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Candelaria MA, Tellerman K, Hutchison H, Silver D, Feigelman S, Endy K, Afkinich J, Wilms Floet AM. The TREE Program: Promoting Positive Early Childhood Experiences During Well-Child Visits. Clin Pediatr (Phila) 2024:99228241258526. [PMID: 38853704 DOI: 10.1177/00099228241258526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
This feasibility study evaluated the developmental coaching TREE (Talk Read Engage Encourage) program for historically marginalized children ages 0 to 2 years, embedded within pediatric visits, examining if TREE could enhance caregiver-child interactions and increase pediatric resident report of competency and self-efficacy in coaching caregivers. Using a quasi-experimental design, a convenience sample (n = 167 families) was recruited (79 intervention; 88 control). Follow-up data were obtained from 45% of families (38 intervention; 38 control), impacted by COVID-19 attendance. Analyses demonstrated significant increases in self-reported Parent Verbal Responsivity (d = 0.68; 95% confidence interval [CI] = 0.17 to 1.18; P = .009) by intervention group caregivers. Intervention pediatric residents reported significant increases in promoting positive caregiver-child interactions and confidence in conveying child development (d = -.73; 95% CI = -1.21 to -0.22; P = .003). The TREE program is a promising practice that operationalizes promotion of relational health and positive early childhood experiences within pediatric primary care.
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Affiliation(s)
- Margo A Candelaria
- Innovations Institute, University of Connecticut School of Social Work, Hartford, CT, USA
| | - Ken Tellerman
- Committee on Emotional Health, Maryland Chapter, American Academy of Pediatrics, Baltimore, MD, USA
| | - Heather Hutchison
- Innovations Institute, University of Connecticut School of Social Work, Hartford, CT, USA
| | | | - Susan Feigelman
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine Endy
- Women's Institute of Torah Seminary & College, Baltimore, MD, USA
| | - Jenny Afkinich
- Collaborative for Implementation Practice, School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna Maria Wilms Floet
- Department of Pediatrics, Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Reynolds-Salmon R, Samms-Vaughan M, Coore-Desai C, Reece J, Pellington S. Does household size matter? Crowding and its effects on child development. PSYCHOL HEALTH MED 2024:1-14. [PMID: 38770923 DOI: 10.1080/13548506.2024.2326867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/01/2024] [Indexed: 05/22/2024]
Abstract
There is very little compelling evidence that household size negatively affects child development. In this study, the effects of household size on child development were analysed using data collected for a sample of 1311 four-year-old Jamaican children. Children's development was assessed using the Griffiths Mental Development Scales across six developmental domains: locomotor, personal-social, language, coordination, performance and practical reasoning. The findings suggest that children's locomotor and personal-social development are negatively affected by household crowding, with no significant effects observed for other domains. Additional results show that these adverse effects are strongest if the child lives in a single room compared to a separately detached house. This evidence speaks to the need to tailor policies towards access to good housing infrastructure and the provision of recreational spaces to encourage play and social interaction among children.
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Affiliation(s)
- Rosan Reynolds-Salmon
- Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Maureen Samms-Vaughan
- Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Charlene Coore-Desai
- Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Jody Reece
- Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Sydonnie Pellington
- Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
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Gill R, Karim ME, Puyat JH, Guhn M, Janus M, Gagné Petteni M, Forer B, Gadermann AM. Childhood poverty and school readiness: Differences by poverty type and immigration background. SSM Popul Health 2024; 25:101563. [PMID: 38144443 PMCID: PMC10746556 DOI: 10.1016/j.ssmph.2023.101563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
Objectives Poverty exposes children to adverse conditions that negatively impact development. However, there is limited understanding on how different types of poverty may affect children of various immigration backgrounds differently in outcomes such as school readiness. This study examined these relationships between household and/or neighbourhood poverty, poverty timing, and immigration background with school readiness outcomes at kindergarten. Methods This study utilized a retrospective, population-based cohort of administrative records linked with surveys completed by kindergarten teachers for 15 369 children born in British Columbia, Canada. The exposures investigated were neighbourhood poverty (residing in a neighbourhood in the lowest income-quintile) and/or household poverty (receiving a health insurance subsidy due to low household income). Experiencing both neighbourhood and household poverty simultaneously was defined as "combined" household and neighbourhood poverty. The outcome of vulnerability on school readiness domains was assessed at kindergarten (47.8% female; mean age = 6.01 years) using teacher ratings on the Early Development Instrument (EDI). Results Children exposed to combined poverty between age 0 and 2 had greater odds of being vulnerable in two or more domains of school readiness than children not exposed to any poverty during this period (adjusted odds ratio (aOR) = 2.07, 95% CI: [1.74; 2.47], p < 0.001). The effect of combined poverty was larger than household poverty only (aOR = 1.54, 95% CI: [1.31; 1.82], p < 0.001) or neighbourhood poverty only (aOR = 1.49, 95% CI: [1.30; 1.70], p < 0.001). Combined poverty was associated with negative outcomes regardless of timing. Both non-immigrants (aOR = 2.40, 95% CI: [1.92; 3.00], p < 0.001) and second-generation immigrants (aOR = 1.63, 95% CI: [1.22; 2.17], p < 0.001) experiencing combined poverty scored lower on school readiness. Conclusions Children who experienced combined poverty had lower levels of school readiness at kindergarten, regardless of timing and immigration background.
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Affiliation(s)
- Randip Gill
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, 570-1081 Burrard Street, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Joseph H. Puyat
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, 570-1081 Burrard Street, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Martin Guhn
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
| | - Magdalena Janus
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Canada
| | - Monique Gagné Petteni
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, 570-1081 Burrard Street, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Barry Forer
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
| | - Anne M. Gadermann
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, 570-1081 Burrard Street, St. Paul’s Hospital, Vancouver, BC, Canada
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Renneberg CK, Brund RBK, Heuckendorff S, Gunaseelan A, Kruse LV, Fonager K. Preschool children from lower household incomes experience inequality in asthma treatment: findings from a Danish nationwide cohort study. Eur J Public Health 2024; 34:85-90. [PMID: 37862429 PMCID: PMC10843934 DOI: 10.1093/eurpub/ckad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The obligation to pay for asthma medication in a country with universal healthcare might lead to increased asthma exacerbations and inequitable healthcare access for children from low-income households. Thus, the aim of this study was to examine the association between household income and childhood/preschool asthma regarding hospitalization and medication receipt. METHODS In this nationwide register-based cohort study, we encompassed all 3-year-old children residing in Denmark, born between 2000 and 2014, along with their linked parents and followed them until their sixth birthday. Household income was divided into quartiles. Asthma was categorized in two mutually exclusive groups as either the redemption of two prescriptions for asthma medication or receiving a hospital diagnosis. We utilized Poisson regression to estimate the risk ratio (RR). RESULTS The analysis included 834 422 preschool children. The prevalence of asthma dependent on medication alone was 7.3%, while 1.8% of children necessitated asthma-related hospitalization. Income inequality was evident across all income quartiles. Notably, children from the lowest income quartile had a RR of 0.95 (95% CI: 0.92-0.98) of redeeming asthma medication and conversely a RR of 1.18 (95% CI: 1.14-1.23) of asthma-related hospitalization. CONCLUSIONS Despite universal healthcare, income inequality has a dual impact on children from low-income households. They face a diminished risk of redeeming asthma medication and a higher susceptibility to asthma-related hospitalizations indicating an unequal access to healthcare. Prioritizing efforts to reduce childhood health inequalities is crucial. However, further research, particularly qualitative studies, is needed to better comprehend the underlying mechanisms to address the complexities of income inequality.
