Disparities in adolescent health and health care: does socioeconomic status matter?

Sociodemographic inequality in children aged 0-19 years with and without parents diagnosed with heart disease: a Danish nationwide register-based study

OBJECTIVES

This study aimed to estimate the prevalence of children aged 0-19 years who have a parent with a history of heart disease and investigate their sociodemographic characteristics.

STUDY DESIGN

A national register-based study.

METHODS

From the Danish Fertility Register and the Danish National Patient Register information on children of parents with ischemic heart disease, arrhythmia, heart failure and heart valve disease in the period 1981-2018 were obtained. Statistical analyses including descriptive statistics, logistic and linear regression were used to illuminate associations between parental heart disease and sociodemographic characteristics.

RESULTS

The study population consisted of 142,480 children aged 0-19 years with at least one parent diagnosed with heart disease, corresponding to every 9th child in Denmark in 2018. The number increased from 4.5% in 2002 to 11.1% in 2018. In the study population most had a father with heart disease (57.8%) and 4.6% had two parents with heart disease. Parents with heart disease had significantly higher odds of being out of work (OR 1.68, 95% CI 1.64; 1.72), in a single-parent household (OR 1.09, 95% CI 1.07; 1.11), divorced or widowed (OR: 1.10, 95% CI 1.08; 1.12), having a lower educational level (OR 1.35, 95% CI 1.33; 1.37), and a lower family income (-42,410 DKR, 95% CI -50,306; -34,514, P < 0.0001) compared to those without heart disease.

CONCLUSION

Children affected by parental heart disease comprise a substantial part of the Danish population. These have significantly different sociodemographic characteristics than children in families without parental heart disease, which might affect social heritage and parental capacity.

Adolescents Identify Modifiable Community-Level Barriers to Accessing Mental Health and Addiction Services in a Rural Canadian Town: A Survey Study

Adolescents are particularly vulnerable to inadequate provision of mental health and addictions care, as services have been traditionally conceptualized to serve the needs of children or adults. Additionally, rural communities have been largely excluded from research investigating mental healthcare access and exhibit unique barriers that warrant targeted interventions. Finally, perspectives from the target population will be most important when understanding how to optimize adolescent mental health and addictions care. Therefore, the purpose of this study was to identify what adolescents in a rural town perceive as barriers to accessing mental health services. We conducted a cross-sectional survey study with high school students to generate ranked lists of the top perceived individual-level, community-level, and overall barriers. A total of 243 high school students responded to the survey. Perceived barriers were predominantly at the community level. Overall, the top barriers reported were a lack of awareness and education regarding mental health, resources, and the nature of treatment. Students who had previously accessed mental health services identified primary barriers related to mental health professionals, whereas students who had not accessed care reported fear and uncertainty as primary barriers. Modifiable community-level factors related to (1) mental health literacy and (2) mental healthcare professionals were identified by adolescents as the main perceived barriers to accessing mental health and addiction services in a rural town. The findings of this preliminary study should inform intervention strategies and further rigorous research for this traditionally underserved target population.

The impact of poverty and socioeconomic status on brain, behaviour, and development: a unified framework

In this article, we, for the first time, provide a comprehensive overview and unified framework of the impact of poverty and low socioeconomic status (SES) on the brain and behaviour. While there are many studies on the impact of low SES on the brain (including cortex, hippocampus, amygdala, and even neurotransmitters) and behaviours (including educational attainment, language development, development of psychopathological disorders), prior studies did not integrate behavioural, educational, and neural findings in one framework. Here, we argue that the impact of poverty and low SES on the brain and behaviour are interrelated. Specifically, based on prior studies, due to a lack of resources, poverty and low SES are associated with poor nutrition, high levels of stress in caregivers and their children, and exposure to socio-environmental hazards. These psychological and physical injuries impact the normal development of several brain areas and neurotransmitters. Impaired functioning of the amygdala can lead to the development of psychopathological disorders, while impaired hippocampus and cortex functions are associated with a delay in learning and language development as well as poor academic performance. This in turn perpetuates poverty in children, leading to a vicious cycle of poverty and psychological/physical impairments. In addition to providing economic aid to economically disadvantaged families, interventions should aim to tackle neural abnormalities caused by poverty and low SES in early childhood. Importantly, acknowledging brain abnormalities due to poverty in early childhood can help increase economic equity. In the current study, we provide a comprehensive list of future studies to help understand the impact of poverty on the brain.

Lessons Learned From Adolescent COVID-19 Vaccine Administration in Medically Underserved Communities

OBJECTIVES

In May 2021, the Health Resources and Services Administration Health Center COVID-19 Vaccine Program (HCCVP) began supporting the national adolescent vaccination rollout for a safe return to in-person learning for children and adolescents from medically underserved communities. To understand the initial implementation of adolescent vaccinations, we estimated the number of vaccines administered through the HCCVP at the national and state level to adolescents aged 12-17 years, and we examined challenges and solutions in vaccine deployment.

METHODS

We analyzed data on vaccine administration, challenges, and solutions from the Health Center COVID-19 Survey during May 14-August 27, 2021, and we analyzed data on patients served from the 2019 Uniform Data System. National adolescent COVID-19 vaccination and population data came from CDC's COVID Data Tracker and the US Census Bureau's 2019 Current Population Survey.

RESULTS

HCCVP health centers administered >485 000 COVID-19 vaccine doses to adolescents during the study period, with variations across states. Health centers in 13 states and territories (Arizona, California, Colorado, Connecticut, Delaware, Maine, Massachusetts, Missouri, Nebraska, Nevada, Oregon, Virginia, and Puerto Rico) vaccinated more adolescents than their share of prepandemic adolescent patients. The most frequently reported challenges in vaccine administration were vaccine confidence and staffing availability.

CONCLUSIONS

This assessment of the initial months of COVID-19 vaccine administration among adolescent health center patients suggests rapid response by health centers in several states, reaching beyond their adolescent patient population to support state-level pandemic response. Future research could examine processes to optimize strategic activation of health centers in public health emergency responses.

Association of Adolescents' Body Mass Index Classification With Preventive Clinical Care Receipt

PURPOSE

To examine differences in screening and advising for modifiable risk behaviors during well-visits based on adolescents' body mass index categories.

METHODS

Retrospective analyses were conducted with the National Institute of Health's NEXT Generation Health Study data, a nationally representative cohort of 10th graders. In wave 1 (2010), adolescents were classified as being underweight (<4.99th percentile), normal-weight (5-84.99th percentile), overweight (85-94.99th percentile), or with obesity (≥95th percentile) based on the body mass index categories described by the Centers for Disease Control and Prevention. In wave 2 (2011), adolescents were asked by their provider about smoking, alcohol use, use of other drugs, sexual activity, nutrition, and exercise, and whether they were advised about risks associated with these behaviors.

RESULTS

The sample consisted of 1,639 eligible participants as follows: 57.8% females, 63.3% 16-year-olds, 47.8% non-Hispanic Whites, 41.5% living in the South, 75.4% with health insurance, and 29.8% with low family affluence. Screening rates for overweight compared to normal-weight males were 51% reduced for smoking, 46% for alcohol use, 47% for other drug use, 57% for nutrition, and 47% for exercise. Screening rates were 40% reduced for other drug use for males with obesity, and 89% reduced for alcohol use for underweight males compared to normal-weight males. Advice receipt for females with obesity compared to normal-weight females was 90% increased for nutrition and 78% increased for exercise.

DISCUSSION

Overweight male adolescents reported being less likely to be screened across almost all preventive service topics representing missed opportunities for care delivery.

What risk factors for Developmental Language Disorder can tell us about the neurobiological mechanisms of language development

Language is a complex multidimensional cognitive system that is connected to many neurocognitive capacities. The development of language is therefore strongly intertwined with the development of these capacities and their neurobiological substrates. Consequently, language problems, for example those of children with Developmental Language Disorder (DLD), are explained by a variety of etiological pathways and each of these pathways will be associated with specific risk factors. In this review, we attempt to link previously described factors that may interfere with language development to putative underlying neurobiological mechanisms of language development, hoping to uncover openings for future therapeutical approaches or interventions that can help children to optimally develop their language skills.

