Pub Date : 2026-03-01Epub Date: 2025-11-14DOI: 10.1016/j.acap.2025.103188
Angela G. Campbell PhD, MPH
Objective
Introduction of complementary foods (CF) prior to 6 months is discouraged due to the impacts on breastfeeding duration and concerns regarding the infant being developmentally ready. Previous work has established that a large proportion of infants in the United States receive CF (water, juice, purees, solids, etc.) prior to 6 months of age. This study examines timing of CF introduction by mother’s nativity status (foreign-born vs US-born).
Methods
This is a nationally representative descriptive study utilizing the National Survey of Children’s Health (2022–2023). Children aged 1 to 5 years old residing with their biological or adoptive mother were included (N = 30,617).
Results
Overall, 32% of all infants were given CF prior to 6 months of age. A smaller percentage of foreign-born mothers introduced CF to their infants prior to 6 months (29.5%) compared to US-born mothers (32.7%) (P<.05). A larger percentage of foreign-born mothers introduced CF when the infant was <2 months (5.4%) compared to US-born mothers (3.9%) (P<.05). A significantly larger percentage of US-born mothers introduced CF in the fourth month (13.4%) compared to foreign-born mothers (10.1%, P<.01).
Conclusions
CF introduction prior to 6 months remains common among both US-born and foreign-born mothers, but the timing of introduction differs significantly by nativity. Public health efforts to promote exclusive breastfeeding through 6 months should incorporate culturally informed approaches to address the diverse feeding practices present in the US population.
{"title":"Timing of Complementary Food Introduction in the US National Survey of Children’s Health: Differences by Mother’s Nativity","authors":"Angela G. Campbell PhD, MPH","doi":"10.1016/j.acap.2025.103188","DOIUrl":"10.1016/j.acap.2025.103188","url":null,"abstract":"<div><h3>Objective</h3><div>Introduction of complementary foods (CF) prior to 6 months is discouraged due to the impacts on breastfeeding duration and concerns regarding the infant being developmentally ready. Previous work has established that a large proportion of infants in the United States receive CF (water, juice, purees, solids, etc.) prior to 6 months of age. This study examines timing of CF introduction by mother’s nativity status (foreign-born vs US-born).</div></div><div><h3>Methods</h3><div>This is a nationally representative descriptive study utilizing the National Survey of Children’s Health (2022–2023). Children aged 1 to 5 years old residing with their biological or adoptive mother were included (N = 30,617).</div></div><div><h3>Results</h3><div>Overall, 32% of all infants were given CF prior to 6 months of age. A smaller percentage of foreign-born mothers introduced CF to their infants prior to 6 months (29.5%) compared to US-born mothers (32.7%) (<em>P</em><.05). A larger percentage of foreign-born mothers introduced CF when the infant was <2 months (5.4%) compared to US-born mothers (3.9%) (<em>P</em><.05). A significantly larger percentage of US-born mothers introduced CF in the fourth month (13.4%) compared to foreign-born mothers (10.1%, <em>P</em><.01).</div></div><div><h3>Conclusions</h3><div>CF introduction prior to 6 months remains common among both US-born and foreign-born mothers, but the timing of introduction differs significantly by nativity. Public health efforts to promote exclusive breastfeeding through 6 months should incorporate culturally informed approaches to address the diverse feeding practices present in the US population.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103188"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-28DOI: 10.1016/j.acap.2025.103164
Jason M. Nagata MD, MSc , Christiane K. Helmer MPH , Zain Memon , Jonanne Talebloo , Kyle T. Ganson PhD , Alexander Testa PhD , Jinbo He PhD , Hoda S. Abdel Magid PhD , Holly C. Gooding PhD , Fiona C. Baker PhD
Objective
To determine the relationship between various measures of neighborhood quality and adolescent screen use in a demographically diverse, US cohort of early adolescents.
Methods
We analyzed cohort data of 8446 adolescents (aged 9–10 at baseline in 2016–2018) with 2 years of follow-up from the Adolescent Brain Cognitive Development (ABCD) Study. Mixed-effects models adjusted for age, sex, race and ethnicity, household income, parents’ highest education, and study site were used to examine the associations of baseline indices of children’s neighborhood quality measures based on geospatial location data with daily screen time measures at baseline, Year 1, and Year 2.
Results
Lower child opportunity index (COI), higher social vulnerability index (SVI), and higher area deprivation index (ADI) at baseline were associated with higher total screen time, particularly higher television/movie watching, video game playing, and video streaming. Specifically, compared to the highest COI quintile, lower COI quintiles (1st–4th) were associated with higher total screen time (B = 0.39–0.64, P<.05). Compared to the first SVI quintile, higher SVI quintiles (2nd–5th) were associated with higher total screen time (B = 0.28–0.64, P<.01). Similarly, compared to the first ADI quintile, higher ADI quintiles (2nd–5th) were also associated with higher total screen time (B = 0.46–1.17, P<.001).
