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Objective: Despite evidence‐based guidelines for obstructive sleep‐disordered breathing (SDB), recent studies continue to highlight treatment inequities. We used qualitative research methods to examine parental facilitators and barriers to SDB treatment. Study Design: Qualitative interviews. Setting: Tertiary care center. Methods: Semistructured interviews were conducted (January‐April 2022) with parents of children with SDB who underwent tonsillectomies to understand the processes of SDB detection and accessing specialty care. Interviews were conducted until thematic saturation was reached and coded using NVivo software. Results: Of the 17 parents who completed the key informant interviews, 6 (35%) were of non‐Hispanic black race, and 3 (17.6%) interviews were conducted in Spanish. Parents noted that the more knowledge their primary care provider (PCP) had about SDB, the easier it was to obtain a diagnostic workup (41%). The most common barrier included difficulty obtaining a specialist (otolaryngology or sleep medicine) referral from their PCP and encountering providers who were dismissive of parent‐reported symptoms related to SDB, leading them to seek a second opinion or self‐refer (53%). Medicaid coverage was a strong facilitator to receipt of care (59%). Three (17.6%) parents noted alienation in the process due to racial bias or language barriers. Conclusion: Parental interviews revealed that facilitators of SDB treatment included high clinician knowledge and perceived importance of SDB as well as Medicaid insurance which decreased financial strain. Parents also cited the attainment of referrals as a significant barrier to obtaining specialty evaluation. These findings identify potential modifiable areas to tailor future interventions for timely and equitable SDB care. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). Study Design: Retrospective cohort study. Setting: Tertiary children's hospital. Methods: A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. Results: In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance (P <.001) and had a median driving distance of 74.8 vs 16.8 miles (P <.001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). Conclusion: Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB. [ABSTRACT FROM AUTHOR]

The article discusses the development and operations of the K-12 school-based obesity prevention and wellness program Docs Adopt School Health Initiative in South Carolina (SC) involving community health care professionals. Other topics include the factors affecting childhood obesity like the built environment, social norms, and social policies, and how multi-component school-based wellness programs are linked to healthier student body mass index (BMI).

Objective: To determine the impact of race and ethnicity on 30‐day complications following pediatric endoscopic sinus surgery (ESS). Study Design: Cross‐sectional cohort study. Subjects and Methods: Patients ≤ 18 years of age undergoing ESS from 2015 to 2017 were identified in the Pediatric National Surgical Improvement Program‐Pediatric database. Patient demographics, comorbidities, surgical indication, and postoperative complications were extracted. Patient race/ethnicity included non‐Hispanic black, non‐Hispanic white, Hispanic, and other. Multivariable logistic regression was performed to determine if race/ethnicity was a predictor of postoperative complications after ESS. Results: A total of 4,337 patients were included in the study. The median age was 10.9 (interquartile range: 14.5–6.7) years. The cohort was comprised of 68.3% non‐Hispanic white, 13.9% non‐Hispanic black, 9.7% Hispanic, and 2.1% other. The 30‐day complication rate was 3.2%, and the mortality rate was 0.3%. The rate of reoperation was 3.8%, and readmission was 4.1%. Black and Hispanic patients had higher rates of urgent operations (P =.003 and P <.001, respectively), and black patients had a higher incidence of emergent operations (P <.001) compared to their white peers. For elective ESS cases, multivariable analysis adjusting for sex, age, comorbidities, and surgical indication indicated that children of Hispanic ethnicity had increased postoperative complications (odds ratio: 1.57, 95% confidence interval: 1.04–2.37). Conclusion: This analysis demonstrated that black and Hispanic children disproportionately undergo more urgent and emergent ESS. Hispanic ethnicity was associated with increased 30‐day complications following elective pediatric ESS. Further studies are needed to elucidate potential causes of these disparities and identify areas for improvement. Level of Evidence: 3 Laryngoscope, 131:E1369–E1374, 2021 [ABSTRACT FROM AUTHOR]