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Affiliation(s)
| | | | - Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Psychiatry Region North Jutland, Aalborg, Denmark
| | - Artika Gunaseelan
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Lisbeth Venø Kruse
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Janus M, Brownell M, Reid-Westoby C, Pottruff M, Forer B, Guhn M, Duku E. Neighbourhood-level socioeconomic status and prevalence of teacher-reported health disorders among Canadian kindergarten children. Front Public Health 2024; 11:1295195. [PMID: 38303964 PMCID: PMC10830680 DOI: 10.3389/fpubh.2023.1295195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024] Open
Abstract
Background The evidence on the association between neighborhood-level socioeconomic status (SES) and health disorders in young children is scarce. This study examined the prevalence of health disorders in Canadian kindergarten (5-6 years old) children in relation to neighborhood SES in 12/13 Canadian jurisdictions. Methods Data on child development at school entry for an eligible 1,372,980 children out of the total population of 1,435,428 children from 2004 to 2020, collected using the Early Development Instrument (EDI), were linked with neighborhood sociodemographic data from the 2006 Canadian Census and the 2005 Taxfiler for 2,058 neighborhoods. We examined the relationship using linear regressions. Children's HD included special needs, functional impairments limiting a child's ability to participate in classroom activities, and diagnosed conditions. Results The neighborhood prevalence of health disorders across Canada ranged from 1.8 to 46.6%, with a national average of 17.3%. The combined prevalence of health disorders was 16.4%, as 225,711 children were identified as having at least one health disorder. Results of an unadjusted linear regression showed a significant association between neighborhood-level SES and prevalence of health disorders (F(1, 2051) = 433.28, p < 0.001), with an R2 of 0.17. When province was added to the model, the R2 increased to 0.40 (F(12, 2040) = 115.26, p < 0.001). The association was strongest in Newfoundland & Labrador and weakest in Ontario. Conclusion Our study demonstrated that the prevalence of health disorders among kindergarten children was higher in lower SES neighborhoods and varied by jurisdiction in Canada, which has implications for practice and resource allocation.
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Affiliation(s)
- Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Molly Pottruff
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Barry Forer
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Haraldstad K, Abildsnes E, Bøe T, Vigsnes KL, Wilson P, Mølland E. Health-related quality of life of children from low-income families: the new patterns study. BMC Public Health 2023; 23:2439. [PMID: 38057731 PMCID: PMC10702070 DOI: 10.1186/s12889-023-17335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Child poverty has been gradually rising, and about 12% of all Norwegian children are living in a state of relative poverty. This study was part of the New Patterns project, which recruits low-income families requiring long-term welfare services. Included families receive integrated welfare services, with the help of a family coordinator. The current study objectives were to explore the associations between HRQoL, demographic variables (age, gender, immigration status) and leisure activities in children and adolescents in low-income families. METHODS A cross-sectional survey was conducted among low-income families. Participating families had children (N = 214) aged 8-18 years.The family had a household income below 60% of the equivalized median population income for three consecutive years and needed long-term welfare services. HRQoL was measured using the KIDSCREEN-27 self-report instrument. Descriptive statistics, including means, standard deviations, and proportions, were calculated, and ordinary least squares regressions were performed, clustering standard errors at the family level. RESULTS Compared with boys, girls reported lower HRQoL on only one out of five dimensions, physical wellbeing. In the regression analysis we found statistically significant positive associations between migrant status and HRQoL on all five dimensions: physical wellbeing, psychological wellbeing, parents and autonomy, peers and social support, and school environment. In addition, age was associated with school environment, and age, gender and participation in leisure activities was associated with better physical wellbeing. CONCLUSIONS Baseline results regarding HRQoL among children and adolescents in low-income families indicate that they have overall good HRQoL, though some participants had low HRQoL scores, especially on the physical and social support dimensions. Children with an immigrant background report higher HRQoL than do children without an immigrant background.
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Affiliation(s)
- Kristin Haraldstad
- Department of Health and Nursing science, Faculty of Health and Sport Science, University of Agder, Agder, Norway.
| | - Eirik Abildsnes
- Department of Psychosocial Health, Faculty of Health and Sport Science, University of Agder, Agder, Norway
- Kristiansand Municipality, Agder, Norway
| | - Tormod Bøe
- Department of psychosocial science, Faculty of Psychology, University of Bergen, Bergen, Norway
- RKBU Vest, NORCE Norwegian Research Center, Bergen, Norway
| | - Kristine L Vigsnes
- Kristiansand Municipality, Agder, Norway
- Department of Nutrition and Public Health, Faculty of Health and Sport Science, University of Agder, Agder, Norway
| | - Philip Wilson
- Institute of Applied Health Science, University of Aberdeen, Aberdeen, Scotland
- Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Eirin Mølland
- Department of Economics and Finance, School of Business and Law, University of Agder, Agder, Norway
- NORCE, Norwegian Research Centre As, Bergen, Norway
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7
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Phua DY, Chen H, Yap F, Chong YS, Gluckman PD, Broekman BFP, Eriksson JG, Meaney MJ. Allostatic load in children: The cost of empathic concern. Proc Natl Acad Sci U S A 2023; 120:e2217769120. [PMID: 37725642 PMCID: PMC10523447 DOI: 10.1073/pnas.2217769120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 07/26/2023] [Indexed: 09/21/2023] Open
Abstract
Early-life adversity affects long-term health outcomes but there is considerable interindividual variability in susceptibility to environmental influences. We proposed that positive psychological characteristics that reflect engagement with context, such as being concerned about people or performance on tasks (i.e., empathic concern), could moderate the interindividual variation in sensitivity to the quality of the early environment. We studied 526 children of various Asian nationalities in Singapore (46.6% female, 13.4% below the poverty line) with longitudinal data on perinatal and childhood experiences, maternal report on empathic concern of the child, and a comprehensive set of physiological measures reflecting pediatric allostatic load assessed at 6 y of age. The perinatal and childhood experiences included adversities and positive experiences. We found that cumulative adverse childhood experience was positively associated with allostatic load of children at 6 y of age at higher levels of empathic concern but not significantly associated at lower levels of empathic concern. This finding reveals evidence for the importance of empathic concern as a psychological characteristic that moderates the developmental impact of environmental influences, serving as a source for vulnerability to adversities in children.
