Academic Pediatrics最新文献

Objective: Elicit the perspectives of mothers with substance use disorder (SUD) on child well-being and parental substance use.

Methods: We conducted semistructured focus groups of mothers with SUD on parenting, child well-being, naloxone, and experiences with medical care and Child Protective Services (CPS). Focus group transcripts were iteratively reviewed to generate a codebook, which was applied in NVivo by 2 independent coders. We used inductive thematic analysis to examine codes relevant to child well-being, harm reduction, and clinician reporting to CPS.

Results: Twenty-three women participated in 5 focus groups. Four themes emerged: 1) mothers felt their substance use negatively impacted their ability to provide attentive supervision and emotional support; 2) mothers discussed strategies to minimize harm to children but had limited familiarity with naloxone use for unintentional ingestions; 3) mothers viewed child well-being as a spectrum but felt that clinicians often approached well-being as a binary of "safe" or "unsafe"; and 4) mothers recognized that clinicians are obligated to report child abuse or neglect and recommended transparent CPS reporting.

Conclusions: Participants viewed child well-being in the setting of parental substance use as a multidimensional construct. Mothers acknowledged the potential emotional harms of substance use, an important target for family-based intervention. Mothers used harm reduction strategies to keep their children safe, but not all were aware that naloxone could be used to reverse pediatric overdoses. Improved provider guidance on comprehensively assessing child well-being, supporting harm reduction, and trauma-informed CPS reporting may help clinicians partner with families to support child health and safety.

Objective: Child sexual abuse is associated with mental health (MH) challenges across the lifespan. Black and Latino children are less likely to receive MH services than children of other backgrounds. We aimed to identify facilitators and barriers to MH services for Black and Latino children after sexual abuse.

Methods: We conducted semi-structured interviews with 30 Black and Latino, English and Spanish-speaking caregivers of children who have experienced sexual abuse. Interviews were completed in caregivers' preferred language and modality (phone, video conferencing, or in person). Caregivers were asked about their opinions and experiences with initiating child MH services after sexual abuse. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Results: Caregivers (27% Black, 47% Latino, 27% Black and Latino) were mostly biological mothers (87%). Half were born outside the U.S. Caregivers reported three facilitators to MH services after sexual abuse: 1) perceived benefits of MH services; 2) trust in MH providers; and 3) support from frontline professionals and systems. Caregivers reported timely support when there was cross-system care coordination. Caregivers described five barriers to MH services after sexual abuse: 1) perceived harms of MH services; 2) concerns about misjudgment and discrimination by MH providers; 3) stigma of sexual abuse; 4) youth's lack of engagement in MH services; and 5) structural obstacles to MH services.

Conclusions: Black and Latino caregivers identified multiple facilitators and barriers to MH services after sexual abuse. Our findings can inform the development and testing of evidence-based strategies to improve MH engagement and outcomes after sexual abuse.

Objective: Age alone is often used to define appropriate child restraint system (CRS) use. Children who lack access to primary care may rely on acute care settings and miss opportunities for anticipatory guidance on child passenger safety. We sought to characterize age- and size-appropriate CRS use among emergency department (ED) and urgent care patients in metropolitan Chicago to inform targets for intervention.

Methods: We conducted a secondary cross-sectional analysis of clinical trial screening data collected from English and Spanish-speaking caregivers of 6-month through 10-year-old children, 1/2021-8/2022. Caregiver-reported transportation behaviors were linked to electronic health record (EHR) data. CRS use was categorized as appropriate or prematurely transitioned for age and size. Descriptive statistics were calculated. Chi-square and logistic regression analyses were used to test for child, family, and visit characteristics associated with premature transitions.

Results: Of the 4,269 caregivers with matched screening and EHR data, 4,045 (94.8%) were included and 933 (23.1%) had prematurely transitioned their child. Premature transitions were most associated with child age 2-4 or 8+, Black race or Hispanic/Latine ethnicity, and being seen in the ED. Premature transitions differed across child age groups and were most common among Hispanic/Latine and Black children (age <8), families with larger household size (age 8+), and children seen in the ED (age 2-4).

Conclusion: Premature transitions are common among children who received acute care in metropolitan Chicago. This population is at risk for crash-related injuries. Child passenger safety interventions targeted to families who seek acute care may benefit specific demographic groups.

Objective: To extend providers' HPV vaccine communication, we sought to understand confidence in nursing staff as vaccine communicators and identify implementation strategies associated with confidence.

Methods: In 2022, we surveyed 2,527 US providers and nursing staff with a role in adolescent HPV vaccination. Topics included perceptions of nursing staff effectiveness at HPV vaccine communication and experiences with vaccine implementation strategies.

Results: A majority of respondents believed nursing staff could effectively announce children are due for HPV vaccine (81%), counsel parents (64%), and recommend the vaccine (51%). Nursing staff were more likely than providers to believe nurses could effectively communicate about HPV vaccine (announce: AOR = 2.7, 95% CI = 1.9, 3.7; counsel: AOR = 7.1, 95% CI = 5.4, 9.3; recommend: AOR = 2.5, 95% CI = 1.9, 3.2). Believing nurses could effectively counsel parents was more common among respondents whose clinics frequently used HPV vaccine standing orders (OR = 1.5, 95% CI = 1.3, 1.9), those who worked most closely with a nurse vaccine champion (AOR = 2.1, 95% CI = 1.6, 2.7), or those who had received HPV vaccine communication training (AOR = 1.4, 95% CI = 1.2, 1.7). The same pattern of findings held for belief about other communication roles (announce and recommend).

Conclusion: Implementation strategies to improve HPV vaccine uptake, including standing orders and vaccine champions, may improve confidence in nursing staff as vaccine communicators. These findings provide opportunities to build capacity for vaccine communication in pediatric primary care.

