priorities for such a system include supporting healthy family environments, parent-child and family relationships, parents' emotional/behavioral health, and family routines as a means of providing the best possible neurobiological foundation for mental health across the life span. The system would include proactive, trauma-informed, multidisciplinary care, with integrated mental health and social services support embedded in pediatric primary care settings. Novel intervention approaches in need of further research include 2-generational dyadic interventions designed to improve the mental health of parents and children, mental health-oriented telemedicine, and contingency management (CM) strategies. Integral to this Life Course Health Development reformulation is a commitment by all organizations supporting children to primordial and primary prevention strategies to reduce racial and socioeconomic disparities in all settings. We contend that it is the family, not the individual child, that ought to be the identified target of these redesigned approaches, delivered through a transformed pediatric system with anticipated benefits for multiple health outcomes across the life course.
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Affiliation(s)
- Stephen L. Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island,Address correspondence to Stephen Buka, ScD, Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Providence, RI 02912. E-mail:
| | - Lee S. Beers
- Children’s National Hospital, Washington, District of Columbia,Child Health Advocacy Institute, Washington, District of Columbia
| | - Matthew G. Biel
- Departments of Psychiatry and Pediatrics, Georgetown University School of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Nathaniel Z. Counts
- Mental Health America, Alexandria, Virginia,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, The Bronx, New York
| | - James Hudziak
- Division of Child Psychiatry, Vermont Center for Children, Youth, and Families, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Stephanie H. Parade
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island,Bradley/Hasbro Children’s Research Center, Bradley Hospital, East Providence, Rhode Island
| | - Ruth Paris
- Boston University School of Social Work, Boston, Massachusetts
| | - Ronald Seifer
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stacy S. Drury
- Departments of Psychiatry,Pediatrics, Tulane University, New Orleans, Louisiana,Children’s Hospital New Orleans, New Orleans, Louisiana
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281
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Lopez KN, Baker-Smith C, Flores G, Gurvitz M, Karamlou T, Nunez Gallegos F, Pasquali S, Patel A, Peterson JK, Salemi JL, Yancy C, Peyvandi S. Addressing Social Determinants of Health and Mitigating Health Disparities Across the Lifespan in Congenital Heart Disease: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025358. [PMID: 35389228 PMCID: PMC9238447 DOI: 10.1161/jaha.122.025358] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the overall improvement in life expectancy of patients living with congenital heart disease (congenital HD), disparities in morbidity and mortality remain throughout the lifespan. Longstanding systemic inequities, disparities in the social determinants of health, and the inability to obtain quality lifelong care contribute to poorer outcomes. To work toward health equity in populations with congenital HD, we must recognize the existence and strategize the elimination of inequities in overall congenital HD morbidity and mortality, disparate health care access, and overall quality of health services in the context of varying social determinants of health, systemic inequities, and structural racism. This requires critically examining multilevel contributions that continue to facilitate health inequities in the natural history and consequences of congenital HD. In this scientific statement, we focus on population, systemic, institutional, and individual‐level contributions to health inequities from prenatal to adult congenital HD care. We review opportunities and strategies for improvement in lifelong congenital HD care based on current public health and scientific evidence, surgical data, experiences from other patient populations, and recognition of implicit bias and microaggressions. Furthermore, we review directions and goals for both quantitative and qualitative research approaches to understanding and mitigating health inequities in congenital HD care. Finally, we assess ways to improve the diversity of the congenital HD workforce as well as ethical guidance on addressing social determinants of health in the context of clinical care and research.
