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Pierce KA, Mendelsohn A, Smith B, Johnson SB, Duh-Leong C. Trajectories of Housing Insecurity From Infancy to Adolescence and Adolescent Health Outcomes. Pediatrics 2024:e2023064551. [PMID: 38946454 DOI: 10.1542/peds.2023-064551] [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: 10/04/2023] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Housing insecurity is associated with adverse effects on child growth and development cross-sectionally; less is known about its cumulative, long-term effects. This study describes longitudinal experiences of housing insecurity during childhood from infancy (age 1 year) to adolescence (age 15 years) and examines their associations with adolescent health outcomes. METHODS Using data from the Future of Families and Child Wellbeing Study, we created a composite measure of housing insecurity using 5 indicators (eg, skipping a rent or mortgage payment, eviction) for participants at ages 1, 3, 5, 9, and 15 years. We used group-based trajectory modeling to identify distinct patterns of housing insecurity, sociodemographic predictors of these patterns, and how these patterns relate to adolescent health outcomes. RESULTS We identified 3 trajectories of housing insecurity from infancy to adolescence: secure, moderately insecure, and highly insecure. Adolescents who experienced moderately and highly insecure housing had decreased odds of excellent health (adjusted odds ratio, 0.81; 95% confidence interval [CI], 0.69-0.95; adjusted odds ratio, 0.67; 95% CI, 0.50-0.92, respectively) and more depressive symptoms (adjusted incidence rate ratio, 1.05; 95% CI, 1.02-1.08; 1.13; 95% CI, 1.08-1.19, respectively) than adolescents with secure housing. Adolescents who experienced highly insecure housing reported significantly higher anxiety symptoms (adjusted incidence rate ratio, 1.05; 95% CI, 1.003-1.113). CONCLUSIONS Housing insecurity starting in infancy was associated with poorer adolescent health outcomes. These longitudinal patterns emphasize the need for novel screening mechanisms to identify housing insecurity when it emerges, as well as policies to prevent housing insecurity and its associated health outcomes.
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Affiliation(s)
- Kristyn A Pierce
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Alan Mendelsohn
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Brandon Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carol Duh-Leong
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
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Lebrun-Harris LA, Sandel M, Sheward R, Poblacion A, Ettinger de Cuba S. Prevalence and Correlates of Unstable Housing Among US Children. JAMA Pediatr 2024; 178:707-717. [PMID: 38767882 PMCID: PMC11106712 DOI: 10.1001/jamapediatrics.2024.1159] [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] [Received: 12/12/2023] [Accepted: 02/26/2024] [Indexed: 05/22/2024]
Abstract
Importance Housing instability is an important public health issue, particularly for children. This study provides nationally representative estimates of unstable housing among US children. Objective To examine unstable housing prevalence; differences by sociodemographic characteristics, health, and state of residence; and associations with other hardships. Design, Setting, and Participants This survey study examined data from the 2022 National Survey of Children's Health, a population-based, nationally representative survey of randomly selected children whose parent or caregiver responded to an address-based mail or web-based survey. Participants were children aged 0 to 17 years living in households in the 50 US states and District of Columbia (N = 54 103). Bivariate analyses tested for observed differences in unstable housing between groups; logistic regression models tested for significant disparities. Associations between unstable housing and health care and food-related hardships, neighborhood conditions, and adverse childhood experiences were examined. Exposure Unstable housing experiences. Main Outcomes and Measures Unstable housing, comprising 3 indicators: inability to pay mortgage or rent on time in the past 12 months, 2 or more moves in the past 12 months, and homelessness in the child's lifetime. Analyses were adjusted for child age and family poverty ratio. Secondary analyses examine caregiver-reported stress or worry about eviction, foreclosure, or condemned housing in the past 12 months. Weighted prevalence estimates accounted for probability of selection and nonresponse. Results In 2022, 17.1% (95% CI, 16.4%-17.8%) of children living in US households, representing more than 12.1 million children, experienced 1 or more forms of unstable housing: 14.1% (95% CI, 13.4%-14.7%) lived in households that were unable to pay mortgage/rent, 2.9% (95% CI, 2.6%-3.3%) moved frequently, and 2.5% (95% CI, 2.2%-2.8%) experienced lifetime homelessness. Additionally, 9.0% (95% CI, 8.5%-9.5%) of children had caregivers who reported stress/worry over housing. Prevalence of unstable housing varied across states (range, 12.0%-26.6%). Unstable housing was highest among American Indian or Alaska Native children (27.9%; 95% CI, 21.3%-35.6%), Black or African American children (30.4%; 95% CI, 27.8%-33.1%), and Native Hawaiian or Pacific Islander children (27.6%; 95% CI, 16.6%-42.1%) and also differed by special health care needs, family poverty ratio, caregiver education and unemployment status, and whether the family rented or owned their home. Unstable housing was associated with all other types of hardships examined. Conclusions and Relevance This study found that 1 in 6 US children experienced unstable housing, varying by state and sociodemographic factors. The prevalence is likely underestimated because the sample excluded children who are currently institutionalized or experiencing homelessness. Results may help move the field toward a unified national definition of unstable housing for families with children and lead to clinically appropriate and evidence-based screening and interventions to support housing stability and improve children's health.