Challenges and achievements in the utilization of the health system among adolescents in a region of Burkina Faso particularly affected by poverty

OBJECTIVE

Healthcare for adolescents receives little attention in low-income countries globally despite their large population share in these settings, the importance of disease prevention at these ages for later life outcomes and adolescent health needs differing from those of other ages. We therefore examined healthcare need and use among adolescents in rural Burkina Faso to identify reasons for use and gaps in provision and uptake.

METHODS

We interviewed 1,644 adolescents aged 12-20 living in rural northwestern Burkina Faso in 2017. Topics included healthcare need and satisfaction with care provided. We calculated response-weighted prevalence of perceived healthcare need and utilization, then conducted multivariable regression to look at predictors of need, realized access and successful utilization based on the Andersen and Aday model.

RESULTS

43.7 [41.2 - 46.0] % of participants perceived need for healthcare at least once in the preceding 12 months - 52.0 [48.1 - 56.0] % of females and 35.6 [32.5 - 39.0] % of males. Of those with perceived need, 92.6 [90.0 - 94.3] % were able to access care and 79.0 [75.6 - 82.0] % obtained successful utilization. Need was most strongly predicted by gender, education and urbanicity, while predictors of successful use included household wealth and female guardian's educational attainment.

CONCLUSION

Healthcare utilization among adolescents is low in rural Burkina Faso, but mostly thought of as sufficient with very few individuals reporting need that was not linked to care. Future objective assessment of healthcare need could help identify whether our results reflect a well-functioning system for these adolescents, or one where barriers lead to low awareness of needs or low expectations for service provision.

The role of social adversity on emotional dysregulation during infancy and early childhood

PURPOSE

The purpose of this study was to investigate if social adversity is associated with mother reported emotional dysregulation behaviors and trajectories during infancy and early childhood.

DESIGN & METHODS

A secondary data analysis from the Durham Child Health and Development study study included 206 child-mother dyads. Three models were used to explore the relationship between social adversity and mother reported emotional dysregulation during infancy (Infant Behavior Questionnaire-Revised) and early childhood (Child Behavior Checklist - Dysregulation Profile). Linear mixed effects models were adopted to investigate if social adversity was associated with mother reported emotional dysregulation longitudinally. Regression analysis was conducted to explore if social adversity was associated with maternal reported emotional dysregulation trajectory slope scores and maternal reported emotional dysregulation trajectory class. Maternal psychological distress and the child's sex assigned at birth were included as covariates in each analysis.

RESULTS

Infants with greater social adversity scores had significantly higher maternal reported fear responses across the first year of life. Social adversity was associated with maternal reported distress to limitations trajectory, dysregulated recovery class, and dysregulated distress to limitations class. During early childhood social adversity was significantly associated with maternal reported emotional dysregulation but not trajectories which showed little variability.

CONCLUSION & PRACTICAL IMPLICATIONS

Our results indicate that social adversity is associated with maternal reported emotional dysregulation during infancy and early childhood. Nursing and other professionals can participate in early screening to determine risk and provide intervention.

Associations of Sociodemographic and Psychosocial Factors with Headache Symptom Among Indonesian Adolescents Based on the 5th Wave of the Indonesian Family Life Survey (IFLS-5)

BACKGROUND

Headaches are common among children and adolescents, with more than half of adolescents reporting headache symptom worldwide. The number of migraine sufferers among adolescents has increased dramatically in the past decade. Headache has negatively influenced children and has been linked with emotional and behavioral problems.

STUDY DESIGN

A cross-sectional study.

METHODS

This study was conducted using secondary data from the Indonesian Family Life Survey (IFLS) to evaluate the relationship between sociodemographic and psychosocial factors in Indonesian adolescents and headaches. We used data from the fifth wave of IFLS, which was conducted between September 2014 and April 2015. The figures represent roughly 83% of the Indonesian population. We investigated the possible relationship between sociodemographic and psychosocial factors in adolescents with headaches.

RESULTS

A total of 3605 participants (1875 females and 1730 males) aged 15 to 19 years with headache symptom were included in the study. Headache was associated with sleep disturbances (OR 1.99; 95% CI: 1.72, 2.30), depression (OR 1.94; 95% CI: 1.65, 2.28), and female gender (OR 1.72; 95% CI: 1.50, 1.98). Other factors contributing to headaches include poor/moderate sleep quality (OR 1.25; 95% CI: 1.08, 1.45) and low income (OR 1.22; 95% CI: 1.01, 1.48).

CONCLUSION

In Indonesian adolescents aged 15 to 19 with headaches, sleep disturbances were the dominant factor associated with headache occurrence. Other factors such as depression, female gender, low socioeconomic status (SES), and poor/moderate sleep quality showed a positive association with headaches but further large population-based studies with more refined variables are needed to elucidate this association.

Human papillomavirus vaccination receipt and provider counseling rates among high-risk patients

OBJECTIVE

We describe provider documented counseling patterns and perception regarding HPV vaccination among patients with a history of cervical dysplasia.

METHODS

All patients ages 21-45 who underwent colposcopy at a single academic medical center from 2018 to 2020were sent a self-administered survey through the electronic medical record patient portal to assess their attitudes regarding human papillomavirus (HPV) vaccination. Demographic information, HPV vaccination history, and documented obstetrics and gynecology provider counseling at the time of colposcopy were examined.

RESULTS

Of 1465patients, 434 (29.6 %) reported or had documented receipt of at least one dose of the human papillomavirus vaccine. The remainder reported they were not vaccinated or had no documentation of vaccination. Proportion of vaccinated patients was higher among White compared to Black and Asian patients (P = 0.02). On multivariate analysis, private insurance (aOR 2.2, 95 % CI 1.4-3.7) was associated with vaccinated status while Asian race (aOR 0.4, 95 % CI 0.2-0.7) and hypertension (aOR 0.2, 95 % CI 0.08-0.7) were less likely to be associated with vaccination status. Among patients with unvaccinated or unknown vaccination status, 112 (10.8 %) received documented counseling regardingcatch-up human papillomavirus vaccination at a gynecologic visit. Patients seen by a sub-specialist obstetrics and gynecologic provider were more likely to have documented provider counseling regarding vaccination compared to those seen by a generalist obstetric/gynecologist provider (26 % vs 9.8 %, p < 0.001). Patients cited lack of physician discussion (53.7 %) and the belief that they were too old to receive the HPV vaccine (48.8 %) as the main reasons for remaining unvaccinated.

CONCLUSION

HPV vaccination and the rate of obstetric and gynecologic provider counseling regarding HPV vaccination among patients undergoing colposcopy remains low. When surveyed, many patients with a history of colposcopy cited provider recommendation as afactor in their decision to undergo adjuvant HPV vaccination, demonstrating the importance of provider counseling in thisgroup.

Persistent Child Poverty and Mortality in a Cohort of Children with Cancer in Alabama

BACKGROUND

One-fifth of U.S. counties are designated persistent child poverty counties (≥20% of children in poverty since 1980). The association between a persistent child poverty environment and mortality in children with cancer is unknown.

METHODS

Our cohort includes 2,089 children with cancer (2000-2016) in Alabama. We used multivariable Cox proportional hazards modeling (adjusted for sociodemographics/clinical characteristics) to assess mortality by persistent child poverty designation at 1, 5, and 10 years from diagnosis. Distance to treatment was subsequently explored.

