Family structure and children's unmet health-care needs

Disparities in accessing specialty behavioral health services during the COVID-19 pandemic and why we need pediatric integrated primary care

Objective

Youth unmet behavioral health needs are at public health crisis status and have worsened since the onset of the coronavirus disease 2019 pandemic (Covid-19). Integrating behavioral health services into pediatric primary care has shown efficacy in addressing youth behavioral health needs. However, there is limited guidance on facilitating equitable access to care in this setting, including in triaging access to co-located services (i.e., onsite outpatient behavioral health services with only the behavioral health provider) or to specialty behavioral health services in other clinics within larger health systems.

Methods

A retrospective, comparative study was conducted to examine variability in access to co-located and specialty behavioral health (SBH) services for a pre-Covid-19 cohort (April 2019 to March 2020; n = 367) and a mid-Covid-19 cohort (April 2020 to March 2021; n = 328), while accounting for integrated primary care consultation services. The sample included children 1-18 years old served through a large, inner-city primary care clinic. Logistic regression models were used to examine the association between scheduled and attended co-located and SBH visits, pre- and mid-Covid-19 effects, and sociodemographic factors of race and ethnicity, language, health insurance (SES proxy), age, and sex.

Results

The majority of youth were not directly scheduled for a co-located or SBH visit but the majority of those scheduled attended their visit(s). The odds of not being directly scheduled for a co-located or SBH visit were greater for the mid-Covid-19 cohort, Black youth, and older youth. Accounting for integrated primary care consultation visits addressed these disparities, with the exception of persisting significant differences in scheduled and attended co-located and SBH visits for Black youth even while accounting for IPC consultation.

Implication

Findings from the current study highlight the effective role of integrated primary care consultation services as facilitating access to initial behavioral health services, especially given that referrals to integrated primary care co-located and SBH services within the larger health system often involve barriers to care such as longer wait-times and increased lack of referral follow through. Ongoing research and equitable program development are needed to further this work.

Factors associated with unmet pediatric health care needs during the coronavirus pandemic

PURPOSE

To examine risk factors for unmet pediatric health care needs during the coronavirus pandemic in a national sample of US children under 17 years of age.

DESIGN AND METHODS

In this cross-sectional study, we used data from the 2021 National Survey of Children's Health (n = 50,892). Unmet pediatric health care needs were assessed as follows: "during the past 12 months, was there any time when this child needed health care but it was not received?". Logistic regression with multiple imputations was used to evaluate bivariate and multivariable associations between predisposing, enabling, and need factors of health care services use and unmet pediatric health care needs.

RESULTS

Approximately 3.6% of children had unmet health care needs, with significant differences by sample characteristics. Unmet health care needs were notably prevalent among select groups, including children with difficulty covering basic needs (10.6%) and those with ≥2 health conditions (8.9%). In multivariable analyses, factors associated with unmet pediatric health care needs included predisposing factors such as older age, ≥2 children with special health care needs in the household, primary language other than English or Spanish, and poor caregiver health; enabling factors such as difficulty covering basic needs, no insurance, and no personal doctor or nurse; and need factors such as poor perceived or evaluated child health. Reasons for unmet needs included financial, nonfinancial, and accessibility barriers.

CONCLUSIONS

Several factors were associated with unmet health care needs.

PRACTICE IMPLICATIONS

We identified children who would benefit from targeted interventions aimed at promoting health care services use.

Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic

PURPOSE

This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization.

METHODS

Our retrospective cohort study analyzed adolescents aged 12-17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence.

RESULTS

Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ2 = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02-1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05-1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39-1.91, p < .01) during the COVID-19 pandemic.

DISCUSSION

Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.

Overweight and obesity in preschool children in Turkey: A multilevel analysis

Childhood obesity/overweight is a worldwide concern and its prevalence is increasing in many countries. The first aim of this study is to analyse the trends in overweight and obesity among children under the age of five in Turkey based on the new World Health Organization (WHO) standards, using data from the 'five-round of the Turkey Demographic and Health Surveys' (TDHSs). The second aim is to examine whether or not the maternal/household and individual-level factors are associated with overweight/obesity using TDHS 2003, 2008, and 2013 datasets. A total sample of 14,231 children under the age of five were extracted from the TDHS in 1993, 1998, 2003, 2008, and 2013 to determine the prevalence of the trend. Pooled data from 8,812 children were included in the analysis to examine factors associated with overweight/obesity. Taking into account the clustered data structure, multilevel logistic regression models were utilised. In 1993, 1998, 2003, 2008, and 2013 the prevalence of overweight children was 5.3%, 4.9%, 10.0%, 11% and 11.6%, respectively. The factors that were independently associated with overweight/obesity were as follows: living in single-parent households (adjusted odds ratio (aOR) = 2.27, 95%CI = 1.21-4.26), compared to living in dual-parent households; having an obese mother (aOR = 4.25, 95%CI = 1.73-10.44), overweight mother (aOR = 3.15, 95%CI = 1.29-7.69), and a normal-weight mother (aOR = 2.70, 95%CI = 1.11-6.59) compared to having an underweight mother; being aged between 13-24 months (aOR = 1.72, 95%CI = 1.30 to 2.27), compared to being aged 0-12 months; male gender (aOR = 1.30, 95%CI = 1.11 to 1.53); being stunted (aOR = 2.18, 95%CI = 1.74 to 2.73); high birth weight (aOR = 1.55, 95%CI = 1.08 to 2.23) compared to low birth weight. In addition, overweight was higher in children of mothers who had completed primary school (aOR = 1.21, 95%CI = 1.01 to 1.59) than children of mothers who had not completed primary school. These findings reveal that, over the years, there has been a substantial increase in obesity/overweight among children which demonstrates the importance of evaluating the overweight indicators at the maternal/household level.