Conclusions
Overall, this study found that neighborhood quality is associated with higher screen time, over and above other factors, suggesting it is important to consider the role of environmental factors and identify potential targets for intervention at the neighborhood level.
{"title":"Neighborhood Quality and Screen Use: Findings From the Adolescent Brain Cognitive Development Study","authors":"Jason M. Nagata MD, MSc , Christiane K. Helmer MPH , Zain Memon , Jonanne Talebloo , Kyle T. Ganson PhD , Alexander Testa PhD , Jinbo He PhD , Hoda S. Abdel Magid PhD , Holly C. Gooding PhD , Fiona C. Baker PhD","doi":"10.1016/j.acap.2025.103164","DOIUrl":"10.1016/j.acap.2025.103164","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the relationship between various measures of neighborhood quality and adolescent screen use in a demographically diverse, US cohort of early adolescents.</div></div><div><h3>Methods</h3><div>We analyzed cohort data of 8446 adolescents (aged 9–10 at baseline in 2016–2018) with 2 years of follow-up from the Adolescent Brain Cognitive Development (ABCD) Study. Mixed-effects models adjusted for age, sex, race and ethnicity, household income, parents’ highest education, and study site were used to examine the associations of baseline indices of children’s neighborhood quality measures based on geospatial location data with daily screen time measures at baseline, Year 1, and Year 2.</div></div><div><h3>Results</h3><div>Lower child opportunity index (COI), higher social vulnerability index (SVI), and higher area deprivation index (ADI) at baseline were associated with higher total screen time, particularly higher television/movie watching, video game playing, and video streaming. Specifically, compared to the highest COI quintile, lower COI quintiles (1st–4th) were associated with higher total screen time (B = 0.39–0.64, <em>P</em><.05). Compared to the first SVI quintile, higher SVI quintiles (2nd–5th) were associated with higher total screen time (B = 0.28–0.64, <em>P</em><.01). Similarly, compared to the first ADI quintile, higher ADI quintiles (2nd–5th) were also associated with higher total screen time (B = 0.46–1.17, <em>P</em><.001).</div></div><div><h3>Conclusions</h3><div>Overall, this study found that neighborhood quality is associated with higher screen time, over and above other factors, suggesting it is important to consider the role of environmental factors and identify potential targets for intervention at the neighborhood level.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103164"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-12DOI: 10.1016/j.acap.2025.103177
Natalie J. Tedford MD, MScPH , Tala Mujahed MD, MS , Isabel K. Taylor MD , Rachael Thorpe BS , Bob Wong BS, MS, PhD , Ernest Gregorian BS , Maija Holsti MD, MPH , Jeff Robison MD , Andrea S. Wallace PhD, RN, FAAN , Jia-Wen Guo PhD, RN, FAMIA
Objective
To examine disparities in unmet social needs (USNs) and caregiver interest in community resource center (CRC) referrals in the pediatric emergency department (PED), focusing on language preference, insurance, and race and ethnicity, and to explore predictors of referral interest.
Methods
This observational study utilized administrative data from the real-world prospective effectiveness parent study [5R01NR019944–04]. English- and Spanish-speaking caregivers of pediatric patients (<18 years) presenting to a free-standing, quaternary care, level 1 trauma center PED were recruited using convenience sampling through a research assistant program. Caregivers completed a 10-item social needs screener (p-SINCERE), followed by an opt-in referral opportunity to 211Utah, and child-specific demographic questions. Outcomes included USN prevalence (≥1 reported need) and caregiver interest in CRC referral. Descriptive statistics summarized characteristics, and multivariable logistic regression identified predictors of referral interest.
Results
Of 18,319 caregivers approached, 16,909 (92.3%) completed the screener. USN prevalence was 47.2% among English-speaking, 78.3% among Spanish-speaking, and 53% among other-language caregivers. Overall, 15.4% expressed interest in CRC referral, including 9.8% of English-speaking, 53.3% Spanish-speaking, and 31.3% of other-language caregivers. Multivariable analysis revealed that Spanish language preference, public or no insurance, Hispanic ethnicity, and non-White racial backgrounds were independently associated with greater interest in referral. A "voltage drop" was observed between USN disclosure and referral interest.
Conclusions
Disparities in USNs and referral interest vary by language, insurance, and race and ethnicity. The gap between need identification and interest in connecting to resources highlights the need for linguistically and culturally responsive interventions and system-level strategies to advance health equity in the PED.