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282
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Docherty A, Stoyles S, Najjar R, Woolley R. Oregon PRAMS 2012–2018: Revealing racial inequity in postpartum depression. Res Nurs Health 2022; 45:163-172. [DOI: 10.1002/nur.22214] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/21/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Angie Docherty
- School of Nursing Oregon Health and Science University Monmouth Oregon USA
| | - Sydnee Stoyles
- School of Nursing Oregon Health and Science University Monmouth Oregon USA
| | - Rana Najjar
- School of Nursing Oregon Health and Science University Monmouth Oregon USA
| | - Rachel Woolley
- School of Nursing Oregon Health and Science University Monmouth Oregon USA
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283
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Jones BL, Hoffman M, Kane N. "Redlining" to "Hot Spots": The Impacts of a Continued Legacy of Structural and Institutional Racism and Bias on Asthma in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:992-993. [PMID: 35397818 DOI: 10.1016/j.jaip.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Bridgette L Jones
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Division of Pediatric Pharmacology and Therapeutic Innovation, Section of Allergy, Asthma, and Clinical Immunology, Children's Mercy, Kansas City, Mo.
| | - Mark Hoffman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Biomedical and Health Informatics, Children's Mercy, Kansas City, Mo
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284
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Allwood M, Ghafoori B, Salgado C, Slobodin O, Kreither J, Waelde LC, Larrondo P, Ramos N. Identity-based hate and violence as trauma: Current research, clinical implications, and advocacy in a globally connected world. J Trauma Stress 2022; 35:349-361. [PMID: 34708457 DOI: 10.1002/jts.22748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 11/08/2022]
Abstract
Hate-based violence is increasingly recognized as an urgent social justice and human rights issue that is pervasive across geographical and socioeconomic boundaries. There is a growing body of research that demonstrates the traumatic impact of hate-based violence on the victim's mental and physical health. This review focuses on examining scientific knowledge and prevalence data on identity-based hate and violence exposure. A framework for conceptualizing hate-based violence as a traumatic event or series of traumatic events is offered as a means to understand research findings and intervention approaches. The importance of research, advocacy, and human rights training is highlighted in the efforts to address the traumatic impact of identity-based hate and violence.
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Affiliation(s)
- Maureen Allwood
- Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York, New York, USA
| | - Bita Ghafoori
- Long Beach Trauma Recovery Center, Department of Advanced Studies in Education and Counseling, California State University, Long Beach, Long Beach, California, USA
| | - Carolina Salgado
- Department of Psychiatry, Universidad Catolica del Maule, Talca, Chile
| | - Ortal Slobodin
- Department of Education, Ben-Gurion University of the Negev, Beersheba, Israel
| | | | - Lynn C Waelde
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Paulina Larrondo
- Centre for Reproductive Medicine and Adolescent Integral Development, School of Medicine, University of Chile, Santiago, Chile
| | - Nadia Ramos
- Department of Psychiatry, Universidad de Talca, Talca, Chile
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285
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Argabright ST, Visoki E, Moore TM, Ryan DT, DiDomenico GE, Njoroge WFM, Taylor JH, Guloksuz S, Gur RC, Gur RE, Benton TD, Barzilay R. Association Between Discrimination Stress and Suicidality in Preadolescent Children. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:252-262. [PMID: 37153135 PMCID: PMC10153507 DOI: 10.1176/appi.focus.22020005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 05/09/2023]
Abstract
Objective Youth suicide rates in the United States have been increasing in recent years, especially in Black Americans, the reasons for which are unclear. Environmental adversity is key in youth suicidality; hence there is a need to study stressors that have a disproportionate impact on Black youths. We aimed to disentangle the unique contribution of racial/ethnic discrimination from other adversities associated with childhood suicidal ideation and attempts (suicidality). Method We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, which included a large, diverse sample of US children (N = 11,235, mean age 10.9 years, 20.2% Black), assessed for multiple environmental adversities including discrimination. Multivariate regression models tested the association of self-reported racial/ethnic discrimination with suicidality, covarying for multiple confounders including other discrimination types (toward non-US-born individuals, sexual orientation-based, and weight-based). Matched analyses contrasted effects of racial/ethnic discrimination and racial identity on suicidality. Results Black youths reported more discrimination and higher suicidality rates than non-Black youths. High racial/ethnic discrimination was positively and significantly associated with suicidality, adjusting for other discrimination types (odds ratio = 2.6, 95% CI = 2.1-3.2). Findings remained significant after adjusting for multiple suicidality risk factors. Once experienced, racial/ethnic discrimination was similarly associated with suicidality in White, Black, and Hispanic youths. Matched analyses revealed that racial/ethnic discrimination was associated with suicidality (relative risk = 2.7, 95% CI = 2-3.5), whereas Black race was not (relative risk = 0.9, 95% CI = 0.7-1.2). Conclusion Racial/ethnic discrimination is disproportionately experienced by Black children, and is associated with preadolescent suicidality, over and above other adversities. Findings highlight the need to address discrimination as part of suicide prevention strategies. Cross-sectional design hampers causal inferences.Reprinted from J Am Acad Child Adolesc Psychiatry, Argabright et al., Association Between Discrimination Stress and Suicidality in Preadolescent Children, S0890-8567(21)01355-1, copyright 2021, with permission from Elsevier.
