1
|
Fyfe-Johnson AL, Reid MM, Jiang L, Chang JJ, Huyser KR, Hiratsuka VY, Johnson-Jennings MD, Conway CM, Goins TR, Sinclair KA, Steiner JF, Brega AG, Manson SM, O'Connell J. Social Determinants of Health and Body Mass Index in American Indian/Alaska Native Children. Child Obes 2023; 19:341-352. [PMID: 36170116 PMCID: PMC10316527 DOI: 10.1089/chi.2022.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To examine the associations between social determinants of health (SDOH) and prevalent overweight/obesity status and change in adiposity status among American Indian and Alaska Native (AI/AN) children. Methods: The study sample includes 23,950 AI/AN children 2-11 years of age, who used Indian Health Service (IHS) from 2010 to 2014. Multivariate generalized linear mixed models were used to examine the following: (1) cross-sectional associations between SDOH and prevalent overweight/obesity status and (2) longitudinal associations between SDOH and change in adiposity status over time. Results: Approximately 49% of children had prevalent overweight/obesity status; 18% had overweight status and 31% had obesity status. Prevalent severe obesity status was 20% in 6-11-year olds. In adjusted cross-sectional models, children living in counties with higher levels of poverty had 28% higher odds of prevalent overweight/obesity status. In adjusted longitudinal models, children 2-5 years old living in counties with more children eligible for free or reduced-priced lunch had 15% lower odds for transitioning from normal-weight status to overweight/obesity status. Conclusions: This work contributes to accumulating knowledge that economic instability, especially poverty, appears to play a large role in overweight/obesity status in AI/AN children. Research, clinical practice, and policy decisions should aim to address and eliminate economic instability in childhood.
Collapse
Affiliation(s)
| | - Margaret M. Reid
- Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Luohua Jiang
- Department of Epidemiology, University of California, Irvine, Irvine, CA, USA
| | - Jenny J. Chang
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Kimberly R. Huyser
- Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Y. Hiratsuka
- Center for Human Development, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Cheryl M. Conway
- Charles George Veterans Medical Center, Veterans Health Administration, Washington, DC, USA
| | - Turner R. Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA
| | | | - John F. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Angela G. Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| |
Collapse
|
2
|
Vasan A, Krass P, Seifu L, Hitt TA, Ijaz N, Villegas L, Pallegedara K, Pandurangi S, Congdon M, Rezet B, Kenyon CC. Pediatric provider perspectives and practices regarding health policy discussions with families: a mixed methods study. BMC Pediatr 2020; 20:343. [PMID: 32660527 PMCID: PMC7359268 DOI: 10.1186/s12887-020-02238-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/02/2020] [Indexed: 01/22/2023] Open
Abstract
Background Advocacy regarding child health policy is a core tenet of pediatrics. Previous research has demonstrated that most pediatric providers believe collective advocacy and political involvement are essential aspects of their profession, but less is known about how pediatric providers engage with families about policy issues that impact child health. The objectives of this study were to examine providers’ perceptions and practices with regards to discussing health policy issues with families and to identify provider characteristics associated with having these discussions. Methods In this cross-sectional mixed methods study, pediatric resident physicians, attending physcians, and nurse practitioners at primary care clinics within a large academic health system were surveyed to assess (1) perceived importance of, (2) frequency of, and (3) barriers to and facilitators of health policy discussions with families. Multivariable ordinal regression was used to determine provider characteristics (including demographics, practice location, and extent of civic engagement) associated with frequency of these discussions. A subset of providers participated in subsequent focus groups designed to help interpret quantitative findings. Results The overall survey response rate was 155/394 (39%). The majority of respondents (76%) felt pediatricians should talk to families about health policy issues affecting children, but most providers (69%) reported never or rarely having these discussions. Factors associated with discussing policy issues included being an attending physician/nurse practitioner (OR 8.22, 95% CI 2.04–33.1) and urban practice setting (OR 3.85, 95% CI 1.03–14.3). Barriers included feeling uninformed about relevant issues and time constraints. In provider focus groups, four key themes emerged: (1) providers felt discussing policy issues would help inform and empower families; (2) providers frequently discussed social service programs, but rarely discussed policies governing these programs; (3) time constraints and concerns about partisan bias were a barrier to conversations; and (4) use of support staff and handouts with information about policy changes could help facilitate more frequent conversations. Conclusions Pediatric providers felt it was important to talk to families about child health policy issues, but few providers reported having such conversations in practice. Primary care practices should consider incorporating workflow changes that promote family engagement in relevant health policy discussions.