{"title":"Language and Demographic Disparities in Social Needs and Referral Preferences in the Pediatric ED","authors":"Natalie J. Tedford MD, MScPH , Tala Mujahed MD, MS , Isabel K. Taylor MD , Rachael Thorpe BS , Bob Wong BS, MS, PhD , Ernest Gregorian BS , Maija Holsti MD, MPH , Jeff Robison MD , Andrea S. Wallace PhD, RN, FAAN , Jia-Wen Guo PhD, RN, FAMIA","doi":"10.1016/j.acap.2025.103177","DOIUrl":"10.1016/j.acap.2025.103177","url":null,"abstract":"<div><h3>Objective</h3><div>To examine disparities in unmet social needs (USNs) and caregiver interest in community resource center (CRC) referrals in the pediatric emergency department (PED), focusing on language preference, insurance, and race and ethnicity, and to explore predictors of referral interest.</div></div><div><h3>Methods</h3><div>This observational study utilized administrative data from the real-world prospective effectiveness parent study [5R01NR019944–04]. English- and Spanish-speaking caregivers of pediatric patients (<18 years) presenting to a free-standing, quaternary care, level 1 trauma center PED were recruited using convenience sampling through a research assistant program. Caregivers completed a 10-item social needs screener (p-SINCERE), followed by an opt-in referral opportunity to <em>211Utah</em>, and child-specific demographic questions. Outcomes included USN prevalence (≥1 reported need) and caregiver interest in CRC referral. Descriptive statistics summarized characteristics, and multivariable logistic regression identified predictors of referral interest.</div></div><div><h3>Results</h3><div>Of 18,319 caregivers approached, 16,909 (92.3%) completed the screener. USN prevalence was 47.2% among English-speaking, 78.3% among Spanish-speaking, and 53% among other-language caregivers. Overall, 15.4% expressed interest in CRC referral, including 9.8% of English-speaking, 53.3% Spanish-speaking, and 31.3% of other-language caregivers. Multivariable analysis revealed that Spanish language preference, public or no insurance, Hispanic ethnicity, and non-White racial backgrounds were independently associated with greater interest in referral. A \"voltage drop\" was observed between USN disclosure and referral interest.</div></div><div><h3>Conclusions</h3><div>Disparities in USNs and referral interest vary by language, insurance, and race and ethnicity. The gap between need identification and interest in connecting to resources highlights the need for linguistically and culturally responsive interventions and system-level strategies to advance health equity in the PED.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103177"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-28DOI: 10.1016/j.acap.2025.103159
Amanda E. Ng PhD MPH , Nicholas Tkach DO MPH , Lindsey I. Black MPH , Héctor E. Alcalá PhD MPH
Objective
Previous work has highlighted associations between Adverse Childhood Experiences (ACEs) and mental health care use, but few studies use nationally representative data self-reported by teenagers.
Methods
Data came from the cross-sectional National Health Interview Survey (NHIS)– Teen (July 2021–December 2023), an online follow-back survey of teenagers whose parents answered the child portion of the main NHIS. Multivariate logistic regression models estimated associations between selected ACEs and a summed ACEs score (four or more ACEs vs. three or less), and mental health care use in the past 12 months: 1) took prescription medication, 2) received therapy, and 3) unmet mental health care need due to 4) cost, 5) stigma, and 6) not knowing where to go, among teenagers aged 12–17 (N = 1677).
Results
One-tenth of teenagers (11.5%) had four or more selected ACEs. Around 15.2% of teenagers took prescription medication for their mental health in the past 12 months, while 18.7% received therapy. Having four or more ACEs (adjusted prevalence ratio, APR: 1.43, 95% confidence interval, CI: 1.02–2.01), being a victim or witnessing violence in the neighborhood (APR: 1.41, 95% CI: 1.06–1.88), experiencing emotional abuse (APR: 1.50, 95% CI: 1.12–2.02), and experiencing racism (APR: 1.46, 95% CI: 1.10–1.94) were related to taking prescription medication. Most selected ACEs were related to higher prevalence of receiving therapy (eg, household mental illness, APR:1.97; 95% CI: 1.50–2.58).
Conclusions
ACEs were related to greater use of mental health care and selected barriers for unmet mental health care need. Future work may examine the underlying mechanisms of these associations.
