This article focuses on the rationale, design and methods of an effectiveness-implementation hybrid type I randomized trial of eHealth Familias Unidas Mental Health, a family-based, online delivered ...intervention for Hispanic families to prevent/reduce depressive and anxious symptoms, suicide ideation/behaviors, and drug use in Hispanic youth. Utilizing a rollout design with 18 pediatric primary care clinics and 468 families, this study addresses intervention effectiveness, implementation research questions, and intervention sustainment, to begin bridging the gap between research and practice in eliminating mental health and drug use disparities among Hispanic youth. Further, we will examine whether intervention effects are partially mediated by improved family communication and reduced externalizing behaviors, including drug use, and moderated by parental depression. Finally, we will explore whether the intervention's impact on mental health and drug use, as well as sustainment of the intervention in clinics, varies by quality of implementation at clinic and clinician levels. Trail registration: ClinicalTrials.gov Identifier: NCT05426057, First posted June 21, 2022.
Adverse Childhood Experiences (ACEs) have been associated with a higher risk of developing cardiovascular diseases and premature mortality in adults.
We evaluated the associations between ACEs and ...heart diseases among children in the United States.
Data on children ages 0 to 17 years reported by parents/guardians to have current heart conditions were analyzed. Using Stata version 17 software, descriptive statistics were generated for the demographic characteristics and the various health outcomes using the chi-square of independence. Multivariate logistic regression models were employed to determine the associations between ACEs and heart conditions, the severity of heart conditions, and overall health status.
There were 826 children with current heart conditions from a total of 68,753 surveyed children. This corresponded to an estimated 780,000 (1.13%) children living with heart conditions in the U.S. On multivariate logistic models, several ACEs, including household economic hardship, parental/guardian's alcohol/drug abuse, severe mental health illness of parents/guardians, racial/ethnic discrimination, exposure to neighborhood violence, and accumulation of two or more ACEs, were significantly associated with heart diseases among children. Though the accumulation of two or more ACEs did not have a significant association with the severity of heart condition, it was significantly associated with caregiver reports of undesirable overall health status.
ACEs are significantly associated with heart conditions among children and contribute to unfavorable overall health status among children with heart conditions in the U.S. There is a need for policies and programs that will promptly identify ACEs and mitigate their negative impact on children.
Racial and ethnic minority communities have been disproportionately affected by COVID-19, but the uptake of COVID-19 mitigation strategies like vaccination and testing have been slower in these ...populations. With the continued spread of COVID-19 while in-person learning is a priority, school-aged youth and their caregivers must make health-related decisions daily to ensure health at school. It is critical to understand factors associated with COVID-related health decisions such as vaccination, testing, and other health behaviors (e.g., wearing masks, hand washing). Community-engaged campaigns are necessary to overcome barriers to these health behaviors and promote health equity. The aim of this study was to examine COVID-19-related concerns and influences on health decisions in middle and high schools serving primarily racial and ethnic minority, low-income families. Seven focus groups were conducted with school staff, parents, and students (aged 16 years and older). Qualitative data were analyzed using a general inductive approach. Factors related to COVID-19 concerns and health decisions centered on (1) vaccine hesitancy, (2) testing hesitancy, (3) developmental stage (i.e., ability to engage in health behaviors based on developmental factors like age), (4) cultural and family traditions and beliefs, (5) compatibility of policies and places with recommended health behaviors, (6) reliability of information, and (7) perceived risk. We explore sub-themes in further detail. It is important to understand the community's level of concern and identify factors that influence COVID-19 medical decision making to better address disparities in COVID-19 testing and vaccination uptake.
Inadequate access to menstrual hygiene supplies, termed “period poverty,” has been documented in low-resource settings globally. However, there is little data on period poverty among American ...adolescents, with no data available on immigrants or non-English speaking adolescents. The objective of this study is to quantify period poverty among a diverse population of adolescent girls in Miami, Florida. This study determines where adolescents obtain menstrual products, how they cope with inadequate supplies and the effect of period poverty on education.