Family Structure Diversity and Youth Health Care Access and Interactions With Health Care Providers

Using data from the 2019 National Survey of Children's Health, we evaluated family structure differences in youth health care access and experiences. We found youth living with their married biological/adoptive parents generally had greater health care access than youth living in structurally diverse families. Differences, however, varied based on which aspect of health care access was examined and the specific types of structurally diverse families youth were living in. Youth living in single-father and other relative-headed families showed the most consistent differences in health care access from youth living with their married biological/adoptive parents. In terms of health care experiences, youth living in several structurally diverse families were more likely to have had time alone with health care providers. Furthermore, there were differences in family-centered care, but the effect size and magnitude of the differences were small.

Childhood socioeconomic status and adulthood dietary diversity among Indonesian adults

Food insecurity problems still exist among people in low-to-middle income countries. The long-term disadvantages of socioeconomic status may contribute to chronic food insecurity. However, whether childhood socioeconomic status factors are related to food insecurity in adulthood remains unclear. Thus, the aim of this study was to test the association between childhood socioeconomic status factors and one of the proxies for adulthood food security, dietary diversity. This study used the 2014 RAND Indonesia Family Life Survey dataset with 22,559 adult participants as study samples. The childhood socioeconomic status factors consisted of 16 questions about the participants’ conditions when they were 12 years old. Adult dietary diversity was assessed using the United Nations World Food Programme’s food consumption score. A linear regression model was used to analyze the association between variables. This study found that the number of owned books (β coef.: 3.713–7.846, p < 0.001), the use of safe drinking-water sources (β coef.: 0.707–5.447, p < 0.001–0.009) and standard toilets (β coef.: 1.263–4.955, p < 0.001–0.002), parents with the habit of alcohol consumption (β coef.: 2.983, p = 0.044) or the combination with smoking habits (β coef.: 1.878, p < 0.001), self-employed with the permanent worker (β coef.: 2.904, p = 0.001), still married biological parents (β coef.: 1.379, p < 0.001), the number of rooms (β coef.: 0.968, p < 0.001), people (β coef.: 0.231, p < 0.001), and younger siblings (β coef.: 0.209–0.368, p < 0.001–0.039) in the same house were positively and significantly associated with the outcome variable. Furthermore, in the order of childhood socioeconomic status factors, self-employment without permanent workers and casual work types (β coef.: –9.661 to –2.094, p < 0.001–0.001), houses with electricity facilities (β coef.: –4.007, p < 0.001), and parents with smoking habits (β coef.: –0.578, p = 0.006) were negatively and significantly associated with the food security proxy. In conclusion, childhood and early socioeconomic disadvantage is related to adult food security status and may lead to poor health.

Barriers to Equity in Pediatric Hearing Health Care: A Review of the Evidence

PURPOSE

We review the evidence regarding barriers to hearing health care for children who are deaf or hard of hearing.

BACKGROUND

There are considerable data to suggest that hearing health care disparities constitute a major factor in loss to follow-up or documentation for children going through the Early Hearing Detection and Intervention process. Families are affected by a combination of factors underlying these disparities, resulting in delayed care and suboptimal developmental outcomes for children who are deaf or hard of hearing.

CONCLUSIONS

To address the socioeconomic, cultural, and linguistic inequities seen in the diagnosis and management of childhood hearing loss, pediatric audiologists and speech-language pathologists have a responsibility to provide culturally responsive practice to their individual clients and their families, as well as advocate for substantive changes at the policy level that impact their clients' daily lives.

The impact of school life and family involvement on Western China junior high school students’ wellbeing at multidimensional levels

Background

The focus of students’ health concerns has gradually progressed from the single factor of physical health to comprehensive health factors, and the physical and mental health of students are now generally considered together. This study focuses on exploring the status of junior high school students’ physical health and their subjective health assessment with the major societal factors that affect students’ lives: School Life and Family involvement. In addition, we explore the main factors influencing students’ subjective health.

