1
|
Bethell CD, Wells N, Bergman D, Reuland C, Stumbo SP, Gombojav N, Simpson LA. Scaling Family Voices and Engagement to Measure and Improve Systems Performance and Whole Child Health: Progress and Lessons from the Child and Adolescent Health Measurement Initiative. Matern Child Health J 2023:10.1007/s10995-023-03755-9. [PMID: 37624473 DOI: 10.1007/s10995-023-03755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The 1997 legislation authorizing the United States Child Health Insurance Program sparked progress to measure and publicly report on children's healthcare services quality and system performance. To meet the moment, the national Child and Adolescent Health Measurement Initiative (CAHMI) public-private collaboration was launched to put families at the center of defining, measuring and using healthcare performance information to drive improved services quality and outcomes. METHODS Since 1996 the CAHMI followed an intentional path of collaborative action to (1) articulate shared goals for child health and advance a comprehensive, life-course and outcomes-based healthcare performance measurement and reporting framework; (2) collaborate with families, providers, payers and government agencies to specify, validate and support national, state and local use of dozens of framework aligned measures; (3) create novel public-facing digital data query, collection and reporting tools that liberate data findings for use by families, providers, advocates, policymakers, the media and researchers (Data Resource Center, Well Visit Planner); and (4) generate field building research and systems change agendas and frameworks (Prioritizing Possibilities, Engagement In Action) to catalyze prevention, flourishing and healing centered, trauma-informed, whole child and family engaged approaches, integrated systems and supportive financing and policies. CONCLUSIONS Lessons call for a restored, sustainable family and community engaged measurement infrastructure, public activation campaigns, and undeterred federal, state and systems leadership that implement policies to incentivize, resource, measure and remove barriers to integrated systems of care that scale family engagement to equitably promote whole child, youth and family well-being. Population health requires effective family engagement.
Collapse
Affiliation(s)
- Christina D Bethell
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E4152, Baltimore, MD, 21205, USA.
| | - Nora Wells
- Family Voices, 1250 I St NW #250, Washington, DC, 20005, USA
| | - David Bergman
- Department of Pediatrics, General Pediatrics, Stanford Medicine Children's Health, MSOB, 1265 Welch Road X240, Palo Alto, CA, 94305-5459, USA
| | - Colleen Reuland
- Oregon Pediatric Improvement Project, Department of Pediatrics, Division of General Pediatrics, Oregon Health and Sciences University, 707 SW Gaines St, Mail Code CDRC-P, Portland, OR, 97239, USA
| | - Scott P Stumbo
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E4152, Baltimore, MD, 21205, USA
| | - Narangerel Gombojav
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E4152, Baltimore, MD, 21205, USA
| | - Lisa A Simpson
- AcademyHealth, 1666 K St NW #1100, Washington, DC, 20006, USA
| |
Collapse
|
2
|
Bethell C, Blackwell CK, Gombojav N, Davis MB, Bruner C, Garner AS. Toward Measurement for a Whole Child Health Policy: Validity and National and State Prevalence of the Integrated Child Risk Index. Acad Pediatr 2022; 22:952-964. [PMID: 34896272 DOI: 10.1016/j.acap.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/13/2021] [Accepted: 12/03/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To develop, validate and estimate national and across state prevalence on a multidimensional index that assesses the complex medical, social, and relational health risks experienced by United States children. METHODS Data from the National Survey of Children's Health were used to construct the Integrated Child Risk Index (ICRI) which includes medical health risk (MHR), social health risk (SHR) and relational health risk (RHR) domains. Confirmatory factor analysis and logistic regression analyses were employed to assess construct and predictive validity. Validity outcomes were child flourishing, school engagement/readiness, emergency room utilization and forgone care. RESULTS Confirmatory factor analysis confirmed the ICRI 3-domain structure and greater correlation between MHR and RHR than MHR and SHR. Logistic regressions confirmed strong predictive validity of the ICRI for all study outcomes and ICRI scoring approaches. Nearly two-thirds of children (64.3%) with MHR also experienced SHR and/or RHR. Nearly one-third of United States children experienced risks on 2 or more ICRI domains and 15% of publicly insured children had risks on all domains (16.2%; 9.0%-25.7% across states). Significant variations were observed across states and by age, race/ethnicity, health insurance and household income. CONCLUSIONS The ICRI is a valid national and state level index associated with children's flourishing and educational preparedness and emergency and forgone care. National child health policies and Medicaid risk stratification and payment models should consider children's RHR in addition to SHR and MHR. Results call for integrated systems of care with the capacity to address medical, social and relational health risks and promote well-being. Substate and clinical applications require research.
