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Adolescent relationship abuse (ARA) is associated with myriad negative health outcomes. Pediatric primary care presents an opportunity to engage adolescents and parents (who can be protective against ARA) in ARA prevention; however, no family-focused, healthcare-based ARA interventions exist. The purpose of this study is to explore the perspectives of adolescents, parents, and healthcare providers (HCPs) on incorporating ARA prevention into primary care, including 1) current discussions around ARA; 2) how to best include ARA prevention education; and 3) how to address implementation barriers.We conducted individual, semi-structured interviews with HCPs, adolescents ages 11-15, and parents recruited through convenience sampling. Transcripts were individually coded by four study team members (with every third transcript co-coded to assess discrepancies) and analyzed via thematic analysis.Participants identified a need for pediatric HCPs to involve younger adolescents and parents in universal, inclusive ARA prevention and noted that HCPs require training, techniques, and resources around ARA. Participants acknowledged multi-level barriers to implementing primary care-based ARA prevention. They suggested that ARA education be intentionally integrated into HCP and clinic workflows and recommended strategies to garner adolescent and parent buy-in to facilitate ARA-focused conversations.Pediatric primary care is a promising environment to involve parents and adolescents in universal ARA-prevention. Future research should contextualize these results with larger samples across multiple practice settings and integrate relevant partners in the development and evaluation of evidenced-based ARA prevention for pediatric primary care.

ImportanceThe inclusion of non–English-speaking (NES) participants in pediatric research is an essential step to improving health equity for these populations. Although some studies have shown lack of progress in NES research participation in the past decade, few have examined NES inclusivity in pediatric research or details about the practices that researchers have used to communicate with NES participants.ObjectiveTo assess how frequently NES families were included in pediatric research, how rates of inclusion changed over time, what languages were included, and methodological details about oral and written communication with NES participants.Evidence ReviewIn this review, all original investigation articles published in JAMA Pediatrics, Pediatrics, and The Journal of Pediatrics between January 2012 and November 2021 were screened. Eligible articles, which included those based in the US and with human participants, were reviewed to determine whether they included or excluded NES participants or whether or not there was specific mention of language. A second-round review was conducted on the subset of articles that included NES participants to determine methodological details (eg, languages included, type of study, region where the study was located, and oral and written communication practices with NES participants).FindingsOf the 8142 articles screened, 5008 (62%) met inclusion criteria; of these, 469 (9%) included NES participants. The most common language was Spanish (350 [75%]); 145 articles (31%) reported non-English or other language without specification. A total of 230 articles (49%) reported the number of NES participants, and 61 (13%) specified the methods used to determine whether participants preferred a language other than English. In all, 101 (22%) and 136 (29%) articles specified how oral and written communication occurred with NES participants, respectively.Conclusions and RelevanceThis review of 3 pediatric journals provides preliminary evidence suggesting exclusion of NES communities from pediatric research from 2012 to 2021 and highlights an opportunity to provide more methodological detail about communication with NES participants. Best practices for improving inclusivity of NES participants are needed to guide researchers toward improved methods and more relevant results.

In this community-partnered study we conducted focus groups with non-English speaking immigrant and refugee communities of color in 4 languages to understand their perspectives on COVID-19 vaccines, barriers to accessing vaccines, and recommendations for healthcare providers. We used a mixed deductive-inductive thematic analysis approach and human centered design to guide data analysis. 66 individuals participated; 85% were vaccinated. The vaccination experience was often positive; however, participants described language inaccessibility, often relying on family members for interpretation. Community-based organizations played a role in connecting participants to vaccines. Unvaccinated participants expressed fear of side effects and belief in natural immunity. Participants shared recommendations to providers around increasing vaccine access, improving language accessibility, and building trust. Results from our study show numerous barriers immigrant and refugee communities of color faced getting their COVID-19 vaccine, but also highlights opportunities to engage with community partners. Future implications for research, policy, and practice are described.

