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Ertel KA, Okuzono SS, Beyer LN, Pintro K, Cuevas AG, Slopen N. Neighborhood Opportunity and Obesity in Early Adolescence: Differential Associations by Sex. J Adolesc Health 2024; 75:314-322. [PMID: 38852089 DOI: 10.1016/j.jadohealth.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Though research indicates that certain aspects of adverse neighborhood conditions may influence weight development in childhood and adolescence, it is unknown if the Child Opportunity Index (COI), a composite measure of 29 indicators of neighborhood conditions, is associated with weight outcomes in adolescence. We hypothesized that lower COI would be associated with higher overweight and obesity in cross-sectional and longitudinal modeling in a national sample of 9 year olds and 10 year olds and that this association would be different by sex. METHODS Using data from the Adolescent Brain Cognitive Development study (n = 11,857), we examined the cross-sectional association between COI quintile and overweight and obesity in 9 year olds and 10 year olds. Additionally, we used hazard ratios to examine incident overweight and obesity across three waves of data collection. RESULTS Due to the interaction between sex and COI (p < .05), we present sex-specific models. There was a stepwise bivariate association, in which higher COI was associated with lower obesity prevalence. This pattern held in multilevel models, with a stronger association in females. In models adjusted for individual and household characteristics, female adolescents in the lowest quintile COI neighborhoods had 1.81 (95% confidence interval: 1.32, 2.48) times the odds of obesity compared to those in the highest quintile. In longitudinal models, the COI was associated with incident obesity in females only: adjusted hazard ratio = 4.27 (95% confidence interval: 1.50, 12.13) for lowest compared to highest COI. DISCUSSION Neighborhood opportunity is associated with risk of obesity in pre-adolescence into mid-adolescence. Females may be particularly influenced by neighborhood conditions.
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Affiliation(s)
- Karen A Ertel
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Sakurako S Okuzono
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Logan Nicole Beyer
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kedie Pintro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Adolfo G Cuevas
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York; Center for Anti-racism, Social Justice, and Public Health, New York University School of Global Public Health, New York, New York
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Center on the Developing Child, Harvard University, Cambridge, Massachusetts
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Srinivas S, Henderson K, Griffin KL, Thomas E, Wood RJ, Langer JC, Halaweish I. Rates of Hirschsprung-Associated Enterocolitis Decrease With Increasing Child Opportunity Index. J Pediatr Surg 2024; 59:1240-1244. [PMID: 38584009 DOI: 10.1016/j.jpedsurg.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/01/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Hirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality in patients with Hirschsprung disease (HD). There is a correlation between social determinants of health (SDOH) and outcomes in children with HD. The Child Opportunity Index (COI) is a publicly available dataset that stratifies patients by address into levels of opportunity. We aimed to understand if a relationship exists between COI and HAEC. METHODS A single-institution, IRB-approved, retrospective cohort study was performed of children with HD. Census tract information was used to obtain COI scores, which were stratified into categories (very low, low, medium, high, very high). Subgroups with and without history of HAEC were compared. RESULTS The cohort had 100 patients, of which 93 had a COI score. There were 27 patients (29.0%) with HAEC. There were no differences in demographics or clinical factors, including length of aganglionic colon, operative approach, and age at pull-through. As child opportunity score increased from very low to very high, there was a statistically significant decrease in the incidence of HAEC (p = 0.04). CONCLUSION We demonstrate a significant association between increasing opportunity and decreasing incidence of HAEC. This suggests an opportunity for targeted intervention in populations with low opportunity. LEVEL OF EVIDENCE III. IRB NUMBER IRB14-00232.
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Affiliation(s)
- Shruthi Srinivas
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Katelyn Henderson
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Kristine L Griffin
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Elizabeth Thomas
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Jacob C Langer
- Department of Surgery, Hospital for Sick Children at the University of Toronto, Toronto, Canada
| | - Ihab Halaweish
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Abraham OC, Jampa A, Quinney SK, Haas DM. The Childhood Opportunity Index's Association with Adverse Pregnancy and Newborn Outcomes in Nulliparous Persons. Am J Perinatol 2024; 41:e3052-e3058. [PMID: 37793429 DOI: 10.1055/a-2185-8882] [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: 10/06/2023]
Abstract
OBJECTIVE The objective of the study was to determine if using a novel measure of social determinants of health, the Childhood Opportunity Index (COI), at the time of delivery was associated with development of adverse pregnancy outcomes (APO) in nulliparous pregnant persons. STUDY DESIGN Data were extracted from the 779 participants from a single nuMoM2b (Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be) study site, a prospective cohort study designed to identify contributors to APOs. Residential address information at delivery was linked to the location's COI. The overall composite and component scores in education, health and environmental, and socioeconomic indices were recorded. APOs of interest included preterm birth, hypertensive disorders of pregnancy, small for gestational age at birth, stillbirth, and gestational diabetes. Participant characteristics were compared by COI category and the association of COI with APOs was analyzed by logistic regression, controlling for age and self-reported race/ethnicity. RESULTS The overall COI distribution was very low (45%), low (17%), moderate (10%), high (15%), and very high (13%). A total of 329 (43.5%) participants experienced at least one APO. Overall COI was associated with developing an APO (p = 0.02). Each component score was also associated with developing APOs and with race/ethnicity (p < 0.05). Compared with higher COI categories, an overall low or very low categorized location was independently associated with developing an APO (odds ratio: 1.636, 95% confidence interval: 1.16-2.31). Adjusting for gestational age at birth, those in lower COI areas had newborns with lower birth weight, birth length, and head circumference (estimate [95% confidence interval] birth weight: -0.0005 g [-0.0008 to -0.0001]; length: -0.065 cm [-0.124 to -0.0091]; head circumference: -0.123 cm [-0.208 to -0.045]). COI was not associated with other newborn outcomes. CONCLUSION COI, a marker for social determinants of health, is independently associated with APOs. The COI may be a tool for risk stratification for pregnant people to help with APO-reducing strategies. KEY POINTS · The COI is a neighborhood-level marker for social determinants of health.. · The COI at time of delivery is associated with APO and newborn birth weight, length, and head circumference.. · The COI may be usable in pregnancy clinics to help identify resource needs to optimize outcomes for pregnant individuals and newborns..
