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Objective: To evaluate concordance of asthma severity classification via physician chart notation compared with guideline-based criteria in adolescents with diagnosed asthma. Methods: Of 284 urban primary care and subspecialty clinic patients aged 13–18 years approached through convenience sampling, 203 surveys were completed (RR = 71.5%). We assessed concordance with sensitivity, specificity, and positive predictive values; overall agreement was evaluated with weighted kappa coefficients and McNemar's test. Results: When considering prescribed treatment according to NAEPP guidelines as a gold standard, the sensitivity for chart notation was very good for intermittent (95%) and less for non-intermittent severity ratings (51%, 58%, and 67% for moderate, severe, and mild persistent asthma, respectively). Overall agreement between chart notation and guideline-based asthma criteria ranged from fair-to-good for mild- (k = 0.36), moderate- (k = 0.44), and severe-persistent severity (k = 0.66). Although the agreement for intermittent severity was highest (k = 0.88), it did not significantly differ by between the two classifications (p ≥ 0.05). Conclusions: Concordance for all non-intermittent asthma severity classifications varied between physician and medication-driven 2007 NAEPP guideline classifications in an ethnically diverse urban adolescent patient sample. Physicians should remain aware of the potential for this discordance and refer to the guidelines to classify and treat adolescents with asthma. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND METHODS RESULTS CONCLUSIONS Limited information about school outcomes among children (especially early childhood) with lifetime history of head injury, including traumatic brain injury (TBI), may inhibit efforts to support their academics and physical and mental health.Baseline data (2016‐2018) from the Adolescent Brain Cognitive Development (ABCD) study were analyzed to describe associations between parent‐proxy reported lifetime history of head injury or TBI before age 9 and school outcomes and behavioral challenges among 9‐ and 10‐year‐old children.Having a lifetime history of head injury before age 9 was associated with increased odds of parent‐perceived poor school performance (adjusted odds ratio [AOR] = 1.44, 95% confidence interval [CI] = 1.14‐1.81), a drop in grades (AOR = 1.28, 95%CI = 1.06‐1.54), recent receipt of detentions or suspensions (AOR = 1.29, 95%CI = 1.02‐1.65), and receipt of special educational services (AOR = 1.23, 95%CI = 1.08‐1.41). Of those with a lifetime history of head injury, males displayed poorer school outcomes and greater behavioral challenges than females. Similar associations were observed between lifetime history of TBI before age 9 and worse school outcomes, with males continuing to demonstrate stronger associations.These findings underscore the importance of screening for history of head injury and TBI and providing training for school professionals to help ensure students with a history of head or traumatic brain injury have appropriate supports in place. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite historical and contemporary trauma, American Indian and Alaska Native (AIAN; Indigenous) communities responded with resilience to the COVID‐19 pandemic. However, AIANs experienced disproportionate rates of infection, hospitalization, death, and reduced life expectancy. School closures exacerbated disparities, leading to learning loss, economic instability, and mental health challenges among AIAN youth. METHODS: The Project SafeSchools cohort study employed a comprehensive longitudinal convergent mixed‐methods approach, integrating community‐based participatory research principles. The study enrolled Navajo Nation caregivers whose children were eligible to attend local reservation‐based schools. We conducted an analysis of caregiver self‐report baseline data collected between August 2021 and May 2022. RESULTS: A total of 242 caregivers completed at least part of the baseline assessment and were included in data analysis. Caregivers were primarily female (88.7%), non‐Hispanic (97%), and Indigenous (97%). Most caregivers were in their late 30s (mean age 38), with varying educational backgrounds and employment statuses. Children were evenly split between males and females and distributed across different age groups. Most children attended school at baseline in various formats, including in‐person, hybrid, and online‐only settings. Caregivers reported a range of psychosocial and behavioral risks, including general mental distress, depressive symptoms, and anxiety for themselves and their children. Furthermore, caregivers and children exhibited various protective factors, such as strong cultural identity, resilience, and academic self‐efficacy. CONCLUSIONS: This study highlights the higher rates of mental health distress among participating caregivers and children compared to national averages. Despite these challenges, cultural protective factors remained strong and should guide future crisis response efforts. [ABSTRACT FROM AUTHOR]

Background: Recent guidelines, supported by large, well-designed studies, suggest that bariatric surgery is a safe and effective treatment for adolescents living with severe obesity to improve health and psychosocial functioning. The aim of this study was to assess the opinions and referral practices of general practitioners (GPs) and paediatricians in Ireland. Methods: A cross-sectional survey was circulated online to practising paediatricians and GPs. The survey consisted of a short introduction about childhood obesity and 12 questions on adolescent bariatric surgery and obesity medications. Results: There were 45 unique responses to the survey from 22 GPs (48%), 8 paediatricians (17%), and 15 others. Most GPs (72%) would not consider referring an adolescent for bariatric surgery. Paediatricians were significantly more likely to refer (72% vs. 28%, p = 0.034). A minimum BMI of 40 kg/m2 was the most common response, which GPs (45%) and paediatricians (37.5%) suggested should be a pre-requisite for surgery. There was strong support for family psychological assessment and a reported deficit in the community support needed to manage obesity. GPs were more likely than paediatricians to respond that anti-obesity medications should be made available to adolescents, specifically liraglutide (45% vs. 25%), semaglutide (45% vs. 37.5%), and orlistat (22% vs. 0%). Discussion: There is a reluctance among GPs to refer adolescents with severe obesity for consideration of bariatric surgery. Concerns regarding the different obesity treatments held by medical professionals should be addressed through education and engagement and should be fundamental to the development of child and adolescent obesity services. [ABSTRACT FROM AUTHOR]

ObjectiveTo describe the process of implementing a Youth Participatory Action Research (YPAR) project at a continuation high school (CHS) and share the results of a youth-designed research project that explores barriers to high school completion.Data sources and study settingYPAR was implemented across three cohorts at a CHS in the central coast of California from 2019 to 2022. Student survey respondents were enrolled CHS students between March and April 2021.Study designA modified YPAR curriculum integrating research methodology and social justice topics was used to guide student-led research that resulted in a cross-sectional survey.Data collectionField notes maintained by the first author documented the process of implementing YPAR including the curriculum, conversations, and research decisions and procedures. A student-designed survey disseminated to all enrolled students resulted in 76 (66%) participant responses. The survey included 18 close-ended questions and three narrative responses.Principal findingsThis study details how YPAR methodologies can be translated to a high school credit recovery program. For example, student cohorts were needed to maintain continuity over time. A student-designed survey revealed that 72% of student respondents reported taking care of family members and illuminated high rates of depression symptoms.ConclusionsThis study offers a detailed description of how we implemented YPAR at a credit recovery program and provides student-driven perspectives on educational reform and evaluation. This project addresses the implementation and challenges of using YPAR to engage youth in transformational resistance to rapidly study and improve CHS' policy and practice.