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Affiliation(s)
- Lydie A. Lebrun-Harris
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville, Maryland
| | - Megan Sandel
- Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Richard Sheward
- Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ana Poblacion
- Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Stephanie Ettinger de Cuba
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
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Howard EC, Murray Horwitz ME, Gunn CM, Bak S, Nelson KP, Morton S, Flacks-Dunning JG, Battaglia TA. Burden and trajectory of social needs after breast cancer diagnosis at a safety-net hospital. Breast Cancer Res Treat 2024:10.1007/s10549-024-07389-5. [PMID: 38851661 DOI: 10.1007/s10549-024-07389-5] [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] [Received: 01/28/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Unmet social needs pose barriers to cancer care, contributing to adverse outcomes and health inequities. A better understanding of how social needs change after cancer diagnosis can inform more effective, equity-focused interventions. METHODS In this study, we examined self-reported social needs at 0, 3, and 6 months after a breast cancer diagnosis in a racially diverse, multilingual sample (n = 222) enrolled in patient navigation intervention at an urban safety-net hospital. At each timepoint, respondents completed surveys about social needs related to employment, disability benefits, housing and utilities, and personal and family stability. RESULTS Over three-quarters (78%, n = 175) reported ≥ 1 social need, and 46% (n = 102) reported ≥ 3 social needs. The most frequently reported need was housing and utilities (64%, n = 142), followed by employment (40%, n = 90). Individuals from minoritized groups more frequently reported an increased number of social needs over time, compared with their White counterparts (p = 0.02). CONCLUSION Our findings suggest that despite navigation, many cancer patients from historically underrepresented populations continue to experience social concerns over the first 6 months of treatment. Further research, conducted with historically underrepresented populations in research, is needed to better understand the social needs of breast cancer patients to inform effective and equitable interventions.
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Affiliation(s)
- Eileen C Howard
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA.
| | - Mara E Murray Horwitz
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, 02118, USA
- The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine, Lebanon, NH, 03755, USA
| | - Sharon Bak
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Kerrie P Nelson
- Department of Biostatistics, Boston University School of Public Health, Boston, 02118, USA
| | - Samantha Morton
- Samantha Morton Consulting, Boston, USA
- Formerly of MLPB (f/k/a Medical-Legal Partnership | Boston), Boston, USA
| | | | - Tracy A Battaglia
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
- Yale School of Medicine, Yale Cancer Center, New Haven, 06510, USA
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Hicks PM, Lin G, Newman-Casey PA, Niziol LM, Lu MC, Woodward MA, Elam AR, Musch DC, Mehdipanah R, Ehrlich JR, Rein DB. Place-Based Measures of Inequity and Vision Difficulty and Blindness. JAMA Ophthalmol 2024; 142:540-546. [PMID: 38722650 PMCID: PMC11082749 DOI: 10.1001/jamaophthalmol.2024.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/26/2024] [Indexed: 05/12/2024]
Abstract
Importance Known social risk factors associated with poor visual and systemic health in the US include segregation, income inequality, and persistent poverty. Objective To investigate the association of vision difficulty, including blindness, in neighborhoods with measures of inequity (Theil H index, Gini index, and persistent poverty). Design, Setting, and Participants This cross-sectional study used data from the 2012-2016 American Community Survey and 2010 US census tracts as well as Theil H index, Gini index, and persistent poverty measures from PolicyMap. Data analysis was completed in July 2023. Main Outcomes and Measures The main outcome was the number of census tract residents reporting vision difficulty and blindness (VDB) and the association with the Theil H index, Gini index, or persistent poverty, assessed using logistic regression. Results In total, 73 198 census tracts were analyzed. For every 0.1-unit increase in Theil H index and Gini index, there was an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size (Theil H index: odds ratio [OR], 1.14 [95% CI, 1.14-1.14; P < .001]; Gini index: OR, 1.15 [95% CI, 1.15-1.15; P < .001]). Persistent poverty was associated with an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size compared with nonpersistent poverty (OR, 1.36; 95% CI, 1.35-1.36; P < .001). Conclusions and Relevance In this cross-sectional study, residential measures of inequity through segregation, income inequality, or persistent poverty were associated with a greater number of residents living with VDB. It is essential to understand and address how neighborhood characteristics can impact rates of VDB.