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Affiliation(s)
- Olivia C Abraham
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alekhya Jampa
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sara K Quinney
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
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Kalluri AL, Jiang K, Abu-Bonsrah N, Ammar A, Reynolds R, Alomari S, Odonkor MN, Bhimreddy M, Ram N, Robinson S, Akbari SHA, Groves ML. Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles. Childs Nerv Syst 2024; 40:1177-1184. [PMID: 38133684 DOI: 10.1007/s00381-023-06254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To investigate differences in sociodemographic characteristics and short-term outcomes between patients undergoing prenatal versus postnatal myelomeningocele repair. METHODS Patients who underwent myelomeningocele repair at our institution were stratified based on prenatal or postnatal timing of repair. Baseline characteristics and outcomes were compared. Multivariate analysis was performed to identify whether prenatal repair was a predictor of outcomes independent of socioeconomic measures. RESULTS 49 patients underwent postnatal repair, and 30 underwent prenatal repair. Patients who underwent prenatal repair were more likely to have private insurance (73.3% vs. 42.9%, p = 0.03) and live farther from the hospital where they received their repair (251.5 ± 447.4 vs. 72.5 ± 205.6 miles, p = 0.02). Patients who underwent prenatal repair had shorter hospital stays (14.3 ± 22.7 days vs. 25.3 ± 20.1 days, p = 0.03), fewer complications (13.8% vs. 42.9%, p = 0.01), fewer 30-day ED visits (0.0% vs. 34.0%, p < 0.001), lower CSF diversion rates (13.8% vs. 38.8%, p = 0.02), and better functional status at 3-months (13.3% vs. 57.1% delayed, p = 0.009), 6-months (20.0% vs. 56.7% delayed, p = 0.03), and 1-year (29.4% vs. 70.6% delayed, p = 0.007). On multivariate analysis, prenatal repair was an independent predictor of inpatient complication (OR(95%CI): 0.19(0.05-0.75), p = 0.02) and 3-month (OR(95%CI): 0.14(0.03-0.80) p = 0.03), 6-month (OR(95%CI): 0.12(0.02-0.73), p = 0.02), and 1-year (OR(95%CI): 0.19(0.05-0.80), p = 0.02) functional status. CONCLUSION Prenatal repair for myelomeningocele is associated with better outcomes and developmental functional status. However, patients receiving prenatal closure are more likely to have private health insurance and live farther from the hospital, suggesting potential barriers to care.
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Affiliation(s)
- Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA.