Collapse
Affiliation(s)
- Christina Bethell
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Child and Adolescent Health Measurement Initiative (C Bethell and N Gombojav), Baltimore, Md.
| | - Courtney K Blackwell
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences (CK Blackwell), Chicago, Ill
| | - Narangerel Gombojav
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Child and Adolescent Health Measurement Initiative (C Bethell and N Gombojav), Baltimore, Md
| | - Martha B Davis
- Robert Wood Johnson Foundation (MB Davis), Princeton, NJ
| | | | - Andrew S Garner
- Partners in Pediatrics and Case Western Reserve University School of Medicine (AS Garner), Cleveland, Ohio
| |
Collapse
|
3
|
Bethell CD, Garner AS, Gombojav N, Blackwell C, Heller L, Mendelson T. Social and Relational Health Risks and Common Mental Health Problems Among US Children: The Mitigating Role of Family Resilience and Connection to Promote Positive Socioemotional and School-Related Outcomes. Child Adolesc Psychiatr Clin N Am 2022; 31:45-70. [PMID: 34801155 DOI: 10.1016/j.chc.2021.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nearly 70% (67.6%) of US children with mental, emotional, and behavioral problems (MEB) experienced significant social health risks (SHR) and/or relational health risks (RHR). Shifts are needed in child mental health promotion, prevention, diagnosis, and treatment to address both RHR and SHR. Public health approaches are needed that engage families, youth, and the range of child-serving professionals in collaborative efforts to prevent and mitigate RHR and SHR and promote positive mental health at a community level. Building strong family resilience and connection may improve SR and, in turn, academic and social outcomes among all US children with or without MEB.
Collapse
Affiliation(s)
- Christina D Bethell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Andrew S Garner
- Partners in Pediatrics and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Narangerel Gombojav
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Courtney Blackwell
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laurence Heller
- NeuroAffective Relational Model Training Institute, Inc, Littleton, CO, USA
| | - Tamar Mendelson
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
4
|
Bergman D, Bethell C, Gombojav N, Hassink S, Stange KC. Physical Distancing With Social Connectedness. Ann Fam Med 2020; 18:272-277. [PMID: 32393566 PMCID: PMC7213990 DOI: 10.1370/afm.2538] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 11/09/2022] Open
Abstract
In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our multidisciplinary group considered the possible ways that relationships might be developed in different kinds of health care encounters.We were surprised to discover many avenues to invest in relationships, even in non-continuity consultations, and how meaningful human connections might be developed even in telehealth visits. Opportunities range from the quality of attention or the structure of the time during the visit, to supporting relationship development in how care is organized at the local or system level and in the use of digital encounters. These ways of investing in relationships can exhibit different manifestations and emphases during different kinds of visits, but most are available during all kinds of encounters.Recognizing and supporting the many ways of investing in relationships has great potential to create a positive sea change in a health care system that currently feels fragmented and depersonalized to both patients and health care clinicians.The current COVID-19 pandemic is full of opportunity to use remote communication to develop healing human relationships. What we need in a pandemic is not social distancing, but physical distancing with social connectedness.
