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Background: Emerging research shows that children and young adults (CYAs) with cerebral palsy (CP) are at higher risk for attention-deficit/hyperactivity disorder (ADHD). However, little is known about the clinical and functional characteristics of CYAs with these co-occurring disorders., Aim: To estimate associations between a diagnosis of ADHD among CYAs with CP and clinical and functional characteristics., Methods: This retrospective, cross-sectional study used data from the electronic health records of CYAs (aged 4-26 years) with CP (n = 1145). We used bivariate and multivariable analyses to estimate associations between an ADHD diagnosis, CP type, Gross Motor Function Classification System (GMFCS) level, speech or language disorder, and intellectual disability., Results: 18.1 % of CYAs with CP had a diagnosis of ADHD. CYAs with spastic-bilateral CP had lower odds of ADHD (adjusted odds ratio [AOR] = 0.58; 95 % confidence interval [CI], 0.35-0.96). Odds of having ADHD were significantly lower for those with GMFCS levels III-V (AOR = 0.10; 95 % CI, 0.06-0.15)., Conclusions: Our study found that a diagnosis of ADHD among CYAs with CP was associated with greater clinical and functional impairments compared to counterparts without ADHD. Findings highlight the need to screen for both conditions because of the high comorbidity rates in this population., Competing Interests: Declaration of Competing Interest There are no conflicts of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Nicotine vaping is more prevalent among U.S. adults with disabilities compared to those without disabilities. However, less is known about nicotine vaping among adolescents (12-17 years) and young adults (18-25 years) by disability status., Methods: Using data from a sample of 24,722 adolescents and young adults (AYAs) from the 2021 National Survey on Drug Use and Health, we conducted descriptive and multivariable analyses to estimate the national prevalence of nicotine vaping by disability type and examined major depressive episodes (MDEs) as a risk factor for nicotine vaping., Results: A greater proportion of AYAs with disabilities engaged in past-month nicotine vaping compared to those without a disability (13.9 % vs 9.6 %, p = 0.0001). Also, when MDE was excluded from the model, AYAs with any disability had higher odds of nicotine vaping (AOR = 1.41; 95 % CI 1.15, 1.74) than those without a disability. However, disability status was no longer significant when MDE was included (AOR = 1.16; 95 % CI 0.91, 1.46) in the model., Conclusions: The higher prevalence of nicotine vaping among AYAs with disabilities suggests that tailored messages may be needed to communicate health risks and adverse outcomes of e-cigarette use. Also, MDE is associated with nicotine vaping among AYA populations. This information can be helpful to school nurses, counselors, and mental health professionals in their screening of major depression as a risk factor for e-cigarette use., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: There is a dearth of large, nationally representative studies that examine racial/ethnic disparities in self-reported unmet need for mental health care among children and youth., Objective: This study assessed racial/ethnic disparities in unmet need for mental health care, use of psychotropic medication, and reasons for forgone care among children and youth., Methods: This nationally representative cross-sectional study analyzed data from the combined 2016-2020 National Survey of Children's Health (n = 151,876). Bivariate statistics and multivariable logistic regression models assessed the association between race/ethnicity, unmet need for mental health care, and use of psychotropic medication. Reasons for forgone care were also examined., Results: Black non-Hispanic children and youth had approximately twice the odds of unmet mental health care needs (AOR, 1.97; 95% CI 1.53-2.55) as White non-Hispanic children and youth. The likelihood of reporting that it was not possible to see a mental health professional was higher for Black non-Hispanic (AOR, 3.39; 95% CI 1.64-7.01) and Multi-racial/Other non-Hispanic children and youth (AOR, 2.96; 95% CI 1.40-6.25) compared with White non-Hispanic peers. Black non-Hispanic, Hispanic, and Multi-racial/Other non-Hispanic children and youth were also less likely to use psychotropic medication (p < 0.001). Common reasons for forgoing care included cost, problems getting an appointment, and lack of transportation or childcare., Conclusions: This study found significant racial/ethnic disparities in unmet mental health care, psychotropic medication use, and barriers in accessing mental health care. Data from this study suggest that eliminating these disparities requires policy interventions that address medical and societal barriers to health care access and quality., (© 2023. W. Montague Cobb-NMA Health Institute.)

