African American Children Research Articles

Rates of diagnoses of sleep disorders in children with chronic medical conditions.

This investigation examines sleep disorder (SD) diagnoses in a large population of children and adolescents with chronic medical conditions (CMCs). Little is known about SD diagnoses in this population. The large population used in this study allowed examination of SD rates by CMC type and demographics. Data were from the Coordinated Health Care for Complex Kids (CHECK) project designed for Medicaid-funded children and adolescents with at least 1 CMC from a large metropolitan area. The study population (n = 16,609) was limited to children and adolescents, 0 to 18 years of age. SD and CMC diagnoses were obtained from Medicaid claims data. Fourteen percent of the population (mean age of 9.1 years [standard deviation = 5.2]; 35.8% African American; 56.4% male; 77 with more than 1 CMC) received a sleep disorder diagnosis. The most frequent diagnosis was sleep-disordered breathing (11.2%), followed by nocturnal enuresis (1.2%) and insomnia (1%). SDs were diagnosed more frequently in those with multiple CMCs than in those with 1 CMC (19.7% vs 5.8%; P < .001). Insomnia rates in Hispanic/Latinx (1.2%) and African American (0.8%) children and adolescents were significantly lower (both P < .001) than in Caucasians (3.5%). Odds of receiving a sleep diagnosis varied among CMCs. Our analysis of Medicaid claims data of a large urban cohort offers detailed information about the rates of sleep diagnoses and suggests underdiagnosis of SDs in this vulnerable, high-risk, primarily ethnic minority population. Underrecognition of sleep disorders has short- and long-term health and economic consequences. Study results may help clinicians implement appropriate SD screening and management for children and adolescents with CMCs. Adavadkar PA, Pappalardo AA, Glassgow AE, etal. Rates of diagnoses of sleep disorders in children with chronic medical conditions. J Clin Sleep Med. 2022;18(8):2001-2007.

Sociopsychological cost of AAE-to-SAE code-switching

Objective: This conceptual article outlines the sociopsychological cost that speakers of African American English (AAE) may incur when having to use the Standard dialect of American English (SAE) in academic and professional settings. Its goal is to detail the challenges to speakers’ self-concept resulting from this cost, to outline how clinical work may be affected by it, and to issue a call of action to qualitative researchers in the field of communication sciences and disorders. It will be argued that a symbolic interactionist account of identity, informed by qualitative research data, can guide clinicians into action regarding therapy and advocacy. Methods: A contrastive definition of code-switching versus code-mixing/code-meshing or translanguaging will be provided. Existing research, cultural artifacts, and personal accounts will be used to illustrate the sociopsychological cost of code-switching, and the ways in which it can have important impacts on individuals’ self-concept and their attitude toward learning. In order to conceptualize these dynamics in interactional terms, Mead’s model of the self will be deployed. Results: It can be expected that a sizable portion of African American children and adolescents incur sociopsychological cost when faced with the expectation to code-switch from AAE to SAE at school. This cost can be explained using a Meadian model of identity. Little research has explored this cost, the interactional dynamics in which it is incurred, or its impact on speech-language therapy. Summary and conclusion: Speech-language pathologists’ scope of practice includes therapeutic work with students who speak AAE, as well as advocacy for all students, disordered or not, who are faced with the cost of this particular type of code-switching. Qualitative research in the field of communication sciences and disorders is uniquely well suited to illuminate the precise form of the interactional dynamics in question, and to develop ways of addressing them in clinical and advocacy work. Such research should employ a symbolic interactionist model of identity that is not tied to psychological assumptions, but which can be derived entirely from empirical observations.

