Prevalence of maltreatment among youths in public sectors of care

Few studies have investigated the prevalence of maltreatment among youths in public sectors of care despite the critical public health concern and the burden of suffering on such youths. The current study examined the prevalence of multiple types of maltreatment across five public sectors of care. Youths aged 11-18 (n = 1,135) enrolled in one of five public sectors of care reported on their maltreatment history using the Childhood Trauma Questionnaire. Across all sectors, 78% of youth reported experiencing at least moderate levels of maltreatment with the majority (58%) reporting multiple types of maltreatment. The prevalence of maltreatment was highest for youths involved in the alcohol/drug (86%) and child welfare (85%) sectors, and lowest in the serious emotional disturbance sector (72%). Logistic regressions were conducted to examine differences in the likelihood of multiple types of maltreatment by sector affiliation, controlling for the effects of gender, race/ethnicity, and age. The results indicate that rates of maltreatment across sectors do not differ greatly from those in child welfare. The high incidence of maltreatment across all sectors, not solely child welfare, indicates that all youth in public sectors of care should be screened for a history of maltreatment when they enter into care.     

Understanding social support's role in the relationship between maltreatment and depression in youth with foster care experience

This study investigated whether more complex maltreatment experiences predicted higher levels of depressive symptomatology for young adults and examined the role of social support during late adolescence in that association. Specifically, the study tested whether social support had a direct effect on depression and whether it mediated and/or moderated the relationship between self-reported maltreatment and depression in a sample of 513 youth exiting the child welfare system. Indices of maltreatment types (neglect and physical, sexual, psychological abuse) experienced during two periods (precare and during-care) were used in conjunction with a measure of perceived social support (reflecting support availability and social network sufficiency) in negative binomial regression models predicting depressive symptoms. Both precare and during-care maltreatment were associated with depressive symptoms as a young adult. Social support had a direct effect on depressive symptoms as well as moderation and partial mediation effects on the relationship between maltreatment and depression. Social support's buffering effect was stronger for those experiencing fewer types of maltreatment. This buffering effect appears to diminish as maltreatment histories become more complex.     

Exclusive Breastfeeding in the Northwest: Disparities Related to Race/Ethnicity and Substance Use

Background and ObjectivesMothers who are Black, Indigenous, and people of color (BIPOC) are disproportionately impacted by substance use in pregnancy and less likely to breastfeed. Our objectives were to assess relationships between substance use in pregnancy and exclusive breastfeeding at discharge (EBF) and race/ethnicity and EBF, and determine the extent to which substance use influences the relationship between race/ethnicity and EBF.MethodsThis is a retrospective cohort study of term mother-infant dyads using 2016 to 2019 data from a Northwest quality improvement collaborative, Obstetrical Care Outcomes Assessment Program. Stepwise and stratified multivariable logistic regression analyses were conducted to determine associations between independent variables consisting of characteristics, including maternal race/ethnicity and substance use, and the dependent variable, EBF.ResultsOur sample consisted of 84,742 dyads, 69.5% of whom had EBF. The adjusted odds of EBF for non-Hispanic Black and Hispanic mothers were half, and for American Indian/Alaska Native mothers two-thirds, that of White mothers (aOR [95% CI]: 0.52 [0.48, 0.57], 0.51 [0.48, 0.54], 0.64 [0.55, 0.76], respectively). Substance use did not mediate the association between race/ethnicity and EBF, but it modified the association. Among those reporting nicotine or marijuana use, Hispanic mothers were half as likely as White mothers were to exclusively breastfeed. Other factors associated with a lower likelihood of EBF included public or no insurance, rural setting, C-section, NICU admission, and LBW.ConclusionsDisparities in EBF related to race/ethnicity and substance use were pronounced in this study, particularly among Hispanic mothers with nicotine or marijuana use.     

Differences in Tonsillectomy Utilization by Race/Ethnicity,Type of Health Insurance,and Rurality

ObjectiveTonsillectomy is one of the most common pediatric surgical procedures. In previous decades, large geographic variation and racial disparities in its use have been reported. We aimed to compare contemporary rates of pediatric tonsillectomy utilization in the United States by child race/ethnicity, type of health insurance, and metropolitan/nonmetropolitan residence.MethodsWe performed a cross-sectional study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project State Ambulatory Surgery and Services Databases and State Inpatient Databases of 8 US states. We included all children aged <15 years who underwent tonsillectomy in 2013 to 2017. Annual population-level tonsillectomy rates across states and sociodemographic groups overall and by surgical indication were calculated using US Census data. Negative binomial regression models were used to compare rates between groups.ResultsIn all states evaluated, tonsillectomy utilization was higher in non-Hispanic white children than non-Hispanic black or Hispanic children, higher in publicly insured than privately insured children, and higher in children residing in nonmetropolitan areas as compared to metropolitan areas (all P < .05). Tonsillectomy use was highest among white children from nonmetropolitan areas, both overall and for each indication (all P < .05).ConclusionsTonsillectomy utilization is higher in US children who are white, publicly insured, and who live in nonmetropolitan areas. Future research should identify multilevel factors, such as those at the patient, family, primary care provider, otolaryngologist, health care delivery system, interpersonal and community levels, that explain these differences in utilization in order to improve the appropriateness and equity of tonsillectomy use in children.     