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Affiliation(s)
- Patrice M. Hicks
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Housing Solutions for Health Equity, University of Michigan, Ann Arbor
| | - George Lin
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
| | - Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | - Leslie M. Niziol
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
| | - Ming-Chen Lu
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
| | - Maria A. Woodward
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | - Angela R. Elam
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | - David C. Musch
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Roshanak Mehdipanah
- Housing Solutions for Health Equity, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| | - Joshua R. Ehrlich
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
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Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Health equity: A concept analysis. Nurs Outlook 2023; 71:102032. [PMID: 37683597 DOI: 10.1016/j.outlook.2023.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions. PURPOSE Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy. METHOD Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity. FINDINGS Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology. DISCUSSION Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.
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Affiliation(s)
- Chrystal L Lewis
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA.
| | - Alice Yan
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Michelle Y Williams
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA; Division of Primary Care and Population Health and Nursing Research Section, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Lynette V Apen
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Cecelia L Crawford
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Lisa Morse
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Anna M Valdez
- Department of Nursing, Sonoma State University, Rohnert Park, CA
| | - G Rumay Alexander
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Dale Beatty
- Executive Administration, Stanford Health Care, Palo Alto, CA
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Ellis DA, Cutchin MP, Carcone AI, Evans M, Weissberg-Benchell J, Buggs-Saxton C, Boucher-Berry C, Miller JL, Drossos T, Dekelbab MB, Worley J. Racial Residential Segregation and the Health of Black Youth With Type 1 Diabetes. Pediatrics 2023; 151:e2022058856. [PMID: 37096459 PMCID: PMC10263024 DOI: 10.1542/peds.2022-058856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVES Black youth with type 1 diabetes (T1D) are at heightened risk for suboptimal glycemic control. Studies of neighborhood effects on the health of youth with T1D are limited. The current study investigated the effects of racial residential segregation on the diabetes health of young Black adolescents with T1D. METHODS A total of 148 participants were recruited from 7 pediatric diabetes clinics in 2 US cities. Racial residential segregation (RRS) was calculated at the census block group level based on US Census data. Diabetes management was measured via self-report questionnaire. Hemoglobin A1c (HbA1c) information was gathered from participants during home-based data collection. Hierarchical linear regression was used to test the effects of RRS while controlling for family income, youth age, insulin delivery method (insulin pump versus syringe therapy), and neighborhood adversity. RESULTS HbA1c was significantly associated with RRS in bivariate analyses, whereas youth-reported diabetes management was not. In hierarchical regression analyses, whereas family income, age, and insulin delivery method were all significantly associated with HbA1c in model 1, only RRS, age, and insulin delivery method were significantly associated with HbA1c in model 2. Model 2 explained 25% of the variance in HbA1c (P = .001). CONCLUSIONS RRS was associated with glycemic control in a sample of Black youth with T1D and accounted for variance in HbA1c even after controlling for adverse neighborhood conditions. Policies to reduce residential segregation, along with improved screening for neighborhood-level risk, hold the potential to improve the health of a vulnerable population of youth.