Family Income May Better Protect White Than Black American Youth Against Suicidality

Background: High income is a protective factor against suicidality for children, youth, and adults, however, recent research has documented weaker health effects of high income for Black than White individuals, a pattern also called marginalization-related diminished returns (MDRs). Objectives: In this study, we tested racial variation in the association between high income and suicidality in a national sample of 9-10-year-old Black and White American children. Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study, which included 7298 White or Black children between the ages of 9 and 10. Of all the participants, 5652 were White and 1646 were Black. The predictor variable was family income, treated as a continuous measure. Race was the moderator. The outcome variable was suicidality, treated as a dummy variable, reflecting any positive suicidal thoughts or behaviors endorsed over the lifecourse. Covariates included sex, age, family structure (parental marital status), parental education, trauma, history of depression, neighborhood poverty, and family conflict. Logistic regression was used for data analysis. Results: Overall, family income was inversely associated with children’s suicidality, net of all covariates. A statistically significant interaction was found between race and family income, suggesting that the inverse association between family income and suicidality is weaker in Black than White children. Conclusion: The observed weaker association between income and suicidality in Black than White children suggests that family income does not provide the same protection against suicidality for Black as White children. Due to racism, income and some other socioeconomic status indicators show weaker than expected health effects on Black families in the US.

Association of fractional exhaled nitric oxide with asthma morbidity in urban minority children

Objective Fractional exhaled nitric oxide (FeNO) is a well-established measure of allergic airway inflammation and possible useful adjunct disease management tool. We investigated the association of baseline and follow-up FeNO measurements with disease burden in minority children with persistent asthma. Methods A retrospective chart review was conducted on 352 African American and Hispanic children seen at an urban Asthma Center in Bronx, NY. Demographic, clinical characteristics, and pulmonary function tests (PFTs) were compared between children with low, intermediate, and high baseline FeNO levels. Among 95 children with subsequent follow up visits, associations of change in FeNO with demographics, clinical characteristics, and PFTs were examined using mixed effects linear regression models. Results A higher proportion of children with intermediate (54%) and high FeNO (58%) levels had lower airways obstruction compared to those with low FeNO levels (33%). Children with intermediate FeNO levels had more annual hospitalizations (2.8 ± 6.2) compared to those with low and high FeNO levels (1.3 ± 2.8 and 1.3 ± 2.5). These associations did not differ between ethnicities. An increase in FeNO over time was associated with higher BMI z-scores (β = 6.2, 95% CI: 1.0 to 11.4) and two or more hospitalizations in the past year (β = 16.1, 95% CI: 1.5 to 30.8). Conclusions Intermediate and high FeNO levels are associated with lower airways obstruction and hospitalizations. Initial and serial FeNO measurements can be a useful adjunctive tool in identifying asthma-related morbidity in urban African American and Hispanic children.

Epigenetic marks identify asthma susceptibility in African Americans

Despite advances in therapeutics and a better understanding of environmental contributions, ethnic disparities are profound in asthma; asthma prevalence is &gt;2 times higher in African compared to European Americans, and African American children are &gt;3 times more likely to be hospitalized and die from asthma than whites. Epigenetic marks, including DNA methylation, are a key mechanistic component of gene‐environment interactions that affect gene expression, respiratory epithelial dysfunction, and immune cell skewing in asthma. Our group performed pioneering work to identify asthma associated‐DNA methylation changes that affect gene expression in African American inner city children. Our work identified 81 differentially methylated regions (DMRs) in peripheral blood mononuclear cells (PBMCs) associated with allergic asthma. DNA methylation changes in PBMCs are small (median 1.3%; range 0.02%‐3.1%) but consistent with the majority of DMRs hypomethylated in asthma, including important immune genes such as IL‐13, RUNX3, and TIGIT. In the nasal epithelia, we identified much larger (median 9.5%, range: 2.6‐29.5%) methylation changes, both in the form of single CpG methylation (differentially methylated positions[DMPs]) and regions (DMRs). 60% of genes that are differentially expressed in the asthmatic nasal epithelium have significant associations of DNA methylation and gene expression; these include asthma genes (ALOX15, CAPN14, POSTN), genes involved in inflammation and immunity, cell adhesion, extracellular matrix, obesity and autophagy, and epigenetic regulators, among others. Importantly, these results have been replicated in multiple cohorts, including a cohort of Puerto Rican children, another population that shares an unproportional disease burden. We are currently involved in projects that aim to integrate genetic ancestry, DNA methylation, and gene expression data to better understand genetic underpinnings of these DNA methylation changes. Our earlier work also showed that nasal epithelia capture disease activity seen in the lung airway epithelia but that there are many more significant associated DNA methylation changes in the nasal epithelia, suggesting an important role for the environment in influencing these epigenetic changes and the need to understand environmental exposures that are driving these changes. In summary, our findings that epigenetic marks in respiratory epithelia are associated with allergic asthma in inner‐city children provide new targets for understanding the biology of the disease, developing biomarkers of exposure or disease, and potentially identifying novel therapeutic approaches for this disease.