Difference between self-reported and accelerometer measured moderate-to-vigorous physical activity in youth

We examined differences between objective (accelerometer) and subjective (selfreport) measures of moderate-to-vigorous physical activity (MVPA) in youth. Participants included 2761 youth aged 12-19 years. Within each sex and race group, objective and self-reported measures of MVPA were poorly correlated (R2 = .01-.10). Self-reported MVPA values were higher than objective values (median: 42.4 vs. 15.0 min/d). 65.4% of participants over-reported their MVPA by 35 min/d. The difference between self-reported and objective measures was not influenced by sex, age, or race. There was, however, a systematic difference such that inactive participants over-reported their MVPA to the greatest extent.     

Accelerated schedule of hepatitis B vaccination in high-risk youth

Objective : To perform a feasibility and immunogenicity study of an accelerated schedule of hepatitis B immunization for high-risk youth.
Methodology : High-risk adolescents attending a youth health centre and nearby youth refuges were immunized with Engerix-B recombinant vaccine, 20 μg intramuscularly, at 0,2 and 6 weeks. Serology was performed prior to immunization and 3 months after the third dose.
Results : Forty-two subjects (27 female) aged 13-20 years entered the study. Two (4.8%), already hepatitis B virus (HBV) seropositive, were excluded. Thirty-six of 40 subjects had one or more risk factors for HBV. Participants were often elusive, needing multiple attempts to establish contact. Twenty (50%) of the 40 completed three immunizations and all 14 studied developed anti-hepatitis B surface titres of > 100mlU/mL (geometric mean titre 630 mIU/mL, 95% confidence intervals 309-1290).
Conclusion : High-risk youth can be immunized against hepatitis B successfully using an accelerated schedule, but compliance is difficult.     

Health care of very low birth weight infants in Montevideo, Uruguay: a comparison between public and private sectors

OBJECTIVE: To compare morbidity and mortality in very low birthweight infants admitted to public and private intensive care units in Montevideo, Uruguay. METHODS: Longitudinal design. All very low birth weight infants born in public hospitals of Montevideo between May 1st and October 31st, 1999, were included in the study and followed up until they were discharged from hospital, or died. The quality of care, and morbidity and mortality rates obtained in private intensive care units were compared with those observed in public intensive care units (infants who were never transferred). RESULTS: Of 141 infants, 19 were excluded from the study (13 died at the delivery room and six were transferred to intensive care units of other public hospitals). Of the remaining 122 infants, 61 were kept at the intensive care units of public hospitals, and 61 were transferred to a private unit. The infants who were transferred presented lower gestational age and increased neonatal depression. However, mortality among infants treated at intensive care units of public hospitals was twice as high (Hazard Ratio 1.8; 95%CI 1.1-3.4; P=0.04), especially in infants who weighed less than 1,000g (Hazard Ratio 2.4; 95%CI 1.1-5.5; P=0.04). CONCLUSIONS: The health status of very low birth weight infants treated at intensive care units of public and private hospitals in Montevideo, Uruguay, was assessed. Mortality was lower, and health care was better in neonatal units of private hospitals.     

Effects of 2 prevention programs on high-risk behaviors among African American youth: a randomized trial

OBJECTIVE: To test the efficacy of 2 programs designed to reduce high-risk behaviors among inner-city African American youth. DESIGN: Cluster randomized trial. SETTING: Twelve metropolitan Chicago, Ill, schools and the communities they serve, 1994 through 1998. PARTICIPANTS: Students in grades 5 through 8 and their parents and teachers. INTERVENTIONS: The social development curriculum (SDC) consisted of 16 to 21 lessons per year focusing on social competence skills necessary to manage situations in which high-risk behaviors occur. The school/community intervention (SCI) consisted of SDC and school-wide climate and parent and community components. The control group received an attention-placebo health enhancement curriculum (HEC) of equal intensity to the SDC focusing on nutrition, physical activity, and general health care. MAIN OUTCOME MEASURES: Student self-reports of violence, provocative behavior, school delinquency, substance use, and sexual behaviors (intercourse and condom use). RESULTS: For boys, the SDC and SCI significantly reduced the rate of increase in violent behavior (by 35% and 47% compared with HEC, respectively), provoking behavior (41% and 59%), school delinquency (31% and 66%), drug use (32% and 34%), and recent sexual intercourse (44% and 65%), and improved the rate of increase in condom use (95% and 165%). The SCI was significantly more effective than the SDC for a combined behavioral measure (79% improvement vs 51%). There were no significant effects for girls. CONCLUSIONS: Theoretically derived social-emotional programs that are culturally sensitive, developmentally appropriate, and offered in multiple grades can reduce multiple risk behaviors for inner-city African American boys in grades 5 through 8. The lack of effects for girls deserves further research.     