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Affiliation(s)
- Desiree Y. Phua
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
| | - Helen Chen
- Department of Psychological Medicine, Kandang Kerbau Women’s and Children’s Hospital, Singapore229899, Republic of Singapore
- Paediatric Medicine Academic Clinical Programme, Duke-National University of Singapore, Singapore169857, Republic of Singapore
| | - Fabian Yap
- Department of Psychological Medicine, Kandang Kerbau Women’s and Children’s Hospital, Singapore229899, Republic of Singapore
- Department of Paediatric Medicine, Kandang Kerbay Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore229899, Republic of Singapore
| | - Yap Seng Chong
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
- Yong Loo Lin School of Medicine, Human Potential Translational Research Programme and O&G Department, National University of Singapore, Singapore117597, Singapore
| | - Peter D. Gluckman
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
- Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland, Auckland1023, New Zealand
- Public Health Research Program, Folkhalsan Research Center, Helsinki00250, Finland
| | - Birit F. P. Broekman
- Department of Psychiatry, Amsterdam University Medical Centers (UMC) and Onze Lieve Vrouwe Gasthuis (OLVG), Vrije Universiteit (VU), Amsterdam1081 HV, The Netherlands
| | - Johan G. Eriksson
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
- Yong Loo Lin School of Medicine, Human Potential Translational Research Programme and O&G Department, National University of Singapore, Singapore117597, Singapore
- Public Health Research Program, Folkhalsan Research Center, Helsinki00250, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki00100, Finland
| | - Michael J. Meaney
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
- Yong Loo Lin School of Medicine, Human Potential Translational Research Programme and O&G Department, National University of Singapore, Singapore117597, Singapore
- Brain-Body Initiative, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore117597, Republic of Singapore
- Sackler Program for Epigenetics and Psychobiology at McGill University, MontrealQCH3A 0G4, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, MontrealQCH3A 0G4, Canada
- Brain-Body Initiative, Agency for Science, Technology and Research (A*STAR), Singapore138632, Republic of Singapore
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White AS. Transitioning from Medicaid to private health insurance: informing public and private sector outreach. FRONTIERS IN HEALTH SERVICES 2023; 3:1166034. [PMID: 37720845 PMCID: PMC10504662 DOI: 10.3389/frhs.2023.1166034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Abstract
This study explored the lived experiences of transitioning from Medicaid to private health insurance upon college graduation. Fifteen recent graduates of an urban, commuter, public college in the Mid-Atlantic were interviewed via Zoom® to understand what they regard as crucial aspects of the transition experience, especially during the COVID pandemic. The subjects all identified as being members of a minority racial or ethnic group, the average age was 33 years (SD = 10.96), and all but one interview subject majored in the health sciences. Every recent graduate reported experiencing difficulty in the transition. Subjects felt unprepared for the transition, alone, and without support. "Copays" was the most common response to questions, frequently said with arms in the air for emphasis, as if the word "copay" summarized all of the lack of preparation, difficulty, and expense of the healthcare system after previously receiving Medicaid (i.e., free healthcare). The findings inform how the private sector should on-board new college graduates. There is a need for Medicaid case officers to better prepare clients for the transition and for human resources personnel in the private sector to sufficiently explain how private health insurance works.
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Affiliation(s)
- Amy Samantha White
- Department of Health Equity, Administration, and Technology, School of Health Sciences, Human Services, and Nursing, Lehman College, Bronx, NY, United States
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Hamilton C, Sariscsany L, Waldfogel J, Wimer C. Experiences of Poverty Around the Time of a Birth: A Research Note. Demography 2023; 60:965-976. [PMID: 37326011 DOI: 10.1215/00703370-10837403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
While research highlights that, on average, women's income and labor force participation fall around the time of a birth, little is known about how women's experiences of poverty around childbirth vary by birth parity or race and ethnicity. Using data from the Survey of Income and Program Participation and the Supplemental Poverty Measure (a comprehensive measure of poverty), this research note examines the poverty rate of mothers overall and by birth parity and racial and ethnic group in the six months before and after childbirth. We also assess the role of current government support programs in moderating financial losses during the time around a birth. We find that poverty rates among mothers increase after childbirth, with the magnitude varying by birth parity and racial and ethnic group. While current government programs help reduce poverty among mothers around childbirth, these programs do not protect mothers from falling into poverty after childbirth nor do they reduce the inequities in poverty by race or ethnicity. Our results highlight the need for greater public assistance for mothers with recent births to ensure improved child and family well-being and also call attention to the need for policies to address long-standing racial and ethnic inequities in child and family well-being.