The burden of obesity, diabetes mellitus and asthma remains a significant public health issue worldwide. These conditions are associated with premature deaths and a reduced quality of life. Primary health care plays a key role in the prevention, detection, and management of noncommunicable diseases in childhood, including diabetes and asthma. Health promotion is crucial for a healthy life from early childhood, preventing from obesity, a sedentary lifestyle, exposure to tobacco smoke, and other risk factors associated to noncommunicable diseases. Asthma and type 1 diabetes mainly begin in childhood; thus, recognition and early detection at the primary health care level are essential. In the long term, management of children with chronic diseases requires regular follow-up and cooperation with a specialized team. Care coordination by the primary health care provider is key for optimal control of the disease and development of the child or adolescent in the physical, emotional, and social spheres. Over-referral for diagnosis and follow-up is associated with unnecessary specialist overload, patient anxiety, and financial burden for the families and the health system. Clear criteria and referral pathways with efficient communication between the professional team members are essential to empower primary health care providers, avoid unnecessary referrals, and optimize the care and quality of life of children and adolescents with chronic diseases.The WHO Pocket book of primary health care for children and adolescents was recently developed to address knowledge gaps and improve the diagnosis and management of children and adolescents at the outpatient level. It dedicates an entire chapter to health promotion and disease prevention with counselling messages addressed to children, adolescents and their families; provides guidance for the diagnosis and management of asthma, diabetes and other chronic diseases; and includes additional considerations for adolescents living with chronic conditions.

Summary: Background: Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country. Methods: We conducted a population-based national retrospective cohort study of children (0–9 years) and adolescents (10–17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively. Findings: A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9–3.1) and did not receive DOT (2.3, 1.9–2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2–2.0), illicit drug use (4.2, 3.4–5.1), tobacco use (1.6, 1.3–2.1), HIV infection (2.7, 2.2–3.4), and not receiving DOT (2.6, 2.3–2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3–0.9). Interpretation: In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated. Funding: Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.

Background: Dental caries (tooth decay) is the world's most prevalent noncommunicable disease and can lead to pain, infection, and edentulism. Many children with caries lack access to traditional dental services. School‐based caries prevention can increase access to care and reduce health inequities. Disruptions in school‐based care due to pandemic control policies may result in children losing access to their primary dental care option. Methods: The CariedAway project was a school‐based caries prevention program in operation from 2019 to 2023 in urban schools with a high proportion of low‐income, minority students. Program operations were suspended for 2 years due to the COVID‐19 pandemic. We estimated the prevalence of untreated decay, swelling, fistula, and pulpal involvement in participants at baseline and again after restrictions were lifted. Results: A total of 2998 children between the ages of 5 and 13 years were enrolled and received preventive care prior to pandemic shutdowns, and 1398 (47%) completed a follow‐up observation after 2 years. At baseline, approximately 30% had untreated caries on any dentition, 11% of children presented with evidence of dental sealants, and no participants had swelling, fistula, or pulpal involvement. After 24 months, 12% of participants had swelling fistula, or pulpal involvement that was not treated during the pandemic period. Conclusion: There are considerable unmet dental needs in high‐risk children that may be further exacerbated by a lack of access to care during disease outbreaks. [ABSTRACT FROM AUTHOR]

BACKGROUND: State‐level leadership and conditions are instrumental to local and regional comprehensive school mental health system (CSMHS) quality, sustainability, and growth. However, systematic documentation of state‐level school mental health (SMH) policy, infrastructure, funding, and practice is limited. METHODS: Using a multi‐phase, multi‐method process, we developed the State School Mental Health Profile (State Profile) to offer a comprehensive landscape of state SMH efforts. State leaders in 25 states completed the State Profile once over a 3‐year data collection period. Mixed methods results are reported in 8 domains. RESULTS: State education agencies were reportedly most involved in SMH technical assistance, advocacy, leadership, funding, and service provision, with mental health agencies reported as second most involved. Nearly half of state respondents reported having a state‐level SMH director or coordinator. Policies with the greatest perceived impact require implementation of and funding for SMH services and supports. Despite leveraging multiple sources of funding, most states emphasized lack of funding as a primary barrier to establishing CSMHSs. All states reported staffing shortages. CONCLUSION: The State Profile can assist multi‐agency state leadership teams to self‐assess policy, infrastructure, and resources to support CSMHSs statewide. Findings point to areas of opportunity to advance equity across resource allocation, service provision, and policy development. [ABSTRACT FROM AUTHOR]

Schools' health screenings can identify students' missed health concerns. Data from the 2016 School Health Policies and Practices Study were used to determine the proportion of U.S. school districts with physical and mental health screening policies and the proportion that arrange off-campus mental health services. We also examined differences between districts with and without mental health screening policies regarding having physical health screening policies, patterns of these policies, and off-campus mental health service arrangements. Eleven percent of districts had no policies on any of the four physical health screenings assessed, and 87% lacked policies on mental health screenings, the latter especially concerning considering the impact of COVID-19. Districts with policies on mental health screenings were significantly more likely to have body mass index (p <.01) and oral health (p <.001) screening policies, and to arrange for off-campus case management (p <.001), family counseling (p <.05), group counseling (p <.01), self-help (p <.05) and intake evaluation (p <.05). [ABSTRACT FROM AUTHOR]

School acoustics is pivotal for children's well-being given their substantial time commitment to education within these environments, with potential positive or negative impacts. Soundscape has gained relevance in various settings, including indoor environments, and explores both positive and negative responses of individuals to sounds within a context. This scoping review aims to investigate the application of the soundscape approach within the school environment, with a primary focus on evaluating perceptions of the acoustic environment. It aims to identify key factors considered in the studies, such as age groups, sound sources, and methodologies. A Scopus search was conducted, covering the period from January 2000 to September 2023. The search was limited to peer-reviewed articles published in English. The inclusion criteria required studies to investigate schools and assess the perceptions. After screening, 11 studies met the inclusion criteria from 49 articles. The most targeted age cohort was primary school-aged children. Yet, the need to consider secondary school children's perceptions persists. The dominant sounds investigated were categorized as "negative" sounds, referring to auditory stimuli that are commonly perceived as unpleasant. These negative sounds were primarily traffic-induced noise. The prevailing method used was questionnaires. To advance school soundscape research, exploring secondary school-aged children's views would provide valuable insights. By enhancing knowledge in this field, researchers can improve school acoustics for student well-being. Notably, a limitation of this review is that soundscape studies have centered around urban environments so far. Consequently, there have been only a limited number of studies examining indoor environments, and even less for schools. [ABSTRACT FROM AUTHOR]

IntroductionGaucher disease (GD) is a rare, autosomal recessive lysosomal storage disorder caused by a deficiency in the enzyme glucocerebrosidase. The most common subtype in Europe and the USA, type 1 (GD1), is characterized by fatigue, cytopenia, splenomegaly, hepatomegaly, bone disease, and rarely pulmonary disease. Increased life expectancy brought about by improved treatments has led to new challenges for adolescents and their transition to adult care. Efficient healthcare transition to adult care is essential to manage the long-term age-related complications of the disease.MethodsThis international study consisted of two online surveys: one survey for patients with GD1 and one survey for healthcare professionals (HCPs) involved in treatment of patients with GD1. The aims of this international, multi-center project were to evaluate the current transition process in various countries and to understand the challenges that both HCPs and patients experience.ResultsA total of 45 patients and 26 HCPs took part in the survey, representing 26 countries. Our data showed that a third (11/33) of patients were aware of transition clinics and most stated that the clinic involved patients with metabolic diseases or with GD. Seven patients attended a transition clinic, where most patients (5/7) received an explanation of the transition process. Approximately half of HCPs (46%; 12/26) had a transition clinic coordinator in their healthcare center, and 10 of HCPs had a transition clinic for patients with metabolic diseases in their healthcare center. HCPs reported that transition clinics were comprised of multi-disciplinary teams, with most patients over the age of 18 years old managed by hematology specialists. The main challenges of the transition process reported by HCPs included limited funding, lack of expertise and difficulty coordinating care amongst different specialties.DiscussionOur study demonstrates the lack of a standardized process, the need to raise awareness of transition clinics amongst patients and the differences between the transition process in different countries. Both patients and HCPs expressed the need for a specialist individual responsible for transition, efficient coordination between pediatricians and adult specialists and for patient visits to the adult center prior to final transition of care.