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286
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Cohen A, Montez K, Orr C, Konrath J, Oddiri U, Russell CJ, Gambill L, Nesiama JA, Chung PJ, McNeal-Trice K. Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism. Acad Pediatr 2022; 22:352-355. [PMID: 35032709 DOI: 10.1016/j.acap.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
The Academic Pediatrics Association has taken multiple steps over the last 2 years to incorporate the lenses of anti-racism and social justice into our mission and work. In this commentary, we discuss the creation and work of the Anti-Racism and Diversity Task Force, which was charged by the Academic Pediatrics Association's Board of Directors with identifying strategies to promote anti-racism and advance the diversity, equity and inclusion agenda.
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Affiliation(s)
- Adam Cohen
- Division of Hospital Medicine, (Adam Cohen), Baylor College of Medicine and Texas Children's Hospital, Houston, Tex.
| | - Kimberly Montez
- Department of Pediatrics, (Kimberly Montez), Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC
| | - Colin Orr
- Division of General Pediatrics and Adolescent Medicine, (Colin Orr), Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jessica Konrath
- Academic Pediatrics Association, (Jessica Konrath), McLean, Va
| | - Uchechi Oddiri
- Division of Pediatric Critical Care Medicine, (Uchechi Oddiri), Stony Brook University Renaissance School of Medicine, Stony Brook, NY
| | - Christopher J Russell
- Division of Hospital Medicine, (Christopher J. Russell), Children's Hospital Los Angeles, Los Angeles Calif; Department of Pediatrics, (Christopher J. Russell), Keck School of Medicine, University of Southern California, Los Angeles Calif
| | - Lauren Gambill
- Pediatrics University of Texas at Austin Dell Medical School, (Lauren Gambill), Pediatric Hospitalist Dell Children's Medical Center of Central, Austin, Tex
| | - Jo-Ann Nesiama
- Division of Emergency Medicine, (Jo-Ann Nesiama), UT Southwestern Medical Center, Dallas, Tex
| | - Paul J Chung
- Kaiser Permanente Bernard J. Tyson School of Medicine, (Paul J. Chung), Pasadena, CA; University of California Los Angeles, Los Angeles, Calif
| | - Kenya McNeal-Trice
- Department of Pediatrics, (Kenya McNeal-Trice), Division of Hospital Medicine and Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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287
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Yusuf HE, Copeland-Linder N, Young AS, Matson PA, Trent M. The Impact of Racism on the Health and Wellbeing of Black Indigenous and Other Youth of Color (BIPOC Youth). Child Adolesc Psychiatr Clin N Am 2022; 31:261-275. [PMID: 35361364 DOI: 10.1016/j.chc.2021.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Black, Indigenous, and other Youth of Color (BIPOC youth) experience racism from a young age. These experiences have both immediate and long-term impacts on their health and wellbeing. Systemic racism contributes to the inequitable distribution of health resources and other social determinants of health, creating barriers to accessing care. Substance use disorders and sexual/nonsexual risk behaviors have been linked to experiences of racism in BIPOC youth. The legacy of generational racial trauma can frame behaviors and attitudes in the present, undermining health and survival in this group. BIPOC youth also face difficulties navigating spheres characterized as white spaces. Ethnic-racial socialization may promote resilience and help with coping in the context of racial stress. While many professional health organizations have embraced dismantling racism, a shift in the narrative on racial values will be critical for preventing adversity and achieving health equity for BIPOC youth.