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Affiliation(s)
- Christal Hamilton
- Center on Poverty and Social Policy, Columbia University, New York, NY, USA
| | - Laurel Sariscsany
- Grace Abbott School of Social Work, University of Nebraska, Omaha, NE, USA
| | - Jane Waldfogel
- School of Social Work, Columbia University, New York, NY, USA
| | - Christopher Wimer
- Center on Poverty and Social Policy, Columbia University, New York, NY, USA
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10
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Mariko H, Uban KA. The implications of socioeconomic factors on salivary bioscience methodological variables in a large pediatric multi-site study. Front Public Health 2023; 11:1088043. [PMID: 37427258 PMCID: PMC10327643 DOI: 10.3389/fpubh.2023.1088043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Salivary bioscience has found increased utilization within pediatric research, given the non-invasive nature of self-collecting saliva for measuring biological markers. With this growth in pediatric utility, more understanding is needed of how social-contextual factors, such as socioeconomic factors or status (SES), influence salivary bioscience in large multi-site studies. Socioeconomic factors have been shown to influence non-salivary analyte levels across childhood and adolescent development. However, less is understood about relationships between these socioeconomic factors and salivary collection methodological variables (e.g., time of saliva collection from waking, time of day of saliva collection, physical activity prior to saliva collection, and caffeine intake prior to saliva collection). Variability in salivary methodological variables between participants may impact the levels of analytes measured in a salivary sample, thus serving as a potential mechanism for non-random systematic biases in analytes. Methods Our objective is to examine relationships between socioeconomic factors and salivary bioscience methodological variables within the Adolescent Brain Cognitive Development Study© cohort of children aged 9-10 years old (n = 10,567 participants with saliva samples). Results We observed significant associations between household socioeconomic factors (poverty status, education) and salivary collection methodological variables (time since waking, time of day of sampling, physical activity, and caffeine intake). Moreover, lower levels of household poverty and education were significantly associated with more sources of potential bias in salivary collection methodological variables (e.g., longer times since waking, collections later in the day, higher odds of caffeine consumption, and lower odds of physical activity). Consistent associations were not observed with neighborhood socioeconomic factors and salivary methodological variables. Discussion Previous literature demonstrates associations between collection methodological variables and measurements of salivary analyte levels, particularly with analytes that are more sensitive to circadian rhythms, pH levels, or rigorous physical activity. Our novel findings suggest that unintended distortions in measured salivary analyte values, potentially resulting from the non-random systematic biases in salivary methodology, need to be intentionally incorporated into analyses and interpretation of results. This is particularly salient for future studies interested in examining underlying mechanisms of childhood socioeconomic health inequities in future analyses.
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Affiliation(s)
- Hawa Mariko
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
| | - Kristina A. Uban
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
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Zhang C, Zafari Z, Slejko JF, Camelo Castillo W, Reeves GM, dosReis S. Impact of different interventions on preventing suicide and suicide attempt among children and adolescents in the United States: a microsimulation model study. Front Psychiatry 2023; 14:1127852. [PMID: 37333921 PMCID: PMC10275605 DOI: 10.3389/fpsyt.2023.1127852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Despite considerable investment in suicide prevention since 2001, there is limited evidence for the effect of suicide prevention interventions among children and adolescents. This study aimed to estimate the potential population impact of different interventions in preventing suicide-related behaviors in children and adolescents. Methods A microsimulation model study used data from national surveys and clinical trials to emulate the dynamic processes of developing depression and care-seeking behaviors among a US sample of children and adolescents. The simulation model examined the effect of four hypothetical suicide prevention interventions on preventing suicide and suicide attempt in children and adolescents as follows: (1) reduce untreated depression by 20, 50, and 80% through depression screening; (2) increase the proportion of acute-phase treatment completion to 90% (i.e., reduce treatment attrition); (3) suicide screening and treatment among the depressed individuals; and (4) suicide screening and treatment to 20, 50, and 80% of individuals in medical care settings. The model without any intervention simulated was the baseline. We estimated the difference in the suicide rate and risk of suicide attempts in children and adolescents between baseline and different interventions. Results No significant reduction in the suicide rate was observed for any of the interventions. A significant decrease in the risk of suicide attempt was observed for reducing untreated depression by 80%, and for suicide screening to individuals in medical settings as follows: 20% screened: -0.68% (95% credible interval (CI): -1.05%, -0.56%), 50% screened: -1.47% (95% CI: -2.00%, -1.34%), and 80% screened: -2.14% (95% CI: -2.48%, -2.08%). Combined with 90% completion of acute-phase treatment, the risk of suicide attempt changed by -0.33% (95% CI: -0.92%, 0.04%), -0.56% (95% CI: -1.06%, -0.17%), and -0.78% (95% CI: -1.29%, -0.40%) for reducing untreated depression by 20, 50, and 80%, respectively. Combined with suicide screening and treatment among the depressed, the risk of suicide attempt changed by -0.27% (95% CI: -0.dd%, -0.16%), -0.66% (95% CI: -0.90%, -0.46%), and -0.90% (95% CI: -1.10%, -0.69%) for reducing untreated depression by 20, 50, and 80%, respectively. Conclusion Reducing undertreatment (the untreated and dropout) of depression and suicide screening and treatment in medical care settings may be effective in preventing suicide-related behaviors in children and adolescents.
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Affiliation(s)
- Chengchen Zhang
- Shanghai Children's Medical Center Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Zafar Zafari
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Julia F. Slejko
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Wendy Camelo Castillo
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Gloria M. Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Susan dosReis
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
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12
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Nickel NC, Enns JE, Freier A, McCulloch SC, Chartier M, Casidsid HJM, Balogun OD, Mulhall D, Dragan R, Sarkar J, Bolton J, Konrad G, Phillips-Beck W, Sanguins J, Shimmin C, McDonald N, Mignone J, Hinds A. Characterising methamphetamine use to inform health and social policies in Manitoba, Canada: a protocol for a retrospective cohort study using linked administrative data. BMJ Open 2022; 12:e062127. [PMID: 36261234 PMCID: PMC9582321 DOI: 10.1136/bmjopen-2022-062127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Rising use of methamphetamine is causing significant public health concern in Canada. The biological and behavioural effects of methamphetamine range from wakefulness, vigour and euphoria to adverse physical health outcomes like myocardial infarction, haemorrhagic stroke, arrhythmia and seizure. It can also cause severe psychological complications such as psychosis. National survey data point to increasing rates of methamphetamine use, as well as increasing ease of access and serious methamphetamine-related harms. There is an urgent need for evidence to address knowledge gaps, provide direction to harm reduction and treatment efforts and inform health and social policies for people using methamphetamine. This protocol describes a study that aims to address this need for evidence. METHODS The study will use linked, whole population, de-identified administrative data from the Manitoba Population Research Data Repository. The cohort will include individuals in the city of Winnipeg, Manitoba, who came into contact with the health system for reasons related to methamphetamine use from 2013 to 2021 and a comparison group matched on age, sex and geography. We will describe the cohort's sociodemographic characteristics, calculate incidence and prevalence of mental disorders associated with methamphetamine use and examine rates of health and social service use. We will evaluate the use of olanzapine pharmacotherapy in reducing adverse emergency department outcomes. In partnership with Indigenous co-investigators, outcomes will be stratified by First Nations and Métis identity. ETHICS AND DISSEMINATION The study was approved by the University of Manitoba Health Research Ethics Board, and access datasets have been granted by all data providers. We also received approval from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Métis Federation. Dissemination will be guided by an 'Evidence 2 Action' group of public rightsholders, service providers and knowledge users who will ensure that the analyses address the critical issues.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Freier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott C McCulloch
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hera J M Casidsid
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Drew Mulhall
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Carolyn Shimmin
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Neil McDonald
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Javier Mignone
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aynslie Hinds
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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13
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Roos LL, Wall-Wieler E, Burchill C, Hamm NC, Hamad AF, Lix LM. Record Linkage and Big Data-Enhancing Information and Improving Design. J Clin Epidemiol 2022; 150:18-24. [PMID: 35760238 DOI: 10.1016/j.jclinepi.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To highlight the potential of multiple file record linkage. Linkage increases the value of existing information by supplying missing data or correcting errors in existing data, through generating important covariates, and by using family information to control for unmeasured variables and expand research opportunities. STUDY DESIGN AND SETTING Recent Manitoba papers highlight the use of linkage to produce better studies. Specific ways in which linkage helps deal with different substantive issues are described. RESULTS Wide data files-files containing considerable amounts of information on each individual-generated by linkage improve research by facilitating better design. Nonexperimental work in particular benefits from such linkages. Population registries are especially valuable in supplying family data to facilitate work across different substantive fields. CONCLUSION Several examples show how record linkage magnifies the value of information from individual projects. The results of observational studies become more defensible through the better designs facilitated by such linkage.