Abstract Background Reducing health inequities for children from a disadvantaged background is an important task in public health. While intersectoral partnerships are a promising way to achieve this, few studies have examined the factors influencing the success of these interventions. In this study, we conducted a process evaluation of the integrated community-based intervention Präventionskette Freiham that the city of Munich, Germany, has implemented in a new residential development area. The aim was to investigate the implementation process as well as barriers and facilitators. Methods Following a mixed methods approach, we collected data from different core groups making up Präventionskette Freiham from April 2020 to August 2022, exploring their perspective on the implementation process. We conducted repeated qualitative interviews with the network coordinators and eleven local professionals from institutions engaged with or relevant for the intervention. We also undertook a focus group with four members of the advisory group representing the three municipal departments guiding the intervention. Ego-centered network maps were drawn by the network coordinators to chart the development of the network. Subsequently, we also conducted an online survey with local network members. Results At the early stage of the implementation process, the intervention was able to integrate actors from different sectors, serving as a platform for mutual exchange. However, the network produced limited output. According to the interviews, this may be mainly attributable to the early development status of the area. We identified seven topics that may act as facilitators or barriers to implementation of Präventionskette Freiham: (1) availability of resources, (2) political and administrative support, (3) the network coordinators, (4) network-internal processes, (5) trans-institutional cooperation, (6) perceived benefits of engagement, and (7) the output of the network. Conclusions The early development status of the area was a challenge for the intervention. This emphasizes the need to carefully consider context when planning and implementing integrated community-based public health interventions in new residential development areas.

Background: Reducing health inequities for children from a disadvantaged background is an important task in public health. While intersectoral partnerships are a promising way to achieve this, few studies have examined the factors influencing the success of these interventions. In this study, we conducted a process evaluation of the integrated community-based intervention Präventionskette Freiham that the city of Munich, Germany, has implemented in a new residential development area. The aim was to investigate the implementation process as well as barriers and facilitators. Methods: Following a mixed methods approach, we collected data from different core groups making up Präventionskette Freiham from April 2020 to August 2022, exploring their perspective on the implementation process. We conducted repeated qualitative interviews with the network coordinators and eleven local professionals from institutions engaged with or relevant for the intervention. We also undertook a focus group with four members of the advisory group representing the three municipal departments guiding the intervention. Ego-centered network maps were drawn by the network coordinators to chart the development of the network. Subsequently, we also conducted an online survey with local network members. Results: At the early stage of the implementation process, the intervention was able to integrate actors from different sectors, serving as a platform for mutual exchange. However, the network produced limited output. According to the interviews, this may be mainly attributable to the early development status of the area. We identified seven topics that may act as facilitators or barriers to implementation of Präventionskette Freiham: (1) availability of resources, (2) political and administrative support, (3) the network coordinators, (4) network-internal processes, (5) trans-institutional cooperation, (6) perceived benefits of engagement, and (7) the output of the network. Conclusions: The early development status of the area was a challenge for the intervention. This emphasizes the need to carefully consider context when planning and implementing integrated community-based public health interventions in new residential development areas. [ABSTRACT FROM AUTHOR]

Objective: To describe network structure and alignment across organizations in healthcare, public health, and social services sectors that serve pregnant and parenting women with substance use disorder (SUD) in an urban and a rural community. Data Sources and Study Settings: Two community networks, one urban and one rural with each including a residential substance use treatment program, in Kentucky during 2021. Study Design: Social network analysis measured system collaboration and cross‐sector alignment between healthcare, public health, and social services organizations, applying the Framework for Aligning Sectors. To understand the alignment and structure of each network, we measured network density overall and between sectors, network centralization, and each organization's degree centrality and effective size. Data Collection/Extraction Methods: Computer‐assisted telephone interviews were conducted to document alignment around shared purpose, data, financing, and governance. Principal Findings: On average, overall and cross‐sector network densities in both communities were similar. However, alignment was highest for data sharing and financing in the urban community and for shared purpose and governance in the rural community. Cross‐sector partnerships involving healthcare organizations were more prevalent in the rural county (44% vs. 38% for healthcare/public health, 44% vs. 29% for healthcare/social services), but more prevalent for those involving public health/social services organizations in the urban county (42% vs. 24%). A single healthcare organization had the highest degree centrality (Mdn [IQR] = 26 [26–9.5]) and effective size (Mdn [IQR] = 15.9 [20.6–8.7]) within the rural county. Social services organizations held more central positions in the urban county (degree centrality Mdn [IQR] = 13 [14.8–9.5]; effective size Mdn [IQR] = 10.4 [11.4–7.9]). Conclusions: Cross‐sector alignment may strengthen local capacity for comprehensive SUD care for pregnant and parenting women. Healthcare organizations are key players in cross‐sector partnerships in the rural community, where one healthcare facility holds the central brokerage role. In contrast, public health agencies are key to cross‐sector collaboration with social services in the urban community. [ABSTRACT FROM AUTHOR]

The financial difficulties of parents have a negative impact on the health of their children. This problem is more pronounced in single mother families. There is limited research on low-income, single mothers and how interventions to help them address financial difficulties may also benefit their children. The purpose of this study was to evaluate the effect of a year-long financial education and coaching program on school absenteeism and health care utilization of children in employed, low-income, single mother households. This was a post hoc analysis of the Finances First study, a randomized controlled trial conducted in 2017–2020 examining the impact of a financial coaching and education program on economic stability and health outcomes in 345 low-income, single mothers. Either generalized estimating equations (GEEs) or generalized linear mixed models (GLMMs) were used to account for relationships between participants. For the continuous outcomes of child absenteeism, physician visits, emergency room visits, and hospitalization days, a linear mixed-effects model was used. The Finances First study demonstrated improvements in various financial strain measures. Compared to the control group, children of intervention group participants experienced 1 fewer day of school absence (p = 0.049) and 1 fewer physician visit (p = 0.032) per year, but no impact was seen on emergency room visits (p = 0.55) or hospitalizations (p = 0.92). Addressing social determinants of health in parents is necessary for improving child health outcomes. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine how body mass index assessments are conducted in schools and whether student comfort with assessments varies by students' perceived weight status, weight satisfaction, or privacy during measurements.MethodsIn-person cross-sectional surveys with diverse fourth- to eighth-grade students (n = 11,510) in 54 California schools in 2014-2015 about their experience being weighed in the prior school year.ResultsHalf of the students (49%) reported being weighed by a physical education teacher and 28% by a school nurse. Students were more comfortable being weighed by nurses than physical education teachers (P = 0.01). Only 30% of students reported privacy during measurements. Students who were unhappy with their weight (P