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Affiliation(s)
- Hasiya E Yusuf
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University, 200 N Wolfe Street, Baltimore, MD 21287, USA.
| | - Nikeea Copeland-Linder
- Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD 21205, USA
| | - Andrea S Young
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, 1800 Orleans Street, Bloomberg 12 N, Baltimore, MD 21287 USA
| | - Pamela A Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University, 200 N Wolfe Street, Baltimore, MD 21287, USA
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University, 200 N Wolfe Street, Baltimore, MD 21287, USA.
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288
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Alegría M, O'Malley IS, DiMarzio K, Zhen-Duan J. Framework for Understanding and Addressing Racial and Ethnic Disparities in Children's Mental Health. Child Adolesc Psychiatr Clin N Am 2022; 31:179-191. [PMID: 35361358 PMCID: PMC9382888 DOI: 10.1016/j.chc.2021.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this framework, we synthesize the results of studies addressing racial/ethnic disparities in children's mental health through 4 domains hypothesized to impact minoritized children and their families: (1) policies, (2) institutional systems, (3) neighborhoods/community system, and (4) individual/family-level factors. We focus on children and adolescents, presenting findings that may impact mental health outcomes for major racial/ethnic groups in North America: Black/African American, Latinx, Asian, and American Indian youth. We conclude by suggesting areas for needed research, including whether certain domains of influence demonstrate differential impact for inequities reduction depending on the youth's race/ethnicity.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2 West, Room 305, Boston, MA 02215, USA.
| | - Isabel Shaheen O'Malley
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA 02114, USA
| | - Karissa DiMarzio
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St, AHC-1, Miami, FL 33199, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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289
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Mpofu JJ, Cooper AC, Ashley C, Geda S, Harding RL, Johns MM, Spinks-Franklin A, Njai R, Moyse D, Underwood JM. Perceived Racism and Demographic, Mental Health, and Behavioral Characteristics Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021. MMWR Suppl 2022; 71:22-27. [PMID: 35358163 PMCID: PMC8979604 DOI: 10.15585/mmwr.su7103a4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Perceived racism in school (i.e., a student’s report of being treated badly or unfairly because of their race or ethnicity) is an important yet understudied determinant of adolescent health and well-being. Knowing how perceived racism influences adolescent health can help reduce health inequities. CDC’s 2021 Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9–12 (N = 7,705), was conducted during January–June 2021 to assess student behaviors during the COVID-19 pandemic. CDC analyzed data from ABES to measure perceived racism and the extent to which perceptions of racism are associated with demographic, mental health, and behavioral characteristics. Mental health and behavioral characteristics analyzed included mental health status; virtual connection with others outside of school; serious difficulty concentrating, remembering, or making decisions; and feeling close to persons at school. Demographic characteristics analyzed included sex, race and ethnicity, and grade. Prevalence of perceived racism and associations between perceived racism and demographic, mental health, and behavioral characteristics are reported overall and stratified by race and ethnicity. Approximately one third (35.6%) of U.S. high school students reported perceived racism. Perceived racism was highest among Asian (63.9%), Black (55.2%), and multiracial students (54.5%). Students who reported perceived racism had higher prevalences of poor mental health (38.1%); difficulty concentrating, remembering, or making decisions (44.1%); and not feeling close to persons at school (40.7%). Perceived racism was higher among those students who reported poor mental health than those who did not report poor mental health during the pandemic among Asian (67.9% versus 40.5%), Black (62.1% versus 38.5%), Hispanic (45.7% and 22.9%), and White students (24.5% versus 12.7%). A better understanding of how negative health outcomes are associated with student experiences of racism can guide training for staff and students to promote cultural awareness and antiracist and inclusivity interventions, which are critical for promoting safe school environments for all students.