Adolescent girls attending public schools served by University of Miami school-based clinics were surveyed upon presentation to the clinic. Students were given menstrual pads with an attached QR code that linked to an anonymous, online survey. Convenience sampling was used. Funding was provided by the NASPAG Young Investigators grant.
73 students completed the survey. 63 surveys were in English, 7 in Spanish and 3 in Haitian-Creole. This is the first study that includes adolescents speaking Spanish and Haitian-Creole. The average age was 15. 60% were born in the United States, 29% in Haiti, 11% in Latin America. 58% of adolescents did not have enough menstrual products available at home in the past year. Every month or almost every month, girls asked family and friends (37%) and/or went to the school clinic (37%). 53% of girls soaked through their clothes with their periods. 41% missed school because of their periods and 14% of girls missed school because of period poverty. Among girls who stated that it was “easy” to manage their periods, 29% missed school because of their periods; among girls who said it was “difficult” to manage their periods, 65% of girls missed school because of their periods. 39% reported getting into trouble at school because of their periods.
Our study represents the most ethnically diverse study population on American adolescents and period poverty available in the literature. The majority of adolescents in our study did not have adequate access to menstrual supplies and school participation was negatively impacted as a result. This study highlights the importance of providing period products in schools and the need that school-based clinics fill by providing menstrual products to vulnerable adolescents. Increasing access to period supplies should be a priority for adolescent health care providers. Health care providers should ask adolescents if they have access to sufficient menstrual products, legislation to provide funding for free menstrual products in schools should be passed, and “banks” of menstrual supplies should be made available in low-resource areas.
Background
Numerous studies have shown a disproportionate impact of COVID-19 infection on Black and Hispanic Americans in the adult patient population. However, few studies have been done with ...pediatric populations. The aim of this study is to identify the prevalence and distribution of COVID-19 cases among pediatric patients in Miami-Dade and Broward counties and identify any sociodemographic disparities.
Methods
A total of 10,087 children/adolescents ages zero years-old to 20 years-old were tested from July 1, 2020, to December 31, 2020. ArcGIS was used to map cases and obtain sociodemographic data. SPSS software was used to determine significance of data trends and create a predictive model.
Results
There were 1,161 pediatric COVID-19 cases detected. White Hispanics and Black Hispanics had statically significantly higher cases when compared to White non-Hispanics and Black non-Hispanics. Percentage of households on food stamps, percentage of households below the poverty line, percentage of minority populations, and percentage of Hispanic population showed a positive correlation with detected pediatric COVID-19 cases. Alternatively, areas with higher median household incomes and higher educational status were negatively correlated with COVID-19. Percentage of Hispanic population and percentage of households below the poverty line were predictive of pediatric COVID-19 cases.
Conclusion
There was a disproportionate impact of pediatric COVID-19 infection on zip codes of lower socioeconomic status and increased racial/ethnic minority populations. This study demonstrates the need for public health policies that prioritize testing children/adolescents in these communities.
Objective
The Centers for Disease Control and Prevention’s (CDC’s) recommendation for blood lead level (BLL) screening of refugee children is to test new arrivals aged 6 months to 16 years. No such ...recommendations exist for testing immigrant children. Our objective was to provide evidence in support of creating lower age-specific guidelines for BLL screening for newly arrived immigrant populations to reduce the burden of unnecessary BLL testing.
Methods
We conducted a 3-year (2013-2016) retrospective analysis of BLLs of 1349 newly arrived immigrant children, adolescents, and young adults aged 3-19 who visited the University of Miami Pediatric Mobile Clinic in Miami, Florida. We obtained capillary samples and confirmed values >5 μg/dL via venous sample. The primary outcome was BLL in μg/dL. The main predictor variable was age. We further adjusted regression models by poverty level, sex, and ethnicity.
Results
Of 15 patients with a BLL that warranted further workup and a lead level of concern, 9 were aged 3-5 and 6 were aged 6-11. None of the adolescent and young adult patients aged 12-19 had a lead level of concern. Nearly half of the patients (n = 658, 48.8%) lived in zip codes of middle to high levels of poverty.
Conclusion
This study provides evidence to support the creation of lower age-specific guidelines for BLL screening among newly arrived immigrant children and adolescents. Future studies should elucidate appropriate age ranges for BLL testing based on epidemiologic evidence, such as age and country of origin.