Collapse
|
5
|
Bethell C, Jones J, Gombojav N, Linkenbach J, Sege R. Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA Pediatr 2019; 173:e193007. [PMID: 31498386 PMCID: PMC6735495 DOI: 10.1001/jamapediatrics.2019.3007] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/14/2019] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Associations between adverse childhood experiences (ACEs) and risks for adult depression, poor mental health, and insufficient social and emotional support have been documented. Less is known about how positive childhood experiences (PCEs) co-occur with and may modulate the effect of ACEs on adult mental and relational health. OBJECTIVE To evaluate associations between adult-reported PCEs and (1) adult depression and/or poor mental health (D/PMH) and (2) adult-reported social and emotional support (ARSES) across ACEs exposure levels. DESIGN, SETTING, AND PARTICIPANTS Data were from the cross-sectional 2015 Wisconsin Behavioral Risk Factor Survey, a random digit-dial telephone survey of noninstitutionalized Wisconsin adults 18 years and older (n = 6188). Data were weighted to be representative of the entire population of Wisconsin adults in 2015. Data were analyzed between September 2016 and January 2019. MAIN OUTCOMES AND MEASURES The definition of D/PMH includes adults with a depression diagnosis (ever) and/or 14 or more poor mental health days in the past month. The definition of PCEs includes 7 positive interpersonal experiences with family, friends, and in school/the community. Standard Behavioral Risk Factor Survey ACEs and ARSES variables were used. RESULTS In the 2015 Wisconsin Behavioral Risk Factor Survey sample of adults (50.7% women; 84.9% white), the adjusted odds of D/PMH were 72% lower (OR, 0.28; 95% CI, 0.21-0.39) for adults reporting 6 to 7 vs 0 to 2 PCEs (12.6% vs 48.2%). Odds were 50% lower (OR, 0.50; 95% CI, 0.36-0.69) for those reporting 3 to 5 vs 0 to 2 PCEs (25.1% vs 48.2%). Associations were similar in magnitude for adults reporting 1, 2 to 3, or 4 to 8 ACEs. The adjusted odds that adults reported "always" on the ARSES variable were 3.53 times (95% CI, 2.60-4.80) greater for adults with 6 to 7 vs 0 to 2 PCEs. Associations for 3 to 5 PCEs were not significant. The PCE associations with D/PMH remained stable across each ACEs exposure level when controlling for ARSES. CONCLUSIONS AND RELEVANCE Positive childhood experiences show dose-response associations with D/PMH and ARSES after accounting for exposure to ACEs. The proactive promotion of PCEs for children may reduce risk for adult D/PMH and promote adult relational health. Joint assessment of PCEs and ACEs may better target needs and interventions and enable a focus on building strengths to promote well-being. Findings support prioritizing possibilities to foster safe, stable nurturing relationships for children that consider the health outcomes of positive experiences.
Collapse
Affiliation(s)
- Christina Bethell
- Johns Hopkins Bloomberg School of Public Health and Child and Adolescent Health Measurement Initiative, Baltimore, Maryland
| | - Jennifer Jones
- Alliance for Strong Families and Communities, Milwaukee, Wisconsin
| | - Narangerel Gombojav
- Johns Hopkins Bloomberg School of Public Health and Child and Adolescent Health Measurement Initiative, Baltimore, Maryland
| | | | - Robert Sege
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
6
|
Bethell CD, Gombojav N, Whitaker RC. Family Resilience And Connection Promote Flourishing Among US Children, Even Amid Adversity. Health Aff (Millwood) 2019; 38:729-737. [DOI: 10.1377/hlthaff.2018.05425] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Christina D. Bethell
- Christina D. Bethell is a professor in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Narangerel Gombojav
- Narangerel Gombojav is an assistant scientist in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - Robert C. Whitaker
- Robert C. Whitaker is director of research and research education at the Columbia-Bassett Program of the Columbia University Vagelos College of Physicians and Surgeons, in New York, New York, and the Bassett Medical Center, in Cooperstown, New York. He is also affiliated with the Bassett Research Institute at the Bassett Medical Center, in Cooperstown
| |
Collapse
|
7
|
