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Woodward-Lopez G, Esaryk EE, Hewawitharana SC, Kao J, Talmage E, Rider CD. Supplemental Nutrition Assistance Program Education reductions during COVID-19 may have exacerbated health inequities. SSM Popul Health 2023; 23:101471. [PMID: 37560088 PMCID: PMC10407591 DOI: 10.1016/j.ssmph.2023.101471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Describe, and assess disparities in, the changes in Supplemental Nutrition Assistance Program Education (SNAP-Ed) that occurred the year before vs. the year when COVID-19 restrictions were implemented. DESIGN Observational study comparing reach, intensity, and dose of California Local Health Department (LHD) SNAP-Ed interventions in Federal Fiscal years 2019 and 2020 (FFY19, FFY20). ANALYSIS Student t-tests determined significance of differences in the number of Direct Education (DE) programs, Policy, Systems and Environmental change (PSE) sites, people reached, and intervention intensity and dose between FFY19 and FFY20 using data reported online by LHDs. Linear regression assessed associations between census tract-level characteristics (urbanicity; percentages of population with income <185% of federal poverty level, under 18 years of age, and belonging to various racial/ethnic groups; and California Healthy Places Index) and changes in number of DE programs, PSE sites, people reached, and intervention dose between FFY19 and FFY20. RESULTS From FFY19 to FFY20, the number of DE programs, PSE sites, people reached, and census tract-level intervention intensity and dose decreased. Higher census tract poverty, higher proportions of Black and Latino residents, and less healthy neighborhood conditions were associated with greater decreases in some intervention characteristics including PSE sites, PSE reach, DE programs, and DE dose. CONCLUSIONS AND IMPLICATIONS These reductions in LHD SNAP-Ed interventions indicate reduced access to education and environments that support healthy eating and obesity prevention during a time when this support was especially needed to reduce risk of COVID-19 infection and complications. Disproportionately reduced access, may have worsened health disparities in already-disadvantaged communities. Assuring maintenance of SNAP-Ed interventions, especially in disadvantaged communities, should be a priority during public health emergencies.
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Affiliation(s)
- Gail Woodward-Lopez
- University of California, Nutrition Policy Institute, Division of Agriculture and Natural Resources, 1111 Franklin Street, 11th Floor, Oakland, CA, 94607, USA
| | - Erin E. Esaryk
- University of California, Nutrition Policy Institute, Division of Agriculture and Natural Resources, 1111 Franklin Street, 11th Floor, Oakland, CA, 94607, USA
| | - Sridharshi C. Hewawitharana
- University of California, Nutrition Policy Institute, Division of Agriculture and Natural Resources, 1111 Franklin Street, 11th Floor, Oakland, CA, 94607, USA
| | - Janice Kao
- University of California, Nutrition Policy Institute, Division of Agriculture and Natural Resources, 1111 Franklin Street, 11th Floor, Oakland, CA, 94607, USA
| | - Evan Talmage
- University of California, Nutrition Policy Institute, Division of Agriculture and Natural Resources, 1111 Franklin Street, 11th Floor, Oakland, CA, 94607, USA
| | - Carolyn D. Rider
- University of California, Nutrition Policy Institute, Division of Agriculture and Natural Resources, 1111 Franklin Street, 11th Floor, Oakland, CA, 94607, USA
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Tyris J, Rodean J, Kulesa J, Dixon G, Bhansali P, Gayle T, Akani D, Magyar M, Tamaskar N, Parikh K. Social Risks and Health Care Utilization Among a National Sample of Children With Asthma. Acad Pediatr 2023; 23:130-139. [PMID: 35940571 DOI: 10.1016/j.acap.2022.07.025] [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] [Received: 03/03/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Prior studies using single-center populations have established associations between social risks and health care utilization among children with asthma. We aimed to evaluate associations between social risks and health care utilization among a nationally representative sample of children with asthma. STUDY DESIGN In this cross-sectional study, we utilized the 2018-2019 National Survey of Children's Health to identify children 2 to 17 years old with asthma. Using the Healthy People (HP) 2030 social determinants of health (SDOH) framework, we identified 31 survey items assessing 18 caregiver-identified social risks as exposure variables and classified them into the 5 HP SDOH domains (Economy, Education, Health care, Community, and Environment). Primary outcome was caregiver-reported health care utilization. Associations between individual social risks and total number of SDOH domains experienced with health care utilization were assessed. RESULTS The weighted study population included 8.05 million children, 96% of whom reported ≥1 social risk. Fourteen social risks, spanning all 5 SDOH domains, were significantly associated with increased health care utilization. The 3 risks with the highest adjusted odds ratios (aOR) of health care utilization included: experiencing discrimination (aOR 3.26 [95% confidence interval (CI): 1.75, 6.08]); receiving free/reduced lunch (aOR 2.16, [95% CI 1.57, 2.98]); and being a victim of violence (aOR 2.11, [95% CI 1.11, 4]). Children with risks across more SDOH domains reported significantly higher health care utilization. CONCLUSIONS Among our national population of children with asthma, social risks are prevalent and associated with increased health care utilization, highlighting their potential contribution to pediatric asthma morbidity.
