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Cheek swabs, heterogeneous samples consisting primarily of buccal epithelial cells, are widely used in pediatric DNA methylation studies and biomarker creation. However, the decrease in buccal proportion with age in adults remains unexamined in childhood. We analyzed cheek swabs from 4626 typically developing children 2-months to 20-years-old. Estimated buccal proportion declined throughout childhood with both increasing chronological and predicted epigenetic age. However, buccal proportion did not associate with age throughout adolescence. Variability in buccal proportion increased with age through the entire developmental range. These trends held inversely true for neutrophil proportions. Correcting for buccal proportion attenuated the weak association with PedBE age acceleration to non-significance during initial estimation. Notably, correcting for buccal proportion attenuated the association of PedBE age acceleration with obsessive-compulsive disorder and strengthened the association with diurnal cortisol slope. Thus, the age-related change in childrens oral cells is a crucial consideration for cell type-sensitive research.

Family Medicine physicians provide contraceptive, prenatal, and obstetric care; however, within our department physicians had not historically prescribed abortion medications to clinic patients. Early abortion care is within the scope of family medicine and is considered part of full reproductive health care for our patients. Research shows patients are open to and prefer to have abortion care from their primary care physician1 . It is estimated that one in four women will have an abortion by 45 years old2. This quality improvement project aims to improve health and healthcare access to persons seeking pregnancy termination or needing early pregnancy loss medication management. Following the PDSA cycle, planning included partnering with department leadership for approval, collaborating with MedStaff for physician privileging and malpractice coverage, building templates for the electronic medical record (EMR) with clinical informatics, training support staff at all three clinics, and educating our triage team and call center on triage management and patient support. We are developing a dedicated monthly procedure clinic specifically to access medication abortion for patients established within our family medicine clinics. Additionally, we will continue to offer training for interested faculty through yearly or twice-yearly presentations at department meetings and collaborate with residency leadership to provide ongoing residency education around medication abortion care. Six months post implementation of the procedure clinic, we will analyze if this dedicated clinical space is an appropriate method to increase access for medication abortion. After reviewing the results, we will revise and improve work processes as needed.

The warm handoff (WHO) has long been considered an essential and necessary element of integrated behavioral health (IBH). It is seen as critical to improving patient access and engagement with behavioral health care. While some studies have demonstrated that WHOs improve engagement with behavioral health care, other studies have revealed contradictory results. These mixed findings suggest that more nuanced examination may help elucidate other factors that increase the effectiveness of WHOs in improving access and patient engagement with behavioral health care. Our study seeks to expand on the existing literature by examining 1) whether WHOs increase patient engagement with behavioral health services, 2) what factors increase the likelihood of a WHO, 3) whether the content of the WHO (e.g., inclusion of brief intervention) or non-WHO factors (e.g., time on waitlist) impact engagement with behavioral health services. To address these questions, we extracted Electronic Health Record (EHR) data collected on IBH referrals and completed WHOs across 10 UC San Diego Health primary care clinics from 2018-2023. Specifically, we extracted a) patient demographic variables, b) patient health status data, c) referral information (e.g., referral date, date added to waitlist, date of first scheduled IBH visit), and d) warm handoff information (e.g., location and mode of consultation, consultation focus, and follow-up plan). We will present initial results, address limitations, including generalization of results, and discuss future directions.

Early-life adversity increases the risk of health problems. Interventions supporting protective and responsive caregiving offer a promising approach to attenuating adversity-induced changes in stress-sensitive biomarkers. This study tested whether participation in an evidence-based dyadic psychosocial intervention, child-parent psychotherapy (CPP), was related to lower epigenetic age acceleration, a trauma-sensitive biomarker of accelerated biological aging that is associated with later health impairment, in a sample of children with trauma histories. Within this quasi-experimental, repeated-measures study, we examined epigenetic age acceleration at baseline and postintervention in a low-income sample of children receiving CPP treatment (n = 45; age range = 2-6 years; 76% Latino) compared with a weighted, propensity-matched community-comparison sample (n = 110; age range = 3-6 years; 40% Latino). Baseline epigenetic age acceleration was equivalent across groups. However, posttreatment, epigenetic age acceleration in the treatment group was lower than in the matched community sample. Findings highlight the potential for a dyadic psychosocial intervention to ameliorate accelerated biological aging in trauma-exposed children. [ABSTRACT FROM AUTHOR]

We examined whether prenatal exposure to two classes of endocrine-disrupting chemicals (EDCs) was associated with infant epigenetic age acceleration (EAA), a DNA methylation biomarker of aging. Participants included 224 maternal–infant pairs from a Canadian pregnancy cohort study. Two bisphenols and 12 phthalate metabolites were measured in maternal second trimester urines. Buccal epithelial cell cheek swabs were collected from 3 month old infants and DNA methylation was profiled using the Infinium MethylationEPIC BeadChip. The Pediatric-Buccal-Epigenetic tool was used to estimate EAA. Sex-stratified robust regressions examined individual chemical associations with EAA, and Bayesian kernel machine regression (BKMR) examined chemical mixture effects. Adjusted robust models showed that in female infants, prenatal exposure to total bisphenol A (BPA) was positively associated with EAA (B = 0.72, 95% CI: 0.21, 1.24), and multiple phthalate metabolites were inversely associated with EAA (Bs from −0.36 to −0.66, 95% CIs from −1.28 to −0.02). BKMR showed that prenatal BPA was the most important chemical in the mixture and was positively associated with EAA in both sexes. No overall chemical mixture effects or male-specific associations were noted. These findings indicate that prenatal EDC exposures are associated with sex-specific deviations in biological aging, which may have lasting implications for child health and development. [ABSTRACT FROM AUTHOR]

"Storying" captures our interest in the unfolding stories of lives--those of young children, parents, caregivers, teachers, and ourselves. The sharing and building of stories is a social experience--a way to establish early connections that are essential to young children's learning and development. Stories, and the building of stories, are at the heart of ZERO TO THREE's Literacy, Learning, and Life (LLL) initiative. The application of storying to the LLL initiative entails the weaving of stories--those of caregivers, teachers, programs, community, partners, and LLL staff members--into one story that will become a positive part of the children's and their families' story. The article describes how storying provides a framework for the initiative in five ways: (1) storying supports caregiver and teacher learning; (2) storying supports professionalism; (3) storying supports intentional, high-quality caregiving; (4) storying supports changes in caregivers' and teachers' attitudes and practices; and (5) storying supports meaning-making.

Attachment is a motivational system promoting felt security to a caregiver resulting in a persistent internal working model of interpersonal behavior. Attachment styles are developed in early social environments and predict future health and development outcomes with potential biological signatures, such as epigenetic modifications like DNA methylation (DNAm). Thus, we hypothesized infant DNAm would associate with toddler attachment styles. An epigenome-wide association study (EWAS) of blood DNAm from 3-month-old infants was regressed onto children's attachment style from the Strange Situation Procedure at 22-months at multiple DNAm Cytosine-phosphate-Guanine (CpG) sites. The 26 identified CpGs associated with proinflammatory immune phenotypes and cognitive development. In post-hoc analyses, only maternal cognitive-growth fostering, encouraging intellectual exploration, contributed. For disorganized children, DNAm-derived cell-type proportions estimated higher monocytes –cells in immune responses hypothesized to increase with early adversity. Collectively, these findings suggested the potential biological embedding of both adverse and advantageous social environments as early as 3-months-old. [ABSTRACT FROM AUTHOR]