Methods

A cross-sectional survey was conducted with 190 Tibetan junior high school students in the Maozhuang Township. The intentional sampling was used to choose the research object. The structured questionnaire comprised four parts, namely social and demographic information, family condition, school life, and subjective health quality which was assessed by PROMIS (Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System).

Result

The average height and weight of boys and girls are statistically different (p-values of 0.026 and 0.044, respectively), but there is no statistically significant difference in BMI (Body Mass Index) between boys and girls (p-value of 0.194). The average values of the five dimensions of depression, anger, anxiety, fatigue, and peer relationships in the PROMIS of the research subjects were 58.9 ± 5.3, 53.3 ± 8.0, 58.1 ± 7.3, 52.8 ± 8.0, 39.3 ± 6.6. In the demographic dimension, the grade was the main factor influencing anger (p < 0.01) and fatigue (p < 0.01), while gender was related to peer relationships (p = 0.02). In the family dimension, the father’s educational level was related to peer relationships (p = 0.05), while the family financial situation was related to depression (p = 0.01). In the school life dimension, relationship with classmates was found to affect anger (p = 0.05), while homework was related to anxiety (p = 0.02) and fatigue (p = 0.05).

Conclusion

the physical health index BMI and subjective health evaluation of students are worse than students of more developed areas in China. Their family environment and school life all have varying degrees of impact on the five subjective health outcomes. There are differences in gender and grade level. The government and society need to pay more attention to the physical and mental health of students in remote and underdeveloped areas and improve their health through a student nutrition plan and the establishment of mental health offices.

Prevalence of Unmet Healthcare Needs in Adolescents and Associated Factors: Data from the Seventh Korea National Health and Nutrition Examination Survey (2016-2018)

Adolescent health is considered the basis of adult health, and the unmet healthcare needs in adolescents are an important issue to be solved. This study, therefore, aimed to explore the prevalence of unmet healthcare needs, and examine its associated factors among adolescents in Korea based on Andersen's Behavioral Model of Health Services, using data from the Seventh Korea National Health and Nutrition Examination Survey (2016 to 2018). This survey's data source comprised 12- to 18-year-old adolescents, of which 1425 provided information on their unmet healthcare needs, as well as their predisposing, enabling, and need factors. For statistical analysis, SPSS version 25.0 was used. Descriptive analyses were performed to assess each variable, whereas multiple logistic regression was used to determine the associated factors. The overall prevalence of unmet healthcare needs was 5.5%. The factors that had statistically significant relationships with adolescents' unmet healthcare needs were: age; stress perceptions; housing types; and perceived health status. Unlike previous studies that presented related factors on vulnerable groups, this study's results presented unmet healthcare needs and related factors for all Korean adolescents using a national survey dataset. Hence, its findings could provide feedback on current policies, and guide future studies.

Income Shocks and Out-of-Pocket Health Care Spending: Implications for Single-Mother Families

We examine how out-of-pocket health care spending by single-mother families responds to income losses. We use eleven two-year panels of the Medical Expenditure Panel Survey for the period 2004-2015 and apply the correlated random effects estimation approach. We categorize income in relation to the federal poverty line (FPL): poor or near-poor (less than 125% of the FPL); low income (125 to 199% of the FPL); middle income (200 to 399% of the FPL); and high income (400% of the FPL or more). Income losses among high-income single-mother families lead a decline in out-of-pocket spending toward office-based care and emergency room care of $119-$138 and $30-$60, respectively. Among middle-income single-mother families, income losses lead to a $30 decline in out-of-pocket spending toward family emergency room care and a $45-$91 decline in mother's out-of-pocket spending toward prescription medications. Further research should examine whether these declines compromise health status of single-mother family members.

Measuring the Barriers to Adherence With Neurology Clinic Appointments for Children With Epilepsy: A Pilot Study

Introduction

Epilepsy is one of the most common neurological disorders in children. Missed appointments reflect missed opportunity to provide care for children with epilepsy. The objective of this study was to identify social determinants of health (SDH) and other factors associated with missed appointments in children with epilepsy and measure the relation between missed appointments and frequency of emergency room (ER) visits and inpatient admissions.

Methods

This was a prospective study conducted in the neurology division at a level 4 epilepsy center. Children (0 to < 18 years of age) with a diagnosis of epilepsy were included and a semi-structured questionnaire was provided to the families. Patients with 2 or more missed neurology clinic appointments in the previous year ("study group", n = 36) were compared to those with 1 or zero missed appointments ("control group", n = 49). A comparison of the clinical characteristics, emergency room visits and hospitalizations in the past year as well as SDH was performed. Statistical analysis was performed using SPSS and p < 0.05 was considered significant.