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Affiliation(s)
| | | | | | - Meredyth Evans
- Ann and Robert H. Lurie Children’s Hospital and Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Jill Weissberg-Benchell
- Ann and Robert H. Lurie Children’s Hospital and Northwestern Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Jennifer L. Miller
- Ann and Robert H. Lurie Children’s Hospital and Northwestern Feinberg School of Medicine, Chicago, Illinois
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Lynch K, Lee M, Loeb S. An investigation of Head Start preschool children's executive function, early literacy, and numeracy learning in the midst of the COVID-19 pandemic. EARLY CHILDHOOD RESEARCH QUARTERLY 2023; 64:255-265. [PMID: 37056356 PMCID: PMC10076510 DOI: 10.1016/j.ecresq.2023.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 05/29/2023]
Abstract
The COVID-19 pandemic's impact on preschool children's school readiness skills remains understudied. This research investigates Head Start preschool children's early numeracy, literacy, and executive function outcomes during a pandemic-affected school year. Study children (N = 336 assessed at fall baseline; N = 237-250 assessed in spring depending on outcome; fall baseline sample: mean age = 51 months; 46% Hispanic; 36% Black Non-Hispanic; 52% female) in a network of Head Start centers in four states (Nevada, New Jersey, Pennsylvania, and Wisconsin) experienced low in-person preschool exposure compared to national pre-pandemic norms. Children experienced fall to spring score gains during the pandemic-affected year of 0.05 SD in executive function, 0.27 SD in print knowledge, and 0.45-0.71 SD in early numeracy skills. Descriptively, for two of the three early numeracy domains measured, spring test score outcomes were stronger among children who attended more in-person preschool. We discuss implications for future research and policy.
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Affiliation(s)
- Kathleen Lynch
- Department of Educational Psychology, Neag School of Education, University of Connecticut, 249 Glenbrook Road, Storrs, CT U-3064, United States
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8
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Mahabee-Gittens EM, Han G, Merianos AL. Child Tobacco Smoke Exposure, Indoor Home Characteristics, and Housing Stability among a National Sample of U.S. Children. TOXICS 2022; 10:639. [PMID: 36355931 PMCID: PMC9695748 DOI: 10.3390/toxics10110639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
(1) Objectives: To examine the associations of child tobacco smoke exposure (TSE) with home quality and housing instability. (2) Methods. A secondary analysis of 32,066 U.S. 0-11-year-old children from the 2018-2019 National Survey of Children's Health was conducted. Child home TSE status was defined as: no TSE: child lived with no smokers; thirdhand smoke (THS) exposure only: child lived with a smoker(s) who did not smoke indoors; and secondhand smoke (SHS) and THS exposure: child lived with a smoker(s) who smoked indoors. Home quality was assessed by the presence of mold or pesticide use and housing instability was assessed by home ownership, frequency of moves, and number of household members. We conducted weighted multivariable logistic regression and linear regression models while adjusting for important child covariates. (3) Results: In total, 12.3% had home THS exposure only and 1.6% had home SHS and THS exposure. Compared to children with no home TSE, children with home SHS and THS exposure were 2.60 times more likely (95%CI = 1.73, 3.92) to have mold inside their homes; 1.57 times more likely (95%CI = 1.09, 2.26) to live in homes where pesticides were used ≥1 time during the past 12-months; and more likely to have more frequent moves (β = 1.06, 95%CI = 0.62, 1.50). (4) Conclusions: Children with home TSE have higher rates of mold, pesticide use, frequent moves, and household members compared to children with no home TSE. Children with TSE should also be screened for home quality and housing instability and provided with appropriate interventions and resources.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH 45229, USA
| | - Gang Han
- Department of Epidemiology and Biostatistics, Texas A&M University School of Public Health, College Station, TX 77843, USA
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH 45221, USA
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9