Ethnicity in child maltreatment research: a replication of Behl et al.'s content analysis

This study examines the use of ethnicity in 489 empirical research articles published in three major child maltreatment specialty journals from 1999 to 2002. Of the American samples, 12.5% focus on ethnicity, 76.2% report the ethnic composition of participants, and 33.8% use ethnicity of participants in analyses. Ethnicity has a significant effect in 52.3% of articles in which it was used in analyses, suggesting its importance as a variable in a wide range of studies. African Americans and Native Americans are underrepresented in research samples. These findings indicate more attention to ethnicity in American research than Behl, Crouch, May, Valente, and Conyngham's 2001 study might suggest but also highlight the need for continued expansion in focusing on, reporting, and using ethnicity in research.     

Family context and HIV risk among youth in psychiatric care: what pediatricians can do

PURPOSE OF REVIEW: The HIV/AIDS epidemic is one of the most widespread public health problems today. Teens with mental health concerns are particularly vulnerable to infection because they engage in higher rates of risky behaviors than their peers. Families are vital influences in protecting teens from HIV exposure, but parents often feel unprepared to discuss sexual behavior with teens. This review provides an overview of the role of teens' mental illness in HIV risk and suggests guidelines for pediatricians to facilitate parents' ability to keep teens safe from risky behaviors. RECENT FINDINGS: Young people account for more than 50% of new infections each year, and mental health problems are related to increased risk taking via inconsistent condom use, multiple partners, and decreased assertiveness. Parents can protect youth from engaging in HIV risk behaviors through supervision, providing support, and communicating effectively about sexual topics. SUMMARY: Pediatricians can support parents in keeping youth safe from HIV infection by openly discussing ways to reduce teens' risk of exposure. Talking to families about risks, empowering parents to address issues with teens, and providing referrals for parents to build a network of support can reduce mental health problems and HIV risk among teens.     

Elevated child maltreatment rates in immigrant families and the role of socioeconomic differences

Are immigrant families at elevated risk for child maltreatment, and if so, what role do socioeconomic and family composition factors play? In a national prevalence study on child maltreatment in the Netherlands, child maltreatment cases were reported by 1,121 professionals from various occupational branches. Maltreating families were compared to a national representative family sample on immigrant status and parental educational level and family composition factors. The authors differentiated between traditional immigrant families who immigrated as labor migrants from Turkey, Morocco, Suriname, and the Antillean Islands, and nontraditional immigrant families who more recently immigrated from countries with severe economic hardships or political turmoil (refugees). Traditional immigrant and nontraditional immigrant families were both significantly overrepresented among maltreating families, but this overrepresentation disappeared for the traditional immigrants after correction for educational level of the parents. Nontraditional immigrant families, however, remained at increased risk for child maltreatment even after correction for educational level. It is proposed that interventions to prevent child maltreatment in immigrant families should focus on decreasing socioeconomic risks associated with low levels of education.     

Improving participation in Chlamydia screening programs: perspectives of high-risk youth

BACKGROUND: Many young people at highest risk for chlamydial infection do not use chlamydia screening services. OBJECTIVES: To describe young people's beliefs and opinions about obstacles to and motivators for obtaining testing and to provide recommendations for how to improve youth participation in chlamydia screening programs. METHODS: Eight focus group interviews (4 male and 4 female groups) were conducted with young people using a semistructured interview guide. Thirty-two male and 23 female volunteers (mean age, 18.2 years; age range, 15-24 years) were recruited from Job Corps and Department of Youth Services sites. The main outcome measure was categorization of textual data using content analysis techniques. Data were coded by 2 investigators into categories of responses based on research questions and spontaneously offered comments. Satisfactory intercoder agreement was achieved. RESULTS: Participants described many obstacles to testing, including concern that someone will know they were tested or tested positive, fear about discovering they have a sexually transmitted disease, and fear of acquired immunodeficiency syndrome. Many participants were unsure what physical effects chlamydia produced or thought it was possible to die of a chlamydial infection. Participants recommended providing more information about the effects of chlamydia, availability of urine testing, and ease of treatment to motivate more young people to seek testing. They also emphasized the need to make sexually transmitted disease screening services more private and confidential. There was an overwhelming interest in using a home Chlamydia test (much like a home pregnancy test) if one were available. CONCLUSIONS: To increase youth participation in screening programs, it will be necessary to address their concerns, dispel misconceptions, and provide more information about chlamydia. A home Chlamydia test might be one way to increase screening.