To ensure equity in coronavirus disease 2019 (COVID-19) vaccine access, it is critical that Black and Latine communities receive trustworthy COVID-19 information. This study uses community-based participatory research to understand sources of COVID-19 information for Black and Latine adults, how trustworthy that information is, and relationships between information sources and COVID-19 vaccine intention.We co-created a survey in Spanish and English and distributed it to Black and Latine adults residing in the Pittsburgh area. Data were analyzed using descriptive statistics and multivariate logistic regression.There were 574 participants who completed the survey. Participants reported accessing a variety of COVID-19 information sources and generally trusted these sources. Few sources of information were associated with COVID-19 vaccine intention. We also review lessons learned from our community-academic collaboration.Trustworthy COVID-19 information sources may not be sufficient for increasing vaccine intention. Results can help other community-academic partnerships working to improve COVID-19 vaccine equity.

CONTEXTCulturally sensitive interventions in the pediatric primary care setting may help reduce health disparities. Less is known on the development of these interventions, their target groups, and their feasibility, acceptability, and impact on health outcomes.OBJECTIVEWe conducted a systematic review to describe culturally sensitive interventions developed for the pediatric primary care setting.DATA SOURCESPubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo (January 2000 to July 2020).STUDY SELECTIONStudies were eligible for inclusion if they were (1) original research on an intervention with an evaluation, (2) within a pediatric primary care setting, (3) not limited to education for providers, (4) not limited to interpreter use, and (5) based in the United States.DATA EXTRACTIONThe following were extracted: study topic, study design, intervention, cultural sensitivity strategies and terminology, setting, target group, sample size, feasibility, acceptability, and health outcomes.RESULTSTwenty-five studies described 23 interventions targeting a variety of health topics. Multiple cultural sensitivity strategies were used, most commonly sociocultural (83%). Most interventions (57%) were focused on Hispanic/Latino families. Interventions were generally reported as being feasible and acceptable; some also changed health outcomes.LIMITATIONSSmall samples and heterogenous methods subject to bias were used. Relevant articles may have been missed because of the variety of terms used to describe cultural sensitivity.CONCLUSIONSThe included articles provide preliminary evidence that culturally sensitive interventions can be feasible and effective and may help eliminate disparities for patients from communities with barriers to equitable care.

Pediatricians have obligations to respond with care to all children's clinical and social vulnerabilities. Finding and addressing causes of children's stress (ie, family separation, child abuse, and trauma) are also obligations. Preventive and rescue interventions should be implemented to address potential short- and long-term harms of toxic stress and their short- and long-term consequences.

In Latin America, violence is a major public health issue causing many families to flee to the United States to seek safety. Current US immigration policies fail to address why families are forced to depart their home country or the needs of families once arriving in the United States. This article identifies root causes of family displacement, examines the insufficient protections for children in families during US immigration processing, and provides practice and policy recommendations on how to transform the US immigration system so that it is more humane for children and families forcibly displaced by violence.

Background: Latinas are at a higher risk than Caucasians for both type 1 and type 2 diabetes (DM), as well as DM-associated reproductive health (RH) complications. Healthcare providers (HCPs) should deliver culturally-sensitive care to enhance the care relationship between Latinos and HCPs and to improve patient outcomes. This study explored an expert panel’s cultural understanding, experiences, barriers, and facilitators regarding RH and preconception counseling (PC) for adolescent Latinas with DM and their families. Methods: This study used open-ended questions with a focus group of 8 HCPs from the mid-Atlantic, Southwest, and Northwest regions of the United States in a teleconference format. Two researchers transcribed and reviewed the transcript for accuracy. Using content analysis, four members of the team identified themes. All researchers discussed themes and a 100% consensus was reached. For confirmation, a coding protocol was created based on the emerging themes. Results: Five themes related to cultural understanding and experiences were identified: 1) issues of identity; 2) acculturation; 3) stigma; 4) ambivalence toward birth control, RH education, and PC; and 5) cultural sensitivity vs. best practice. Four barriers were identified: 1) language; 2) religion; 3) access to healthcare, and 4) discomfort with discussion. Ten facilitators were identified: 1) the importance of support and support networks; 2) promoting trust among HCPs, daughters, and families; 3) assessing emotional development; 4) empowerment; 5) emphasizing safety; 6) communicating in patients’ preferred language; 7) discussing RH-related topics and PC using cultural sensitivity; 8) importance of being ready/temporality/planning for the future; 9) the importance of family-centered care; and 10) variation in educational tailoring and dissemination/ care delivery. Conclusions: Findings support the need for culturally sensitive and developmentally appropriate PC programs to empower adolescent Latinas with DM.