Biologic, Demographic and Clinical Factors Associated with Acute Postsurgical Pain in Racially Diverse Pediatric Cohorts Undergoing Major Surgery

Despite postoperative pain being a predictor for chronic postsurgical pain, postoperative pain remains undertreated in children. Pediatric studies examining disparities in acute pain outcomes are mostly limited to ambulatory surgeries. We evaluated risk for severe post-surgical pain after major surgeries in children. In Cohort 1 (retrospective, N=2788; 5 surgeries) and Cohort 2 (Prospective; N=360; spine/pectus surgery), surgical, pain, opioid use, analgesia, demographics, Area deprivation index (ADI) data were analyzed for association with outcomes sing Wilcoxon/Chi-square tests and linear regression Outcomes: Pain score AUC and opioid use on postoperative days 0-2, regional analgesia. Compositional analysis was conducted for %AUC for pain score<4, 4-7, and >7/10 using Aitchison compositional scale. Genotyping and association of 355 variants (21 genes in HPA/immune pathways) were studied (cohort 2). Cohort 1: Pain AUC was associated with age (p=0.002), sex (p=0.004), surgery (p<0.001). ADI was higher in African Americans (AA) (p<0.001). Opioid use was higher for abdominal surgery, lower with age and regional use. Pain AUC and opioid use were not different between races, though NRS AUC% for severe pain (POD2) and use of regional analgesia was higher in Whites (p<0.001). FLACC and NRS were negatively correlated in AA but not Whites. Cohort 2: AUC POD0-2 was higher among Whites compared to AA (p=0.002). Female sex (p=0.006), White race (p=0.026), surgery type (p=0.001), age (p<0.001), weight (p<0.001) and preoperative pain (p<0.001) were associated with AUC. 9 SNPs from stress genes: ANXA2, CRHR2, FKBP5, IGF2, MC2R were associated with AUC (p<0.05). Both cohorts showed associations for age, sex, race, preoperative pain and surgery type with acute post-surgical pain. Underlying socioeconomic disparities and stress genomics need consideration in racially diverse pain cohorts. Differences in education/understanding might influence regional analgesia use. Potential provider bias in objective pain assessments in AA children needs to be ruled out. Grant support from 1R01AR075857 (NIAMS).

Culturally Relevant Parenting Approaches Among African American and Latinx Children and Families: Toward Resilient, Strengths-Based, Trauma-Informed Practices

Children and families of color in the United States (U.S.) have long had to battle to develop a positive identity in the face of discrimination based upon race, ethnicity, immigration status, and gender. Historically, racial-ethnic minorities have experienced various types of trauma exposures in the U.S., including enslavement, family separation, deportation, colonization, discrimination, ridicule, and stereotyping that permeate U.S. society. Yet, they still have managed within their families to advance some sense of shared within-group identities, values, beliefs, and practices that have fostered child and family development. This paper focuses on the experiences of African American and Latinx families who, though distinct in historical and cultural experiences, have some similarities in social disparities that should inform parenting programs. Prevention and intervention that seeks to engage families of color should be sensitive to centuries of racism and structural inequalities that have contributed to their unique socio-cultural contexts (Bernal et al., 2009; Spencer et al., 1997).We first explore the historical context of racial-ethnic trauma among children of color in the U.S. Second, we build upon the work in traumatic stress as a rationale for examining culturally relevant and responsive adaptations that address linguistics, worldviews, and contexts, describing the ways in which these concepts are evidenced in programming and effects upon family processes, and youth socio-emotional development. We discuss the implications for multi-group intervention, homogenous and heterogeneous group composition, underscoring the value of critical frameworks attuned to psychological trauma that draw upon a strengths-based perspective of culture for African American and Latinx children and families.

African American Children's Racial Discrimination Experiences and Mental Health.