RESULTS

Forty-two percent of the cohort lived in a persistent child poverty county; they were more likely to be African American (P < 0.0001), have public/no insurance (P = 0.0009), and live >100 miles to treatment (P < 0.0001). Children in persistent child poverty counties were 30% more likely to die by 5 years [95% confidence interval (CI) = 1.06-1.59; P = 0.012]. Distance (per 20-mile increase) to treatment was associated with a 9% increased mortality risk (P < 0.0001). Children with both exposures (distance >100 miles and persistent child poverty) faced the highest mortality risk at 5 years (HR = 1.80; 95% CI = 1.39-2.33; P < 0.0001). In subanalysis, children exposed to persistent child poverty were at higher risk for cancer-related mortality. However, the risk of health-related mortality did not differ.

CONCLUSIONS

Among children with cancer from the Deep South, persistent child poverty was a prevalent exposure associated with inferior overall survival. Distance to treatment was independently associated with inferior survival. Children with both exposures had the highest risk of mortality.

IMPACT

Persistent child poverty is associated with inferior survival among children with cancer; mechanisms underlying this disparity warrant investigation. See related commentary by Orjuela-Grimm and Beauchemin, p. 295.

Optimizing menstrual health and hygiene management in the U.S.: A mixed-methods study of the barriers and the role of healthcare professionals

OBJECTIVE

Menstrual health (MH) practices have been understudied in the U.S. This study aimed to assess patient and medical staff views of MH.

METHODS

The mixed-methods approach included medical staff and patient surveys, and patient interviews on MH experiences. Quantitative survey data generated descriptive statistics. Thematic content analysis (TCA) evaluated qualitative interviews. Convergent Parallel Triangulation Analysis (CPTA) evaluated both datasets in tandem.

RESULTS

The medical staff survey's response rate was 72% (54 participants/75 invited staff). Only 7% (4/54) of staff consistently asked patients about menstrual products (MP), while 54% (29/54) were concerned about patients affording MP. The patient survey's response rate was 90% (186/207); 22% (40/186) of respondents showed MH insecurity, which was associated with annual income <$30,000 (p < 0.01); 45% (85/186) missed commitments during menses; 53% (98/186) never discussed MP with healthcare providers. To reach thematic saturation 10/17 invited patients were interviewed. Five themes were identified through TCA: menstruation as a social barrier; menstrual education comes from a variety of sources; MP choice is a balance of comfort, cost, and convenience; patients value relationships with their providers; adolescence is the window for establishing MH. Three threads were identified through CPTA: MH insecurity is common; MH screening and education are limited; menstruation impacts patients' ability to engage in daily activities.

CONCLUSION

A holistic approach toward MH is needed; education and screening are inconsistent. Comprehensive MH can enhance a patient's understanding of and capacity to advocate for their health. These findings are specific to this population and may not be generalizable.

Determinants and disparities in access to paediatricians in Poland

Background

The purpose of this study was to identify the factors that determine the differences in the distribution and workload of paediatricians in Poland. This research, specific to conditions found within Poland, will help further advance knowledge in this area. Data were derived from the database of Statistics Poland. The level of convergence of the phenomenon studied was analysed. The paediatricians' accessibility index was ascertained and its spatial diversity examined. The level of correlation of patients treated per paediatrician was analysed in relation to indices of urbanisation, availability of paediatricians and disposable income.

Results

A moderate variation of patients treated per paediatrician was found and the conditional convergence of the investigated phenomenon observed. A close negative association between the number of patients treated and access to paediatricians (-0.686, p = 0.005) was revealed.

Conclusions

The research suggests that socioeconomic factors may affect the uneven spatial distribution of the workload of paediatricians in Poland and cause differences between the provinces in the equal access to paediatricians. This research may thus provide implications for policy and practice as well as lead to a better understanding of the problem.

Black girls and referrals: racial and gender disparities in self-reported referral to substance use disorder assessment among justice-involved children

Background

There is a higher prevalence of substance use disorder (SUD) among justice-involved children (JIC). It is critical to ensure that JIC who report current use are referred for SUD assessment and potentially life-saving treatment services. Prior research suggests that certain minoritized groups may be less likely to have ever been referred for screening, and research on intersectionality suggests that these disparities may be exacerbated for racially minoritized females.

Methods

Multivariate logistic regression and interaction effects were employed to analyze longitudinal data from the Florida Department of Juvenile Justice on 12,128 JIC who reported SU in the past 6 months. The main and interaction effects of race and gender on the odds of having a history of reporting a referral to SUD assessment were tested. The primary outcome variable was a self-reported measure of a youth’s history of being referred to service. The control variables included substance type, household income, current SU problems, history of mental health problems, number of misdemeanors, risk to recidivate, and age at first offense.

Results

There were no significant differences in the likelihood of having a history of reporting being referred to SUD assessment between White females, White males, and Latinx females. However, Black females (AOR = 0.62), Latinx males (AOR = 0.71), and Black males (AOR = 0.65) were significantly less likely to self-report having a history of being referred than White males. Black females were 34% likely to report a history of being referred as White males and females.

Conclusion

In this sample, Black females who use substances were substantially less likely to self-report being referred to SUD screening. According to officials, FLDJJ has solid process to ensure referrals are made. Therefore, the results are likely to be due to external factors and alternative explanations. Community leaders and stakeholders may consider culturally relevant and gender-sensitive programs to expand access to services for minoritized adolescents in their communities, schools, and other institutions.

Diagnostic Utility of Endocervical Curettage During Colposcopy Among Patients of Varying Risk Factors

OBJECTIVE

Endocervical curettage (ECC) during colposcopy is recommended in certain circumstances; however, diagnostic use remains unclear. We evaluate the utility of ECC among patients with non-fully visualized squamocolumnar junction (SCJ) and certain patient socioeconomic factors.

METHODS

Retrospective chart analysis was completed for patients aged older than 21 years who underwent a colposcopy at 2 study sites between 2012 and 2021. Demographics and histopathologic results were analyzed.

RESULTS

A total of 1,516 colposcopies were reviewed; 73.8% (n = 1,119) had an ECC with colposcopy. Of those, 92.1% (n = 1,031) had benign ECC whereas 13.9% (n = 156) had a positive ECC at time of colposcopy. Most patients with benign ECC had benign/low-grade squamous intraepithelial lesion pathology on colposcopy biopsy (82.3%; n = 914; p < .001), and most patients with high-grade squamous intraepithelial lesion (HSIL) on ECC had HSIL on colposcopy biopsy (63.4%; n = 52; p < .001) However, when looking at patients with high-grade pathology on colposcopy biopsy, it was seen that most had benign or low-grade squamous intraepithelial lesion on ECC (79.5%; n = 205; p < .001). Most patients with adequately visualized SCJ on colposcopy were noted to have HSIL on biopsy and negative ECC (73%; n = 81; p < .001). This result was similar in patients with non-fully visualized SCJ, although not statistically significant. When stratified by socioeconomic status, most patients with high-grade lesions had a benign ECC.

CONCLUSIONS

Endocervical curettage has been described to increase the identification of high-grade lesions at time of colposcopy. This descriptive study shows that many high-grade lesions at time of excisional procedure had a benign ECC on colposcopy, with no demonstrated clear additional utility in high-risk groups.

State Policies that Impact the Design of Children's Mental Health Services: A Modified Delphi Study

To identify the state-level policies and policy domains that state policymakers and advocates perceive as most important for positively impacting the use of children's mental health services (CMHS). We used a modified Delphi technique (i.e., two rounds of questionnaires and an interview) during Spring 2021 to elicit perceptions among state mental health agency officials and advocates (n = 28) from twelve states on state policies that impact the use of CMHS. Participants rated a list of pre-specified policies on a 7-point Likert scale (1 = not important, 7 = extremely important) in the following policy domains: insurance coverage and limits, mental health services, school and social. Participants added nine policies to the initial list of 24 policies. The "school" policy domain was perceived as the most important, while the "social" policy domain was perceived as the least important after the first questionnaire and the second most important policy domain after the second questionnaire. The individual policies perceived as most important were school-based mental health services, state mental health parity, and Medicaid reimbursement rates. Key stakeholders in CMHS should leverage this group of policies to understand the current policy landscape in their state and to identify gaps in policy domains and potential policy opportunities to create a more comprehensive system to address children's mental health from a holistic, evidence-based policymaking perspective.