Understanding the motivators and barriers to testing enrollment from different stakeholder perspectives is essential to increasing participation in school-based testing programs, particularly among ...underserved populations. This multistudy analysis aimed to identify facilitators and barriers to enrollment in school-based testing for coronavirus disease 2019 (COVID-19).
Four independent studies collected and analyzed qualitative data from study participants regarding: (1) motivators, benefits, and/or reasons for enrolling and/or participating in COVID-19 testing in schools; and/or (2) concerns, barriers, and/or negative outcomes related to COVID-19 testing in schools. Study authors conducted a retrospective review of findings from the independent studies to identify themes related to testing motivators and concerns that emerged across the studies.
The analysis identified 10 distinct themes regarding the perceived motivators of COVID-19 testing in schools and 15 distinct themes regarding concerns and barriers to COVID-19 testing in schools. Common motivators across multiple studies included convenience of testing in school and the desire to keep self and others safe from COVID-19. Concerns about the implications of receiving a positive test result was a barrier identified by multiple studies.
Themes from 4 independent studies revealed insights about the motivations and barriers to enrolling and participating in COVID-19 testing programs in kindergarten through 12th grade school settings. Study findings can be used to improve enrollment and participation in new and existing school-based testing programs to reduce transmission of COVID-19 and other infectious diseases in schools.
The Centers for Disease Control and Prevention recommend that schools can offer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic (on-demand) testing for students and staff with ...coronavirus disease 2019 symptoms or exposures. Data related to the uptake, implementation, and effect of school-associated on-demand diagnostic testing have not been described.
The Rapid Acceleration of Diagnostics Underserved Populations Return to School program provided resources to researchers to implement on-demand SARS-CoV-2 testing in schools. This study describes the strategies used and uptake among the different testing programs. Risk of positivity was compared for symptomatic and exposure testing during the δ and ο variant periods. We estimated the number of school absence days saved with school-based diagnostic testing.
Of the 16 eligible programs, 7 provided school-based on-demand testing. The number of persons that participated in these testing programs is 8281, with 4134 (49.9%) receiving >1 test during the school year. Risk of positivity was higher for symptomatic testing compared with exposure testing and higher during the ο variant predominant period compared with the δ variant predominant period. Overall, access to testing saved an estimated 13 806 absent school days.
School-based on-demand SARS-CoV-2 testing was used throughout the school year, and nearly half the participants accessed testing on more than 1 occasion. Future studies should work to understand participant preferences around school-based testing and how these strategies can be used both during and outside of pandemics.
ABSTRACT
BACKGROUND
Most pediatric elevated blood pressure (BP) remains undiagnosed. The American Academy of Pediatrics states “there is limited evidence to support school‐based measurement of ...children's BP.” We explored the utility school‐based BP screening.
METHODS
A cross‐sectional sample of 4096 students ages 6 to 17 from Title 1 Miami‐Dade Public Schools (50% female, 71% non‐Hispanic black, 26% Hispanic) had their systolic/diastolic BP (SBP/DBP) and body mass index (BMI) collected over the 2016 to 2017 or 2017 to 2018 school years. Relative risks (RRs) ratios were calculated to estimate normal/elevated SBP/DBP by BMI percentile, ethnicity, and
sex.
RESULTS
Overall, 26.4% had at least one elevated BP measurement, of which 59% were not obese. RR for obese status was significant for all categories of elevated BP (RRs > 1.88, p < .0001). Being either female (RR = 1.34, p = .009) or Hispanic (RR = 1.31, p = .014) was significantly associated with elevated DBP. BMI accounted for <10% of the variation in BP (SBP: F(1, 4095) = 367.6, adjusted R2 = .08, p < .0001; DBP: F(1, 4095) = 93.3, adjusted R2 = .02, p < .0001).
CONCLUSION
These findings support providing BP screenings in school settings. Low‐income and minority students often have limited access to health care, higher obesity rates, and unhealthy behaviors. Our findings support universal school‐based BP screening regardless of weight status, particularly among ethnically diverse populations.
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