The current study examined how African American children's experiences of perceived personal racial discrimination and perceived vicarious racial discrimination were linked with depressive and anxiety symptoms, and whether there were significant sex differences in these relations. The sample included 73 African American children (48% male), ranging from 7 to 12 years of age (M = 8.82, SD = 2.06). Models specified children's personal discrimination and vicarious discrimination as predictors of depressive and anxiety symptoms. Nested model comparisons were also used to examine whether associations varied as a function of children's sex. The current study hypothesized that both forms of discrimination would be associated with greater anxiety and depressive symptoms. Findings indicated that children's personal racial discrimination significantly predicted greater child anxiety symptoms for both boys and girls. No significant sex differences emerged. Neither personal nor vicarious discrimination significantly predicted depressive symptoms. Our findings highlight that racialized experiences occur early in childhood and have important implications for children's mental health.

Racial/ethnic differences in receipt of surgery among children in the United States

BackgroundIt is unknown whether racial/ethnic disparities exist in surgical utilization for children. The aim, therefore, was to evaluate the odds of surgery among children in the US by race/ethnicity to test the hypothesis that minority children have less surgery. MethodsCross-sectional data were analyzed on children 0–18 years old from the 1999 to 2018 National Health Interview Survey, a large, nationally representative survey. The primary outcome was odds of surgery in the prior 12 months for non Latino African-American, Asian, and Latino children, compared with non Latino White children, after adjustment for relevant covariates. The National Surgical Quality Improvement Program Pediatric Dataset was used to analyze the odds of emergent/urgent surgery by race/ethnicity. ResultsData for 219,098 children were analyzed, of whom 10,644 (4.9%) received surgery. After adjustment for relevant covariates, African-American (AOR, 0.54; 95% CI, 0.50–0.59), Asian (AOR, 0.39; 95% CI, 0.33–0.46), and Latino (AOR, 0.62; 95% CI, 0.57–0.67) children had lower odds of surgery than White children. Latino children were more likely to require emergent or urgent surgery (AOR, 1.71; 95% CI, 1.68–1.74). ConclusionsLatino, African-American, and Asian children have significantly lower adjusted odds of having surgery than White children in America, and Latino children were more likely to have emergent or urgent surgery. These racial/ethnic differences in surgery may reflect disparities in healthcare access which should be addressed through further research, ongoing monitoring, targeted interventions, and quality-improvement efforts. Level of evidenceII. Type of studyPrognosis study.

Supporting Multilingual Black Children: Building on Black Language Genius

AbstractNegative societal beliefs and language ideologies about Black Language speakers continue to shape how Black Language is perceived from deficit perspectives in schools. However, educators must challenge these negative ideologies by amplifying the rich linguistic features that Black Language speakers already have by positioning these language practices as valuable resources in the classroom. From translanguaging and critical perspectives, the authors demonstrate how multilingual Black American children use various complex language and literacy practices to make sense of their worlds, including vignettes from bilingual classrooms and childhood memories. The authors offer practical implications using classroom and community examples that can serve as models to educators on how to support and build upon the richness of Black Language speakers’ literacy and language practices.

Fighting the School to Prison Pipeline One Child at A Time: A Clinical Tale of Race and Advocacy

ABSTRACT This article recounts my treatment of David, an African American child of 12 who faced suspension and removal from his school in a wealthy, mostly all-white school district in the suburbs. During the treatment, David was primarily silent. The paper discusses his silence from two perspectives: (1) his need to protect and support his emerging self from the fear of abuse and (2) from the racism he experienced in his school district and from White people in general. I discuss how I worked with his silence and how our work reflected several racial enactments. The resolution of which furthered our relationship and his treatment. In this vein, I illuminate some of the ingredients of successful Cross-Racial work. I move onto a broader discussion of African-American children’s racialized school experience as they and their teachers struggle to mentalize each other constructively.