There is a lack of nationally representative studies examining the co-occurrence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children. This study examines comorbid mental, behavioral, and developmental disorders (MBDDs) and associated treatment modalities for children with co-occurring ASD and ADHD. Cross-sectional analyses were conducted using data from the pooled 2016-2018 National Survey of Children's Health (sample n = 102,341). Nationally representative prevalences were estimated for sociodemographic variables, comorbidities, psychotropic medication, and behavioral treatment. We assessed multivariable associations between co-occurring ASD + ADHD and MBDDs, use of psychotropic medication, and receipt of behavioral treatment after adjustment for sociodemographic confounders. Compared to children with ASD without co-occurring ADHD, children with ASD + ADHD had higher prevalence of most MBDDs, including anxiety (AOR 4.03 [95% CI 2.77, 4.87]), depression (AOR 3.08 [95% CI 1.77, 5.36]), behavior or conduct problems (AOR 4.06 [95% CI 2.72, 6.06]), and other mental health conditions. Similarly, compared to children with ADHD without ASD, children with ASD + ADHD had higher odds of anxiety (AOR 3.49 [95% CI 2.65, 4.61]), depression (AOR 1.67 [95% CI 1.21, 2.29]), behavior or conduct problems (AOR 2.31 [95% CI 1.68, 3.17]), and other mental health conditions. Children with ASD + ADHD were significantly more likely to take psychotropic medication than children with ASD without ADHD. Among children with ASD + ADHD, males had higher odds of receiving behavioral treatment, whereas older children and adolescents were more likely to take psychotropic medication. A multidisciplinary approach is necessary to support the complex needs of these children., (© 2023 International Society for Autism Research and Wiley Periodicals LLC.)

Purpose: The benefits of volunteering among youth are well documented. However, research is limited on volunteering among youth with disabilities. This study examined prevalence and associations of volunteering among youth with disabilities., Methods: We analyzed data from the 2016-2018 National Survey of Children's Health ( n = 42 204). Prevalence estimates were calculated for sociodemographic and household factors, volunteering, and functional limitations. Bivariate and multivariable associations between participation in volunteering activities and variables of interest were assessed., Results: Youth with disabilities had lower prevalence of volunteering compared to youth without disabilities (48.4% vs. 55.6%). Youth with hearing and vision impairments had the lowest prevalence of volunteering (2.1% and 2.5%, respectively). Correlates of volunteering included health status (adjusted odds ratios (aOR)=1.81; 95% confidence interval (CI) 1.13-2.91), sex, and age., Conclusions: Our study found low prevalence of volunteering among youth with disabilities. Since youth with disabilities face unique barriers to social inclusion, it is important to identify and reduce the barriers to participation among this group. Volunteer opportunities in the community should be designed to be both environmentally and programmatically accessible to youth with disabilities. These efforts should include accommodations and other support so that participants can fully experience all of the benefits of volunteering.Implications for rehabilitationOur multiyear nationally representative study found low prevalence of volunteering among youth with disabilities, particularly those with hearing and vision impairments.Since youth with disabilities face unique barriers to social inclusion, it is important to identify and reduce the barriers to participation among this group.Our findings support the need for environmentally and programmatically accessible volunteering opportunities for youth with disabilities.These efforts should include accommodations and other support so that participants can fully experience all of the benefits of volunteering.

Objective To describe the prevalence of tobacco use among a nationally representative sample of college students with disabilities. Participants: Analyses were conducted on a sample of 6189 college students. Methods: Data from the 2017 National Survey on Drug Use and Health were analyzed for ever use, past-month, past-year use of tobacco products, and nicotine dependence. Regression models were conducted to examine the association between tobacco use and disability. Results: Prevalence of tobacco use was higher for students with disabilities. Odds of current tobacco use were higher for students with disabilities (adjusted odds ratio = 1.77) compared to those without disabilities. Students with disabilities also had greater odds of nicotine dependence. Conclusions: The prevalence of tobacco use and nicotine dependence was higher among students with disabilities compared to nondisabled students. As more students with disabilities enroll in postsecondary institutions, services must be provided to these students who are at increased risk for tobacco use.

Lay Abstract: Autism spectrum disorder and attention deficit/hyperactivity disorder are neurodevelopmental disorders that often co-occur in children. However, there are few large, nationally representative studies examining the prevalence of co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder in children. The aim of this study was to estimate the prevalence of parent-reported co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder in the United States and examine associations between having co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder and sociodemographic and household factors. Data were analyzed from the 2016-2018 National Survey of Children's Health. A total of 88,051 children aged 3-17 years old were included in the analysis. Statistical analyses were conducted to assess the associations between sociodemographic and household characteristics and current co-occurrence of autism spectrum disorder and attention deficit/hyperactivity disorder. Approximately 1.2% of children (740,816) aged 3-17 years had co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder. Children who were male, older, reported poor health, or had public or combined public and private health insurance were more likely to have co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder. Conversely, children who were Black, non-Hispanic or multi-racial/other, non-Hispanic were less likely to report co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder than White non-Hispanics. Findings suggest implementing early developmental screening and surveillance for co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder, and coordinating strategies that optimize early identification and intervention for all children suspected of having co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder, particularly those from underrepresented groups.