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290
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Johnson TJ. Antiracism, Black Lives Matter, and Critical Race Theory: The ABCs of Promoting Racial Equity in Pediatric Practice. Pediatr Ann 2022; 51:e95-e106. [PMID: 35293809 DOI: 10.3928/19382359-20220217-01] [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: 11/20/2022]
Abstract
Police shootings of unarmed Black men, women, and children at the intersection of disparities in the setting of the coronavirus disease 2019 pandemic have resulted in a long overdue national awakening regarding race and racism in society. This article defines some of the key terms, providing a foundation to help promote equity in pediatric practice. Although no single article can result in full competency regarding such complex issues, it is meant to provide a foundation for pediatricians on a journey to deepen their knowledge and understanding toward a path to action. [Pediatr Ann. 2022;51(3):e95-e106.].
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291
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Bowen FR, Lewandowski LA, Snethen JA, Childs G, Outlaw FH, Greenberg CS, Burke PJ, Sloand E, Gary F, DeSocio J. A Schema of Toxic Stress Informed by Racism, Transgenerational Stress, and Disadvantage. J Pediatr Health Care 2022; 36:79-89. [PMID: 34627667 DOI: 10.1016/j.pedhc.2021.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Toxic Stress Schema (TSS) is an ecological framework with a social justice lens for identifying and alleviating stress and strengthening social determinants of health for children and families of color impacted by the COVID-19 pandemic and the cumulative effects of racism and generational, systemic inequities. METHOD Relevant literature is reviewed, and examples were provided to illustrate the differential impacts of the "stress superstorm" of 2020 had on children of color based on their family's position on the advantage-disadvantage continuum. RESULTS The utility of the TSS framework as a model for advanced nursing practice is demonstrated, and recommendations are formulated for the pediatric nurse practitioner's role in health policy. DISCUSSION The COVID-19 pandemic elucidated the historical inequities experienced by children and families of color. The TSS framework provides a model for recognizing, organizing, and implementing.
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292
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Andrews AL, Killings X, Oddo ER, Gastineau KAB, Hink AB. Pediatric Firearm Injury Mortality Epidemiology. Pediatrics 2022; 149:184887. [PMID: 35224633 DOI: 10.1542/peds.2021-052739] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Firearm injury is a leading and preventable cause of death for youth in the United States. The Centers for Disease Control and Prevention web-based injury statistics query and reporting system was queried to examine changes in firearm injury mortality among youth aged 0 to 19 from 2001 to 2019. This includes assessment of overall mortality rates, mortality rates based on intent and race/ethnicity, and the proportion of deaths due to homicide, suicide, and unintentional shootings among different age groups. Regression analysis was used to identify significant differences in mortality rate over time between Black and White youth. Deaths due to firearm injury were compared with deaths due to motor vehicle traffic collisions. In 2019, firearm injuries surpassed motor vehicle collisions to become the leading cause of death for youth aged 0 to 19 years in the United States. Homicide is the most common intent across all age groups, but suicide represents a large proportion of firearm deaths in 10- to 19-year-old youth. In 2019, Black youth had a firearm mortality rate 4.3 times higher than that of White youth and a firearm homicide rate over 14 times higher than that of White youth. For each additional year after 2013, the mortality rate for Black youth increased by 0.55 deaths per 100 000 compared with White youth (time by race interaction effect P < .0001). These data indicate the growing burden of firearm injuries on child mortality and widening racial inequities with Black youth disproportionately affected by firearm violence. This public health crisis demands physician advocacy to reduce these preventable deaths among youth.