Background: It is well known that there are gender differences in the health behaviour and physical and mental health of children. The COVID-19 pandemic influenced the health and lifestyles of children and adolescents by changing their living conditions. The present work investigates whether gender differences in selected health indicators are evident more than two years after the onset of the pandemic. Methods: In the study Kindergesundheit in Deutschland aktuell (KIDA) (German Children’s Health Update), cross-sectional telephone surveys were conducted with parents of 3- to 15-year-olds (n=3,478). Parental information on the general and mental health of the child, on increased need for health care and mental health services, as well as on physical activity and utilisation of sports activities were queried in standardised manner. Gender differences were assessed using Chi2 tests. Results: A total of 91% of the girls and 92% of the boys had their general health assessed as being (very) good by their parents (difference not significant, n.s.). An increased need for care and support was indicated for 10.6% of the 3- to 15-year-olds (girls: 9%, boys: 12%, n.s.). Boys met the physical activity recommendations of the WHO significantly more often (60%) than girls (54%). Good to excellent mental health was reported for 93% of both boys and girls. When changes during the pandemic were reported, no differences were found in the responses for girls compared to boys. Conclusions: Gender differences were found for individual parameters and age groups. These differences must be assessed in the context of other social determinants of health, and need to be considered when planning preventive measures.

Abstract Background The health of adolescents is determined by structural and intermediary factors. Such factors operate through pathways that foster different opportunities to achieve health and wellbeing, contributing to inequities. Past analyses of cross-national adolescent health data show that measures of child spirituality, conceptualized as the strength of the connections in our lives, may operate as intermediary determinants in some Western countries. Inspired by this idea, the current analysis provides an in-depth exploration of such pathways among Canadian adolescents. Our objectives were to confirm the existence of relationships between economic position and seven indicators of adolescent health status, then explore whether any observed inequities could be explained by the strength of connections afforded by a healthy spirituality. Methods Cycle 8 of the Canadian Health Behaviour in School-aged Children (HBSC) study was conducted in 2017–18. A school-based sample (n = 18,962) of adolescents was obtained from across Canada following a standard cross-national protocol. Eligible participants completed a general survey about their health, health behaviours and their determinants. Survey data were used to model the potential effect of perceived levels of relative affluence on each of seven health indicators. Comparison of crude and adjusted relative risks estimates from weighted log-binomial regression models provided evidence of indirect mediating effects attributable to each of four domains of spirituality. Results As perceived levels of family affluence increased, the percentages of young people who reported each (7/7) of the negative health outcomes decreased. The spiritual health domain “connections to self” (i.e., the importance of meaning, purpose, joy and happiness in life) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes in boys and girls. “Connections to others” (the importance of kindness, respect and forgiveness) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes among girls. Inconsistent evidence of possible mediation was identified for connections to others in boys, as well as the other two domains of spirituality (connections to nature, then connections to the transcendent) in boys and girls. Conclusion Specific connections afforded by a healthy spirituality could be intermediary determinants of health in Canadian adolescent populations.

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Objective: To estimate the effects of prenatal public health insurance targeting noncitizens on the health of U.S.‐born children of noncitizen mothers beyond birth outcomes. Data Sources and Study Setting: This paper uses the restricted version of the 1998–2014 National Health Interview Survey with state‐level geographic identifiers. Study Design: The empirical strategy compares outcomes in states that adopted the Children's Health Insurance Plan (CHIP) Unborn Child Option with states that never adopted or adopted it at different times, controlling for differences in the pre‐treatment period. I use a flexible event‐study analysis to quantify the effects of the Unborn Child Option on noncitizen women's health insurance coverage, health care utilization, and their children's health. Data Collection/Extraction Methods: All data are derived from pre‐existing sources. Principal Findings: The study finds that the impact of the Unborn Child Option is a 4.7%‐point increase in public health insurance coverage (p < 0.01) and 0.48 more doctor's office visits (p < 0.1) annually among noncitizens of childbearing ages. Subsequently, the reform leads to a 7%‐point rise in the rate of parents reporting their 4–6‐year‐old children are in "excellent" or "very good" health (p < 0.01). While no improvements are evident at birth and at younger ages, observed health improvements begin to appear by preschool age. Conclusions: The study contributes to the literature by providing evidence that certain benefits of in‐utero public health insurance targeting noncitizens may appear several years after birth, specifically around preschool age. [ABSTRACT FROM AUTHOR]

This study examines how community-level cumulative environmental stress affects child and adolescent emotional distress and chronic health conditions both directly and indirectly through stressors at the household, family, and individual levels. Data comes from the Women and their Children’s Health (WaTCH) Study, which sought to understand the health implications of exposure to the 2010 Deepwater Horizon oil spill (DHOS) among a cohort of 596 mothers with children ages 10 to 17 in southeastern Louisiana. Community-level environmental stress was measured using a newly developed geospatial index. Household-level stressors included previous hurricane impacts, impacts of DHOS, degree of financial difficulty, and degree of housing physical decay. Family stressors included maternal depression, self-rated physical health, and degree of parenting stress. Child stress was based on perceived stress; child mental health was based on serious emotional disturbance; and child physical health was based on diagnosis of chronic illness. Structural equation modeling used weighted least squares means and variance and theta parameterization. Results showed a significant negative direct path between community-level cumulative environmental stress and child/adolescent serious emotional disturbance and chronic illness. However, the indirect relationship through household, family, and individual-level stressors was significant and positive for both child/adolescent serious emotional disturbance and chronic illness. These findings point to the centrality of the household and family in determining child and adolescent physical and mental health outcomes in communities exposed to frequent disasters and ongoing environmental stressors. [ABSTRACT FROM AUTHOR]

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There is a strong association between family meals and child and adolescent health. To systematically understand the associations between family meals with a variety of health and risk outcomes, we developed and conducted a validation study of child- and parent-versions of the Family Dinner Index (FDI; FDI-C/FDI-P). We validated the measures with a national sample of 2,090 parent–child dyads. Using factor analysis, we reduced the initial FDIs each to eight items representing communication, enjoyment, and digital distractions; the FDI-C also included meal logistics and the FDI-P, family bonding. Using multivariable log-binomial regression models, we examined the relationships between FDI scores and substance use, violence, weight perception, weight control intention, and health indicators. Children who scored ≥21 on the FDI-C had a significantly lower average prevalence of a ‘negative outcome’ composite, as well as a lower prevalence of each of the individual behaviors. Children of parents who scored ≥24 on the FDI-P had a significantly lower average prevalence of the ‘negative outcome’ composite, as well as a lower prevalence of substance use indicators, negative weight perception and intentions to lose weight, less than daily fruit and vegetable consumption, and not meeting guidelines for physical activity. The FDI measures provide support for face and content validity, as well as concurrent criterion validity and construct validity. Further validation with these measures using a longitudinal design will allow for the establishment of predictive validity. Currently, the FDI measures may help researchers and practitioners identify points of emphasis for tailoring family-based prevention programs accordingly.