Results

The mean age, gender distribution and presence of medical refractoriness were comparable between the 2 groups. Families in the study group reported a higher likelihood of having to make special work arrangements for clinic appointments. Children in the study group were noted to have a significantly higher frequency of single mother households, presence of public insurance, father not graduating from high school and household income less than 50,000 dollars. Within the preceding year, children in the study group were noted to have a higher frequency of visits to the emergency department as well as 6 times higher likelihood of inpatient hospitalization for seizures.

Conclusions

Social determinants of health play an important role in determining adherence with neurology clinic visits in children with epilepsy. Children with more missed appointments are likely to have a higher frequency of visits to the emergency department as well as a higher incidence of hospitalization for seizures. Identification of high-risk families and implementation of early interventions may improve adherence to office visits and decrease emergency room visits and hospitalization for seizures.

Differences in Reporting Child Health Needs and Status and Developmental Concerns between Mothers and Fathers: Findings from the National Survey of Children's Health

Nationally representative data of 140 000 children in 2-parent households showed that fathers were more likely than mothers to report that a child was in good health and less likely to report the presence of a specific health condition, special health care needs, or unmet health service needs.

Oral Health Problems and Utilization of Dental Services Among Spanish and Immigrant Children and Adolescents

Spanish and immigrant children and adolescents vary widely in their frequency of dental visits and occurrence of dental problems. The aims of this study were to discover the prevalence of dental problems and utilization of dental services in the Spanish and immigrant child population, identify the type of treatment received, and analyze the socioeconomic and demographic variables which are associated with dental problems and non-regular utilization of dental services, based on data from the 2017 National Health Survey in Spain. The sample consisted of 4568 children aged between 3 and 14 years old. Utilization of dental services and dental problems were assessed against socioeconomic and demographic characteristics using logistic regression models. The prevalence of caries in Spanish children was 9.29% compared with 18.58% (p < 0.001) in their immigrant counterparts. The most common reason for dental visits was a check-up (Spanish: 65.05%; immigrants: 54.94%). In both groups, from the age of 7, there was a lower probability of non-regular utilization of dental services, although this increased when the social class was lower. The probability of presenting dental problems was lower in Spanish children living in towns with over 10,000 inhabitants and was higher, in both groups, over the age of 7 and in lower social classes.

Children of single-parent households are at a higher risk of obesity: A systematic review

The goal of this systematic review was to evaluate whether children living in single-parent households have a higher risk of obesity. Of the 539 studies identified using keywords, a total of 10 original studies met the inclusion criteria for this review. The outcome measures included objective assessment of adiposity (weight or body mass index (BMI)), dietary consumption, physical activity, and/or obesogenic behaviors (bedroom television, elevated television viewing time, insufficient physical activity, and infrequent family meals). Overall, the studies found higher BMIs and obesogenic behaviors in children of single-parent households. Characteristics identified with this association is comprised of being most prevalent among girls and Black children. Possible explanations for this association include single-parent households having higher time demands due to the lack of shared household responsibilities. Subsequently, a reduction of homemade meals, shared family meals, and physical activity can occur. Also, lower incomes and higher instability related to living transitions may be other possible challenges experienced in single-parent households. Based on the limited number of studies found, further research of the obesity risk in children from single-parent families is recommended. The findings can help provide clinicians and public health programs with a better understanding of how to effectively target family-based interventions for this population.

Physical Symptoms, Depression, and Related Factors of Late School-age Children in Seoul, Korea: The Mediating Role of Peer Relationships

PURPOSE

Recent studies have highlighted the importance of peer relationships on the physical and mental health of late school-age children. However, little is known about the causal relationships whereby peer relationships affect health problems. This study aimed to examine the specific associations between physical symptoms and depression and their influential factors, including the quality of peer relationships. Additionally, the causal relationships were examined, focusing on the mediating role of the quality of peer relationships.

DESIGN AND METHODS

A cross-sectional study design was employed with 302 elementary students in grades four and five. Perceived socioeconomic status, the quality of peer relationships, family functioning, physical symptoms, and depression symptoms were measured with self-report questionnaires. Data were analyzed with descriptive statistics, t-tests, ANOVA, Pearson's correlations, and multiple regression.

RESULTS

The number of reported physical symptoms had a significant negative correlation with peer relationships (r = -0.517, p < 0.001) and family functioning (r = -0.279, p < 0.001). Depression was significantly negatively correlated with the quality of peer relationships (r = -0.775, p < 0.001) and family functioning (r = -0.428, p < 0.001). Peer relationships mediated the link between family functioning and physical symptoms. Peer relationships also mediated the relationship between family functioning and depression.

CONCLUSIONS

Peer relationships significantly influenced the physical and mental health of late school-age children in Korea.

PRACTICE IMPLICATIONS

Nursing intervention programs for improving peer relationships among children may be necessary to achieve their optimal health status.