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Affiliation(s)
| | - Xzavier Killings
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | - Kelsey A B Gastineau
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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293
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Abstract
Black, Latino/a/e, American Indian, and Alaska Native children often receive lower quality health care than White children. As the predominant health insurer for medically underserved populations, Medicaid plays a critical role in advancing socioeconomic and racial health equity. In this article, we focus on structural barriers to health equity in the Medicaid program and potential steps for improving long-standing socioeconomic and racial health inequities through programmatic innovation. We identify opportunities for expanding care models for holistically addressing the social determinants of health, aligning clinical care delivery around health equity principles, diversifying the clinical workforce, and promoting meaningful and consistent provider participation in Medicaid. Practitioners and policy makers can start to undertake many of these steps today to set the stage for more sweeping reforms that can help achieve national health equity goals for children. [Pediatr Ann. 2022;51(3):e118-e122.].
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294
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Kuo DZ, Lail J, Comeau M, Chesnut E, Meyers A, Mosquera R. Research Agenda for Implementation of Principles of Care for Children and Youth With Special Health Care Needs. Acad Pediatr 2022; 22:S41-S46. [PMID: 35248247 DOI: 10.1016/j.acap.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Children and youth with special health care needs (CYSHCN) have a range of medical, educational, and support service needs to achieve optimal health and wellness. Principles of care for CYSHCN have been well described, but the literature is lacking particularly on implementation and integration of care across different settings and systems. The objective of this manuscript is to define a research agenda for principles of care for CYSHCN. METHODS Literature review examined principles of care for CYSHCN. Existing research gaps and priorities for principles of care were drawn from the literature review, a recently developed national research agenda for CYSHCN, and stakeholder consensus. RESULTS Specific implementation areas of inquiry include family partner roles within and across systems; life course approach for CYSHCN; roles and training of interdisciplinary team members; and implementation, spread, and sustainability studies. Proposed methods include implementation science-based and comparative effectiveness research. A common set of metrics including health care utilization, clinical outcomes, and family and provider needs should be considered to evaluate implementation of principles of care. CONCLUSIONS Implementation science and comparative effectiveness methods are needed to further understanding about how to adopt and spread principles of care for CYSHCN. The evolving demographics of CYSHCN add relevance and urgency for research findings.
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Affiliation(s)
- Dennis Z Kuo
- Department of Pediatrics, University at Buffalo (DZ Kuo), Buffalo, NY.
| | | | - Meg Comeau
- Center for Innovation in Social Work & Health, Boston University School of Social Work (M Comeau), Boston, Mass
| | - Emily Chesnut
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (E Chesnut), Cincinnati, Ohio
| | - Alissa Meyers
- Department of Pediatrics, University of Texas at Houston (A Meyers and R Mosquera), Houston, Tex
| | - Ricardo Mosquera
- Department of Pediatrics, University of Texas at Houston (A Meyers and R Mosquera), Houston, Tex
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295
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English D, Boone CA, Carter JA, Talan AJ, Busby DR, Moody RL, Cunningham DJ, Bowleg L, Rendina HJ. Intersecting Structural Oppression and Suicidality Among Black Sexual Minority Male Adolescents and Emerging Adults. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2022; 32:226-243. [PMID: 35166417 PMCID: PMC9047029 DOI: 10.1111/jora.12726] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/30/2021] [Accepted: 12/30/2021] [Indexed: 05/02/2023]
Abstract
This study examined associations between structural racism, anti-LGBTQ policies, and suicide risk among young sexual minority men (SMM). Participants were a 2017-2018 Internet-based U.S. national sample of 497 Black and 1536 White SMM (ages 16-25). Structural equation modeling tested associations from indicators of structural racism, anti-LGBTQ policies, and their interaction to suicide risk factors. For Black participants, structural racism and anti-LGBTQ policies were significantly positively associated with depressive symptoms, heavy drinking, perceived burdensomeness, thwarted belongingness, self-harm, and suicide attempt. There were significant interaction effects: Positive associations between structural racism and several outcomes were stronger for Black participants in high anti-LGBTQ policy states. Structural racism, anti-LGBTQ policies, and their interaction were not significantly associated with suicide risk for White SMM.