{"title":"Selected Teen-Reported Adverse Childhood Experiences (ACEs) and Mental Health Care Use","authors":"Amanda E. Ng PhD MPH , Nicholas Tkach DO MPH , Lindsey I. Black MPH , Héctor E. Alcalá PhD MPH","doi":"10.1016/j.acap.2025.103159","DOIUrl":"10.1016/j.acap.2025.103159","url":null,"abstract":"<div><h3>Objective</h3><div>Previous work has highlighted associations between Adverse Childhood Experiences (ACEs) and mental health care use, but few studies use nationally representative data self-reported by teenagers.</div></div><div><h3>Methods</h3><div>Data came from the cross-sectional National Health Interview Survey (NHIS)– Teen (July 2021–December 2023), an online follow-back survey of teenagers whose parents answered the child portion of the main NHIS. Multivariate logistic regression models estimated associations between selected ACEs and a summed ACEs score (four or more ACEs vs. three or less), and mental health care use in the past 12 months: 1) took prescription medication, 2) received therapy, and 3) unmet mental health care need due to 4) cost, 5) stigma, and 6) not knowing where to go, among teenagers aged 12–17 (N = 1677).</div></div><div><h3>Results</h3><div>One-tenth of teenagers (11.5%) had four or more selected ACEs. Around 15.2% of teenagers took prescription medication for their mental health in the past 12 months, while 18.7% received therapy. Having four or more ACEs (adjusted prevalence ratio, APR: 1.43, 95% confidence interval, CI: 1.02–2.01), being a victim or witnessing violence in the neighborhood (APR: 1.41, 95% CI: 1.06–1.88), experiencing emotional abuse (APR: 1.50, 95% CI: 1.12–2.02), and experiencing racism (APR: 1.46, 95% CI: 1.10–1.94) were related to taking prescription medication. Most selected ACEs were related to higher prevalence of receiving therapy (eg, household mental illness, APR:1.97; 95% CI: 1.50–2.58).</div></div><div><h3>Conclusions</h3><div>ACEs were related to greater use of mental health care and selected barriers for unmet mental health care need. Future work may examine the underlying mechanisms of these associations.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103159"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-14DOI: 10.1016/j.acap.2025.103186
Rachel H.F. Margolis PhD, LICSW , Emma Straton BA , Elizabeth L. McQuaid PhD , Sarah E. Bledsoe PhD
Objective
Social risk factors contribute to inequities in asthma morbidity among Black children and mental health among Black women. Depression affects nearly half of mothers of Black children with asthma and is associated with greater asthma morbidity. Effective maternal depression treatment improves child health outcomes but remains difficult to access. Delivering co-located care for maternal depression and childhood asthma has the potential to improve outcomes for mothers and children. This study examined barriers and facilitators of delivering Brief Interpersonal Psychotherapy (IPT-B), a maternal depression treatment, in an urban clinic to inform the development of a Hybrid Type 1 randomized clinical trial.
Methods
Guided by the Consolidated Framework for Implementation Research 2.0, we conducted qualitative interviews with asthma clinic leadership and staff and psychologists with expertise in co-located maternal mental health care and focus groups with Black mothers of children with asthma. We used rapid qualitative analysis to analyze the data.
Results
We conducted 14 interviews with staff and 4 focus groups with mothers. Anticipated facilitators included the relative advantage and adaptability of IPT-B, compatibility with existing workflow, recipient-centered clinic culture, and mothers’ need for treatment. Anticipated barriers included the staff's lack of self-efficacy in discussing mental health and mothers’ practical and psychological barriers.
Conclusions
We identified anticipated facilitators and barriers to inform a clinical trial of IPT-B for maternal depression treatment in an urban asthma clinic. Addressing these determinants prior to implementation will support co-located treatment, meeting a critical need for mothers and advancing health equity in this population.
{"title":"Implementation of Maternal Depression Treatment in Pediatric Asthma Care: Preparing for a Clinical Trial","authors":"Rachel H.F. Margolis PhD, LICSW , Emma Straton BA , Elizabeth L. McQuaid PhD , Sarah E. Bledsoe PhD","doi":"10.1016/j.acap.2025.103186","DOIUrl":"10.1016/j.acap.2025.103186","url":null,"abstract":"<div><h3>Objective</h3><div>Social risk factors contribute to inequities in asthma morbidity among Black children and mental health among Black women. Depression affects nearly half of mothers of Black children with asthma and is associated with greater asthma morbidity. Effective maternal depression treatment improves child health outcomes but remains difficult to access. Delivering co-located care for maternal depression and childhood asthma has the potential to improve outcomes for mothers and children. This study examined barriers and facilitators of delivering Brief Interpersonal Psychotherapy (IPT-B), a maternal depression treatment, in an urban clinic to inform the development of a Hybrid Type 1 randomized clinical trial.</div></div><div><h3>Methods</h3><div>Guided by the Consolidated Framework for Implementation Research 2.0, we conducted qualitative interviews with asthma clinic leadership and staff and psychologists with expertise in co-located maternal mental health care and focus groups with Black mothers of children with asthma. We used rapid qualitative analysis to analyze the data.</div></div><div><h3>Results</h3><div>We conducted 14 interviews with staff and 4 focus groups with mothers. Anticipated facilitators included the relative advantage and adaptability of IPT-B, compatibility with existing workflow, recipient-centered clinic culture, and mothers’ need for treatment. Anticipated barriers included the staff's lack of self-efficacy in discussing mental health and mothers’ practical and psychological barriers.</div></div><div><h3>Conclusions</h3><div>We identified anticipated facilitators and barriers to inform a clinical trial of IPT-B for maternal depression treatment in an urban asthma clinic. Addressing these determinants prior to implementation will support co-located treatment, meeting a critical need for mothers and advancing health equity in this population.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103186"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-26DOI: 10.1016/j.acap.2025.103192
Erin Roby PhD , Roger Mills-Koonce PhD , Alan Mendelsohn MD
Children living in the rural United States are more likely to live below the poverty line than their urban counterparts, and rural poverty is associated with greater disparities than urban poverty for many indicators of health, behavior, and school readiness. However, rural communities have often been overlooked in research focused on the prevention of disparities in child development. Early Relational Health (ERH), which includes positive parenting practices and parent-child relationship quality, can support family resilience and buffer the consequences of racism, poverty, and related stressors on child development in families across geographical regions. In this narrative review, we describe the unique contextual factors within rural communities that facilitate and impose barriers to ERH and demonstrate the need for implementation and study of interventions that can support ERH in rural families. We describe platforms that have previously been used to deliver interventions in rural settings and recognize pediatric primary care as an underutilized context for supporting ERH and reducing disparities in child development in rural populations. Finally, we provide examples of key strategies that can reduce barriers to population-level delivery of interventions to rural families, including improving access and providing culturally appropriate programming. Additional research is needed to address core gaps in the knowledge base related to the prevention of inequities in rural populations through supporting ERH.