How do underserved adolescents want to learn about health? An exploration of health concerns, preferences, and resources utilized

Understanding health concerns and preferences of underserved adolescents has potential to shape health interventions. The objective of this study is to better understand these adolescents' current and preferred health resources, prior to the COVID-19 pandemic. High school students from underrepresented communities in six US cities completed a pre-pipeline program survey in which they reported level of personal concern, as well as current and preferred sources of information about 1) depression/anxiety, 2) nutrition, 3) sexual health, 4) trauma/violence, and 5) alcohol/drugs. 259 participants completed the survey (avg. age 15.7, 79% female, 58.3% Hispanic, and 36.0% Black). At least a moderate level of concern and some degree of prior knowledge (>3 on 5-point Likert scale) were reported across all health topics. Participants reported the lowest level of knowledge on the topic of trauma/violence. Students reported family (24%) and teachers (21%) as the most utilized current sources of information. Students reported doctors as the preferred source of information across all health topics. The difference between students' current source of information and preferred source of information was significant across four topics: depression/anxiety, sexual health, trauma, and alcohol/drugs (p <0.01). These results underscore the important role of physicians as educators and suggest a need for improved education on trauma/violence. These results also establish a pre-COVID-19 baseline for adolescent health concerns, current, and preference health resources. This baseline understanding may shift because of pandemic changes.

Menstrual Health and Hygiene among Adolescents in the United States

STUDY OBJECTIVE

Menstrual health in adolescents has been understudied in the United States. We aimed to assess patient and provider perspectives surrounding menstrual health management and screening.

DESIGN

Our mixed-methods approach consisted of provider surveys, patient surveys, and patient interviews.

SETTING

Participants were recruited from a pediatric gynecology practice or an adolescent medicine clinic at an urban tertiary academic center.

PARTICIPANTS

Providers were pediatrics faculty or residents. Patients aged 13-24 years were eligible.

INTERVENTION

Participants completed an anonymous survey or semi-structured interview about their experiences with menstrual health.

MAIN OUTCOME MEASURES

Descriptive statistics and thematic content analysis were used for quantitative and qualitative data, respectively. Convergent parallel analysis elucidated key findings in both data sets.

RESULTS

The provider survey response rate was 65% (69/106); 15% (9/69) of providers consistently asked patients about menstrual products, whereas 44% (27/68) were concerned patients could not afford products. The patient survey response rate was 85% (101/119); 19% (19/101) of respondents reported menstrual hygiene insecurity, 55% (55/101) missed commitments during menses, and 45% (45/101) discussed menstrual products with providers. Fifteen patients were invited for qualitative interviews; 10 were conducted, and thematic saturation occurred. Interviews highlighted the importance of comprehensive early menstrual health education and providers' role in menstrual management.

CONCLUSION

Adolescence is a crucial point of entry into health care. Because taboos surrounding menstruation could limit access to health care, menstrual health education must be emphasized. Menstrual health education is provided piecemeal by parents, schools, and providers. Current practice should be reevaluated to consider comprehensive educational approaches in which health care leads.

Effects of Child Protective Custody Status and Health Risk Behaviors on Health Care Use Among Adolescents

OBJECTIVE

To determine whether current protective custody status (ie, youth currently in the temporary or permanent custody of child protective services, eg, foster and kinship care) contributes to increased health care utilization compared to youth never in protective custody. Health characteristics (eg, mental health diagnoses) and behaviors (eg, substance use) were expected to account for differences in health care use among the two groups.

METHODS

Retrospective child welfare administrative data and linked electronic health records data were collected from a county's child welfare system and affiliated freestanding children's hospital between 2012 and 2017. Youth currently in protective custody (n = 2787) were identified and demographically matched to peers never in custody (n = 2787) who received health care from the same children's hospital. Health care use, health risk behaviors, and social, demographic, and diagnostic data were extracted and compared for both cohorts.

RESULTS

In baseline models, health care use was higher for youth in protective custody compared to peers. In adjusted models that included health risk behaviors and patient characteristics, protective custody status was associated with decreased primary and missed care, and no longer a significant predictor of other types of health care use.

CONCLUSIONS

Youth had significantly higher utilization while in protective custody than their demographically similar peers; however, health risk behaviors appear to account for most group differences. Identification of current custody status in pediatric settings and addressing health risk behaviors in this population may be important for health care systems interested in altering health care use and/or cost for this population.

Measuring the quality of dental care among privately insured children in the United States

OBJECTIVE

To examine whether quality of dental care varies by age and over time and whether community-level characteristics explain these patterns.

DATA SOURCE

Deidentified medical and dental claims from a commercial insurer from January 2015 to December 2019.

STUDY DESIGN

A retrospective cohort study. The primary outcome was a composite quality score, derived from seven dental quality measures (DQMs), with higher values corresponding to better quality. Hierarchical regression models identified person- and zip code-level factors associated with the quality.

DATA COLLECTION/EXTRACTION METHODS

Continuously enrolled US dental insurance beneficiaries younger than 21 years of age.

PRINCIPAL FINDINGS

Quality was assessed for 4.88 million person-years covering 1.31 million persons. Overall quality slightly improved over time, mostly driven by substantial improvements among children aged 0-5 years by 0.153 points/year (95% confidence interval [CI]:0.151, 0.156). Quality was poorest and declined over time among adolescents with only 20.5% of DQMs met as compared to 42.6% among aged 0-5 years in 2019. Dental professional shortage, median household income, percentages of African Americans, unemployed, and less-educated populations at the zip code level were associated with the composite score.

CONCLUSION

Quality of dental care among adolescents remains low, and place of residence influenced the quality. Increasing the supply of dentists and oral health promotion strategies targeting adolescents and low-performing localities should be explored.

Orthodontic treatment need and perception: A comparative study between different socio-economic groups of patients

Objectives:

The aim of the present study was to compare parents’ perceptions of their children’s malocclusion and clinician-measured normative orthodontic treatment need with the socioeconomic status of the parents as a means of assessing whether demand for treatment is uniform across socioeconomic groups.

Materials and Methods:

In this cross-sectional study, 212 (125 girls and 87 boys) subjects between the ages of 8 and 25 years (mean age 17.03 ± 3.9) were assessed. The parents were asked to score the dental attractiveness of their children and their socioeconomic status (SES) based on the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) and the modified Kuppuswamy scale (2018), respectively. The subjects recorded their self-perception using the OASIS scale. These scores were then compared within themselves and with those of the clinician who also scored the Dental Health Component (DHC) and AC of the IOTN. The AC grade of the IOTN and parents’ SES was tested with the Chi-square test. The association between the AC scores of the IOTN, DHC, and the characteristics of the subjects was tested with Spearman’s correlation coefficient (rho).

Results:

Treatment uptake was uniform throughout the different socioeconomic groups. Association between the SES group and DHC group and clinician-measured AC were statistically not significant (P = 0.3958), (P = 0.3447). Parents, in this study population, irrespective of their socioeconomic status rated their children’s orthodontic treatment need less severely than the clinician (P = 0.0001). Severity of malocclusion as measured by DHC was much higher in male subjects than in females (P = 0.0348).

Conclusion:

Socioeconomic status of the parents did not seem to affect their perception of dental appearance. Self-perception of appearance and perceived treatment need was uniform throughout the different socioeconomic groups.