In a prospective study of developmental outcomes in relation to early-life otitis media, behavioral, cognitive, and language measures were administered to a large, diverse sample of children at 2, 3, 4, 6, and 9-11 years of age (N = 741). At 9-11 years of age, 9% of the children were categorized as having attention-deficit/hyperactivity disorder (ADHD) based on parent report. Compared to the non-ADHD group, the ADHD group had higher (i.e., less favorable) scores on parent and teacher versions of the Child Behavior Checklist at all ages. Children in the ADHD group also had lower scores on cognitive and receptive language measures in preschool. The findings support the concept that ADHD is a cognitive as well as a behavioral disorder.

A woman's birth experience can impact the physical and mental well-being of mothers long after the birth of their child. Little is known about the experiences of Latina women in areas with small, yet growing Latino populations. To understand Latina's perceptions of their childbirth experience and to see how insurance status impacts that experience, we conducted in-depth, semi-structured interviews with a non-proportional quota sampling of ten Latina women, five with and five without health insurance. Most women reported a positive global experience; the birth of a healthy child was the most important factor influencing birth experiences for all of them. Locus of control and support from medical providers and loved ones also shaped experiences. Uninsured women reported lower levels of perceived control and support, which did impact their birthing experience. These differences could be influenced by social status and position. Medical provider, hospital, and policy recommendations are made which could lead to improvements in uninsured Latinas' childbirth experiences.

The study described here was designed to determine treatment preferences among Latinas to identify treatment options that meet their needs and increase their engagement. Focus group interviews were conducted with 22 prenatal and postpartum Latinas at risk for depression. The group interviews were conducted in Spanish and English using a standardized interview protocol. Focus group transcripts were analyzed to identify themes regarding perinatal depression coping strategies, preferred approaches to treating perinatal depression, and recommendations for engaging perinatal Latinas in treatment. The results suggest that Latinas’ treatment preferences consist of a pathway (i.e., hierarchical) approach that begins with the use of one’s own resources, followed by the use of formal support systems (e.g., home-visiting nurse), and supplemented with the use of behavioral therapy. Antidepressant use was judged to be acceptable only in severe cases or after delivery. The data indicate that to increase health-seeking behaviors among perinatal Latinas, practitioners should first build trust.

OBJECTIVE To determine whether elevated fasting or 2-h plasma glucose and/or insulin better reflects the presence of cardiovascular disease (CVD) risk markers in an overweight pediatric population with normal glucose tolerance. RESEARCH DESIGN AND METHODS A total of 151 overweight youths (8–17 years old) were evaluated with oral glucose tolerance tests and measurement of CVD risk factors. The study population was categorized according to quartiles of fasting and 2-h glucose and insulin levels. ANCOVA, adjusted for age, sex, race, Tanner stage, and percent body fat (measured by dual-energy X-ray absorptiometry), was used to compare metabolic variables between the quartiles of glucose and insulin groups. RESULTS Increasing quartiles of fasting and 2-h insulin were associated with increasing CVD risk factors. Glucose quartiles on the other hand, either fasting or at 2 h, were not. CONCLUSIONS These data suggest that hyperinsulinemia may be the earliest and/or primary metabolic alteration in childhood associated with risk markers for CVD. Prospective studies are needed.