{"title":"Preventing Rural Inequities Through Support of Early Relational Health in Pediatric Primary Care: A Narrative Review","authors":"Erin Roby PhD , Roger Mills-Koonce PhD , Alan Mendelsohn MD","doi":"10.1016/j.acap.2025.103192","DOIUrl":"10.1016/j.acap.2025.103192","url":null,"abstract":"<div><div>Children living in the rural United States are more likely to live below the poverty line than their urban counterparts, and rural poverty is associated with greater disparities than urban poverty for many indicators of health, behavior, and school readiness. However, rural communities have often been overlooked in research focused on the prevention of disparities in child development. Early Relational Health (ERH), which includes positive parenting practices and parent-child relationship quality, can support family resilience and buffer the consequences of racism, poverty, and related stressors on child development in families across geographical regions. In this narrative review, we describe the unique contextual factors within rural communities that facilitate and impose barriers to ERH and demonstrate the need for implementation and study of interventions that can support ERH in rural families. We describe platforms that have previously been used to deliver interventions in rural settings and recognize pediatric primary care as an underutilized context for supporting ERH and reducing disparities in child development in rural populations. Finally, we provide examples of key strategies that can reduce barriers to population-level delivery of interventions to rural families, including improving access and providing culturally appropriate programming. Additional research is needed to address core gaps in the knowledge base related to the prevention of inequities in rural populations through supporting ERH.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103192"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-29DOI: 10.1016/j.acap.2025.103157
Sarah M. Marsicek MD , Elizabeth A. Gottschlich MA , Mary Pat Frintner MSPH , Bobbi J. Byrne MD , Laurel K. Leslie MD, MPH
Objectives
Examine pediatrician-reported experiences with harassment and attacks related to misinformation and feeling unsafe at work. Compare characteristics and experiences with feeling unsafe.
Methods
Utilizing national weighted 2023 survey data (66% participation; n = 1666) from the AAP Pediatrician Life and Career Experience Study, we asked about past 12-month experiences (own and colleagues or staff) with harassment and attacks (4 types: physical; verbal in person; on social media; false damaging online reviews) for speaking out for child health and safety. We created summary measures: personally experienced any harassment or attacks (yes to ≥1) and colleague or staff experienced any (yes to ≥1). We also asked how safe they felt at work (very safe/safe/neither safe nor unsafe vs unsafe/very unsafe). Using multivariable logistic regression, we examined feeling unsafe by pediatrician and practice characteristics and experiences with any harassment or attacks.
Results
Thirty percent reported that they experienced any type of harassment or attack, and 49.7% reported a colleague or staff had; 10.7% felt unsafe at work. The odds of feeling unsafe were higher for pediatricians practicing in emergency department settings compared to outpatient (aOR: 3.59, 95% CI: 1.99–6.47), in urban areas compared to suburban (aOR: 2.06, 95% CI: 1.28–3.31), who personally experienced harassment or attacks (aOR: 1.73, 95% CI: 1.15–2.60), and whose colleagues or staff experienced harassment or attacks (aOR: 1.62, 95% CI: 1.06–2.48).
Conclusions
Pediatricians are not immune to workplace harassment and attacks with the growth of misinformation. Strategies are needed to mitigate these negative experiences, which were associated with feeling unsafe at work.