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Affiliation(s)
- Jordan Tyris
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC.
| | | | - John Kulesa
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gabrina Dixon
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Priti Bhansali
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Tamara Gayle
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Damilola Akani
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Matthew Magyar
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Nisha Tamaskar
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kavita Parikh
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
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Shanahan KH, Subramanian SV, Burdick KJ, Monuteaux MC, Lee LK, Fleegler EW. Association of Neighborhood Conditions and Resources for Children With Life Expectancy at Birth in the US. JAMA Netw Open 2022; 5:e2235912. [PMID: 36239940 PMCID: PMC9568807 DOI: 10.1001/jamanetworkopen.2022.35912] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022] Open
Abstract
Importance To address inequities in life expectancy, we must understand the associations of modifiable socioeconomic and structural factors with life expectancy. However, the association of limited neighborhood resources and deleterious physical conditions with life expectancy is not well understood. Objective To evaluate the association of community social and economic conditions and resources for children with life expectancy at birth. Design, Setting, and Participants This cross-sectional study examined neighborhood child opportunity and life expectancy using data from residents of 65 662 US Census tracts in 2015. The analysis was conducted from July 6 to October 1, 2021. Exposures Neighborhood conditions and resources for children in 2015. Main Outcomes and Measures The primary outcome was life expectancy at birth at the Census tract level based on data from the US Small-Area Life Expectancy Estimates Project (January 1, 2010, to December 31, 2015). Neighborhood conditions and resources for children were quantified by Census tract Child Opportunity Index (COI) 2.0 scores for 2015. This index captures community conditions associated with children's health and long-term outcomes categorized into 5 levels, from very low to very high opportunity. It includes 29 indicators in 3 domains: education, health and environment, and social and economic factors. Mixed-effects and simple linear regression models were used to estimate the associations between standardized COI scores (composite and domain-specific) and life expectancy. Results The study included residents from 65 662 of 73 057 US Census tracts (89.9%). Life expectancy at birth across Census tracts ranged from 56.3 years to 93.6 years (mean [SD], 78.2 [4.0] years). Life expectancy in Census tracts with very low COI scores was lower than life expectancy in Census tracts with very high COI scores (-7.06 years [95% CI, -7.13 to -6.99 years]). Stepwise associations were observed between COI scores and life expectancy. For each domain, life expectancy was shortest in Census tracts with very low compared with very high COI scores (education: β = -2.02 years [95% CI, -2.12 to -1.92 years]); health and environment: β = -2.30 years [95% CI, -2.41 to -2.20 years]; social and economic: β = -4.16 years [95% CI, -4.26 to -4.06 years]). The models accounted for 41% to 54% of variability in life expectancy at birth (R2 = 0.41-0.54). Conclusions and Relevance In this study, neighborhood conditions and resources for children were significantly associated with life expectancy at birth, accounting for substantial variability in life expectancy at the Census tract level. These findings suggest that community resources and conditions are important targets for antipoverty interventions and policies to improve life expectancy and address health inequities.