Objective: To describe the process of implementing a Youth Participatory Action Research (YPAR) project at a continuation high school (CHS) and share the results of a youth‐designed research project that explores barriers to high school completion. Data Sources and Study Setting: YPAR was implemented across three cohorts at a CHS in the central coast of California from 2019 to 2022. Student survey respondents were enrolled CHS students between March and April 2021. Study Design: A modified YPAR curriculum integrating research methodology and social justice topics was used to guide student‐led research that resulted in a cross‐sectional survey. Data Collection: Field notes maintained by the first author documented the process of implementing YPAR including the curriculum, conversations, and research decisions and procedures. A student‐designed survey disseminated to all enrolled students resulted in 76 (66%) participant responses. The survey included 18 close‐ended questions and three narrative responses. Principal Findings: This study details how YPAR methodologies can be translated to a high school credit recovery program. For example, student cohorts were needed to maintain continuity over time. A student‐designed survey revealed that 72% of student respondents reported taking care of family members and illuminated high rates of depression symptoms. Conclusions: This study offers a detailed description of how we implemented YPAR at a credit recovery program and provides student‐driven perspectives on educational reform and evaluation. This project addresses the implementation and challenges of using YPAR to engage youth in transformational resistance to rapidly study and improve CHS' policy and practice. [ABSTRACT FROM AUTHOR]

Background Accessibility of food retail in communities may play a role in shaping the food choices of local residents. However, previous studies have shown mixed results. This study examined associations between the local restaurant environment and the frequency of eating food from restaurants and intake of sugary drinks among Canadian children and youth. Data and methods The study cohort consisted of 23,776 participants (aged 1 to 17 years) in the 2019 Canadian Health Survey on Children and Youth who resided in large urban population centres across the Canadian provinces. Measures of geographic access to various restaurant types within walking distance of participants' residential areas came from the 2018 Canadian Food Environment Dataset. Poisson regression models with robust standard errors assessed associations between measures of absolute densities (number per km2) of full-service, fast-food and other restaurants, and the relative density of fast-food restaurants (as a percentage of total restaurants) with the frequency of eating food from fast-food or full-service restaurants and sugary drink intake in the previous seven days. Results After adjustment for a range of sociodemographic covariates, there were no consistent associations between absolute and relative measures of restaurant access and the frequency of eating food from restaurants or intake of sugary drinks. Interpretation Results reveal no consistent relationships between local restaurant exposures and the frequency of eating food from restaurants or sugary drink intake among Canadian children and youth. Efforts to create environments that foster healthy food choices among young people will remain important but will likely need to target multiple activity spaces beyond the local neighbourhood. [ABSTRACT FROM AUTHOR]

Background: The health of adolescents is determined by structural and intermediary factors. Such factors operate through pathways that foster different opportunities to achieve health and wellbeing, contributing to inequities. Past analyses of cross-national adolescent health data show that measures of child spirituality, conceptualized as the strength of the connections in our lives, may operate as intermediary determinants in some Western countries. Inspired by this idea, the current analysis provides an in-depth exploration of such pathways among Canadian adolescents. Our objectives were to confirm the existence of relationships between economic position and seven indicators of adolescent health status, then explore whether any observed inequities could be explained by the strength of connections afforded by a healthy spirituality. Methods: Cycle 8 of the Canadian Health Behaviour in School-aged Children (HBSC) study was conducted in 2017–18. A school-based sample (n = 18,962) of adolescents was obtained from across Canada following a standard cross-national protocol. Eligible participants completed a general survey about their health, health behaviours and their determinants. Survey data were used to model the potential effect of perceived levels of relative affluence on each of seven health indicators. Comparison of crude and adjusted relative risks estimates from weighted log-binomial regression models provided evidence of indirect mediating effects attributable to each of four domains of spirituality. Results: As perceived levels of family affluence increased, the percentages of young people who reported each (7/7) of the negative health outcomes decreased. The spiritual health domain “connections to self” (i.e., the importance of meaning, purpose, joy and happiness in life) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes in boys and girls. “Connections to others” (the importance of kindness, respect and forgiveness) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes among girls. Inconsistent evidence of possible mediation was identified for connections to others in boys, as well as the other two domains of spirituality (connections to nature, then connections to the transcendent) in boys and girls. Conclusion: Specific connections afforded by a healthy spirituality could be intermediary determinants of health in Canadian adolescent populations. [ABSTRACT FROM AUTHOR]

Objective: To examine geographic variation in preventable hospitalizations among Medicaid/CHIP‐enrolled children and to test the association between preventable hospitalizations and a novel measure of racialized economic segregation, which captures residential segregation within ZIP codes based on race and income simultaneously. Data Sources: We supplement claims and enrollment data from the Transformed Medicaid Statistical Information System (T‐MSIS) representing over 12 million Medicaid/CHIP enrollees in 24 states with data from the Public Health Disparities Geocoding Project measuring racialized economic segregation. Study Design: We measure preventable hospitalizations by ZIP code among children. We use logistic regression to estimate the association between ZIP code‐level measures of racialized economic segregation and preventable hospitalizations, controlling for sex, age, rurality, eligibility group, managed care plan type, and state. Data Extraction Methods: We include children ages 0–17 continuously enrolled in Medicaid/CHIP throughout 2018. We use validated algorithms to identify preventable hospitalizations, which account for characteristics of the pediatric population and exclude children with certain underlying conditions. Principal Findings: Preventable hospitalizations vary substantially across ZIP codes, and a quarter of ZIP codes have rates exceeding 150 hospitalizations per 100,000 Medicaid‐enrolled children per year. Preventable hospitalization rates vary significantly by level of racialized economic segregation: children living in the ZIP codes that have the highest concentration of low‐income, non‐Hispanic Black residents have adjusted rates of 181 per 100,000 children, compared to 110 per 100,000 for children in ZIP codes that have the highest concentration of high‐income, non‐Hispanic white residents (p < 0.01). This pattern is driven by asthma‐related preventable hospitalizations. Conclusions: Medicaid‐enrolled children's risk of preventable hospitalizations depends on where they live, and children in economically and racially segregated neighborhoods—specifically those with higher concentrations of low‐income, non‐Hispanic Black residents—are at particularly high risk. It will be important to identify and implement Medicaid/CHIP and other policies that increase access to high‐quality preventive care and that address structural drivers of children's health inequities. [ABSTRACT FROM AUTHOR]

Background: A mismatch between organizational priorities and system‐level policies can negatively impact implementation and sustainment of classroom‐based physical activity (PA) interventions. The purpose of this study was twofold: (1) present methods to systematically identify organization‐ and system‐level implementation barriers, and (2) align organizational priorities and system policies by designing multi‐level implementation strategies. This alignment will support implementation scale‐up of a tailored PA intervention in one low‐resource intermediate school district (ISD; 16 districts, 32 schools) in central Michigan. Methods: Multi‐level assessments of organizational readiness were conducted using the Hexagon Discussion and Analysis Tool to assess intervention‐context fit, the Wellness School Assessment Tool 3.0 to evaluate district PA policy strength and comprehensiveness, and semi‐structured interviews were conducted to assess administrative support and priorities related to PA programming. Results: Our assessments revealed three implementation barriers: limited structural capacity to sustain teacher training, limited resources across districts and school buildings to support teachers, and misalignment of ISD and district PA policies and priorities. Conclusions: Greater attention to organizational capacity and existing infrastructure should be considered a priori to support effective implementation and sustainment of PA interventions in low‐resource schools. [ABSTRACT FROM AUTHOR]

A historical and literature review providing insight into the development of adolescent medicine as a discipline in the Kyrgyz Republic was conducted. In addition, the paper presents the scientific research results considering how to solve urgent health problems in children and adolescents. The research was carried out by adolescent medicine specialists and postgraduate students over the years. A fundamental contribution to the field of adolescent medicine was made by Associate Professors B.M. Mamytov and R.A. Nedviga. In the post-world-war II period, the research was focused primarily on studying nurturing and educational environments, as well as assessing the health status of children and adolescents. However, in recent years, scientific work on providing students with proper nutrition in various educational institutions has become particularly relevant.