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Affiliation(s)
- Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB.
| | - Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
| | - Charles Burchill
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
| | - Naomi C Hamm
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
| | - Amani F Hamad
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
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14
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Collyer C, Bell MF, Christian HE. Associations between the built environment and emotional, social and physical indicators of early child development across high and low socioeconomic neighbourhoods. Int J Hyg Environ Health 2022; 243:113974. [PMID: 35649339 DOI: 10.1016/j.ijheh.2022.113974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/09/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022]
Abstract
Emerging evidence indicates that the built environment influences early child development. Access to, and the quality of, built environment features vary with the socioeconomic status (SES) of neighbourhoods. It has not yet been established whether the association between built environment features and early child development varies by neighbourhood SES. We sought to identify built environment features associated with neighbourhood-level variations in the early child development domains of physical health and wellbeing, social competence, and emotional maturity, and how these associations differ among high and low SES neighbourhoods where child development patterns follow expected outcomes ("on-diagonal" neighbourhoods) and where child development patterns differ from expected outcomes ("off-diagonal" neighbourhoods). This cross-sectional study analysed data from the Australian Early Development Census (AEDC) for children residing in 3839 neighbourhoods in the Perth and Peel metropolitan areas of Western Australia. Children's AEDC scores were aggregated at the area-level and merged with Geographic Information Systems derived measures of neighbourhood residential density, parks, walkability, community facilities and public transport. Multivariate logistic regressions modelled the odds of low and high SES neighbourhoods having a higher proportion of children developmentally "on-track" (scores in the 26th to 100th percentile of the AEDC) or "not on-track" (scores in the bottom 25th percentile of the AEDC) for each built environment feature. In high SES neighbourhoods, better development across all three domains was associated with greater residential density and improved access to parks, public transport, learning, childcare and health services. Conversely, in low SES neighbourhoods, greater residential density was associated with better physical, but poorer social and emotional development; increased traffic and street connectivity were associated with poorer physical and emotional development; shorter distances to parks, learning, childcare and health services were associated with poorer physical and emotional development; and more services and public transport stops were associated with poorer emotional development. The mixed findings in low SES neighbourhoods suggest that positive associations with built environment features seen in one domain of early child development may be negative in other domains. The reasons for the mixed findings in low SES neighbourhoods are likely multifactorial and may include parental neighbourhood perceptions, as well as quality and usage of built environment features. These findings can be used to inform state and local governments to establish child-friendly town planning and urban design features. Further research is needed to confirm the interplay between SES, early child development, the built environment and other unmeasured factors to better inform public health policy.
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Affiliation(s)
- Cassandra Collyer
- School of Population and Global Health, The University of Western Australia, Address: 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Megan F Bell
- School of Population and Global Health, The University of Western Australia, Address: 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Hayley E Christian
- School of Population and Global Health, The University of Western Australia, Address: 35 Stirling Highway, Crawley, Western Australia, 6009, Australia; Telethon Kids Institute, The University of Western Australia, Address: Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia, 6009, Australia.
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15
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Marti-Castaner M, Pavlenko T, Engel R, Sanchez K, Crawford AE, Brooks-Gunn J, Wimer C. Poverty after Birth: How Mothers Experience and Navigate U.S. Safety Net Programs to Address Family Needs. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:2248-2265. [PMID: 35539282 PMCID: PMC9073812 DOI: 10.1007/s10826-022-02322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Although pregnancy and the first year of life are sensitive windows for child development, we know very little about the lived experiences of mothers living in poverty or near poverty during the perinatal period; specifically, how they perceive and use public resources to support themselves and their newborn. In this qualitative study, we explore how predominantly Black and Latinx mothers with infants living in or near poverty and engaged in public assistance manage to meet their family's needs with available resources from safety net programs and social supports. We conducted 20 qualitative interviews with mothers living in (85%) or near poverty in New York City (NYC). All participants (mean age = 24) had an 11-month-old infant at the time of the interview. Using thematic analysis, we identified five main themes reflecting how mothers experience and navigate living with very low incomes while engaging in public assistance programs: (1) experiencing cascading effects of hardships during pregnancy, (2) relying on food assistance and informal supports amid scarcity, (3) waiting for limited affordable housing: 'life on hold', (4) finding pathways towards stability after the baby's birth, (5) making it work: efforts to look forward. Results describe how the current focus on "work first" of existing federal and state policies adds a layer of stress and burden on the lives of single mothers experiencing low incomes and entangled hardships during pregnancy and after birth. We document how mothers experience coverage gaps and implementation challenges navigating the patchwork of public assistance programs, yet how the support of flexible caseworkers accessing, using, and coordinating assistance has the potential to help mothers plan for longer-term goals.
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Affiliation(s)
- Maria Marti-Castaner
- Copenhagen University, Department of Public Health, Section of Health Services Research, Copenhagen, Denmark
| | | | - Ruby Engel
- Columbia University, Center on Poverty and Social Policy, New York, NY USA
| | - Karen Sanchez
- Columbia University, Center on Poverty and Social Policy, New York, NY USA
| | | | | | - Christopher Wimer
- Columbia University, Center on Poverty and Social Policy, New York, NY USA
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16
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Sheehan K, Bhatti PK, Yousuf S, Rosenow W, Roehler DR, Hazekamp C, Wu HW, Orbuch R, Bartell T, Quinlan K, DiCara J. Long-term effects of a community-based positive youth development program for Black youth: health, education, and financial well-being in adulthood. BMC Public Health 2022; 22:593. [PMID: 35346129 PMCID: PMC8962150 DOI: 10.1186/s12889-022-13016-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Childhood poverty is known to be associated with poor health. For youth living in extreme poverty, community-based programs focused on youth development are one strategy to improve health and well-being outcomes. However, very few evaluations of the long-term effectiveness of youth development programs have been conducted.