Collapse
Affiliation(s)
- Aditi Vasan
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA. .,National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 13th Floor, 423 Guardian Drive, Philadelphia, PA, 19104, USA. .,PolicyLab, Children's Hospital of Philadelphia, 2716 South St. Roberts Center for Pediatric Research, 10th Floor, Philadelphia, PA, USA.
| | - Polina Krass
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA.,National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 13th Floor, 423 Guardian Drive, Philadelphia, PA, 19104, USA.,PolicyLab, Children's Hospital of Philadelphia, 2716 South St. Roberts Center for Pediatric Research, 10th Floor, Philadelphia, PA, USA
| | - Leah Seifu
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Talia A Hitt
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Nadir Ijaz
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA.,Department of Pediatrics, Division of Critical Care Medicine, Columbia University, 630 West 168th Street, New York, NY, USA
| | - Leonela Villegas
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Kathryn Pallegedara
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Sindhu Pandurangi
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA.,Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Morgan Congdon
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Beth Rezet
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Chén C Kenyon
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA.,PolicyLab, Children's Hospital of Philadelphia, 2716 South St. Roberts Center for Pediatric Research, 10th Floor, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| |
Collapse
|
3
|
Shah S, Brumberg HL, Kuo A, Balasubramaniam V, Wong S, Opipari V. Academic Advocacy and Promotion: How to Climb a Ladder Not Yet Built. J Pediatr 2019; 213:4-7.e1. [PMID: 31561780 DOI: 10.1016/j.jpeds.2019.07.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Shetal Shah
- Division of Neonatal Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY.
| | - Heather L Brumberg
- Division of Neonatal Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY
| | - Alice Kuo
- Department of Internal Medicine, Pediatrics, and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, and Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Vivek Balasubramaniam
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Shale Wong
- Department of Pediatrics, Eugene S. Farley, Jr Health Policy Center, University of Colorado School of Medicine, Denver, CO
| | - Valerie Opipari
- Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI
| |
Collapse
|
4
|
Belay B, Frintner MP, Liebhart JL, Lindros J, Harrison M, Sisk B, Dooyema CA, Hassink SG, Cook SR. US Pediatrician Practices and Attitudes Concerning Childhood Obesity: 2006 and 2017. J Pediatr 2019; 211:78-84.e2. [PMID: 31113716 PMCID: PMC8856742 DOI: 10.1016/j.jpeds.2019.04.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare primary care pediatricians' practices and attitudes regarding obesity assessment, prevention, and treatment in children 2 years and older in 2006 and 2017. STUDY DESIGN National, random samples of American Academy of Pediatrics members were surveyed in 2006, 2010, and 2017 on practices and attitudes regarding overweight and obesity (analytic n = 655, 592, and 558, respectively). Using logistic regression models (controlling for pediatrician and practice characteristics), we examined survey year with predicted values (PVs), including body mass index (BMI) assessment across 2006, 2010, and 2017 and practices and attitudes in 2006 and 2017. RESULTS Pediatrician respondents in 2017 were significantly more likely than in 2006 and 2010 to report calculating and plotting BMI at every well-child visit, with 96% of 2017 pediatricians reporting they do this. Compared with 2006, in 2017 pediatricians were more likely to discuss family behaviors related to screen time, sugar-sweetened beverages, and eating meals together, P < .001 for all. There were no observed differences in frequency of discussions on parental role modeling of nutrition and activity-related behaviors, roles in food selection, and frequency of eating fast foods or eating out. Pediatricians in 2017 were more likely to agree BMI adds new information relevant to medical care (PV = 69.8% and 78.1%), they have support staff for screening (PV = 45.3% and 60.5%), and there are effective means of treating obesity (PV = 36.3% and 56.2%), P < .001 for all. CONCLUSIONS Results from cross-sectional surveys in 2006 and 2017 suggest nationwide, practicing pediatricians have increased discussions with families on several behaviors and their awareness and practices around obesity care.
Collapse
Affiliation(s)
- Brook Belay
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Mary Pat Frintner
- Department of Research, American Academy of Pediatrics (AAP), Itasca, IL
| | | | | | - Megan Harrison
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Blake Sisk
- Department of Research, American Academy of Pediatrics (AAP), Itasca, IL
| | - Carrie A. Dooyema
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Stephen R. Cook
- Institute for Healthy Childhood Weight, AAP, Itasca, IL;,Department of Research, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|