Context matters: Neighborhood disadvantage is associated with increased disordered eating and earlier activation of genetic influences in girls

Emerging evidence suggests socioeconomic disadvantage may increase risk for eating disorders (EDs). However, there are very few studies on the association between disadvantage and EDs, and all have focused on individual-level risk factors (e.g., family income). Neighborhood disadvantage (i.e., elevated poverty and reduced resources in one's neighborhood) is associated with increased risk for anxiety/depression and poor physical health. To date, no studies have examined phenotypic associations between neighborhood disadvantage and disordered eating, or how any form of disadvantage may interact with genetic individual differences in risk for EDs. We examined phenotypic and etiologic associations between neighborhood disadvantage and disordered eating in 2,922 girls ages 8-17 from same-sex twin pairs recruited through the Michigan State University Twin Registry. Parents rated the twins on nine items assessing core disordered eating symptoms (e.g., weight preoccupation, binge eating), and neighborhood disadvantage was calculated from 17 indicators of contextual disadvantage (e.g., median home value, neighborhood unemployment). Puberty was measured using the Pubertal Development Scale to examine whether associations were consistent across development. At a phenotypic level, greater neighborhood disadvantage was associated with significantly greater disordered eating symptoms in girls at all stages of puberty (β = .07). Moreover, Genotype × Environment models showed that girls living in more disadvantaged neighborhoods exhibited stronger and earlier (i.e., during pre/early puberty) activation of genetic influences on disordered eating. Results highlight the critical importance of considering contextual disadvantage in research on etiology and risk for disordered eating, and the need for increased screening and treatment for EDs in disadvantaged youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Health-Related Quality of Life (HRQoL) Outcomes Following Injury in Childhood and Adolescence Using EuroQol (EQ-5D) Responses with Pooled Longitudinal Data

BACKGROUND

Injury is a leading contributor to the global disease burden in children, affecting their health-related quality of life (HRQoL)-yet valid estimates of burden are absent.

METHODS

This study pooled longitudinal data from five cohort studies of pediatric injury survivors (5-17 years) at baseline, 1-, 4-, 6-, 12-, and 24- months (n = 2334). HRQoL post-injury was measured using the 3-level EQ-5D utility score (EQ-5D) and five health states (mobility, self-care, activity, pain, anxiety and depression (anxiety)).

RESULTS

Mean EQ-5D post-injury did not return to baseline level (0.95) by 24 months (0.88) and was lower for females over time (-0.04, 95%CI -0.05, -0.02). A decreased adjusted risk ratio over time (ARR) was observed for intentional injuries (pain: 0.85, 95%CI 0.73,0.98; anxiety: 0.62, 95%CI 0.49,0.78); spinal cord injuries (mobility: 0.61, 95%CI 0.45,0.83), self-care: 0.76, 95%CI 0.63,0.91, activity: 0.64, 95%CI 0.47,0.88); moderate/severe traumatic brain injury (activity: 0.83, 95%CI 0.71,0.96). ARRs were also low for certain fractures, with various health states affected.

CONCLUSIONS

HRQoL outcomes over time for children and adolescents post-injury differed across key demographic and injury related attributes. HRQoL did not reach levels consistent with full health by 24 months with recovery plateauing from 6 to 24 months. Tailored interventions are required to respond to the varying post-injury recovery trajectories in this population.

Inequality in dental services: a scoping review on the role of access toward achieving universal health coverage in oral health

BACKGROUND

Improving access to health services is a way towards achieving universal health coverage (UHC) in oral health. The purpose of this review was to map the determinants of access to dental services within a UHC framework.

METHOD

Scoping review methods were adopted for the review. PUBMED, Scopus, ISI Web of Science and ProQuest were searched for academic literature on determinants of access to dental services in OCED countries. Articles published in the last 20 years were included. No restriction was placed on study methods; only articles in English language were included. Qualitative synthesis was conducted, along with a trend analysis and mapping exercise.

RESULT

A total of 4320 articles were identified in the initial search; 57 articles were included in the qualitative synthesis. The results indicate 7 main themes as the determinants of access to dental services: family condition, cultural factors, health demands, affordability of services, availability of services, socio-environmental factors, geographical distance. Defined determinants of access to dental services, family condition, cultural factors and geographical access to dental services can fill the population axis of the UHC cube. Health demands and affordability of services fill the gap of financial protection as another axis of the UHC cube and finally, availability of dental services and socio-environmental factors are aligned with the appropriateness of services, the third axis of the UHC cube.

CONCLUSION

According to the results, family condition and cultural, health demands, affordability and availability of services, social environment, and geographic factors can affect dental health access and equality. Socio-cultural determinations also need to be considered in applied planning. Addressing these factors to improve access to dental services can pave the way for achieving universal health coverage in oral health and should be considered in different levels of policymaking.

Inequalities in utilization and provision of dental services: a scoping review

BACKGROUND

There are many determinants that can affect inequality in oral and dental health. This study is aimed to explore the main determinants of inequality in both utilization and provision of dental services in Organization for Economic Co-operation and Development (OECD) countries.

METHODS

Four databases including PubMed, ISI WOS, Scopus, and ProQuest were searched up to 8 Aug 2020, applying the relevant keywords. Thematic analysis was used for synthesizing and extracting data. Trend analysis was applied to determine the trends of the inequality determinants.

RESULTS

Thematic analysis led to 6 main themes, 13 sub-themes, and 53 sub-sub-themes. The main themes represent the main inequality determinants for both utilization and provision of dental services. The streamgraph illustrated that fewer studies have been conducted on social and cultural determinants, and for almost all determinants the trend of published articles has been increasing since 2007, with the exception of health policies.

CONCLUSIONS

Inequality in the utilization and provision of dental services is addressed by various factors including individual, social, cultural and economic determinants, health policies, and availability of services. The first four determinants are related to utilization and the last two are related to the provision of services. All these aspects must be considered to reduce inequality in dental services.

The Role of the Rural Context in the Transition to Adulthood: A Scoping Review

Rural adolescents are transitioning to adulthood in the context of growing disparities. To advance research on the social, behavioral, and contextual factors that influence rural young adult development, this study conducted a scoping review. The review sought to identify how researchers defined rural and how/which theories guided their work; how they integrated the rural context into the research design and methods; and how they used variables, concepts, and outcomes to measure rural experiences. Included articles were published between January 2009 and November 2020, included young adults ages 18-29, measured adult role achievement and/or behavioral health outcomes and reported on these outcomes for young adults, and focused on a rural sample within the United States. A systematic search of four databases resulted in 25 empirical articles for the inductive, qualitative analysis. Most studies used atheoretical approaches focusing on outcomes related to adult social roles, substance use, and mental health. Five themes emerged focused on the definitions of rural, the level of integration into the research design and method, and variables salient to the rural experience. These results reveal that future research should clearly define the rural context and better integrate the rural context into the conceptualization, design, methods, and implications of the empirical research.

Civic engagement: School-based health centers and public health nursing

OBJECTIVES

To understand how the events of the 1996 formation of a school-based health center (SBHC) both illustrate the concept of civic engagement and embody historic aspects of public health nursing practice.

DESIGN

Case study design.

SAMPLE

Interviews, documents, epidemiologic records, and field observations.

RESULTS

The three themes discovered were collaboration to achieve public good, equity and social justice, creation of a long-term partnership, and demonstration of leadership using grassroots advocacy.

CONCLUSION

The SBHC case serves as a contemporary example of public health nurses' leadership in the current practice arena. The experience of nurse leadership evokes the historic mission and practice of public health nursing.

An analysis of pediatric social vulnerability in the Pennsylvania trauma system

BACKGROUND

The social vulnerability index (SVI) is used to assess resilience to external influences that may affect human health. Social vulnerability has been noted to be a barrier to healthcare access for pediatric patients. We hypothesized that Pennsylvania (PA) pediatric trauma patients high on the social vulnerability index would have significantly lower rates of rehab admission following admission to a hospital for traumatic injury.