The aim of this study was to assess the long-term effectiveness of a positive youth development program (PYD), serving a segregated housing project with a history of community violence, to improve the health, education, and financial well-being of its alumni.
Methods
A quasi-experimental causal comparative study design was used to study the effectiveness of the Cabrini-Green Youth Program (CGYP). CGYP alumni (mean: 16.8 +/- 7.4 years after program participation) were surveyed. For comparison, participants from the same housing project who were eligible to participate in the CGYP but did not, were identified.
Results
In total, 246/417 (59%) eligible alumni were located. 221 alumni were available to be interviewed; 191/221 (86%) completed the interview survey along with 143 in the comparison group. Both groups self-identified as being Black, African American, and of Other race. Alumni were younger (34.6 vs. 38.1 years, p < .001), less likely to be female (62% vs. 74%, p =.03), and more likely to have been abused as a child (26% vs. 11%, p = .001). The majority in both groups reported to be in good to excellent health (83% of alumni vs. 74% of comparison group). After adjusting for comparison group differences, alumni were more likely to have completed college, 24% vs. 12% (adjusted odds ratio (aOR) 2.47, 95% CI, 1.25–4.86), and to end up with some money at the end of the month, 35% vs. 19% (aOR 2.16, 95% CI, 1.17, 3.97).
Conclusions
Participation in a PYD program starting at a young age may be associated with reduced poverty in adulthood, possibly aided by higher educational attainment and resultant increased income. PYD may be an effective strategy to supplement evidenced-based poverty reducing policies. This study of a voluntary, community-based PYD program is unique in its up to 33-year follow-up and an outcome assessment that measures more than knowledge change.
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Barrett JT, Lee LK, Monuteaux MC, Farrell CA, Hoffmann JA, Fleegler EW. Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth. JAMA Pediatr 2022; 176:e214822. [PMID: 34807238 PMCID: PMC8609463 DOI: 10.1001/jamapediatrics.2021.4822] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Youth firearm-related deaths are a public health crisis in the US. The association between county-level poverty and the risk of firearm-related deaths among youth is unknown, however. OBJECTIVE To examine the association between county-level poverty concentration and firearm-related mortality rates in US youth. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed US firearm fatalities in children and young adults aged 5 to 24 years that occurred between January 1, 2007, and December 31, 2016. Data were obtained from the Centers for Disease Control and Prevention's Compressed Mortality File, and annual intercensal county population data were obtained from the US Census Bureau. Data analyses were conducted between November 1, 2019, and June 30, 2020. EXPOSURES County-level poverty was categorized into 5 groups: 0% to 4.9%, 5% to 9.9%, 10% to 14.9%, 15% to 19.9%, and ≥20% of the population living below the federal poverty level. MAIN OUTCOMES AND MEASURES The main outcomes were firearm-related deaths in total and by specific intent (homicide, suicide, and unintentional) per 100 000 youths over the entire study period. Multivariable negative binomial regression models were used to analyze the association between firearm-related mortality rates and county poverty concentration, controlling for demographic variables, urbanicity, and statewide firearm prevalence. Adjusted incidence rate ratios (IRRs) were calculated, and statewide firearm prevalence was estimated. The population-attributable fraction (PAF) and years of potential life lost for each intent were calculated. RESULTS A total of 67 905 firearm-related deaths among youth (predominantly composed of 60 164 male individuals [88.6%]) from 2007 to 2016 were analyzed. Of these deaths, 42 512 were homicides (62.6%), 23 034 were suicides (33.9%), and 1627 were unintentional (2.4%). Firearm-related mortality risk increased in a stepwise manner with increasing county poverty concentration. Compared with counties with the lowest poverty concentration, counties with the highest poverty concentration had an increased rate of total firearm-related deaths (adjusted IRR, 2.29; 95% CI, 1.96-2.67), homicides (adjusted IRR, 3.55; 95% CI, 2.80-4.51), suicides (adjusted IRR, 1.45; 95% CI, 1.20-1.75), and unintentional deaths (adjusted IRR, 9.32; 95% CI, 2.32-37.4). The PAF was 0.51 (95% CI, 0.43-0.57) for all firearm-related deaths, 0.66 (95% CI, 0.57-0.73) for homicides, 0.30 (95% CI, 0.17-0.42) for suicides, and 0.86 (95% CI, 0.46-0.97) for unintentional deaths. This calculation translated to 34 292 firearm-related deaths that would not have occurred if all counties had the same risk as counties with the lowest poverty concentration. A total of 3 833 105 years of potential life lost was observed. CONCLUSIONS AND RELEVANCE This study found an association between firearm-related mortality rates among youth and county-level poverty concentration. With more than half of firearm-related deaths and two-thirds of firearm-related homicides potentially associated with living in an area with a high concentration of poverty, a multidimensional strategy to reduce poverty and firearm-related deaths is urgently needed.
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Affiliation(s)
- Jefferson T. Barrett
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Children’s Hospital at Montefiore, Bronx, New York,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York,Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K. Lee
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael C. Monuteaux
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Caitlin A. Farrell
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jennifer A. Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Goldschmidt T, Petersen L, Booley S, Roman NV. Perspectives of nurturance within the parent-child relationship in resource-constrained families. Child Care Health Dev 2021; 47:494-500. [PMID: 33638196 DOI: 10.1111/cch.12861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nurturing parents raise children in an engaged, flexible, emotionally expressive and supportive manner, which is associated with positive outcomes for children. While parenting research within the South African context is increasing, there is a lack of focus on nurturance within the parent-child relationship. Thus, this study sought to explore how parents nurture their children in resource-constrained environments in South Africa. METHOD A qualitative approach with an exploratory research design was used. Participants were purposively recruited via non-governmental institutions and key informants in the communities. A sample of 77 semi-structured interviews was conducted with participants from two rural areas, Calvinia and Lamberts Bay, in South Africa. RESULTS A thematic analysis of the data revealed two themes. The first theme is nurturance approaches, which encapsulate how parents nurture their children physically and emotionally. The second theme focuses on factors contributing to nurturance within the parent-child relationship with regard to parenting practices and external factors. CONCLUSION Although parents are nurturing children physically and emotionally, parenting capacity needs to be improved in the South African context.