{"title":"US Pediatricians’ Reports of Feeling Unsafe at Work: Experiences With Harassment and Attacks","authors":"Sarah M. Marsicek MD , Elizabeth A. Gottschlich MA , Mary Pat Frintner MSPH , Bobbi J. Byrne MD , Laurel K. Leslie MD, MPH","doi":"10.1016/j.acap.2025.103157","DOIUrl":"10.1016/j.acap.2025.103157","url":null,"abstract":"<div><h3>Objectives</h3><div>Examine pediatrician-reported experiences with harassment and attacks related to misinformation and feeling unsafe at work. Compare characteristics and experiences with feeling unsafe.</div></div><div><h3>Methods</h3><div>Utilizing national weighted 2023 survey data (66% participation; n = 1666) from the AAP Pediatrician Life and Career Experience Study, we asked about past 12-month experiences (own and colleagues or staff) with harassment and attacks (4 types: physical; verbal in person; on social media; false damaging online reviews) for speaking out for child health and safety. We created summary measures: personally experienced any harassment or attacks (yes to ≥1) and colleague or staff experienced any (yes to ≥1). We also asked how safe they felt at work (very safe/safe/neither safe nor unsafe vs unsafe/very unsafe). Using multivariable logistic regression, we examined feeling unsafe by pediatrician and practice characteristics and experiences with any harassment or attacks.</div></div><div><h3>Results</h3><div>Thirty percent reported that they experienced any type of harassment or attack, and 49.7% reported a colleague or staff had; 10.7% felt unsafe at work. The odds of feeling unsafe were higher for pediatricians practicing in emergency department settings compared to outpatient (aOR: 3.59, 95% CI: 1.99–6.47), in urban areas compared to suburban (aOR: 2.06, 95% CI: 1.28–3.31), who personally experienced harassment or attacks (aOR: 1.73, 95% CI: 1.15–2.60), and whose colleagues or staff experienced harassment or attacks (aOR: 1.62, 95% CI: 1.06–2.48).</div></div><div><h3>Conclusions</h3><div>Pediatricians are not immune to workplace harassment and attacks with the growth of misinformation. Strategies are needed to mitigate these negative experiences, which were associated with feeling unsafe at work.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103157"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-28DOI: 10.1016/j.acap.2025.103156
Sriram Ramgopal MD
Objective
To characterize the demographics and clinical features of children brought to the pediatric emergency department (ED) by emergency medical services (EMS), and to evaluate the association between mode of arrival and clinical outcomes.
Methods
We conducted a retrospective cross-sectional study using the multicenter Pediatric Emergency Care Applied Research Network (PECARN) Registry to compare ED encounters among children arriving by EMS versus other means. We used logistic regression to assess associations between arrival mode and outcomes: in-hospital mortality, hospital admission or transfer, and admission >48 hours.
Results
We analyzed 5,063,641 ED encounters, of which 368,187 (7.3%) involved children brought by EMS. The most common diagnoses for EMS arrivals were trauma (23.0%), respiratory disease (14.3%), and neurologic disease (11.4%), while non-EMS arrivals most often presented with trauma (16.3%), ENT/dental (15.2%), and gastrointestinal disease (13.3%). Among EMS patients, seizures (7.8%), psychiatric conditions (7.8%), and extremity fractures/dislocations (5.4%) were the most common diagnosis subgroups. EMS arrivals had higher rates of mortality (0.4% vs <0.1%), hospital admission (35.0% vs 11.2%), and secondary transfer (2.0% vs 0.7%), but fewer admissions lasting over 48 hours (44.2% vs 48.8%). In multivariable models, EMS arrival was associated with increased odds of mortality (OR 3.04, 95% CI 2.70–3.44), admission or transfer (OR 2.31, 95% CI 2.29–2.33), and >48-hour admission (OR 0.90, 95% CI 0.89–0.91).
Conclusion
Children brought to pediatric hospitals by EMS more frequently presented with higher acuity of illness and/or injury, as suggested by multiple clinical outcomes. These findings underscore the importance of targeted clinical strategies and resource planning for this higher-risk population.