| | - Adam Ammar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Rebecca Reynolds
- Department of Neurosurgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Michelle N Odonkor
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Natasha Ram
- Department of Neurosurgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Syed Hassan A Akbari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
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Sarnthiyakul S, Ross EE, Ourshalimian S, Spurrier RG, Chaudhari PP. Neighborhood deprivation and childhood opportunity indices are associated with violent injury among children in Los Angeles County. J Trauma Acute Care Surg 2023; 95:397-402. [PMID: 36728330 DOI: 10.1097/ta.0000000000003860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous research has demonstrated mixed relationships between individual neighborhood socioeconomic factors and incidences of violence, such as poverty level, population density, and income inequality. We used the Childhood Opportunity Index and Area Disadvantage Index to evaluate the relationship between neighborhood characteristics and the number of incidents of violence among children across the zip codes of Los Angeles (LA) County. METHODS We performed a retrospective cross-sectional study of children younger than 18 years from 2017 to 2019 who were entered in the LA County Trauma and Emergency Medicine Information System registry with violent mechanisms of injury, including gunshot, stabbing, or assault. Mechanisms classified as self-inflicted injuries were excluded from the study. The number of incidences of violent mechanism per 100,000 persons younger than 18 years for each zip code was calculated using population data from the US Census American Community Survey 5-Year estimates from 2019. The incidences of violence per capita younger than 18 years for each zip code was compared with the zip code Area Deprivation Index and Childhood Opportunity Index using logistic regression models. RESULTS There were 6,791 trauma activations in LA County over the study period, 12.8% (n = 866) of which were due to violence. The mean prevalence of pediatric violent mechanism of injury per zip code was 4 cases per 100,000 persons younger than 18 years. Most injuries were the result of firearms (n = 345 [60.4%]) and occurred among Hispanic/Latino children (n = 362 [57.1%]). There were significantly greater rates of violent injury among children from highest disadvantage (odds ratio, 8.84) and lowest opportunity (odds ratio, 42.48) zip codes. CONCLUSION Children living in high disadvantage or low opportunity zip codes had greater rates of violent injury. Further study of neighborhood factors is needed to develop targeted effective interventions to reduce violent injuries among children living in low opportunity areas. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Sasithorn Sarnthiyakul
- From the Fielding School of Public Health (S.S.), University of California, Los Angeles; Department of Medical Education (E.E.R.), Keck School of Medicine, University of Southern California; Division of Pediatric Surgery, Department of Surgery (S.O., R.G.S.) and Division of Emergency and Transport Medicine (P.P.C.), Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
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Shen TJ, Nathan SL, Wong DE, Gottlieb LJ, Vrouwe SQ. Pediatric instant noodle burns: A ten-year single center retrospective study. Burns 2023; 49:1467-1473. [PMID: 36702681 DOI: 10.1016/j.burns.2023.01.006] [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: 07/28/2022] [Revised: 11/14/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Children are particularly vulnerable to scald injuries, and hot beverages/foods are often implicated in this subset of pediatric burns. Burns from instant noodles are common and thus an attractive target for burn prevention. The purpose of this study is to characterize the frequency, demographics, outcomes, and circumstances of pediatric instant noodle burns to guide future educational and prevention efforts. METHODS This is a retrospective review of all pediatric patients (<18 years) admitted to the University of Chicago Burn Center with a diagnosis of scald injury between 2010 and 2020. Burns caused by instant noodles were identified and compared to all other scald burns over this period. RESULTS Among 790 pediatric scald burns, 245 (31.0 %) were attributed to instant noodles. Compared to other scalds, patients with instant noodle burns were older (5.4 vs. 3.8 years, p < 0.001), equally likely to be male (51 % vs. 54 %, p = 0.488), and more likely to be Black/African American (90.6 % vs. 75.2 %, p < 0.001). Patients with instant noodle burns lived in zip codes with a lower average childhood opportunity index score (9.9 vs. 14.6, p < 0.001). In terms of circumstances, children with instant noodle burns were more likely to be unsupervised at the time of injury (37 % vs 21 %, p < 0.001). Instant noodle burns were smaller (3.6 % total body surface area (TBSA) vs. 5.8 % TBSA, p < 0.001) and less likely to require operative intervention (29 % vs. 41 %, p < 0.001). Instant noodle burns had a shorter length of stay (4.2 days vs. 6.4 days, p < 0.001), but similar adjusted length of stay (1.7 days/%TBSA vs. 1.5 days/%TBSA, p = 0.18) and experienced similar complication rates (10 % vs. 15 %, p = 0.06). CONCLUSION Instant noodle burns comprised nearly one-third of all pediatric scald burn admissions at our institution, a higher proportion than previously reported. While less severe than other scald burns in this series, instant noodles injuries still demonstrated a need for hospitalization and operative intervention. Instant noodle burns disproportionately affected Black/African American patients, as well as from neighborhoods with lower socioeconomic status. These findings suggest that focused burn prevention efforts may be successful at reducing the incidence of these common, but serious injuries.
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Affiliation(s)
- Timothy J Shen
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Shelby L Nathan
- Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, IL, USA
| | - Daniel E Wong
- Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, IL, USA
| | - Lawrence J Gottlieb
- Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, IL, USA
| | - Sebastian Q Vrouwe
- Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, IL, USA.
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Abstract
PURPOSE OF REVIEW This article outlines updates in social determinants of health (SDOH) screening practices in pediatric healthcare and community settings. The transition to value-based care and the COVID-19 pandemic have both had significant impacts on screening practices, with implications for providers, communities, and policymakers. RECENT FINDINGS The COVID-19 pandemic has exacerbated social needs for vulnerable patients and families, resulting in increased recognition by healthcare teams through screening. Policy frameworks like value-based care that aim to deliver whole-child care in the community are reorienting the logistics of screening, including screening in acute-care settings and community settings. Recent studies on family and provider perspectives should be integrated into screening practices. SUMMARY Despite significant advances in and expansion of SDOH screening in the pediatric healthcare setting, there remain limitations and future research needs. More data is needed to evaluate social need screeners and interventions, and determine how healthcare systems, communities, and states can spread and scale such interventions based on outcomes and value measurements. Population-based social indices have the potential to augment individual patient screening, but this remains a future research need.
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Affiliation(s)
- Abby L Nerlinger
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Nemours Children's Hospital, Delaware, Wilmington, Delaware
| | - Gift Kopsombut
- University of Central Florida
- Nemours Children's Hospital, Florida, Orlando, Florida, USA
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