METHODS

The SVI was determined for each PA zip code area utilizing the census tract based 2014 SVI provided by the CDC along with a weighted crosswalk between census tracts and zip code areas using the Housing and Urban Development zip code crosswalk files. The rate of the uninsured population was extracted from the CDC SVI files in addition to other US Census variables based upon estimates from the 2014 American Community Survey (ACS). We also included the individual primary payer status of each subject. Pediatric (age <15 years) trauma admissions with in-hospital mortality excluded, were extracted from the PA Healthcare Cost Containment Council (PHC4) for all hospital admissions for the period of 2003-2015 (n = 63,545). Complete case analysis was conducted based upon the final model providing a sample of 52,794. Cases were coded as rehab patients based upon discharge status (n = 603; 1.1%). A multi-level logistic model was used to determine if subjects had a higher odds of being discharged to rehab based on SVI, undertriage rates of their zip code area of residence and their own primary payer status; this was adjusted for age, multi-system injury and a head, chest or abdomen injury with abbreviate injury scale (AIS) severity > = 3.

RESULTS

SVI and undertriage rates of the zip code areas of residence were not significantly associated with admission to rehab. The individual primary payer status of the subject was significantly associated with admission to rehab (OR 95%CI vs. self/uninsured; Medicaid 3.65 1.84-7.24; Commercial = 3.09 1.56-6.11; other/unknown = 2.85 1.02-7.93). Admission to rehab was also significantly associated with age, injury severity (ISS), head or chest injury with AIS scores > = 3, year of admission and hospital type.

CONCLUSION

Individual patient level factors (primary payer of patient) may be associated with the odds of rehab admission rather than neighborhood factors.

LEVEL OF EVIDENCE

Epidemiologic: Level III.

Racial and/or Ethnic and Socioeconomic Disparities of SARS-CoV-2 Infection Among Children

OBJECTIVES

To evaluate racial and/or ethnic and socioeconomic differences in rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children.

METHODS

We performed a cross-sectional study of children tested for SARS-CoV-2 at an exclusively pediatric drive-through and walk-up SARS-CoV-2 testing site from March 21, 2020, to April 28, 2020. We performed bivariable and multivariable logistic regression to measure the association of patient race and/or ethnicity and estimated median family income (based on census block group estimates) with (1) SARS-CoV-2 infection and (2) reported exposure to SARS-CoV-2.

RESULTS

Of 1000 children tested for SARS-CoV-2 infection, 20.7% tested positive for SARS-CoV-2. In comparison with non-Hispanic white children (7.3%), minority children had higher rates of infection (non-Hispanic Black: 30.0%, adjusted odds ratio [aOR] 2.3 [95% confidence interval (CI) 1.2-4.4]; Hispanic: 46.4%, aOR 6.3 [95% CI 3.3-11.9]). In comparison with children in the highest median family income quartile (8.7%), infection rates were higher among children in quartile 3 (23.7%; aOR 2.6 [95% CI 1.4-4.9]), quartile 2 (27.1%; aOR 2.3 [95% CI 1.2-4.3]), and quartile 1 (37.7%; aOR 2.4 [95% CI 1.3-4.6]). Rates of reported exposure to SARS-CoV-2 also differed by race and/or ethnicity and socioeconomic status.

CONCLUSIONS

In this large cohort of children tested for SARS-CoV-2 through a community-based testing site, racial and/or ethnic minorities and socioeconomically disadvantaged children carry the highest burden of infection. Understanding and addressing the causes of these differences are needed to mitigate disparities and limit the spread of infection.

The Main and Interactive Associations between Demographic Factors and Psychopathology and Treatment Utilization in Youth: A Test of Intersectionality in the ABCD Study

Demographic factors may be associated with youth psychopathology due to social-contextual factors that may also pose barriers to intervention. Further, in line with intersectionality theory, youth with multiple non-dominant identities may be most likely to experience psychopathology and face barriers to care. This study examined rates of parent-reported psychopathology and mental health treatment utilization as a function of several demographic characteristics (in isolation and in concert) in a population-based, demographically diverse sample of 11,875 9- to 10-year-old youth. Results indicated most consistently that lower SES was associated with greater rates of psychopathology and greater likelihood of treatment utilization; that Asian American youth (relative to all other racial groups) and Hispanic/Latinx (relative to non-Hispanic/Latinx) youth were less likely to have a history of psychopathology or to have utilized treatment; and that male youth had greater rates of lifetime Obsessive Compulsive Disorder (OCD) and Oppositional Defiant Disorder (ODD) and were more likely to have utilized treatment. There was more modest support for interactive effects between demographic factors on psychopathology, which are discussed. The present study provides some support for differential rates of parent-reported psychopathology and treatment utilization as a function of demographic identities in youth. Potential explanations for these differences (e.g., cultural differences in symptom presentation; underreporting of symptoms) are discussed.

A Research Agenda for Emergency Medicine-based Adolescent Sexual and Reproductive Health

OBJECTIVE

The objective was to identify key questions for emergency medicine (EM)-based adolescent sexual and reproductive health and to develop an evidence-based research agenda.

METHODS

We recruited national content experts to serve as advisory group members and used a modified Delphi technique to develop consensus around actionable research questions related to EM-based adolescent reproductive and sexual health care. Author subgroups conducted literature reviews and developed the initial list of research questions, which were iteratively refined with advisory members. External stakeholders then independently rated each item for its importance in expanding the evidence base (1 = not important to 5 = very important) via electronic survey.

RESULTS

Our final list of 24 research questions included items that intersected all sexual and reproductive health topics as well as questions specific to human immunodeficiency virus/sexually transmitted infections (HIV/STIs), pregnancy prevention, confidentiality/consent, public health, and barriers and facilitators to care. External stakeholders rated items related to HIV/STI, cost-effectiveness, brief intervention for sexual risk reduction, and implementation and dissemination as most important.

CONCLUSIONS

We identified critical questions to inform EM-based adolescent sexual and reproductive health research. Because evidence-based care has potential to improve health outcomes while reducing costs associated with HIV/STI and unintended pregnancy, funders and researchers should consider increasing attention to these key questions.

Thirty-day Emergency Department Utilization after Distal Radius Fracture Treatment: Identifying Predictors and Variation

Supplemental Digital Content is available in the text.

Unplanned hospital visits are costly and may indicate reduced care quality. In this analysis, we aim to investigate the emergency department (ED) utilization for patients 30 days after treatment for a distal radius fracture (DRF) with an emphasis on DRF-related diagnoses of complications and examine nationwide variation in returns to the ED after treatment.

Is there an app for that? A cluster randomised controlled trial of a mobile app-based mental health intervention

Demand for the use of mobile apps in mental health interventions has grown in recent years, particularly among adolescents who experience elevated levels of distress. However, there is a scarcity of evidence for the effectiveness of these tools within this population. The aim of this study was to test the effectiveness of CopeSmart, a mental health mobile app, using a multicentre cluster randomised controlled trial design. Participants were 15-18-years-olds (N = 560) recruited from 10 schools randomly assigned to an intervention or control condition. Intervention participants used the app over a 4-week period. Multi-level modelling analyses revealed no significant changes in the intervention group from pre-test to post-test, when compared to the control group, in terms of emotional distress, well-being, emotional self-awareness or coping strategies. Findings suggest that a 4-week app-based intervention may not be enough to elicit intra-personal changes in mental health outcomes in a general adolescent population.

O brother how art thou: Propensity to report self-assessed unmet need

Research investigating self-assessed unmet need (SUN) has taken the reports from surveys as given and subsequently attempted to discover patterns in inequality of access to healthcare. This requires the yet untested assumption that, given a certain level of care and demand, the likelihood of reporting unmet need does not vary across socioeconomic/demographic status (SEDS), be satisfied. Using an administrative dataset spanning 2001 to 2011 comprised of sufferers of a set of conditions that suggest unmet need (n = 3300) we evaluate the proposition that, given health status and care received, the propensity to report unmet need does not vary along SEDS. The results are further validated using the Canadian Community Health Surveys between 2001 and 2013 (n = 237,483). We find that the assumption of independence between reporting SUN and SEDS is not satisfied. Many of the groups found to have less access in previous studies may simply be more prone to interpret/answer the survey questions about unmet need in a certain way. The results of this research suggest that, in its present incarnation, survey data on self-assessed unmet need does not accurately measure what much of the academic literature has assumed it does.