Abstract Background Eye conditions in children can have negative consequences on visual functioning and quality of life. There is a lack of data on the magnitude of children with eye conditions who need services for effective planning of school eye health programmes. To address this, the School Eye Health Rapid Assessment (SEHRA) tool is being developed to collect data to support school eye health programme planning. Methods The module, ‘the magnitude and nature of local needs in school children’ is the first of six modules in the SEHRA tool. The module outlines a school-based cluster survey designed to determine the magnitude of eye health needs in children. This paper outlines the survey sampling strategy, and sample size calculations. Results The requirements for the SEHRA survey indicate that in regions where a larger sample size is required, or where fewer schools are recruited to the survey, confidence in the accuracy of the data will be lower. Conclusions The SEHRA survey module ‘the magnitude and nature of local needs in school children’ can be applied in any context. In certain circumstances, the confidence in the survey data will be reduced.

Background: Schools are crucial for preventing negative health outcomes in youth and are an ideal setting to address weight stigma and poor body image. The current study sought to examine and describe the nature of weight stigma and body image in adolescents, ascertain aspects of the school environment that affect body image, and identify recommendations for schools. Methods: We conducted 24 semi‐structured interviews with students at 2 high schools in 2020. Qualitative data were analyzed using inductive coding and an immersion/crystallization approach. Results: Students did not report weight discrimination or harmful body image messaging from teachers or administrators. Physical education (PE) class and dress codes were 2 instances where covert weight stigma appeared. The most common forms of peer weight stigma reported were weight‐based teasing and self‐directed appearance critiques. Students recommended that schools eliminate dress codes, diversify PE activities, address body image issues in school, and be cognizant of teasing within friend groups. Conclusions: Weight stigma presents itself in unique ways in high school settings. Schools can play a role in reducing experiences of weight stigma and negative body image. Weight‐related teasing within friend groups was common and may not be captured in traditional assessments of bullying. More nuanced survey instruments may be needed. [ABSTRACT FROM AUTHOR]

Objective To understand the satisfaction of undergraduate students in preventive medicine to the experimental course of Child and Adolescent Health, and provide clues for optimizing experimental teaching. Methods Undergraduate students in preventive medicine in the class of 2016 were taken as research objects. At the end of the course, a survey was conducted by the form of a self-compiled questionnaire to survey the experimental teaching satisfaction of Child and Adolescent Health. Results 11.1% of the students preferred theoretical courses, and 37.5% preferred practical courses. 86.1 % of the students thought that the experimental teaching was compatible with the theoretical teaching, and 94.5% of the students thought that the experimental courses were important. The overall difficulty of the experimental course was moderate (83.3%), and the proportion of students who believe that the exercise stress test had a certain degree of difficulty was the largest (25.0%). Students generally believed that experimental teaching was helpful to consolidate theoretical knowledge and improve their practical ability. 63.9% of students could grasp the use of experimental equipment well, but there were also a small number of people who have a general grasp. More than70.8% students were satisfied with the experimental curriculum and the teaching effect of teachers, and less than 10.0% were generally satisfied with the overall teaching. Conclusion There are certain deficiencies in the experimental teaching mode of Child and Adolescent Health, and it is necessary to reform it in combination with reality to lay a foundation for cultivating practical preventive medicine talents. [ABSTRACT FROM AUTHOR]

Background: Eye conditions in children can have negative consequences on visual functioning and quality of life. There is a lack of data on the magnitude of children with eye conditions who need services for effective planning of school eye health programmes. To address this, the School Eye Health Rapid Assessment (SEHRA) tool is being developed to collect data to support school eye health programme planning.Methods: The module, 'the magnitude and nature of local needs in school children' is the first of six modules in the SEHRA tool. The module outlines a school-based cluster survey designed to determine the magnitude of eye health needs in children. This paper outlines the survey sampling strategy, and sample size calculations.Results: The requirements for the SEHRA survey indicate that in regions where a larger sample size is required, or where fewer schools are recruited to the survey, confidence in the accuracy of the data will be lower.Conclusions: The SEHRA survey module 'the magnitude and nature of local needs in school children' can be applied in any context. In certain circumstances, the confidence in the survey data will be reduced. [ABSTRACT FROM AUTHOR]

Background: The private healthcare sector in the Eastern Mediterranean Region (EMR) is active and growing, providing curative, preventive, and promotive services related to reproductive, maternal, newborn, child, and adolescent health (RMNCAH). Aims: To understand the contribution of formal for-profit private health-care sector in delivering RMNCAH services and explore best practices for improvement. Methods: Desk review of available literature from Saudi Arabia, Oman, Iraq, Egypt, Sudan, Yemen, Pakistan, and Islamic Republic of Iran, followed by stakeholder interviews in Iraq, Pakistan, and Oman were carried out. Directed content analysis using Maxqda 2020 was performed, and information was triangulated according to a priori themes: governance, health information systems, financing, and service delivery related to RMNCAH. Results: Formal and informal public-private partnerships exist in RMNCAH but lack a strategic roadmap to guide collaboration. The private healthcare sector is minimally represented in the main policy stream at national and subnational levels due to resistance from the private and public sectors. They are weak in collecting, maintaining, and sharing health information. Data on abortion and postabortion complications are scarce. Various models of supply and demand financing (voucher schemes, private and social health insurance) related to antenatal care and contraception have been implemented in the EMR. Despite the higher cost of care in the private sector, limited training of providers, ill-defined service delivery packages, and lack of continuity-of-care and team-based approaches, the private sector remains the predominant sector providing RMNCAH services in the EMR. Conclusion: Partnering with the private sector has huge untapped potential that should be harnessed by national governments for expanding RMNCAH services and progressing towards Universal Health Coverage. [ABSTRACT FROM AUTHOR]

