Family & Community Health最新文献

The purpose of this study was to contextualize the challenges of diagnosing and managing pediatric hypertension (pHTN) in federally qualified health centers. We conducted a survey among primary care clinicians (N = 72) who treat children (3-17 years old) in a national network of health centers. Clinicians reported practices of blood pressure (BP) measurement, barriers to diagnosis and management of pHTN, and use of population health tools. Most clinicians (83%) used electronic devices to measure BP, only 49% used manual BP readings for follow-up measurements, and more than half measured BP at each encounter. The highest-rated barrier to pHTN management was lack of comfort with antihypertensive medications (71% of respondents). Few clinicians (10%) had used population health tools, but most (78%) indicated they would like to use them for pHTN. These results offer clinician-level insights regarding implementation of the pHTN guideline in pediatric primary care settings.

In recent years, there has been increased attention given to how racism fuels health inequities, including the inadequacy of prenatal care (PNC) that Black women and Black birthing people receive. This increase of attention has brought notable advancements in research, practice, and policy that intend to better understand and address these systemic inequities within the health care system. This review aims to provide an overview of promising developments in the study of Black mothers' and birthing people's experiences in PNC and delivery, to detail current research surrounding interventions to improve quality and mitigate bias in obstetric care, and to offer ways in which legislation can support such strategies targeting the root causes of inequities in care.

Neighborhood context plays an important role in producing and reproducing current patterns of health disparity. In particular, neighborhood disorganization affects how people engage in health care. We examined the effect of living in highly disorganized neighborhoods on care engagement, using data from the Coordinated Healthcare for Complex Kids (CHECK) program, which is a care delivery model for children with chronic conditions on Medicaid in Chicago. We retrieved demographic data from the US Census Bureau and crime data from the Chicago Police Department to estimate neighborhood-level social disorganization for the CHECK enrollees. A total of 6458 children enrolled in the CHECK between 2014 and 2017 were included in the analysis. Families living in the most disorganized neighborhoods, compared with areas with lower levels of disorganization, were less likely to engage in CHECK. Black families were less likely than Hispanic families to be engaged in the CHECK program. We discuss potential mechanisms through which disorganization affects care engagement. Understanding neighborhood context, including social disorganization, is key to developing more effective comprehensive care models.

In this study, we explored the relationship between the food environment and food security among rural adults during the COVID-19 pandemic. Researchers, with assistance from community partners, conducted a cross-sectional survey assessing the impact of COVID-19 on food access, food security, and physical activity in 9 rural South Carolina (SC) counties. This survey was administered to a purposive sample (N = 587) from August 2020 to March 2021. The dependent variable was a binary indicator of food insecurity (past 3 months), in accordance with the USDA Household Food Security Survey Module. Independent variables were sociodemographic characteristics, food environment factors (eg, shopping at grocery stores, partial markets, and farmers' markets), and shopping behaviors during the pandemic. Overall, 31% of respondents were food insecure. Food security status differed by income and household composition. Results indicate that the odds of food insecurity were higher for respondents who shopped frequently at partial markets (adjusted odds ratio [AOR] = 1.61, 95% confidence interval [CI]: 1.01-2.56) and shopped more for food before the pandemic than during the pandemic (AOR = 1.68, 95% CI: 1.07-2.64). Findings underscore the importance of examining the relationship between the food environment and food insecurity during COVID-19 in rural settings.

Racial and sexuality-based discrimination can induce depressive symptoms among Black sexual minority men and transgender women (BSMM/BTW). BSMM and BTW who disclose their sexuality to parents may be better prepared to cope with discrimination. We explored the relationship between discrimination and depression among BSMM and BTW and whether parental disclosure modified this relationship. Secondary analysis of The MARI Study was used to test the relationship between discrimination and depression modified by level of disclosure of sexuality to parents among 580 BSMM and BTW in Jackson, Mississippi, and Atlanta, Georgia. Bivariate tests and linear regression models were stratified by sexuality disclosure to parents. Discrimination was associated with greater depression, with significant dose-response modification across levels of disclosure. After adjustment, maximum discrimination scores were associated with depression scores 10.7 units higher among participants with very open disclosure (95% CI, 10.4-11.8), 15.3 units higher among participants with somewhat open disclosure (95% CI, 3.7-26.9), and 19.5 units higher among participants with no disclosure (95% CI, 10.2-26.8). Disclosure of sexuality to supportive parents can substantially benefit the mental health of BSMM and BTW. Future studies should explore intervention approaches to providing social support for BSMM and BTW in unsupportive families.