Background The liver plays a significant role in drug metabolism; thus it would be expected that liver disease may have a detrimental effect on the activity of cytochrome P450 (CYP) enzymes. The extent to which the presence and severity of liver disease affect the activity of different individual drug-metabolizing enzymes is still not well characterized. The purpose of this study was to assess the effect of liver disease on multiple CYP enzymes by use of a validated cocktail approach. Methods The participants in this investigation were 20 patients with different etiologies and severity of liver disease and 20 age-, sex-, and weight-matched healthy volunteers. Liver disease severity was categorized by use of the Child-Pugh score. All participants received a cocktail of 4 oral drugs simultaneously, caffeine, mephenytoin, debrisoquin (INN, debrisoquine), and chlorzoxazone, as in vivo probes of the drug-metabolizing enzymes CYP1A2, CYP2C19, CYP2D6, and CYP2E1, respectively. The primary end points were measurements of specific CYP metabolism indexes for each enzyme. Results Mephenytoin metabolism was significantly decreased in both patients with mild liver disease (Child-Pugh score of 5/6) (−63% [95% confidence interval (CI), −86% to −40%]; P = .0003) and patients with moderate to severe liver disease (Child-Pugh score >6) (−80% [95% CI, −95% to −64%]; P = .0003). In comparison with control subjects, the caffeine metabolic ratio was 69% lower (95% CI, −85% to −54%; median, 0.14 versus 0.62; P = .0003), the debrisoquin recovery ratio was 71% lower (95% CI, −96% to −47%; median, 0.10 versus 0.65; P = .012), and the chlorzoxazone metabolic ratio was 60% lower (95% CI, −91% to −29%; median, 0.21 versus 0.83; P = .0111) in patients with moderate to severe liver disease. All 4 drugs showed significant negative relationships with the Child-Pugh score. Conclusions CYP enzyme activity is differentially affected by the presence of liver disease. We propose that the data can be explained by the “sequential progressive model of hepatic dysfunction,” whereby liver disease severity has a differential effect on the metabolic activity of specific CYP enzymes. Clinical Pharmacology & Therapeutics (2006) 80, 235–245; doi: 10.1016/j.clpt.2006.05.006

Background and objective The activity of cytochrome P450 (CYP) enzymes, which determine the rate of elimination of lipid-soluble drugs, demonstrates considerable interindividual variability. The extent to which age and sex influence CYP activity remains unclear in humans. Our objectives were to determine whether in vivo activity of selected CYP enzymes is affected by age or sex and to evaluate sex bioequivalence in a large sample size. Methods We have assessed in vivo activity of the CYP1A2, 2C19, 2D6, 2E1, and 3A4 enzymes in 161 normal subjects (51% female subjects and 40% aged >50 years). After simultaneous administration of a cocktail of selective probes (caffeine, mephenytoin, debrisoquin [INN, debrisoquine], chlorzoxazone, and dapsone, respectively), phenotypic indices for metabolism of these drugs were used as measures of individual CYP activity. Sex bioequivalence analysis used the bootstrap method. Results There were no sex differences associated with CYP1A2 activity. A significant negative correlation (r = −0.572, P < .01) between enzyme activity and age was observed for CYP2C19, but there were no sex differences. CYP2D6 activity showed no dependence on age or sex. In contrast, CYP2E1 activity showed an age-associated increase (r = 0.393, P < .01), which developed earlier in life in male subjects compared with female subjects. These results were further supported by the sex bioequivalence analysis of CYP phenotypic activity, which revealed that sexes were equivalent with respect to CYP2C19 (90% confidence interval [CI], 0.874–1.04), CYP3A4 (90% CI, 0.95–1.176), and CYP2D6 (90% CI, 0.928–1.09) phenotype and just exceeded the 0.8 to 1.25 limits to be equivalent with respect to CYP2E1 (90% CI, 0.785–1.08) and CYP1A2 (90% CI, 0.736–1.03) phenotype. Conclusion These observations suggest that the presence of selective mechanisms of regulation for individual CYP enzymes can be influenced by age and sex. However, we suggest that sex has a limited ability to explain intersubject variation of activity for these phenotypic measures of CYP enzyme activity. Clinical Pharmacology & Therapeutics (2004) 76, 618–627; doi: 10.1016/j.clpt.2004.08.021