Disparities in Child Well-Being Across Income Groups: Trends in the U.S. from 1985 to 2008

The income available in children’s families can profoundly impact child well-being, and the recent economic recession has drawn renewed attention to income inequality in the U.S. The present research is the first-ever to assess changing disparities in well-being among U.S. children who live in families with vastly different incomes through the use of an overall composite index that incorporates wide ranging domains and indicators of child well-being. Annually since 2004, Kenneth Land and colleagues have developed new results and presented findings for the Foundation for Child Development Child Well-Being Index (CWI) to monitor changes in overall child well-being for the U.S. To study changing disparities in child well-being across five income groups from 1985 to 2008, the present research combines this general approach for calculating a national CWI with a methodology developed by Hernandez and Macartney for assessing both levels and disparities in child well-being. The primary aim is to track and describe these trends, but some attention is devoted to discussion of public policies relevant to several indicators. Results regarding trends in overall well-being show for every income group that the small to negligible changes occurring between 1985 and 1992 were followed by substantial increases in well-being to a historic peak in 2000 for the overall index, and for specific income groups in one of the years between 1998 and 2003. This in turn was followed changes that led to a decline in well-being by 2008 for every income group.     

Visits to Primary Care and Emergency Department Reliance for Foster Youth: Impact of Medicaid Managed Care

Objective

To examine the rate of access to primary and preventive care and emergency department (ED) reliance for foster youth as well as the impact of a transition from fee-for-service (FFS) Medicaid to managed care (MC) on this access.

Predictors of Resident Satisfaction in Caring for Limited English Proficient Families: A Multisite Study

ObjectiveTo assess residents' self-efficacy, satisfaction and frustration in the care of limited English proficient (LEP) families and to identify individual and programmatic factors associated with the above outcomes.MethodsA multisite cross-sectional survey of pediatric residents currently in training and caring for LEP families was conducted. Resident self-efficacy scores in specific skill domains were assessed. Clustered multivariate logistic regression analyses were used to identify individual and programmatic factors associated with increased satisfaction and frustration. Qualitative analyses were also utilized to identify themes related to frustrating aspects of care.ResultsA total of 271 of 449 eligible residents representing 7 US pediatric residency programs participated in our study (60% response rate). A majority of residents (51%) rated their self-efficacy in the overall care of LEP families as low. Satisfaction was associated with a high self-efficacy score (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.8–12.6), increasing year in training (OR 3.2, 95% CI 1.01–10.2), frequent non-English language use (OR 3.1, 95% CI 1.1–8.8), and instruction on the use of interpreters (OR 1.9, 95% CI 1.02–3.64). Satisfaction was inversely associated with increased LEP patient volumes (OR 0.40, 95% CI 0.18–0.91). Clinical inefficiency related to interpreter use and distrust of interpreter skills were frequently cited as aspects that contribute to overall frustration.ConclusionsA majority of residents reported lacking self-efficacy in their ability to deliver care to LEP patients, which may influence overall satisfaction with such encounters. Strategies that promote resident self-efficacy and assess non-English language proficiency should be included in future training curricula. Exposing trainees to best practices in interpreter-based encounters may further promote resident satisfaction.     

Spatial Trends in the Risk of Social Exclusion for Australian Children: Patterns from 2001 to 2006

This paper compares small area estimates of the risk of social exclusion for Australian children aged 0–15 based on data from the 2001 and 2006 Censuses of Population and Housing conducted by the Australian Bureau of Statistics (ABS). Patterns of persistence and change in both the composite index and its underlying variables are analysed. The paper extends earlier work which focussed on 2001 data only. We find an overall tendency for child social exclusion risk to persist in small areas over time, although we also found some tentative support for a possible narrowing of the risk gap between the highest risk and lowest risk areas across the 5 year period. Children living outside the capital cities were at higher risk of social exclusion than those in capital cities across both periods, although most capital cities nevertheless contain areas of high risk in both years.