目的：了解急诊医疗服务（EMS）送到儿科急诊科（ED）的儿童的人口统计学特征和临床特征，并评估到达方式与临床结果的关系。研究设计：我们采用多中心PECARN登记处进行了一项回顾性横断面研究，比较EMS与其他方式到达的儿童的ED遭遇。我们使用逻辑回归来评估到达模式与结局之间的关联：住院死亡率、住院或转院以及入院bbb48小时。结果：我们分析了5,063,641例急诊，其中368,187例（7.3%）涉及EMS带来的儿童。EMS患者最常见的诊断是创伤（23.0%）、呼吸系统疾病（14.3%）和神经系统疾病（11.4%），而非EMS患者最常见的诊断是创伤（16.3%）、耳鼻喉科/牙科（15.2%）和胃肠道疾病（13.3%）。在EMS患者中，癫痫发作（7.8%）、精神疾病（7.8%）和四肢骨折/脱位（5.4%）是最常见的诊断亚组。EMS到达患者的死亡率更高（0.4% vs.入院48小时）（OR 0.90, 95% CI 0.89-0.91）。结论：多项临床结果表明，通过EMS送到儿科医院的儿童更频繁地表现出更高的疾病和/或损伤的敏锐度。这些发现强调了针对这一高危人群的针对性临床策略和资源规划的重要性。
{"title":"Children Brought to the Pediatric Emergency Department by Emergency Medical Services: An Evaluation of the Pediatric Emergency Care Applied Research Network Registry","authors":"Sriram Ramgopal MD","doi":"10.1016/j.acap.2025.103156","DOIUrl":"10.1016/j.acap.2025.103156","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the demographics and clinical features of children brought to the pediatric emergency department (ED) by emergency medical services (EMS), and to evaluate the association between mode of arrival and clinical outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study using the multicenter Pediatric Emergency Care Applied Research Network (PECARN) Registry to compare ED encounters among children arriving by EMS versus other means. We used logistic regression to assess associations between arrival mode and outcomes: in-hospital mortality, hospital admission or transfer, and admission >48 hours.</div></div><div><h3>Results</h3><div>We analyzed 5,063,641 ED encounters, of which 368,187 (7.3%) involved children brought by EMS. The most common diagnoses for EMS arrivals were trauma (23.0%), respiratory disease (14.3%), and neurologic disease (11.4%), while non-EMS arrivals most often presented with trauma (16.3%), ENT/dental (15.2%), and gastrointestinal disease (13.3%). Among EMS patients, seizures (7.8%), psychiatric conditions (7.8%), and extremity fractures/dislocations (5.4%) were the most common diagnosis subgroups. EMS arrivals had higher rates of mortality (0.4% vs <0.1%), hospital admission (35.0% vs 11.2%), and secondary transfer (2.0% vs 0.7%), but fewer admissions lasting over 48 hours (44.2% vs 48.8%). In multivariable models, EMS arrival was associated with increased odds of mortality (OR 3.04, 95% CI 2.70–3.44), admission or transfer (OR 2.31, 95% CI 2.29–2.33), and >48-hour admission (OR 0.90, 95% CI 0.89–0.91).</div></div><div><h3>Conclusion</h3><div>Children brought to pediatric hospitals by EMS more frequently presented with higher acuity of illness and/or injury, as suggested by multiple clinical outcomes. These findings underscore the importance of targeted clinical strategies and resource planning for this higher-risk population.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103156"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-12DOI: 10.1016/j.acap.2025.103176
William W. Lewis-de los Angeles MD , Nicole E. Logan PhD
Objective
To understand the relationships among ACEs, PCEs, and diet quality in early adolescents.
Methods
A cross-sectional analysis of early adolescents (n=7336, mean age 12.0yrs) from the Adolescent Brain Cognitive DevelopmentSM (ABCD) study. Diet measures included a healthy diet score and intake of ultraprocessed foods, added sugar, saturated fat, and sodium. ACEs and PCEs were derived from child and parent questionnaires. Multivariate linear regressions predicting diet quality and intake were performed, with ACEs and PCEs as independent variables, adjusting for demographics and sexual maturity rating.
Results
On one-way ANOVA analyses, both ACEs and PCEs categories were associated with differences in healthy diet score and intake. On multivariate linear regression analyses, a higher PCEs category was associated with higher healthy diet score, compared to 0–2 PCEs; 3–4 PCEs: b=0.65 (0.34 to 0.96); 5+ PCEs: b=1.73 (1.38 to 2.07). Higher ACEs were not significantly associated with the healthy diet score. For ultraprocessed food, higher PCEs category was associated with less intake (compared to 0–2 PCEs; 3–4 PCEs: b=−13.8 (−24.7 to −2.8); 5+ PCEs: b=−33.7 (−46.0 to −21.6), while higher ACEs category was associated with more intake (compared to 0 ACEs, 1–3 ACEs: b=17.1 (6.8 to 27.4), 4+ ACEs: b=41.4 (22.3 to 60.5)).
Conclusion
In early adolescents, PCEs are associated with improved diet quality and less intake of unhealthy foods; in contrast, ACEs are associated with higher intake of ultraprocessed food. These findings may help pediatricians counsel patients about dietary choices.