Interplay of subjective and objective economic well-being on the mental health of Norwegian adolescents

Objective and subjective socioeconomic status (SES) are important determinants of adolescent mental health problems, but we know less about how they interact. Research has demonstrated independent associations of both variables to mental health problems, but less is known about their relationship and role in adolescent mental health problems. Data from the youth@hordaland study, a survey of 9079 Norwegian adolescents aged 16 to 19 were linked to official tax register information about household income, and was used to examine the relationship between perceived economic well-being and household income. We also investigated how perceptions of economic well-being interacted with household income in relation to adolescent mental health problems. The overall relationship between perceived and actual household income was relatively low (r = .33 [95% CI = 0.32–0.35], p < .001, although this relationship was somewhat higher in adolescents with either low or high household incomes. Low income and unfavorable perceptions of economic well-being were associated with most mental health problems. Importantly, the mental health benefits associated with higher income appeared to depend on the adolescents' perceptions of their family's relative economic position. The results show moderate associations between perceived economic well-being and household income and that the influence of perceived economic well-being on conduct- and peer problems depended on the level of household income. Symptoms of depression explained some of this association. Knowledge about how the adolescents feel about their relative economic standing may be potentially important information for adolescents with mental health problems, and additional work is needed to understand how adolescents establish perceptions of economic rank.

The Role of Parents and Family Networks in Adolescent Health-Seeking in Ethiopia

OBJECTIVE

This study examines the roles of parents, extended kin, and exchange networks in adolescent health-seeking behavior in Ethiopia.

BACKGROUND

Prior studies highlight the role of mothers in children's health, whereas fathers, extended kin and other network partners remain largely unexamined. The gender intensification hypothesis suggests that adolescents gravitate toward same gender parents for advice and assistance with health-related issues. A more expansive view of the hypothesis suggests that other same gender adults may also be important sources of support.

METHOD

Survey data were used from a random sample of 2,084 youth ages 13-17 collected in urban and rural communities in southwestern Ethiopia. Sources of advice, treatment, and accompaniment to get treatment were examined. Random intercept logistic regression models were used to identify factors associated with receipt of formal health care.

RESULTS

Fathers and mothers played an important role in all phases of adolescent health-seeking behavior. Fathers' involvement was especially common in rural areas and more so with boys than girls. Extended kin and exchange networks also played a role and were even more important for boys in female-headed households, suggesting they may have substituted for absent fathers.

CONCLUSION

Adolescents rely heavily on parents and other adults for health advice and treatment. Who children go to for assistance is highly gendered, especially in rural areas.

IMPLICATIONS

Studies of adolescent health-seeking and interventions designed to improve health services utilization need to recognize the important involvement of parents and other closely related adults in advising youth and accompanying them to get treatment.

Is the focus of community-based mental health treatment consistent with adolescent psychiatric diagnoses?

Most adolescents do not receive effective mental health services. This may stem in part from infrequent use of evidence-based and multi-informant diagnostic assessments to guide clinical care. The primary purpose of the present study was to examine whether adolescent mental health diagnoses and suicidality, derived via evidence-based diagnostic interviews and assessments, correspond with reported "reason for treatment" received by adolescents. Secondarily, we examined the potential association between socio-economic status and the match between youth diagnoses and reasons for treatment. The influence of parent-adolescent agreement on diagnoses and reasons for treatment on findings was also explored. Using chi-square analyses, a significant association was found between youth diagnoses of mood disorders, disruptive behavior disorders, and suicidality, respectively, and a focus of treatment on these conditions per combined parent-adolescent report. The same was not true for youth anxiety, attention-deficit hyperactivity, or substance abuse disorders. Results of exploratory analyses suggest that these results are driven by adolescent, but not parent report. With regard to socio-economic status, there was a trend for those with higher incomes to report a treatment focus consistent with youth diagnoses, per combined parent-adolescent report. Results suggest that focus of mental health treatment received by adolescents in standard community-based care may not uniformly address all current disorders. Efforts are needed to disseminate multi-informant evidence-based assessments to enhance the quality and effectiveness of care.

An Empirical Investigation of Factors Affecting Perceived Quality and Well-Being of Children Using an Online Child Helpline

Child helplines provide free, accessible, and confidential support for children suffering from issues such as violence and abuse. Helplines lack the barriers often associated with the use of many other health services; and for many children, the helpline is the first point of contact with any kind of child protection and an important venue to go to in times of socio-economic distress. For instance, more children attempt to call the helpline in times of high unemployment, and relatively more of those conversations are about violence. Empirical evidence is scarce regarding how to implement online chat communication to improve quality and the child’s well-being. In this study, we focus on the impact of chat duration, number of words, and the type of support. The results show that for children seeking emotional support, a longer chat negatively influences the immediate well-being and the counsellor needs to listen (i.e., not type), as relatively more child words result in higher evaluations. We conclude that for emotional support, the counsellor should be prepared to listen carefully, but also manage the duration. However, for children chatting for instrumental support, the counsellor needs to type more to create positive perceptions of quality. Since the impact of chat share is different for children seeking emotional support (negative) versus instrumental support (positive), counsellors need to be sensitive to early indicators of the reason for the chat.

Here comes the SUN: Self-assessed unmet need, worsening health outcomes, and health care inequity

Utilization-based approaches have predominated the measurement of socioeconomic-related inequity in health care. This approach, however, can be misleading when preferences over health and health care are correlated with socioeconomic status, especially when the underlying focus is on equity of access. We examine the potential usefulness of an alternative approach to assessing inequity of access using a direct measure of possible barriers to access-self-reported unmet need (SUN)-which is documented to vary with socioeconomic status and is commonly asked in health surveys. Specifically, as part of an assessment of its external validity, we use Canadian longitudinal health data to test whether self-reported unmet need in one period is associated with a subsequent deterioration in health status in a future period, and find that it is. This suggests that SUN does reflect in part reduced access to needed health care, and therefore may have a role in assessing health system equity as a complement to utilization-based approaches.

Does the density of the health workforce predict adolescent health? A cross-sectional, multilevel study of 38 countries

BACKGROUND

Scant evidence exists on the relation between the availability of health professionals and adolescent health, and whether the size of the health workforce equally benefits adolescents across socioeconomic strata.

METHODS

We conducted a cross-sectional analysis of adolescent health in 38 countries. Data from 218 790 adolescents were drawn from the 2013/2014 Health Behavior in School-aged Children survey. We used multilevel regression analyses to examine the association between the density of the health workforce and psychosomatic and mental health symptoms with differences in country wealth and income inequality controlled.

RESULTS

A higher density of psychologists was associated with better self-reported mental health in adolescents (P = 0.047); however, this finding was not robust to sensitivity analyses. The densities of physicians and psychiatrists were not significantly associated with better adolescent psychosomatic or mental health. Cross-level interactions between the health workforce and socioeconomic status did not relate to health, indicating that larger health workforces did not reduce socioeconomic differences in adolescent health.

CONCLUSIONS

This study found that adolescents in countries with a higher density of health providers do not report better psychosomatic or mental health. Other social or structural factors may play larger roles in adolescent health.

The Association between Socioeconomic Status, Smoking, and Chronic Disease in Inner Mongolia in Northern China

The interactive associations of socioeconomic status (SES) and smoking with chronic disease were investigated with a view to expanding the evidence to inform tobacco policies and interventions in Northern China. The fifth NHSS (National Health Service Survey) 2013 in Inner Mongolia was a population-based survey of national residents, aged 15 years and older, in which multi-stage stratified cluster sampling methods were used to survey 13,554 residents. The SES was measured by scores derived from levels of education level and household annual income. Multivariate logistic regression models were performed to determine the association between SES, smoking, and chronic disease adjusted by confounders. Three thousand nine hundred and thirty-seven residents (32.29%) were identified as current smokers and 3520 residents (26.01%) had been diagnosed with chronic diseases. In the males, former smoking with low SES had the highest risk of one chronic disease, with an odds ratio (OR) of 2.505 (95% confidence interval [95% CI] (OR = 2.505, 95% CI: 1.635–3.837) or multiple chronic diseases (OR = 2.631, 95% CI: 1.321–5.243). In the females, current smoking with low SES had the highest risk of one chronic disease (OR = 3.044, 95% CI: 2.158–4.292). The conclusion of this study was that residents with combined ever-smoking and low SES deserved more attention in the prevention and control of chronic disease.