The typical pattern of weight change associated with behavioral obesity treatments has been some loss in weight through approximately 6 months, followed by near complete regain. However, patterns vary widely across individuals. The objectives are to determine whether recent prediction model-based indications of relations among changes in psychosocial correlates of the weight loss behaviors of physical activity and controlled eating vary by patterns of weight change. Women with obesity enrolled in a community-based behavioral obesity treatment who failed to lose at least 5% of their baseline weight (Minimal Effect group, n = 44), lost 5% or greater and then regained most during months 6 to 24 (Loss/Regain group, n = 42), or lost 5% or greater and then maintained/continued loss (Loss/Loss group n = 42) were evaluated. Improvements in physical activity- and eating-related self-regulation and self-efficacy, mood, and emotional eating over 6 months were significant overall and generally most favorable in the Loss/Loss group and least favorable in the Minimal Effect group. Expected model-based relationships between 6-month changes in the aforementioned psychosocial variables were significant and generally not significantly affected by weight change group. However, group substantially affected the prediction of self-regulation of eating at month 24-a key correlate of long-term weight loss. Findings suggested community-based obesity treatment targets and emphases.

Rates of overweight and obesity are problematic among systematically marginalized youth; however, these youth and their families are a hard-to-reach research population. The purpose of our study was to identify facilitators and barriers for recruiting systematically marginalized families in youth weight-management intervention research. This study built upon existing evidence through involvement of youth, parents, community agency workers, and school nurses, and an exploration of both recruitment materials and processes. Seven focus groups were conducted with 48 participants from 4 stakeholder groups (youth, parents, school nurses, and community agency workers). A codebook approach to thematic analysis was used to identify key facilitator and barrier themes related to recruitment materials and processes across the stakeholder groups. Ecological systems theory was applied to contextualize the facilitators and barriers identified. Participants reported the need to actively recruit youth in the study through engaging, fun recruitment materials and processes. Participants reported greater interest in recruitment at community-based events, as compared to recruitment through health care providers, underscoring the depth of distrust that this sample group has for the health care system. Recommendations for recruitment materials and processes for weight-management intervention research with systematically marginalized families are proposed.

Early childhood home visiting (ECHV) is an evidence-based prevention strategy that directly impacts maternal and child health by mitigating the poor outcomes associated with socioeconomic disadvantage and adverse childhood experiences that disproportionately affect marginalized populations. Despite its promise, health care providers in many communities do not routinely refer patients to these services. This qualitative study examined barriers to health care providers' referrals to ECHV services and identified systems-level strategies to overcome those barriers through semistructured interviews with 37 health care providers in New Mexico. Most participants were pediatricians or family practice physicians working in hospitals or community-based primary care settings, and the majority served rural communities. Barriers included insufficient knowledge about ECHV programs; lack of trust of program providers; time constraints; concerns about available funding; lack of a standardized referral process; and concerns about stigma and messaging. Five systems-level recommendations were developed to improve practice: (1) educating health care providers; (2) developing messaging prompts for providers to use when talking with patients about ECHV; (3) increasing engagement among providers and ECHV programs; (4) standardizing referral systems within practices; and (5) promoting universal referrals. Additional research is ongoing to determine the degree to which these health promotion strategies increase referrals and participation in ECHV.

During Ramadan, Muslims fast from dawn to dusk for the duration of the month. The current literature focuses on adults who fast, with little attention to pediatric practices. An anonymous, digital survey was conducted using Qualtrics software and distributed to residents, fellows, or attendings in Michigan in 2019. Overall, 278 participants were included in the analysis, with 87% (242/278) identifying as pediatric trained physicians. In all, 82% (228/278) of physicians identified as non-Muslim and 76% (211/278) had never partaken in the Muslim fast. About 52% (141/273) of participants had at least a moderate amount of exposure to Muslim pediatric patients in their clinical practice. Most physicians (66%; 175/265) reported they never asked their pediatric patients or their families about fasting. About 61% (167/273) of participants rated their understanding of fasting as minimal to none. Another 52% (142/273) of participants reported feeling somewhat or extremely uncomfortable discussing fasting recommendations with their pediatric patients and their families. Our study is the first of its kind in assessing current knowledge and practice regarding pediatric Muslim fasting among physicians in the United States. In addition, it highlights a gap in physicians' understanding and comfort in providing anticipatory guidance for their Muslim patients.

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals experience health inequities and barriers to accessing appropriate, affirming care. Little is known about differing health care experiences within the LGBTQ+ population, particularly among individuals living in underserved areas. This study explored health care experiences and utilization among LGBTQ+ subgroups: lesbian and gay cisgender individuals (n = 258), bisexual+ cisgender individuals (n = 71), and transgender and gender-diverse individuals (n = 80). Participants were recruited from a geographic region in South Carolina and Georgia and completed an online survey regarding negative health care experiences, barriers to care, and utilization of different health care venues and services. Results revealed significant differences between LGBTQ+ subgroups, with transgender and gender-diverse participants reporting more discriminatory experiences and greater barriers to care. Bisexual+ cisgender individuals also experienced some disparities compared with lesbian and gay cisgender individuals. Most participants endorsed a need for more competent providers. Findings and recommendations are considered within the context of the Southeastern United States for addressing access and utilization disparities among LGBTQ+ communities.