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Affiliation(s)
- Kristen H. Shanahan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Michael C. Monuteaux
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K. Lee
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Fritz CQ, Fleegler EW, DeSouza H, Richardson T, Kaiser SV, Sills MR, Cooper JN, Parikh K, Puls HT, DeLaroche AM, Hogan AH, Pantell MS, Kornblith AE, Heller KR, Bigham MT, Goyal M. Child Opportunity Index and Changes in Pediatric Acute Care Utilization in the COVID-19 Pandemic. Pediatrics 2022; 149:185223. [PMID: 35233618 DOI: 10.1542/peds.2021-053706] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pediatric acute care utilization decreased dramatically during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the association between the Child Opportunity Index (COI), a multidimensional neighborhood measure of childhood opportunity, and changes in acute care utilization at US pediatric hospitals during the COVID-19 pandemic compared with the previous 3 years. METHODS This observational study used administrative data across 41 US-based pediatric hospitals. Children aged 0 to 17 years with emergency department (ED) encounters during the study period were included. The COVID-19 pandemic time period (March 15, 2020-March 14, 2021) was the primary exposure. The primary outcome was the relative volume drop in ED encounters and observation/inpatient admissions through the ED by COI quintile. RESULTS Of 12 138 750 encounters, 3 705 320 (30.5%) were among the very low COI quintile. Overall, there was a 46.8% relative volume reduction in the pandemic period compared with the prepandmic period. This drop in volume occurred disproportionately among the very low COI quintile (51.1%) compared with the very high COI quintile (42.8%). The majority of clinical diagnosis groups demonstrated larger relative volume drops among the very low COI quintile. CONCLUSIONS Acute care utilization decreased the most among children from very low COI neighborhoods, narrowing previously described acute care utilization disparities. Additional study of patient perspectives on health care needs and access during this period is required to understand these changes.
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Affiliation(s)
- Cristin Q Fritz
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric W Fleegler
- Department of Pediatrics, Boston Children's Hospitaland Harvard Medical School, Boston, Massachusetts
| | | | | | - Sunitha V Kaiser
- Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, California.,Philip R. Lee Institute of Health Policy Studies, San Francisco, California
| | - Marion R Sills
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colorado
| | | | - Kavita Parikh
- Department of Pediatrics, Children's National Hospitaland The George Washington University, Washington, District of Columbia
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Amy M DeLaroche
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Alex H Hogan
- Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Matthew S Pantell
- Department of Pediatric Hospital Medicine, University of California, San Francisco, California
| | - Aaron E Kornblith
- Division of Emergency Medicine, Department of Pediatrics, University of California, San Francisco, California
| | - Kayla R Heller
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Michael T Bigham
- Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Monika Goyal
- Department of Pediatrics, Children's National Hospitaland The George Washington University, Washington, District of Columbia
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Alachraf K, Currie C, Wooten W, Tumin D. Social Determinants of Emergency Department Visits in Mild Compared to Moderate and Severe Asthma. Lung 2022; 200:221-226. [PMID: 35322286 DOI: 10.1007/s00408-022-00524-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Social determinants of health (SDH) influence emergency department (ED) use among children with asthma. We aimed to examine if SDH were more strongly associated with ED use among children with moderate/severe compared to mild asthma. METHODS This study utilized the 2016-2019 data from the National Survey of Children's Health. Children with asthma ages 0-17 years (N = 9937) were included in the analysis. Asthma severity and all-cause ED use in the past year were reported by caregivers. The association between patient factors and ED visits was evaluated using ordinal logistic regression. RESULTS Based on the study sample, 29% of children with asthma had moderate/severe asthma. In the mild group, 30% visited the ED at least once in the past 12 months, compared to 49% in the moderate/severe group. SDH associated with ED visits included race/ethnicity, insurance coverage, and parental educational attainment, but the strength of these associations did not vary according to asthma severity. CONCLUSIONS In a nationally representative data set, SDH were equally predictive of ED use regardless of children's asthma severity. Interventions to reduce ED use among children with asthma should be considered for children with any severity of asthma, especially children in socially disadvantaged groups at higher risk of ED utilization.
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Affiliation(s)
- Kamel Alachraf
- Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
| | - Caroline Currie
- Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - William Wooten
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
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