{"title":"Positive Childhood Experiences, Adverse Childhood Experiences, and Diet in Early Adolescents","authors":"William W. Lewis-de los Angeles MD , Nicole E. Logan PhD","doi":"10.1016/j.acap.2025.103176","DOIUrl":"10.1016/j.acap.2025.103176","url":null,"abstract":"<div><h3>Objective</h3><div>To understand the relationships among ACEs, PCEs, and diet quality in early adolescents.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis of early adolescents (n=7336, mean age 12.0yrs) from the Adolescent Brain Cognitive Development<sup>SM</sup> (ABCD) study. Diet measures included a healthy diet score and intake of ultraprocessed foods, added sugar, saturated fat, and sodium. ACEs and PCEs were derived from child and parent questionnaires. Multivariate linear regressions predicting diet quality and intake were performed, with ACEs and PCEs as independent variables, adjusting for demographics and sexual maturity rating.</div></div><div><h3>Results</h3><div>On one-way ANOVA analyses, both ACEs and PCEs categories were associated with differences in healthy diet score and intake. On multivariate linear regression analyses, a higher PCEs category was associated with higher healthy diet score, compared to 0–2 PCEs; 3–4 PCEs: b=0.65 (0.34 to 0.96); 5+ PCEs: b=1.73 (1.38 to 2.07). Higher ACEs were not significantly associated with the healthy diet score. For ultraprocessed food, higher PCEs category was associated with less intake (compared to 0–2 PCEs; 3–4 PCEs: b=−13.8 (−24.7 to −2.8); 5+ PCEs: b=−33.7 (−46.0 to −21.6), while higher ACEs category was associated with more intake (compared to 0 ACEs, 1–3 ACEs: b=17.1 (6.8 to 27.4), 4+ ACEs: b=41.4 (22.3 to 60.5)).</div></div><div><h3>Conclusion</h3><div>In early adolescents, PCEs are associated with improved diet quality and less intake of unhealthy foods; in contrast, ACEs are associated with higher intake of ultraprocessed food. These findings may help pediatricians counsel patients about dietary choices.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103176"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-26DOI: 10.1016/j.acap.2025.103190
Kristine Hobbs LMSW , Patrick C. Ryan BA , Lisa M. Horowitz PhD, MPH , Ramkumar Jayagopalan MD, FAAP
Objective
Pediatric primary care settings are ideal venues for detecting suicide risk. This quality improvement project (QIP) aimed to improve suicide risk screening adherence by 25% within a pediatric primary care network. Secondary aims were to increase providers’ comfort in addressing suicidal ideation with their patients, as well as improve management of suicide risk within the office setting.
Methods
Quality Through Technology and Innovation in Pediatrics (QTIP-housed at the South Carolina Department of Health and Human Services [SCDHHS]), a quality improvement collaborative group, helped implement suicide prevention in 28 South Carolina primary care settings. QTIP trained clinicians over 18 months from January 2020 to July 2021, during which each practice completed 10 monthly chart audits. Providers completed an annual survey regarding their comfort level in managing suicidal behavior in June 2020 and 2021.
Results
Suicide risk screening adherence increased 25.1% from 62.3% at month 1 to 87.4% at month 18. Chart audits revealed that 77.8% of patients (3691/4741) were screened for suicide risk, with 3.2% (N = 119/3691) screening positive and 0.4% (N = 14/3691) requiring emergency care. Of the nonacute positive screens, 88.2% (N = 105/119) were referred to outpatient behavioral health care and 90.8% (N = 108/119) received in-office interventions. Clinician satisfaction increased 57.7% over the course of the QI implementation. Exactly 69.6% (N = 16) of practices modified their QIP during the study period based on clinician feedback.
Conclusions
Suicide prevention strategies were feasibly implemented within a large primary care network. Repeated education, best practice clinical skills training, and quality improvement interventions were key to fostering change.
{"title":"Suicide Risk Screening in Pediatric Primary Care: A Quality Improvement Collaborative Approach","authors":"Kristine Hobbs LMSW , Patrick C. Ryan BA , Lisa M. Horowitz PhD, MPH , Ramkumar Jayagopalan MD, FAAP","doi":"10.1016/j.acap.2025.103190","DOIUrl":"10.1016/j.acap.2025.103190","url":null,"abstract":"<div><h3>Objective</h3><div>Pediatric primary care settings are ideal venues for detecting suicide risk. This quality improvement project (QIP) aimed to improve suicide risk screening adherence by 25% within a pediatric primary care network. Secondary aims were to increase providers’ comfort in addressing suicidal ideation with their patients, as well as improve management of suicide risk within the office setting.</div></div><div><h3>Methods</h3><div>Quality Through Technology and Innovation in Pediatrics (QTIP-housed at the South Carolina Department of Health and Human Services [SCDHHS]), a quality improvement collaborative group, helped implement suicide prevention in 28 South Carolina primary care settings. QTIP trained clinicians over 18 months from January 2020 to July 2021, during which each practice completed 10 monthly chart audits. Providers completed an annual survey regarding their comfort level in managing suicidal behavior in June 2020 and 2021.</div></div><div><h3>Results</h3><div>Suicide risk screening adherence increased 25.1% from 62.3% at month 1 to 87.4% at month 18. Chart audits revealed that 77.8% of patients (3691/4741) were screened for suicide risk, with 3.2% (N = 119/3691) screening positive and 0.4% (N = 14/3691) requiring emergency care. Of the nonacute positive screens, 88.2% (N = 105/119) were referred to outpatient behavioral health care and 90.8% (N = 108/119) received in-office interventions. Clinician satisfaction increased 57.7% over the course of the QI implementation. Exactly 69.6% (N = 16) of practices modified their QIP during the study period based on clinician feedback.</div></div><div><h3>Conclusions</h3><div>Suicide prevention strategies were feasibly implemented within a large primary care network. Repeated education, best practice clinical skills training, and quality improvement interventions were key to fostering change.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 2","pages":"Article 103190"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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