Background: Most physical activity (PA) interventions targeting children focus on the school setting. However, children and young people are often less active at home. The purpose of this article is to review evidence from the last ten years of the contribution of physically Active Homework (AH) to the promotion of PA. Methods: Using a rapid review methodology, the article reports on evidence contribution of AH and considers conditions for its effective implementation. Results: Although research literature on the effects of AH is limited and missing a theoretical base, studies reporting small positive associations between AH and PA levels were identified. Increases in PA were, however, of low intensity; moderate and vigorous intensities remained relatively unchanged. Conclusions: Strategies to increase PA extending beyond the school gym are needed. Further and better research is needed to understand the conditions of effective implementation of AH. Nevertheless, there is a plausibility in providing students regular opportunities to further promote PA in students' lives by practicing movement and sports skills, and offering a flexible way of finding and pursuing meaningful activities. The fact that AH may encourage the engagement of families and communities, multiplies its potential benefits. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death for adolescents and young adults, or transitional age youth, and suicidal thoughts and behaviors (STBs) are among the top predictors of suicide. This study aimed to compare the effectiveness of low versus high frequency mental health (MH) specialist visits at preventing suicidal thoughts and behaviors (STBs) among adolescents and transitional age youth receiving combined psychotherapy and psychotropic medication treatment in a culturally-diverse community health system in the United States. Between 2010-2020, we identified 4,888 individuals (12-25 years) with MH disorders who received at least one outpatient psychotherapy visit and one psychotropic medication order during their index treatment month. In the 10-12 months following the index month, unadjusted STBs were higher (3.20 %; 95 % CI 0.49 %, 5.89 %; p < 0.001) in youth with consistently high frequency MH specialist visits (4.40 %) relative to low (1.20 %). After balancing time-varying covariates, STBs were lower, but not statistically different in the consistently high relative to low group (Diff=-1.93 %; 95 % CI -4.56 %, 0.70 %; p = 0.150). Such adjustment for confounding by mental health severity indicators may strengthen evaluations of community-based treatment in diverse populations, where conventional randomization is impossible., Competing Interests: Declaration of competing interest has provided paid statistical consultancy for the University of California, Los Angeles. 〈one anonymized author〉 has received funding from NIA T32AG51108 and the National Institute of Mental Health (Grant No. P50 MH126283, T32 MH019733) since the beginning of this work. In the past 36 months, 〈one anonymized author〉 has received funding from the Manton foundation., (Copyright © 2024. Published by Elsevier B.V.)

Stenotrophomonas maltophilia (S. maltophilia ) is a rare, multi-drug-resistant opportunistic bacteria that typically causes serious infections in immunocompromised and hospitalized patients, often leading to fatal pneumonia or bacteremia. We present the case of a healthy 15-year-old immunocompetent female who developed severe oral ulcers due to S. maltophilia following a recent COVID-19 infection. To our knowledge, this is the first reported case of S. maltophilia  manifesting in this manner after COVID-19. Scrapes from the oral lesions were collected and cultured, confirming the   infection.The CBC and immunoglobulin reports revealed mildly elevated IgA and platelet levels, with no evidence of immunodeficiency.The patient was treated with trimethoprim/sulfamethoxazole (TMP-SMX) based on culture sensitivity, and she responded well to treatment. She was referred to an infectious disease specialist for further monitoring. COVID-19 has recently been implicated in many unusual presentations, associations, and syndromes. One of the most supported theories about COVID-19 is its association with a transient immunodeficient state or a generalized state of immune system dysregulation that can compromise both innate and adaptive immunity. This case supports that theory, as no other apparent etiology for such an otherwise opportunistic infection was identified. The recognition of such atypical infections in previously healthy individuals, particularly post COVID-19, highlights the importance of sharpening clinical vigilance and considering opportunistic pathogens in differential diagnoses. Further research is warranted to explore the potential link between COVID-19 and the susceptibility to rare opportunistic infections, which may guide future clinical practices., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alharami et al.)

The burden of obesity, diabetes mellitus and asthma remains a significant public health issue worldwide. These conditions are associated with premature deaths and a reduced quality of life. Primary health care plays a key role in the prevention, detection, and management of noncommunicable diseases in childhood, including diabetes and asthma. Health promotion is crucial for a healthy life from early childhood, preventing from obesity, a sedentary lifestyle, exposure to tobacco smoke, and other risk factors associated to noncommunicable diseases. Asthma and type 1 diabetes mainly begin in childhood; thus, recognition and early detection at the primary health care level are essential. In the long term, management of children with chronic diseases requires regular follow-up and cooperation with a specialized team. Care coordination by the primary health care provider is key for optimal control of the disease and development of the child or adolescent in the physical, emotional, and social spheres. Over-referral for diagnosis and follow-up is associated with unnecessary specialist overload, patient anxiety, and financial burden for the families and the health system. Clear criteria and referral pathways with efficient communication between the professional team members are essential to empower primary health care providers, avoid unnecessary referrals, and optimize the care and quality of life of children and adolescents with chronic diseases. The WHO Pocket book of primary health care for children and adolescents was recently developed to address knowledge gaps and improve the diagnosis and management of children and adolescents at the outpatient level. It dedicates an entire chapter to health promotion and disease prevention with counselling messages addressed to children, adolescents and their families; provides guidance for the diagnosis and management of asthma, diabetes and other chronic diseases; and includes additional considerations for adolescents living with chronic conditions., Competing Interests: 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., (© 2024 Published by Elsevier Inc.)

Abstract Background In the United Kingdom, rates of childhood obesity are high and inequalities in obesity have widened in recent years. Children with obesity face heightened risks of living with obesity as adults and suffering from associated morbidities. Addressing population prevalence and inequalities in childhood obesity is a key priority for public health policymakers in the United Kingdom and elsewhere. Where randomized controlled trials are not possible, potential policy actions can be simulated using causal modeling techniques. Objectives Using data from the Southampton Women's Survey (SWS), a cohort with high quality dietary and lifestyle data, the potential impact of policy‐relevant calorie‐reduction interventions on population prevalence and inequalities of childhood obesity was investigated. Methods Predicted probabilities of obesity (using UK90 cut‐offs) at age 6–7 years were estimated from logistic marginal structural models adjusting for observed calorie consumption at age 3 years (using food diaries) and confounding. A series of policy‐relevant intervention scenarios were modeled to simulate reductions in energy intake (differing in effectiveness, the targeting mechanisms, and level of uptake). Results At age 6–7 years, 8.3% of children were living with obesity, after accounting for observed energy intake and confounding. A universal intervention to lower median energy intake to the estimated average requirement (a 13% decrease), with an uptake of 75%, reduced obesity prevalence by 1% but relative and absolute inequalities remained broadly unchanged. Conclusions Simulated interventions substantially reduced population prevalence of obesity, which may be useful in informing policymakers.