Identifying opportunities to bridge disparity gaps in curing childhood cancer in Malawi: Malignancies with excellent curative potential account for the majority of diagnoses

The majority of African children with cancer die without access to resources. We describe efforts to build a public treatment program with curative intent for childhood cancer in Lilongwe, Malawi despite severe limitations in diagnostic and therapeutic resources. We retrospectively analyzed a cohort of childhood cancer patients at Kamuzu Central Hospital from 12/2011–6/2013. Consistently available chemotherapeutic agents were limited to cyclophosphamide, vincristine, doxorubicin, bleomycin, methotrexate, and prednisone. Of 258 newly diagnosed childhood malignancies, 17 patients with retinoblastoma were excluded from clinical analyses due to insufficient clinical data. Among the remainder of the cohort (n = 241), 42% were female with median age 8.4 years (range 0.6–17.9). Forty-six (19%) were HIV-infected (42 Kaposi sarcoma, 3 Burkitt lymphoma, 1 Hodgkin lymphoma). The most common clinical presentations were palpable abdominal mass (41%), peripheral lymphadenopathy (33%), and jaw mass (17%). Nearly two-thirds of total diagnoses were accounted for by Burkitt lymphoma (n = 74), Kaposi sarcoma (n = 52), Hodgkin lymphoma (n = 21), and Wilms tumor (n = 19). Twelve-month overall survival for these 4 most common diagnoses was 54% (95% confidence interval 46–61) versus 19% (95% confidence interval 11–30) for all other diagnoses (median follow-up 19 months). Treatment-related mortality was highest in patients with non-Wilms solid tumors of the abdomen (48% versus 10% for the overall cohort, p < 0.001), while treatment abandonment was highest in patients with bone and soft-tissue sarcomas (29% versus 14% overall, p = 0.05). Childhood cancers with excellent curative potential accounted for the majority of patients, establishing an opportunity to build treatment programs with curative intent despite severe limitations.     

Storytelling for persuasion: Insights from community health workers on how they engage family members to improve adoption of recommended maternal nutrition and breastfeeding behaviours in rural Bangladesh

Community health workers (CHWs) increasingly provide interpersonal counselling to childbearing women and their families to improve adoption of recommended maternal and child nutrition behaviours. Little is known about CHWs'' first‐hand experiences garnering family support for improving maternal nutrition and breastfeeding practices in low‐resource settings. Using focused ethnography, we drew insights from the strategies that CHWs used to persuade influential family members to support recommendations on maternal diet, rest and breastfeeding in a behaviour change communication trial in rural Bangladesh. We interviewed 35 CHWs providing at‐home interpersonal counselling to pregnant women and their families in seven ‘Alive & Thrive’ intervention sites. In‐depth probing focused on how CHWs addressed lack of family support. Thematic coding based on Fisher''s narrative paradigm revealed strategic use of three rhetorical principles by CHWs: ethos (credibility), pathos (emotion) and logos (logic). CHWs reported selectively targeting pregnant women, husbands and mothers‐in‐law based on their influence on behavioural adoption. Key motivators to support recommended behaviours were improved foetal growth and child intelligence. Improved maternal health was the least motivating outcome, even among mothers. Logically coherent messaging resonated well with husbands, while empathetic counselling was additionally required for mothers. Mothers‐in‐law were most intransigent, but were persuaded via emotional appeals. Persuasion on maternal rest was most effort‐intensive, resulting in contextually appealing but scientifically inaccurate messaging. Our study demonstrates that CHWs can offer important insights on context‐relevant, feasible strategies to improve family support and uptake of nutrition recommendations. It also identifies the need for focused CHW training and monitoring to address scientifically flawed counselling narratives.     

Use of food labels,awareness of nutritional programmes and participation in the special supplemental program for Women,Infants and Children (WIC): results from the National Health and Nutrition Examination Survey (2005–2006)

Use of nutritional labels in choosing food is associated with healthier eating habits including lower fat intake. Current public health efforts are focusing on the revamping of nutritional labels to make them easier to read and use for the consumer. The study aims to assess the frequency of use of nutritional labels and awareness of the United States Department of Agriculture (USDA) nutritional programmes by low‐income women including those participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as surveyed in the National Health and Nutrition Examination Survey 2005–2006. Many low‐income women do not regularly use the nutrition facts panel information on the food label and less than half had heard of the USDA Dietary Guidelines for Americans (38.9%). In multivariate logistic regression, we found that WIC participation was associated with reduced use of the nutrition facts panel in choosing food products [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.22–0.91], the health claims information (OR 0.54, 95% CI 0.32–0.28) and the information on carbohydrates when deciding to buy a product (OR 0.44, 95% CI 0.20–0.97) in comparison with WIC eligible non‐participants. Any intervention to improve use of nutritional labels and knowledge of the USDA's nutritional programmes needs to target low‐income women, including WIC participants. Future studies should evaluate possible reasons for the low use of nutrition labels among WIC participants in comparison with eligible non‐participants.