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Affiliation(s)
- Tessa Goldschmidt
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, Cape Town, South Africa
| | - Lisa Petersen
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, Cape Town, South Africa
| | - Shakierah Booley
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, Cape Town, South Africa
| | - Nicolette V Roman
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, Cape Town, South Africa
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19
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Yang-Huang J, van Grieken A, You Y, Jaddoe VWV, Steegers EA, Duijts L, Boelens M, Jansen W, Raat H. Changes in Family Poverty Status and Child Health. Pediatrics 2021; 147:peds.2020-016717. [PMID: 33685984 DOI: 10.1542/peds.2020-016717] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In this study, we aim to assess the associations over time between poverty and child weight status, asthma, and health-related quality of life (HRQoL). METHODS We analyzed data for 3968 children from the Generation R Study, a population-based cohort study in the Netherlands. Net household income and the number of adults and children living from this income were measured at 4 time-points (during pregnancy and at ages 2, 3, and 6). Poverty was defined on the basis of the equivalized household income being <60% of the median national income. Child health outcomes were measured at age 6 years. The association was explored by using logistic and linear regression models. RESULTS In this cohort, 9.8% of children were born into poverty and 6.0% had experienced 3 to 4 episodes of poverty. Independent of current poverty status, children born into poverty had an odds ratio (OR) of 1.68 for having overweight/obesity and a lower physical HRQoL (OR = -1.32) than those not born into poverty. Children having experienced 3 to 4 episodes of poverty had an OR of 1.94 for having asthma and a lower physical HRQoL (OR = -3.32) compared with children from never-poor families. Transition out of poverty before age 2 was associated with lower risk of asthma and a higher physical HRQoL compared with children who remained in poverty. CONCLUSIONS Being born into poverty or experiencing multiple episodes of poverty is associated with negative child health outcomes, such as having overweight, asthma, or a lower HRQoL. Support for children and families with a low household income is warranted.
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Affiliation(s)
| | | | - Yueyue You
- The Generation R Study Group.,Public Health, and
| | - Vincent W V Jaddoe
- The Generation R Study Group.,Departments of Pediatrics.,Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric A Steegers
- Obstetrics and Gynecology, Erasmus Medical Center, University Medical Centre Rotterdam, Rotterdam, the Netherlands; and
| | - Liesbeth Duijts
- Divisions of Respiratory Medicine and Allergology and Neonatology, Departments of Pediatrics and
| | | | - Wilma Jansen
- Public Health, and.,Municipality of Rotterdam, Rotterdam, the Netherlands
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20
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Collier LR, Gregory T, Harman-Smith Y, Gialamas A, Brinkman SA. Inequalities in child development at school entry: A repeated cross-sectional analysis of the Australian Early Development Census 2009-2018. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2020; 4:100057. [PMID: 34327392 PMCID: PMC8315438 DOI: 10.1016/j.lanwpc.2020.100057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Australia is the only developed country to consistently undertake a developmental census of its children nationwide. The repeated collection of the Australian Early Development Census (AEDC) has provided an unprecedented opportunity to examine the prevalence of developmental vulnerability across Australia's states and territories, the socio-economic distribution of developmental vulnerability across jurisdictions, and how these distributions might have changed over time. METHODS This study employed multivariable logistic regressions to estimate the probability of developmental vulnerability within each jurisdiction and AEDC collection year (2009 to 2018), adjusting for jurisdictional differences in socio-demographic characteristics. To explore socio-economic inequalities in child development, adjusted slope index of inequality (SII) models were utilised. FINDINGS The results of this study found reductions in the adjusted prevalence of developmental vulnerability over time in Western Australia (26% to 20%) and Queensland (30% to 25%), with an increase observed in the Australian Capital Territory (27% to 30%). Analysis also indicated an increase in socio-economic inequalities over time in the Northern Territory (+12%), the Australian Capital Territory (+6%) and Tasmania (+4%). Sensitivity analysis found these effects to be robust with an alternative measure of socio-economic position. INTERPRETATION There is considerable variation in the prevalence and socio-economic inequalities in developmental vulnerability across Australia's jurisdictions. Future research should explore the policy drivers in early childhood education and health contributing to the findings of this study, with a particular focus on jurisdictions where there have been notable changes in developmental vulnerability and socio-economic inequality over time. FUNDING Analyses were funded under research contract by the Department of Education, Skills and Employment. Prof Brinkman is supported by a National Health and Medical Research Council fellowship, APP1160185.
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Affiliation(s)
- Luke R. Collier
- Telethon Kids Institute, The University of Western Australia, Level 7, 31 Flinders St., Adelaide, SA 5000, Australia
- School of Public Health, The University of Adelaide, Level 9, Adelaide Health And Medical Science Building, 57 North Terrace, Adelaide, SA 5005, Australia
| | - Tess Gregory
- Telethon Kids Institute, The University of Western Australia, Level 7, 31 Flinders St., Adelaide, SA 5000, Australia
- School of Public Health, The University of Adelaide, Level 9, Adelaide Health And Medical Science Building, 57 North Terrace, Adelaide, SA 5005, Australia
| | - Yasmin Harman-Smith
- Telethon Kids Institute, The University of Western Australia, Level 7, 31 Flinders St., Adelaide, SA 5000, Australia
- School of Public Health, The University of Adelaide, Level 9, Adelaide Health And Medical Science Building, 57 North Terrace, Adelaide, SA 5005, Australia
| | - Angela Gialamas
- School of Public Health, The University of Adelaide, Level 9, Adelaide Health And Medical Science Building, 57 North Terrace, Adelaide, SA 5005, Australia
| | - Sally A. Brinkman
- Telethon Kids Institute, The University of Western Australia, Level 7, 31 Flinders St., Adelaide, SA 5000, Australia
- School of Public Health, The University of Adelaide, Level 9, Adelaide Health And Medical Science Building, 57 North Terrace, Adelaide, SA 5005, Australia
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21
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Wall-Wieler E, Roos LL, Gotlib IH. Maternal Depression in Early Childhood and Developmental Vulnerability at School Entry. Pediatrics 2020; 146:e20200794. [PMID: 32817440 PMCID: PMC7461243 DOI: 10.1542/peds.2020-0794] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the relation between exposure to maternal depression before age 5 and 5 domains of developmental vulnerability at school entry, overall, and by age at exposure. METHODS This cohort study included all children born in Manitoba, Canada, who completed the Early Development Instrument between 2005 and 2016 (N = 52 103). Maternal depression was defined by using physician visits, hospitalizations, and pharmaceutical data; developmental vulnerability was assessed by using the Early Development Instrument. Relative risk of developmental vulnerability was assessed by using log-binomial regression models adjusted for characteristics at birth. RESULTS Children exposed to maternal depression before age 5 had a 17% higher risk of having at least 1 developmental vulnerability at school entry than did children not exposed to maternal depression before age 5. Exposure to maternal depression was most strongly associated with difficulties in social competence (adjusted relative risk [aRR] = 1.28; 95% confidence interval [CI]: 1.20-1.38), physical health and well-being (aRR = 1.28; 95% CI: 1.20-1.36), and emotional maturity (aRR = 1.27; 95% CI: 1.18-1.37). For most developmental domains, exposure to maternal depression before age 1 and between ages 4 and 5 had the strongest association with developmental vulnerability. CONCLUSIONS Our finding that children exposed to maternal depression are at higher risk for developmental vulnerability at school entry is consistent with previous findings. We extended this literature by documenting that the adverse effects of exposure to maternal depression are specific to particular developmental domains and that these effects vary depending on the age at which the child is exposed to maternal depression.