Objectives: To examine the prevalence of tobacco use by product type among youths with cognitive disability; the prevalence of tobacco dependence among youths with cognitive disability; and the relationship between age of tobacco use initiation and cognitive disability., Study Design: This cross-sectional study analyzed data from the 2019 National Youth Tobacco Survey (NYTS). Participants were a nationally representative sample of 19 018 students in grades 6-12. Estimates were calculated for ever use, current use, age of tobacco use initiation, and tobacco dependence. Associations between use patterns and cognitive disability status were examined using bivariate analyses and multivariable logistic regression., Results: Compared with youths without cognitive disability, youths with cognitive disability had significantly greater odds of ever using any tobacco product (aOR, 1.49; 95% CI, 1.31-1.70), currently using any tobacco product (aOR, 1.41; 95% CI, 1.26-1.58), and currently using electronic cigarettes (e-cigarettes), cigarettes, cigars, hookahs, roll-your-own cigarettes, and heated tobacco products, specifically. They had higher prevalence and odds of reporting younger age of tobacco use initiation (aOR, 1.25; 95% CI, 1.10-1.43). Higher prevalence and odds of tobacco dependence were also observed among youths with cognitive disability compared with youths without cognitive disability (P < .001)., Conclusions: These findings reinforce the importance of developing early primary prevention efforts to reduce or delay tobacco use among adolescents with cognitive disability. They also suggest the need to address co-occurring disorders during tobacco cessation programs with this high-risk group., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Youth with special healthcare needs have low rates of healthcare transition services, which can affect lifelong functioning and quality of life. This study examines the variations in receipt of healthcare transition services among youth with special healthcare needs., Methods: Data from the 2016-2018 National Survey of Children's Health (N=102,341) were analyzed in 2021. Receipt of healthcare transition services by youth with select health conditions was compared with youth with other special healthcare needs. Bivariate and multivariable analyses assessed the associations between the receipt of healthcare transition services, sociodemographic characteristics, and health conditions., Results: Among youth with special healthcare needs, the prevalence of receiving healthcare transition services was lowest among youth with speech or other language disorders (8.5%), intellectual disabilities (9.4%), and autism spectrum disorder (11.1%). Low prevalence of receiving healthcare transition services was also observed for youth with developmental delays (12.6%), learning disabilities (14.2%), and behavior or conduct problems (15.5%). Youth with developmental delays (AOR=0.70, 95% CI=0.52, 0.95), intellectual disabilities (AOR=0.45, 95% CI=0.26, 0.78), learning disabilities (AOR=0.77, 95% CI=0.60, 0.99), autism spectrum disorder (AOR=0.60, 95% CI=0.41, 0.86), and speech or other language disorders (AOR=0.48, 95% CI=0.32, 0.72) had lower odds of receiving healthcare transition services than youth with other special healthcare needs., Conclusions: Findings suggest that the receipt of healthcare transition services varies substantially by the type of chronic health condition and highlight the need for increased healthcare transition services for youth with special healthcare needs, especially for youth with neurodevelopmental disabilities and speech or other language disorders., (Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Haiti has the highest rate of neonatal mortality in the Latin America and Caribbean region. While the rate of facility births in Haiti has doubled over the past two decades, there have been no comparable reductions in maternal or neonatal mortality. Little data is available on the clinical characteristics of complications and morbidities among newborns requiring hospitalization after birth and their contribution to neonatal mortality. There is a need to better understand the status of newborn clinical care capacity in Haiti to prioritize training and resources., Methods: We performed a retrospective observational cohort study of neonates admitted to a large public referral hospital in southern Haiti in the first 2 years of operation of a new neonatal unit that we established. All neonate cases hospitalized in the unit in these 2 years were reviewed and analyzed to identify their clinical characteristics and outcomes. Multivariable logistic regression was used to identify independent risk factors of hospital mortality. We present the outcomes for 1399 neonates admitted to the unit during August 2017 and August 2019., Results: The leading cause of death was prematurity, followed by hypoxia and infection. Inborn neonates had better rates of hospital survival than those born elsewhere; they were also more likely to be born via cesarean section and to be admitted immediately following birth. There were no differences between the proportion of premature or low-birth-weight babies born at the hospital or elsewhere. Mortality in the second year of the unit's operation was 12%, almost half that of the first year (21%). Multivariable regression analysis showed that mortality was consistently higher among premature and very low birthweight babies., Conclusions: With modest investments, we were able to halve the mortality on a neonatal unit in Haiti. Resources are needed to address prematurity as an important outcome since hospital mortality was significant in this group. To this end, investment in uninterrupted supplies of oxygen and antibiotics, as well as ensuring adequate newborn resuscitation, infection control, laboratory testing, and timely morbidity and mortality reviews would go a long way toward lowering hospital mortality in Haiti., (© 2022. The Author(s).)