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Cutts DB, Ettinger de Cuba S, Bovell-Ammon A, Wellington C, Coleman SM, Frank DA, Black MM, Ochoa E, Chilton M, Lê-Scherban F, Heeren T, Rateau LJ, Sandel M. Eviction and Household Health and Hardships in Families With Very Young Children. Pediatrics 2022; 150:189509. [PMID: 36120757 DOI: 10.1542/peds.2022-056692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Families with versus without children are at greater eviction risk. Eviction is a perinatal, pediatric, and adult health concern. Most studies evaluate only formal evictions. METHODS Using cross-sectional surveys of 26 441 caregiver or young child (<48 months) dyads from 2011 to 2019 in emergency departments (EDs) and primary care clinics, we investigated relationships of 5 year history of formal (court-involved) and informal (not court-involved) evictions with caregiver and child health, history of hospitalizations, hospital admission from the ED on the day of the interview, and housing-related and other material hardships. RESULTS 3.9% of 26 441 caregivers reported 5 year eviction history (eviction), of which 57.0% were formal evictions. After controlling for covariates, we found associations were minimally different between formal versus informal evictions and were, therefore, combined. Compared to no evictions, evictions were associated with 1.43 (95% CI: 1.17-1.73), 1.55 (95% confidence interval [CI]: 1.32-1.82), and 1.24 (95% CI: 1.01-1.53) times greater odds of child fair or poor health, developmental risk, and hospital admission from the ED, respectively, as well as adverse caregiver and hardship outcomes. Adjusting separately for household income and for housing-related hardships in sensitivity analyses did not significantly alter results, although odds ratios were attenuated. Hospital admission from the ED was no longer significant. CONCLUSIONS Demonstrated associations between eviction and health and hardships support broad initiatives, such as housing-specific policies, income-focused benefits, and social determinants of health screening and community connections in health care settings. Such multifaceted efforts may decrease formal and informal eviction incidence and mitigate potential harmful associations for very young children and their families.
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Affiliation(s)
- Diana B Cutts
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | | | - Chevaughn Wellington
- Children's HealthWatch, Boston Medical Center, Boston, Massachusetts.,Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Sharon M Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Maureen M Black
- Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, Maryland.,RTI International, Research Triangle Park, North Carolina
| | - Eduardo Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Félice Lê-Scherban
- Epidemiology and Biostatistics.,Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Timothy Heeren
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Megan Sandel
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
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10
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South E, Venkataramani A, Dalembert G. Building Black Wealth - The Role of Health Systems in Closing the Gap. N Engl J Med 2022; 387:844-849. [PMID: 36053512 DOI: 10.1056/nejmms2209521] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eugenia South
- From the Penn Urban Health Lab (E.S.), and the Departments of Emergency Medicine (E.S.), Medical Ethics and Health Policy (A.V.), and Pediatrics (G.D.), Perelman School of Medicine, and the Leonard Davis Institute for Health Economics (E.S., A.V., G.D.), University of Pennsylvania, and the Possibilities Project, Children's Hospital of Philadelphia (G.D.) - both in Philadelphia
| | - Atheendar Venkataramani
- From the Penn Urban Health Lab (E.S.), and the Departments of Emergency Medicine (E.S.), Medical Ethics and Health Policy (A.V.), and Pediatrics (G.D.), Perelman School of Medicine, and the Leonard Davis Institute for Health Economics (E.S., A.V., G.D.), University of Pennsylvania, and the Possibilities Project, Children's Hospital of Philadelphia (G.D.) - both in Philadelphia
| | - George Dalembert
- From the Penn Urban Health Lab (E.S.), and the Departments of Emergency Medicine (E.S.), Medical Ethics and Health Policy (A.V.), and Pediatrics (G.D.), Perelman School of Medicine, and the Leonard Davis Institute for Health Economics (E.S., A.V., G.D.), University of Pennsylvania, and the Possibilities Project, Children's Hospital of Philadelphia (G.D.) - both in Philadelphia
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11
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Schickedanz A, Szilagyi PG, Dreyer B. Child Poverty and Health in the United States: Introduction and Executive Summary. Acad Pediatr 2021; 21:S81-S85. [PMID: 34740430 DOI: 10.1016/j.acap.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA (A Schickedanz and PG Szilagyi), Los Angeles, Calif.
| | - Peter G Szilagyi
- Department of Pediatrics, David Geffen School of Medicine at UCLA (A Schickedanz and PG Szilagyi), Los Angeles, Calif
| | - Benard Dreyer
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, Bellevue Hospital Center (B Dreyer), New York, NY
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