Bethell CD, Carle A, Hudziak J, Gombojav N, Powers K, Wade R, Braveman P. Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice. Acad Pediatr 2017; 17:S51-S69. [PMID: 28865661 PMCID: PMC6035880 DOI: 10.1016/j.acap.2017.04.161] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 02/21/2017] [Accepted: 04/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Advances in human development sciences point to tremendous possibilities to promote healthy child development and well-being across life by proactively supporting safe, stable and nurturing family relationships (SSNRs), teaching resilience, and intervening early to promote healing the trauma and stress associated with disruptions in SSNRs. Assessing potential disruptions in SSNRs, such as adverse childhood experiences (ACEs), can contribute to assessing risk for trauma and chronic and toxic stress. Asking about ACEs can help with efforts to prevent and attenuate negative impacts on child development and both child and family well-being. Many methods to assess ACEs exist but have not been compared. The National Survey of Children's Health (NSCH) now measures ACEs for children, but requires further assessment and validation. METHODS We identified and compared methods to assess ACEs among children and families, evaluated the acceptability and validity of the new NSCH-ACEs measure, and identified implications for assessing ACEs in research and practice. RESULTS Of 14 ACEs assessment methods identified, 5 have been used in clinical settings (vs public health assessment or research) and all but 1 require self or parent report (3 allow child report). Across methods, 6 to 20 constructs are assessed, 4 of which are common to all: parental incarceration, domestic violence, household mental illness/suicide, household alcohol or substance abuse. Common additional content includes assessing exposure to neighborhood violence, bullying, discrimination, or parental death. All methods use a numeric, cumulative risk scoring methodology. The NSCH-ACEs measure was acceptable to respondents as evidenced by few missing values and no reduction in response rate attributable to asking about children's ACEs. The 9 ACEs assessed in the NSCH co-occur, with most children with 1 ACE having additional ACEs. This measure showed efficiency and confirmatory factor analysis as well as latent class analysis supported a cumulative risk scoring method. Formative as well as reflective measurement models further support cumulative risk scoring and provide evidence of predictive validity of the NSCH-ACEs. Common effects of ACEs across household income groups confirm information distinct from economic status is provided and suggest use of population-wide versus high-risk approaches to assessing ACEs. CONCLUSIONS Although important variations exist, available ACEs measurement methods are similar and show consistent associations with poorer health outcomes in absence of protective factors and resilience. All methods reviewed appear to coincide with broader goals to facilitate health education, promote health and, where needed, to mitigate the trauma, chronic stress, and behavioral and emotional sequelae that can arise with exposure to ACEs. Assessing ACEs appears acceptable to individuals and families when conducted in population-based and clinical research contexts. Although research to date and neurobiological findings compel early identification and health education about ACEs in clinical settings, further research to guide use in pediatric practice is required, especially as it relates to distinguishing ACEs assessment from identifying current family psychosocial risks and child abuse. The reflective as well as formative psychometric analyses conducted in this study confirm use of cumulative risk scoring for the NSCH-ACEs measure. Even if children have not been exposed to ACEs, assessing ACEs has value as an educational tool for engaging and educating families and children about the importance of SSNRs and how to recognize and manage stress and learn resilience.
Collapse
|
8
|
Bethell C, Gombojav N, Solloway M, Wissow L. Adverse Childhood Experiences, Resilience and Mindfulness-Based Approaches: Common Denominator Issues for Children with Emotional, Mental, or Behavioral Problems. Child Adolesc Psychiatr Clin N Am 2016; 25:139-56. [PMID: 26980120 PMCID: PMC4863233 DOI: 10.1016/j.chc.2015.12.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
US children with emotional, mental, or behavioral conditions (EMB) have disproportionate exposure to adverse childhood experiences (ACEs). There are theoretic and empirical explanations for early and lifelong physical, mental, emotional, educational, and social impacts of the resultant trauma and chronic stress. Using mindfulness-based, mind-body approaches (MBMB) may strengthen families and promote child resilience and success. This paper examines associations between EMB, ACEs, and protective factors, such as child resilience, parental coping/stress, and parent-child engagement. Findings encourage family-centered and mindfulness-based approaches to address social and emotional trauma and potentially interrupt cycles of ACEs and prevalence of EMB.