Predictors of self-harm emergency department visits in adolescents: A statewide longitudinal study

OBJECTIVE

This study investigated patient- and area-level characteristics associated with adolescent emergency department (ED) patients' risk of subsequent ED visits for self-harm.

METHOD

Retrospective analysis of adolescent patients presenting to a California ED in 2010 (n = 480,706) was conducted using statewide, all-payer, individually linkable administrative data. We examined associations between multiple predictors of interest (patient sociodemographic factors, prior ED utilization, and residential mobility; and area-level characteristics) and odds of a self-harm ED visit in 2010. Patients with any self-harm in 2010 were followed up over several years to assess predictors of recurrent self-harm.

RESULTS

Self-harm patients (n = 5539) were significantly more likely than control patients (n = 16,617) to have prior histories of ED utilization, particularly for mental health problems, substance abuse, and injuries. Residential mobility also increased risk of self-harm, but racial/ethnic minority status and residence in a disadvantaged zipcode decreased risk. Five-year cumulative incidence of recurrent self-harm was 19.3%. Admission as an inpatient at index visit, Medicaid insurance, and prior ED utilization for psychiatric problems or injury all increased recurrent self-harm risk.

CONCLUSIONS

A range of patient- and area-level characteristics observable in ED settings are associated with risk for subsequent self-harm among adolescents, suggesting new targets for intervention in this clinical context.

School and Community Socioeconomic Status and Access to Athletic Trainer Services in Wisconsin Secondary Schools

CONTEXT

Secondary schools have made significant progress in providing athletic trainer (AT) coverage to their student-athletes, but the levels of access at schools with ATs may vary widely. Socioeconomic disparities in medical coverage and access have been noted in other health care fields, but such disparities in the level of access to AT services have not been thoroughly examined.

OBJECTIVE

To determine if (1) access to AT services or (2) the level of access (AT hours per week and athletes per AT hour) differed based on the socioeconomic characteristics of secondary schools.

DESIGN

Cross-sectional study.

SETTING

Mailed and e-mailed surveys.

PATIENTS OR OTHER PARTICIPANTS

High school athletic directors and ATs from 402 Wisconsin high schools.

MAIN OUTCOME MEASURE(S)

Respondents provided information as to whether their school used the services of an AT and the number of hours per week that their school had an AT on-site. The number of athletes per AT hour was calculated by dividing the total number of athletes at the school by the number of hours of AT coverage per week. The socioeconomic status of each school was determined using the percentage of students with free or reduced-cost lunch and the county median household income (MHI).

RESULTS

Schools without an AT on-site were in lower MHI counties ( P < .001) and had more students eligible for a free or reduced-cost lunch ( P < .001). Lower levels of AT access (fewer hours of AT access per week and more athletes per AT hour) were observed at schools in the lowest third of the county MHI and with the highest third of students eligible for a free or reduced-cost lunch ( P < .001).

CONCLUSIONS

Socioeconomic disparities were present in access to AT services. New models are needed to focus on providing a high level of AT access for all student-athletes, regardless of socioeconomic status.

Higher breast cancer prevalence associated with higher socioeconomic status in the South Korean population; Has it resulted from overdiagnosis?

Recently, breast cancer prevalence has increased in South Korea. In this study, we investigated the correlation between breast cancer prevalence and socioeconomic status. This study enrolled 27,331 people who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) IV–VI (2007–2015). In addition, we obtained data from the Korean Statistical Information Service (KSIS) on the breast cancer age-standardized incidence rate (AIR), the age-standardized mortality rate (AMR), the number of women screened, and the number of newly diagnosed patients. The KHANES data showed that breast cancer prevalence was significantly associated with educational level (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.08–3.77 for 10–12 vs. ≤ 6 years of education, and OR, 2.36; 95% CI, 1.10–5.06 for ≥ 13 vs. ≤ 6 years of education). However, there was no significant association of breast cancer prevalence with monthly household income. In a separate analysis of the AIR, AMR, and number of women screened for breast cancer, the AIR increased with the number of women screened, whereas the AMR did not. Furthermore, the number of newly diagnosed patients in all age groups increased over time. The present results demonstrate that the recently increased breast cancer prevalence documented in South Korea may be attributable to earlier detection rather than to a real increase in prevalence, and that breast cancer may be overdiagnosed.

Integrating Biomarkers in Social Stratification and Health Research

This article provides an overview of the integration of biomarkers and biological mechanisms in social science models of stratification and health. The goal in reviewing this literature is to highlight research that identifies the social forces that drive inequalities over the life course and across generations. The article is structured in the following way. First, descriptive background information on biomarkers is presented, followed secondly by a review of the general theoretical paradigms that lend themselves to an integrative approach. Third, the biomarkers used to capture several biological systems that are most responsive to social conditions are described. Fourth, research that explicates how social exposures "get under the skin" to affect physiological functioning and downstream health is discussed, using socioeconomic disadvantage as an illustrative social exposure. The review ends with emerging directions in the use of biomarkers in social science research. This article endeavors to encourage sociologists to embrace biosocial approaches in order to elevate the importance of social factors in biomedical processes and to intervene on the social conditions that create inequities.

Inequalities in oral health among adolescents in Gangneung, South Korea

Background

This study aims to evaluate inequality in oral health among adolescents and to explain the mechanisms of such inequalities in Gangneung, South Korea.

Methods

One thousand two hundred sixty-seven students in their first year from four vocational and three general schools participated in the baseline survey of 2011, and 84.7% of them were surveyed again in 2013. Oral examinations by the same dentist and a self-administered questionnaire were repeated during both waves. Outcome measure for oral health was the existence of untreated dental caries (DT). As socioeconomic position (SEP) indicators, school type (general vs. vocational), father’s and mother’s education, perceived economic status, and Family Affluence Scale (FAS) were measured. Variables measuring oral health related behaviours included tooth brushing frequency, frequency of eating snacks and drinking sodas, smoking, and annual visits to dental clinics. Chi-square tests and panel logistic regression were adopted to examine the associations between dental caries and SEP indicators by STATA version 15.1.

Results

Having a less educated father and attending a vocational school were significant predictors for untreated caries after controlling for SEP indicators. However, students from general schools, higher SEP by father’s education, perceived economic status, or FAS, or having non-smoking experience or annual visits to dental clinics were more likely to stay caries-free.

Conclusions

There were socioeconomic inequalities in oral health on an adolescent panel. Given that oral health status during adolescents can persist throughout the course of a person’s life, intervention to tackle such inequalities and school environments are required.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0533-3) contains supplementary material, which is available to authorized users.

Access to choice: Examining differences between adolescent and adult abortion fund service recipients

The results of a study examining differences between U.S. adolescent and adult abortion fund service recipients are presented in this paper. Using existing case data from 2010 to 2015 from the National Network of Abortion Funds (N = 3,288), a secondary data analysis was conducted to determine whether or not the experiences of adolescent (n = 481) and adult abortion patients (n = 2,807) who received financial assistance to help pay for an abortion differed. Fisher's exact tests examined differences in dichotomous variables, and regression examined differences in procedural costs, patient resources and expected travel distances to obtain an abortion. Results show that a greater proportion of adolescents in this data set identified as African American, and that adolescents were more likely to report seeking an abortion due to lack of contraception, and rape, while adult patients were more likely to be seeking an abortion due to contraceptive failure and partner violence. Results are discussed using a trauma-informed framework.