Objective: To examine the physical and functional health of children with cerebral palsy (CP) and determine the prevalence and correlates of unmet need for health care coordination among this population., Methods: We analyzed data from the 2016 to 2018 National Survey of Children's Health (n = 102,341). Bivariate and multivariable analyses were conducted to compare the prevalence of chronic health conditions, functional disabilities, and care coordination among children with and without CP. Multivariable logistic regression models were used to estimate the adjusted odds ratio of comorbid conditions, functional disabilities, and unmet need for care coordination. Associations between select sociodemographic factors and unmet need for care coordination were assessed., Results: Children with CP had significantly higher prevalence of all the comorbid conditions and functional disabilities examined. The most prevalent health conditions among children with CP were allergies (34.2%), anxiety (26.5%), and asthma (25.1%). Notably, children with CP had higher odds of autism spectrum disorder (adjusted odds ratio [aOR] = 2.97; 95% confidence interval [CI] 1.40-6.30) and mental health conditions (aOR = 3.65; 95% CI 2.15-6.21). More than half (53.8%) of children with CP had unmet need for care coordination. They also had higher odds of unmet need for care coordination than children without CP (aOR = 2.63; 95% CI 1.69-4.10)., Conclusion: Children with CP have high prevalence of chronic health conditions and are also more likely to have unmet need for care coordination. Given the complexity of CP, our study supports the need for robust efforts to ensure that all children with CP have effective care coordination., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The number of students with disabilities attending postsecondary institutions is increasing. However, research on substance use among this population is limited., Objective: This study examined disparities in the prevalence of illicit drug use and drug use disorders among college students with disabilities and their counterparts without disabilities., Methods: Data from the 2017 National Survey on Drug Use and Health were analyzed. We estimated prevalence and odds of disability, illicit drug use, and illicit drug dependence or abuse in a subsample of college students (n = 6,189)., Results: A majority of college students reporting a disability had a cognitive limitation. Students with any disability had a higher prevalence of illicit drug use and significantly higher odds of ever use of illicit drugs (AOR = 1.47; 95% CI 1.20-1.79). Compared to their peers with no disabilities, they were more likely to have misused any psychotherapeutic in the past year (AOR = 1.38; 95% CI 1.08-1.76), and had nearly twice the odds of misusing prescription pain relievers in the past month (AOR = 1.97; 95% CI 1.11-3.49). Additionally, students with disabilities had three times the odds of meeting criteria for past-year dependence or abuse of any illicit drug (AOR = 3.01; 95% CI 2.06-4.40)., Conclusion: This study documented a higher prevalence of drug use and drug use disorders among college students with disabilities compared to their nondisabled peers. Understanding the risk factors for substance use in this population is critical for developing effective prevention and treatment strategies., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to report., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: Electronic cigarettes (e-cigarettes) are now the most popular tobacco product among youth. Little is known about the relationship between exposure to e-cigarette marketing at the point-of-sale and youth e-cigarette use., Methods: Research staff collected data on e-cigarette availability and promotion in tobacco retailers within a half-mile of 41 schools participating in the 2014 New Jersey Youth Tobacco Survey. These data were linked with participant responses from the New Jersey Youth Tobacco Survey (n = 3,909) and log-Poisson regression models estimated adjusted prevalence ratios for ever and past-month e-cigarette use., Results: Nearly a quarter of high school students in New Jersey have tried e-cigarettes (24.1%) and 12.1% were past-month users. Prevalence was highest among males, non-Hispanic whites, and students who have used other tobacco products. After controlling for covariates and the clustered nature of the data, e-cigarette retailer density around schools was positively associated with ever and past-month use of e-cigarettes (p < .05). E-cigarette advertising volume significantly increased the probability of being a past-month e-cigarette user (adjusted prevalence ratio: 1.03, p = .031)., Conclusions: This study suggests that the point-of-sale environment around schools may contribute to e-cigarette use among youth. Policy efforts to restrict tobacco promotion at the point-of-sale may play a role in reducing the use of e-cigarettes., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)