Racial and/or Ethnic Disparity in Multisystem Inflammatory Syndrome in Children (MIS-C) in the State of Mississippi, USA, July 2020 to June 2021

PurposeThe racial composition of Mississippi is Caucasian (C) 58%, African American (AA) 38%, and others 4%, whereas the SARS-CoV-2 PCR positive rates are 16% in AA, 25% in Hispanics, and 6% in C children. We aimed to study the disparities of MIS-C in Mississippi and whether MIS-C follow the same racial distribution as SARS-CoV-2 infection?MethodsRetrospective study of consecutive MIS-C patients <18 years of age hospitalized at our center over 1 year. We compared demographics, clinical presentation, laboratory findings, and treatment of MIS-C by race/ethnicity. We compared the distribution of MIS-C cases with that of SARS-CoV-2 infection rates.ResultsDuring the study period, 51 MIS-C patients hospitalized. Median age was 9 year, 58% male, 36(71%) were AA, 13(25%) were C, 1 was Asian, and 1 was Hispanic. We found a significant delay between onset of symptoms and hospitalization in AA than C children, 2.3±2.1 vs. 0.6±1.5 days (P=0.002). Cardiac symptoms were present in 24%, and 39% had Kawasaki's disease-like symptoms. Only absolute neutrophil count was associated with cardiac dysfunction (p= 0.01) on multivariate analysis. Creatinine and ferritin levels were associated with ICU admission; p= 0.01 and 0.03, respectively. Differences in inflammatory and cardiac biomarkers between AA and C races are summarized in Figure 1. AA children with MIS-C had increased length of hospitalization (8.1 vs 5.2 days; p=0.04), a higher trend of more admissions to ICU (38.9% vs 23.1%; p=0.3) and cardiac involvement (36.1% vs 23.1%; p=0.5) than C Children (Figure 2).ConclusionIn Mississippi, racial disparity in MIS-C exceeds the differences of SARS-CoV-2 infection rates in children. AA children had delayed hospitalization from the onset of symptoms, severe inflammation, longer length of stay, a higher trend for more cardiac dysfunction and ICU admissions than C children. Our findings could assist health professionals in devising appropriate strategies to target minority children. The racial composition of Mississippi is Caucasian (C) 58%, African American (AA) 38%, and others 4%, whereas the SARS-CoV-2 PCR positive rates are 16% in AA, 25% in Hispanics, and 6% in C children. We aimed to study the disparities of MIS-C in Mississippi and whether MIS-C follow the same racial distribution as SARS-CoV-2 infection? Retrospective study of consecutive MIS-C patients <18 years of age hospitalized at our center over 1 year. We compared demographics, clinical presentation, laboratory findings, and treatment of MIS-C by race/ethnicity. We compared the distribution of MIS-C cases with that of SARS-CoV-2 infection rates. During the study period, 51 MIS-C patients hospitalized. Median age was 9 year, 58% male, 36(71%) were AA, 13(25%) were C, 1 was Asian, and 1 was Hispanic. We found a significant delay between onset of symptoms and hospitalization in AA than C children, 2.3±2.1 vs. 0.6±1.5 days (P=0.002). Cardiac symptoms were present in 24%, and 39% had Kawasaki's disease-like symptoms. Only absolute neutrophil count was associated with cardiac dysfunction (p= 0.01) on multivariate analysis. Creatinine and ferritin levels were associated with ICU admission; p= 0.01 and 0.03, respectively. Differences in inflammatory and cardiac biomarkers between AA and C races are summarized in Figure 1. AA children with MIS-C had increased length of hospitalization (8.1 vs 5.2 days; p=0.04), a higher trend of more admissions to ICU (38.9% vs 23.1%; p=0.3) and cardiac involvement (36.1% vs 23.1%; p=0.5) than C Children (Figure 2). In Mississippi, racial disparity in MIS-C exceeds the differences of SARS-CoV-2 infection rates in children. AA children had delayed hospitalization from the onset of symptoms, severe inflammation, longer length of stay, a higher trend for more cardiac dysfunction and ICU admissions than C children. Our findings could assist health professionals in devising appropriate strategies to target minority children.

Old Adversary, New Challenges: Childhood Lead Exposure and Testing.

Old Adversary, New Challenges: Childhood Lead Exposure and Testing.