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Affiliation(s)
| | | | - Joseph A. Carter
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY)
| | | | | | | | | | | | - H. Jonathon Rendina
- Whitman-Walker Institute
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University
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296
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Berry OO. Editorial: Race-Based Traumatic Stress and Vicarious Racism Within the Parent-Child Dyad: Opportunities for Intervention. J Am Acad Child Adolesc Psychiatry 2022; 61:362-363. [PMID: 34311037 DOI: 10.1016/j.jaac.2021.07.007] [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] [Received: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
With every disaster, there are fault lines that deepen our understanding of what has happened and what needs to come. The events over the past 18 months including the coronavirus disease 2019 (COVID-19) pandemic as well as the murder of George Floyd and the associated protests throughout the United States brought those fault lines into stark relief by highlighting the history of systemic racism that has fostered marginalization and discrimination against Black Americans. These clouds of systemic racism and discrimination-encompassing 250 years of slavery, 100 years of Jim Crow, police brutality, redlining, and the resulting high rates of poverty and poorer health outcomes-have created systems in which Black Americans face unequal and unequitable stressful situations. The medical community is now beginning to take notice of this race-based traumatic stress, a term coined by Carter in 2007,1 to describe how social determinants of health impacted by racial discrimination can "get under the skin" through the accumulative effects of ongoing exposure to toxic stress.2.
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Affiliation(s)
- Obianuju O Berry
- NYU Grossman School of Medicine and the Office of Behavioral Health, NYC Health + Hospitals, New York.
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297
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Mackey ER, Burton ET, Cadieux A, Getzoff E, Santos M, Ward W, Beck AR. Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth. Child Obes 2022; 18:75-83. [PMID: 34491828 DOI: 10.1089/chi.2021.0153] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.
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Affiliation(s)
- Eleanor R Mackey
- Children's National Hospital, Center for Translational Research, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Adelle Cadieux
- Department of Behavioral Health, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, Lansing MI, USA
| | - Elizabeth Getzoff
- Department of Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Melissa Santos
- Division of Pediatric Psychology, Connecticut Children's, Hartford, CT, USA
| | - Wendy Ward
- Department of Pediatrics, College of Medicine, University of Arkansas Medical Center, Little Rock, AR, USA
| | - Amy R Beck
- Center for Children's Healthy Lifestyles and Nutrition and Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
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298
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Acholonu RG, Raphael JL. The Influence of the Electronic Health Record on Achieving Equity and Eliminating Health Disparities for Children. Pediatr Ann 2022; 51:e112-e117. [PMID: 35293812 DOI: 10.3928/19382359-20220215-01] [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: 11/20/2022]
Abstract
The electronic health record (EHR) has been heralded as a transformative approach to modernizing health care and advancing health equity. Access to the EHR can facilitate shared clinical decision-making and improved communication with patients, families, and among health care providers. Recent legislative and regulatory efforts have been passed to increase the transparency as well as the initiatives to increase the meaningful use of the EHR. Yet despite these well-intended efforts, challenges to addressing health equity through the EHR persist. This article reviews three distinct challenges to addressing health equity related to the EHR. We discuss (1) both the implicit and explicit bias that exist in EHR documentation, (2) the gaps that remain between screening for social determinants of health and the effective inclusion and billing of that screening into the EHR, and (3) the disparities that exist with the use of patient portals. Addressing these three areas will enhance the opportunities to advance health equity through the use of the EHR and bring us one step closer to eliminating health disparities in pediatric health care. [Pediatr Ann. 2022;51(3):e112-e117.].