Objective: To develop an algorithm using administrative data to measure adverse childhood experiences (ADM‐ACE) within routinely collected health insurance claims and enrollment data. Data Sources: We used claims and enrollment data from Tennessee's Medicaid program (TennCare) in 2018. Study Design: We studied five types of ACEs: maltreatment and peer violence, foster care and family disruption, maternal mental illness, maternal substance use disorder, and abuse of the mother. We used diagnosis and procedure codes, prescription drug fills, and enrollment files to develop the ADM‐ACE, which we applied to measure the prevalence of ACEs and to examine prevalence by demographic characteristics among our sample of children in TennCare. We compared ADM‐ACE prevalence to child welfare records and survey results from Tennessee. Data Collection/Extraction Methods: Our study sample included children aged 0–17 years who were linked to their mothers if also enrolled in TennCare in 2018 (N = 763,836 children). Principal Findings: Approximately 19.2% of children in TennCare had indicators for ADM‐ACEs. The prevalence of ACEs was higher among children who were younger (p < 0.001), non‐Hispanic white or black (compared to Hispanic) (p < 0.001), and children residing in rural versus urban counties (p < 0.001). The prevalence of maltreatment identified through the ADM‐ACE (1.6%) falls between the percent of children in Tennessee who were reported to child welfare authorities and the percent for whom reports of maltreatment were substantiated. Comparison with survey reports from Tennessee parents suggests an advantage in measuring maternal mental illness with the ADM‐ACE using health insurance claims data. Conclusions: The ADM‐ACE can be applied to health encounter data to study and monitor the prevalence of certain ACEs, their association with health conditions, and the effects of policies on reducing exposure to ACEs or improving health outcomes for children with ACEs. [ABSTRACT FROM AUTHOR]

Poverty alleviation programs, such as cash transfers and monetary grants, may not only lift people out of poverty but, some argue, may improve mental health as well. However, to date, the impact of such programs on children and adolescents' mental health is unclear. We carried out a systematic review and meta-analysis of poverty alleviation interventions providing monetary support and reporting mental health outcomes in 0–19 year olds in low-, middle-, and high-income countries. We searched 11 databases for research published between January 1, 1990 and June 1, 2020 and included interventions offering unconditional and/or conditional monetary support and reporting mental health outcomes. After screening 7,733 unique articles, we included 14 papers (16,750 children and adolescents at follow-up) in our narrative summary. We meta-analyzed data on internalizing symptoms from 8 papers (13,538 children and adolescents analyzed). This indicated a small but significant reduction in adolescents' internalizing problems postintervention compared to control (odds ratio 0.72, 95% confidence interval 0.59–0.88, p <.01; I2 = 67%, τ2 = 0.05, p <.01). Our narrative synthesis provides further support for the overall effectiveness of cash programs but also notes that monetary support alone may not be sufficient in extreme risk settings and that imposing conditions may be actively harmful for the mental health of adolescent girls. We provide causal evidence that monetary interventions reduce internalizing symptoms of adolescents experiencing poverty. We recommend that future programming thoughtfully considers whether to apply conditions as part of their interventions and highlight the importance of providing additional comprehensive support for children and adolescents living in extreme risk settings. [ABSTRACT FROM AUTHOR]

Youth can transmit COVID-19 to adults, but few communication materials exist for engaging youth in COVID-19 prevention behaviors. We describe the process of leveraging a community–academic partnership in a rapid response initiative to engage youth in a contest (i.e., Youth-Led Creative Expression Contest to Prevent COVID-19 across Texas) to develop creative public health messaging centered on the prevention of COVID-19 transmission and infection for their peers. Core activities included developing a request for applications that solicited submission of creative expression materials promoting the use of COVID-19 prevention behaviors (mask-wearing, social distancing, handwashing, not touching the face) from Texas youth in elementary, middle, and/or high school; sending the request for applications to 48 organizations in Austin, Brownsville, Dallas, El Paso, Houston, and San Antonio in summer 2020; and recruiting a youth advisory board to score submissions and award prizes. We report on youth engagement in the COVID communication contest across Texas and use statistics (chi-square and t -tests) to characterize and compare youth participants and their creative expression artwork. The contest resulted in 3,003 website views and 34 submissions eligible for scoring. Each submission averaged >2 prevention behaviors. On average, winning submissions included a higher number of prevention behaviors than nonwinning submissions. The prevention behavior "not touching the face" was included more often in winning submissions than nonwinning submissions. Elementary school children were less likely to include a mask in their submission compared with older youth. Existing community–academic networks can engage youth in the development of geographically and age-tailored communication materials. [ABSTRACT FROM AUTHOR]

Summary: Licensed and brand equity characters are used to target children in the marketing of products high in fat, salt, and sugar (HFSS), but the impact of characters on dietary outcomes is unclear. The primary aim of this review was to quantify the impact of both licensed and brand equity characters on children's dietary outcomes given that existing regulations often differentiates between these character types. We systematically searched eight interdisciplinary databases and included studies from 2009 onwards until August 2021, including all countries and languages. Participants were children under 16 years, exposure was marketing for HFSS product with a character, and the outcomes were dietary consumption, preference, or purchasing behaviors of HFSS products. Data allowed for meta‐analysis of taste preferences. A total of 16 articles (including 20 studies) met the inclusion criteria, of which five were included in the meta‐analysis. Under experimental conditions, the use of characters on HFSS packaging compared with HFSS packaging with no character was found to result in significantly higher taste preference for HFSS products (standardized mean difference on a 5‐point scale 0.273; p < 0.001). Narrative findings supported this, with studies reporting impact of both character types on product preferences including food liking and snack choice. There was limited evidence on the impact on purchase behaviors and consumption. These findings are supportive of policies that limit the exposure of HFSS food marketing using characters to children. [ABSTRACT FROM AUTHOR]

BACKGROUND: School‐based health centers (SBHCs) provide health care to vulnerable youth. The purpose of the study was to identify characteristics of youth who use SBHCs with the highest frequency to understand their health needs and receipt of health services. METHODS: This study examined cross‐sectional survey data from adolescents in 3 urban school districts (n = 2641) to identify the characteristics of youth who use SBHCs with high frequency (10+ visits). Analyses included calculations of simple frequencies and percentages, chi‐square tests of significance and multivariate regression. RESULTS: High‐frequency SBHC users were more likely to have seriously considered attempting suicide (adjusted odds ratio [AOR]: 3.2), be sexually active (AOR: 6.8), and have been victimized at school (AOR: 2.2) compared to their peers who did not use the SBHC. High‐frequency SBHC users were also significantly more likely than their peers to report "always" getting mental health (AOR: 7.0) and sexual health (AOR: 6.6) care when needed, and having talked with a health care provider about their moods/feelings (AOR: 3.1) and how school is going (AOR: 3.2) in the past year. CONCLUSIONS: These findings hold important relevance to demonstrating the value of SBHCs in increasing vulnerable youth's access to health care, particularly in urban settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the United States, approximately seven million students are chronically absent from school each year. Students with disabilities are more likely to be chronically absent than students without a disability. Using the bioecological systems theory, this study examined the impact of individual developmental disabilities and disability severity on frequent school absenteeism. METHODS: This study conducted a secondary analysis using combined data from the National Survey of Children's Health, 2016 to 2017. Bivariate relationships were examined using x2 tests, and odds ratios adjusting for individual, microsystem, and macrosystem factors were calculated using multivariable logistic regressions. RESULTS: Children with selected developmental disabilities had significantly higher odds of absenteeism compared to children without developmental disabilities. The odds of absenteeism differed between age ranges and developmental disability conditions. A dose‐response relationship was also present for certain developmental disabilities in that children with a moderate to severe condition had higher odds of absenteeism. CONCLUSIONS: Children with one or more developmental disabilities had higher odds of absenteeism compared to children with typical development. However, odds were not consistent across age, condition, or condition severity. This population may benefit from tailored school interventions to promote regular attendance and mitigate the impact of frequent school absenteeism on education. [ABSTRACT FROM AUTHOR]