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Affiliation(s)
| | - Leslie L Roos
- Psychology, Stanford University, Stanford, California; and
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22
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Taylor CL, Christensen D, Stafford J, Venn A, Preen D, Zubrick SR. Associations between clusters of early life risk factors and developmental vulnerability at age 5: a retrospective cohort study using population-wide linkage of administrative data in Tasmania, Australia. BMJ Open 2020; 10:e033795. [PMID: 32312726 PMCID: PMC7245408 DOI: 10.1136/bmjopen-2019-033795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Early childhood is a critical time to address risk factors associated with developmental vulnerability. This study investigated the associations between clusters of early life risk factors and developmental vulnerability in children's first year of full-time school at age 5. DESIGN A retrospective cohort study. SETTING Population-wide linkage of administrative data records for children born in Tasmania, Australia in 2008-2010. PARTICIPANTS The cohort comprised 5440 children born in Tasmania in 2008-2010, with a Tasmanian 2015 Australian Early Development Census (AEDC) record and a Tasmanian Perinatal Collection record. OUTCOME MEASURE The AEDC is a national measure of child development across five domains: physical health and well-being, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge. Children who scored below the 10th percentile on one or more AEDC domains were classified as developmentally vulnerable. Children with special needs are not included in the AEDC results. RESULTS Latent class analysis identified five clusters of risk factors: low risks (65% of children), sociodemographic and health behaviour risks (24%), teenage mother and sociodemographic risks (6%), birth risks (3%), and birth, sociodemographic and health behaviour risks (2%). In this sample population, 20% of children were classified as developmentally vulnerable, but the proportion varied substantially by latent class. Logistic regression showed increased odds of developmental vulnerability associated with sociodemographic and health behaviour risks (OR 2.26, 95% CI 1.91 to 2.68, p<0.001), teenage mother and sociodemographic risks (OR 2.01, 95% CI 1.50 to 2.69, p<0.001), and birth, sociodemographic and health behaviour risks (OR 3.29, 95% CI 2.10 to 5.16. p<0.001), but not birth risks (OR 1.34, 95% CI 0.88 to 2.03, p=0.1649), relative to the reference group. CONCLUSIONS The patterning of risks across the five groups invites consideration of multisectoral policies and services to address complex clusters of risk factors associated with developmental vulnerability.
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Affiliation(s)
- Catherine Louise Taylor
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Joel Stafford
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - David Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Stephen Rade Zubrick
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Western Australia, Australia
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23
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Hoffmann JA, Farrell CA, Monuteaux MC, Fleegler EW, Lee LK. Association of Pediatric Suicide With County-Level Poverty in the United States, 2007-2016. JAMA Pediatr 2020; 174:287-294. [PMID: 31985759 PMCID: PMC6990805 DOI: 10.1001/jamapediatrics.2019.5678] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Suicide is the second leading cause of death among youths aged 10 to 19 years in the United States, with rates nearly doubling during the past decade. Youths in impoverished communities are at increased risk for negative health outcomes; however, the association between pediatric suicide and poverty is not well understood. OBJECTIVE To assess the association between pediatric suicide rates and county-level poverty concentration. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study examined suicides among US youths aged 5 to 19 years from January 1, 2007, to December 31, 2016. Suicides were identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes from the Centers for Disease Control and Prevention's Compressed Mortality File. Data analysis was performed from February 1, 2019, to September 10, 2019. EXPOSURES County poverty concentration and the percentage of the population living below the federal poverty level. Counties were divided into 5 poverty concentration categories: 0% to 4.9%, 5.0% to 9.9%, 10.0% to 14.9%, 15.0% to 19.9%, and 20.0% or more of the population living below the federal poverty level. MAIN OUTCOMES AND MEASURES The study used a multivariable negative binomial regression model to analyze the association between pediatric suicide rates and county poverty concentration, reporting adjusted incidence rate ratios (aIRRs) with 95% CIs. The study controlled for year, demographic characteristics of the children who died (age, sex, and race/ethnicity), county urbanicity, and county demographic features (age, sex, and racial composition). Subgroup analyses were stratified by method. RESULTS From 2007 to 2016, a total of 20 982 youths aged 5 to 19 years died by suicide (17 760 [84.6%] were aged 15-19 years, 15 982 [76.2%] male, and 14 387 [68.6%] white non-Hispanic). The annual suicide rate was 3.35 per 100 000 youths aged 5 to 19 years. In the multivariable model, compared with counties with the lowest poverty concentration (0%-4.9%), counties with poverty concentrations of 10% or greater had higher suicide rates in a stepwise manner (10.0%-14.9%: aIRR, 1.25 [95% CI, 1.06-1.47]; 15.0%-19.9%: aIRR, 1.30 [95% CI, 1.10-1.54]; and 20.0% or more: aIRR, 1.37 [95% CI, 1.15-1.64]). When stratified by method, firearm suicides had the strongest association with county poverty concentration (aIRR, 1.87; 95% CI, 1.41-2.49) in counties with 20% or higher poverty concentration compared with counties with 0% to 4.9% poverty concentration. CONCLUSIONS AND RELEVANCE The findings suggest that higher county-level poverty concentration is associated with increased suicide rates among youths aged 5 to 19 years. These findings may guide research into upstream risk factors associated with pediatric suicide to inform suicide prevention efforts.
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Affiliation(s)
- Jennifer A. Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Caitlin A. Farrell
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Michael C. Monuteaux
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Lois K. Lee
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
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24
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Dreyer BP. What Canada Can Teach Us About Addressing Childhood Poverty. Pediatrics 2019; 143:peds.2019-0195. [PMID: 31110163 DOI: 10.1542/peds.2019-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Benard P Dreyer
- Department of Pediatrics, School of Medicine, New York University, New York, New York
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