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299
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Hoover CG, Coller RJ, Houtrow A, Harris D, Agrawal R, Turchi R. Understanding Caregiving and Caregivers: Supporting Children and Youth With Special Health Care Needs at Home. Acad Pediatr 2022; 22:S14-S21. [PMID: 35248243 DOI: 10.1016/j.acap.2021.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
Caregiving encompasses the nurturing, tasks, resources, and services that meet the day-to-day needs of children and youth with special health care needs (CYSHCN) at home. Many gaps exist in the strategies currently offered by the health care system to meet the caregiving needs of CYSHCN. The work of family caregivers of CYSHCN is known to be extensive, but it is so poorly understood that it has been described as "invisible". This invisibility leads to poor communication and gaps in understanding between professional health care providers and family caregivers. To address these gaps, health care researchers must work with family caregivers to incorporate their expertise on caregiving and create meaningful and sustainable research partnerships. A growing body of research is attempting to remedy the problem of caregiving invisibility and lay better foundations for successful integration between health care settings, family caregiving, professional caregiving, and community supports for families of CYSHCN. We identify high-priority gaps in CYSHCN caregiving research and propose research questions that are designed to accelerate growth in evidence-based understanding of the work of family caregivers of CYSHCN and how best to support them.
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Affiliation(s)
| | - Ryan J Coller
- Department of Pediatrics (RJ Coller), School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Win
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation (A Houtrow), School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Debbi Harris
- Family Voices of Minnesota (D Harris), Stillwater, Minn
| | - Rishi Agrawal
- Division of Hospital-Based Medicine (R Agrawal), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Renee Turchi
- Department of Pediatrics (R Turchi), College of Medicine, Drexel University, Philadelphia Pa
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300
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Jindal M, Mistry KB, McRae A, Unaka N, Johnson T, Thornton RLJ. "It Makes Me a Better Person and Doctor": A Qualitative Study of Residents' Perceptions of a Curriculum Addressing Racism. Acad Pediatr 2022; 22:332-341. [PMID: 34923147 DOI: 10.1016/j.acap.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Explore how pediatric residents perceive the impact of a curriculum addressing racism on their knowledge, motivation, skills and behaviors, and investigate the contextual factors that promote or impede the curriculum's effectiveness. METHODS Open-ended, semistructured interviews were conducted at 2 academic medical centers between August 2019 and 2020 among pediatric residents who participated in the curriculum. Interviews were recorded, transcribed, and analyzed by using inductive content analysis. RESULTS Pediatric residents (n = 16) were predominantly white (66.7%), female (86.7%) interns (60%) from the Midwest (40%). Six major themes emerged describing the perceived impact of the curriculum on: knowledge - (1) Understanding of race and racism as structural forces in a historical context; motivation - (2) Owning the issue of racism, (3) Having the curriculum makes a statement; skills - (4) Critical self-reflection, (5) Perceived development of skills to mitigate biases; and action-planning - (6) Turning insight into strategies to combat racism and improve patient care. Two additional themes emerged describing contextual factors that promoted or impeded the curriculum such as the content of the curriculum itself, the racial demographics of the participants, the implementation infrastructure and environmental factors such as the culture of the training program. CONCLUSIONS Medical education addressing racism can facilitate the perceived acquisition of foundational knowledge regarding race and racism; motivation and skill-building to combat racism; and action planning aimed at improving patient care. Contextual factors should be considered when developing and implementing such curricula to not only promote racial equity but avoid unintended harms.
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Affiliation(s)
- Monique Jindal
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Kamila B Mistry
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md; Office of Extramural Research, Education, and Priority Populations (KB Mistry), Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Md
| | - Ashlyn McRae
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ndidi Unaka
- Division of Hospital Medicine (N Unaka), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (N Unaka), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tiffani Johnson
- Department of Emergency Medicine (T Johnson), University of California, Davis, Calif
| | - Rachel L J Thornton
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society (RLJ Thornton), Baltimore, Md
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