Collapse
Affiliation(s)
- Christina Bethell
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
| | - Narangerel Gombojav
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Michele Solloway
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Lawrence Wissow
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| |
Collapse
|
9
|
Bethell C, Gombojav N, Carle A, Neff J, Newacheck P, Koch T. When Complex Care Goes Complementary. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5304.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christina Bethell
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) University of Cincinnati School of Medicine, Cincinnati, OH, USA
- (3) Children's Hospital and Regional Medical Center, Seattle, WA, USA
- (4) University of California San Francisco Medical Center, San Francisco, CA, USA
- (5) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| | - Narangerel Gombojav
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) University of Cincinnati School of Medicine, Cincinnati, OH, USA
- (3) Children's Hospital and Regional Medical Center, Seattle, WA, USA
- (4) University of California San Francisco Medical Center, San Francisco, CA, USA
- (5) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| | - Adam Carle
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) University of Cincinnati School of Medicine, Cincinnati, OH, USA
- (3) Children's Hospital and Regional Medical Center, Seattle, WA, USA
- (4) University of California San Francisco Medical Center, San Francisco, CA, USA
- (5) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| | - John Neff
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) University of Cincinnati School of Medicine, Cincinnati, OH, USA
- (3) Children's Hospital and Regional Medical Center, Seattle, WA, USA
- (4) University of California San Francisco Medical Center, San Francisco, CA, USA
- (5) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| | - Paul Newacheck
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) University of Cincinnati School of Medicine, Cincinnati, OH, USA
- (3) Children's Hospital and Regional Medical Center, Seattle, WA, USA
- (4) University of California San Francisco Medical Center, San Francisco, CA, USA
- (5) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| | - Thomas Koch
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) University of Cincinnati School of Medicine, Cincinnati, OH, USA
- (3) Children's Hospital and Regional Medical Center, Seattle, WA, USA
- (4) University of California San Francisco Medical Center, San Francisco, CA, USA
- (5) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| |
Collapse
|
10
|
Affiliation(s)
- Christina Bethell
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Center for Integrative Health and Wellness, Columbus, OH, USA
- (3) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| | - Kathi Kemper
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Center for Integrative Health and Wellness, Columbus, OH, USA
- (3) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| | - Narangerel Gombojav
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Center for Integrative Health and Wellness, Columbus, OH, USA
- (3) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| | - Thomas Koch
- (1) Oregon Health & Science University, Child and Adolescent Health Measurement Initiative, Portland, OR, USA
- (2) Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Center for Integrative Health and Wellness, Columbus, OH, USA
- (3) Oregon Health & Science University, Division of Pediatric Neurology, Department of Pediatrics, Portland, OR, USA
| |
Collapse
|
11
|
Abstract
OBJECTIVE To identify prevalence and patterns of complementary and alternative medicine (CAM) use among youth with recurrent headaches (HA) and evaluate associations with co-occurring health problems and limitations as well as with the use and expenditures for conventional medical care. METHODS Variables were constructed for youth aged 10 to 17 by using linked data from the 2007 National Health Interview Survey and the 2008 Medical Expenditures Panel Survey. Bivariate, logistic, and 2-part regression analyses were used. RESULTS Of the 10.6% of youth experiencing HA, 29.6% used CAM, rising to 41% for the many HA sufferers who also experienced difficulties with emotions, concentration, behavior, school attendance, or daily activities. Biologically based products (16.2%) and mind-body therapies (13.3%) were most commonly used, especially by the 86.4% of youth with HA experiencing at least 1 other chronic condition. Compared with non-CAM users, youth with HA who used CAM also had higher expenditures for and use of most types of conventional care. CONCLUSIONS CAM use is most common among youth with HA experiencing multiple chronic conditions and difficulties in daily functioning. Associations among CAM use, multiple chronic conditions, and higher use of conventional care highlight the need for medical providers to routinely ask about CAM use to meet the complex health needs of their patients and facilitate the optimal integration of care. Research is needed to identify models for coordinating complementary and conventional care within a medical home and to understand the health benefits or risks associated with CAM use in conjunction with conventional treatments for patients with HA.