Objective: We aimed to describe teens' experiences around school-related internet use, focusing on both benefits and drawbacks within the Problematic Internet Use (PIU) Framework. The PIU Framework describes how risky, excessive, or impulsive internet use affects teens' wellbeing, including emotional, physical and social health. We defined school-related internet use as all internet use for academic purposes, whether at school or outside of it.

Methods: We recruited 51 teens age 13-18 years in a Midwest metropolitan area to participate in 1 of 9 virtual, semi-structured focus groups in August-December 2022. We analyzed focus group transcripts using thematic analysis and a hybrid inductive-deductive approach.

Results: Most teens identified as White non-Hispanic (61%), male sex (51%) and cisgender (90%), representing 33 schools. Four themes emerged regarding the function of teens' school-related internet use: 1) School-related internet is commonly used for multiple academic purposes, at times replacing traditional teaching methods; 2) Easy access to technology increases modes of communication with peers but can impede opportunities for in-person interactions.; 3) School-related internet use can both alleviate and intensify academic stress; 4) School-related internet use can lead to impulsive internet behavior and overuse, which may result in impairment.

Conclusions: Teens reported school-related internet use is ubiquitous and affects wellbeing. Clinicians can help teens and families understand these effects and devise strategies to minimize negative effects and optimize benefits. Future research should explore how individual, family, and school practices can support a school-related internet environment for teens to flourish.

Objective: To examine the relationship between adverse childhood experiences (ACEs), family resilience, and 2 chronic pediatric health conditions-asthma and diabetes-and to investigate whether the association between ACE exposure and these conditions depends on child's level of family resilience.

Methods: A cross-sectional analysis used data from children aged 4 to 17 years in the 2020 to 2021 National Survey of Children's Health. Multiple logistic regression analyses assessed associations among ACEs, family resilience, and health outcomes, adjusting for sociodemographic factors. Interactions between ACEs and family resilience were examined on multiplicative and additive scales.

Results: Among families, 5.4%, 9.4%, and 85.1% demonstrated low, moderate, and high family resilience, respectively. Children with 1 to 3 and 4 to 9 ACEs had higher odds of asthma than those with no ACEs, with aORs (95% CI) of 1.35 (1.20-1.52) and 1.90 (1.54-2.36). Those with 4 to 9 ACEs had more than twice the odds of diabetes, 2.72 (1.53-4.85). Low family resilience was associated with higher odds of diabetes, 2.58 (1.52-4.39), but not asthma. A significant multiplicative interaction between low family resilience and high ACE exposure further increased odds of asthma and diabetes beyond combined effects (interaction ratio: asthma = 1.35, 95% CI 1.22-1.50; diabetes = 9.49, 95% CI 2.64-34.16).

Conclusion: Greater ACE exposure was associated with higher odds of asthma and diabetes. Low family resilience was linked to higher odds of diabetes and intensified the effect of high ACE exposure on both conditions, suggesting that family resilience may play a protective role in child health.

Objective: To examine long-term trends in adolescent depression and suicide risk screening and interim symptom monitoring in pediatric primary care (PC) following implementation of universal screening at well-visits.

Methods: This retrospective cohort study examined electronic health record (EHR) data from 406,192 well-visits of 12 to 17-year-old pediatric patients from 2018 to 2024 in a large PC network in the United States. Screening was conducted using the Patient Health Questionnaire-9: Modified for Teens (PHQ-9-M). We evaluated trends over time in well-visit screening compliance, depression and suicide risk rates, and rates and timing of interim symptom monitoring between well-visits.

Results: Screening compliance improved from 82.1% to 96.0% (χ²_MH[1] = 15,996.93, P<.001; 89.2% 7-year compliance). Annual depression and suicide risk rates were generally stable over time, with highest rates observed in 2021. Less than 8% of patients screening positive for depression risk and less than 7% of patients screening positive for suicide risk received interim symptom monitoring in PC between well-visits. However, rates of interim screens increased over time (χ²_MH[1] = 240.74, P<.001) and days from index well-visit to interim screen decreased by greater than 50%.

Conclusions: In the years following implementation of universal depression and suicide risk screening in a large PC network, screening compliance increased significantly. However, low rates of interim symptom monitoring for patients screening positive indicate a gap in secondary prevention. Improving risk-based follow-up procedures, including interim screening, in PC represents a critical next step to enhance the preventive potential of universal screening.

Objective: Pediatric clinics identify and address food insecurity (FI), but processes vary nationwide. State and federal policies increasingly require FI screening in healthcare settings and as a quality metric in payment models. A better understanding of existing practices and opportunities for efficient and effective clinical integration is needed.

Methods: A multiple-choice survey was first completed with 27 clinics nationwide. Semi-structured interviews informed by the Consolidated Framework for Implementation Research were then conducted with clinics (n=25) to explore current FI practices and understand how policies and payment models could support FI processes. Descriptive analysis was used for survey results. Rapid qualitative analysis was used to identify themes.

Results: Pediatric practices were predominately in the South (44%) and in urban (70%) locations. Most used the Hunger Vital Sign to screen (89%); interventions included resource list distribution (89%), referral to federal nutrition programs (78%) and/or community-based organizations (78%). Few practices coded (37%) or billed (7%) for FI. Three overarching themes were identified: (1) FI screening, intervention, and documentation processes varied across primary care clinics; (2) Multi-level barriers hindered efforts to address FI; and (3) Policy and payment reforms are needed to support the integration of FI screening and intervention in health systems and effectively assist families experiencing FI.

Conclusions: While clinics have integrated FI screening and interventions, streamlined documentation and billing remains limited. As FI screening becomes increasingly incentivized, designing performance metrics that include healthcare provider input and address existing barriers should be a priority.