Collapse
Affiliation(s)
- Christina Bethell
- MBA, Child and Adolescent Health Measurement Initiative, Department of Pediatrics, School of Medicine, Oregon Health and Science University, 707 SW Gaines Ave, Mailcode CDRC-P, Portland, OR 97219.
| | - Kathi J. Kemper
- Wexner Medical Center/Nationwide Children's Hospital, Center for Integrative Health and Wellness, Ohio State University, Columbus, Ohio
| | | | - Thomas K. Koch
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon; and
| |
Collapse
|
12
|
Bethell C, Gombojav N, Stumbo S. OA01.02. Associations between complementary and alternative medicine and conventional medical care utilization, access and quality of care. BMC Complement Altern Med 2012. [PMCID: PMC3373451 DOI: 10.1186/1472-6882-12-s1-o2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
13
|
Bethell C, Stumbo S, Gombojav N, Wilhelm C, Newacheck P. P04.33. A review of existing methods to specify condition specific prevalence and experience of CAM use in US children: toward a strategic data plan. BMC Complement Altern Med 2012. [PMCID: PMC3373699 DOI: 10.1186/1472-6882-12-s1-p303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
14
|
Affiliation(s)
- Christina Bethell
- Christina Bethell is an associate professor and director of the Child and Adolescent Health Measurement Initiative, Department of Pediatrics, School of Medicine, at the Oregon Health and Science University (OHSU) in Portland
| | - Lisa Simpson
- Lisa Simpson is director of the Child Policy Research Center at Cincinnati Children’s Hospital Medical Center and a professor in the Division of Health Policy and Clinical Effectiveness, Department of Pediatrics, at the University of Cincinnati in Ohio
| | - Scott Stumbo
- Scott Stumbo is a senior research associate with the Child and Adolescent Health Measurement Initiative, OHSU
| | - Adam C. Carle
- Adam C. Carle is an assistant professor of pediatrics in the Division of Health Policy and Clinical Effectiveness, Department of Pediatrics, University of Cincinnati, Children’s Hospital and Medical Center
| | - Narangerel Gombojav
- Narangerel Gombojav is a research assistant with the Child and Adolescent Health Measurement Initiative, OHSU
| |
Collapse
|
15
|
Gombojav N, Manaseki-Holland S, Pollock J, Henderson AJ. The effects of social variables on symptom recognition and medical care seeking behaviour for acute respiratory infections in infants in urban Mongolia. Arch Dis Child 2009; 94:849-54. [PMID: 19574234 DOI: 10.1136/adc.2008.157115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate potentially modifiable factors associated with carers' recognition of symptoms and timely presentation of infants with acute respiratory infections (ARI) in urban Mongolia. METHODS A prospective cohort study nested in a randomised controlled trial of infant swaddling. Data were collected on social, educational and childcare variables and all doctor contacts for ARI in primary and secondary care by regular questionnaires to carers of infants during the first 6 months of life. FINDINGS Analyses were based on 9024 ARI related doctor contacts for 4554 illness episodes in 1218 infants. Delay in medical care seeking (>3 days from acute lower respiratory infection (ALRI) symptom onset) was associated with younger maternal age (OR (95% CI) 3.8 (1.2 to 11.6)), single child families (3.8 (1.2 to 11.61)), absent father (4.1 (1.2 to 14.4)) and residence more than 1 km from a clinic (3.5 (1.2 to 10.2)). CONCLUSION There is a continuing need to educate carers of infants in the management of ARI, particularly those of younger age and those with limited family support.
Collapse
Affiliation(s)
- N Gombojav
- Department of General Practice, Health Sciences University, Ulaanbaatar, Mongolia
| | | | | | | |
Collapse
|