The 1921 Tulsa Race Massacre: A Photographic History by Karlos K. Hill

Reviewed by: The 1921 Tulsa Race Massacre: A Photographic History by Karlos K. Hill Hollie A. Teague The 1921 Tulsa Race Massacre: A Photographic History. By Karlos K. Hill. (Norman: University of Oklahoma Press, 2021. Pp. 290. Illustrations, bibliography.) In May and June 2021, Texas governor Greg Abbott and Oklahoma governor Kevin Stitt each signed a bill, part of a spate of similar legislation being passed around the country, attempting to control the ways racial issues are discussed in the classroom. Such bills were of particular concern due to their timing, centered around the one-hundredth anniversary of the Tulsa race massacre. The history of the massacre, in which White people took the lives of approximately three hundred African American men, women, and children, has undergone extraordinary levels of overt erasure and as a result has been largely removed from Americans' collective historical memory. In The 1921 Tulsa Race Massacre: A Photographic History, Oklahoma professor, state senator, and activist Karlos K. Hill challenges that erasure by providing graphic evidence from the scene and in doing so adds meaningfully to the body of scholarship concerned with the horrific events of May 31 and June 1, 1921. Continuing trends attempting to restrict an open and brave acknowledgement of historical traumas, which are becoming ever more entrenched in both Oklahoma and Texas, demonstrate why a book like Hill's is important. In the text, the voices and experiences of survivors are centered and honored rather than dismissed. In the photographs, a heartbreaking and enraging narrative unfolds that leaves little question [End Page 526] that the Black population of Tulsa has been doubly victimized, once by their violently aggressive neighbors set on maintaining White supremacy and again by the gatekeepers of history who have created a false narrative of America's racial past. Quoted in the book, massacre survivor Ruth Dean Nash said, "I was so traumatized by that riot, I don't remember much about anything, except for my terror. I'll never forget that" (224). Indeed, none of us should ever forget what was done in Tulsa in 1921 or what has been done since to cover it up. Stories of what happened when the most economically successful Black community in the United States was destroyed by its White neighbors and a variety of law enforcement personnel may be difficult for many students to process. Viewing the horrific photographs, which make up the major focus of the book, may be exponentially more difficult. Only a teacher or professor sensitive to the realities of racial trauma should assign this book in its entirety, but no educator should ignore it. This work is clearly an inspired and personal endeavor for Hill, who writes in the forward, "As a community and state leader—the only African-American male in the State Senate—I have made recognizing the significance of and honoring the lives, homes, and businesses lost in the most horrific massacre of Americans by Americans a major priority" (x). This book is an important addition to Hill's body of work and to the larger collection of scholarship on race relations in America. The 1921 Tulsa Race Massacre would be a meaningful inclusion in any undergraduate- or graduate-level syllabus dedicated to American history, a history of the Southwest, race relations, and social memory. It will work best as a supplementary piece, either paired with a text that provides more narrative explanation or alongside a skillful professor's lectures. A reader unfamiliar with 1921 Tulsa will likely not come away from the book with a strong understanding of how events actually unfolded over those twenty-four terrible hours. That reader would, however, be unable to deny the horror of it. For those with some knowledge of the massacre, The 1921 Tulsa Race Massacre is an invaluable contribution to expanding our understanding, knowledge, and compassion. Hollie A. Teague Dover-Foxcroft, Maine Copyright © 2022 The Texas State Historical Association

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Device-Based Movement Behaviors, Executive Function, and Academic Skills among African American Children with ADHD and Disruptive Behavior Disorders.

Background: Physical activity (PA) has been identified as a promising intervention to improve executive function (EF) and reduce ADHD symptoms in children. Few African American children with ADHD and Disruptive Behavior Disorders (DBDs) from families with low incomes are represented in this literature. The purpose of this study is to test the relationships between PA and sedentary time (ST), and EF and academic skills among African American children with ADHD and DBD from low-income families. Methods: Children (n = 23, 6–13 years old) wore an ActiGraph for one week to measure PA and ST. EF was measured through parent report and direct neuropsychological tests. Academic skills were measured with the Curriculum-Based Measurement System. Bivariate correlations tested relationships between PA, ST, EF, and academic skills. Results: A significant correlation was observed between vigorous PA time and parent reported EF (r = −0.46, p = 0.040). Light PA and moderate PA were not related to EF or academic skills, and neither was ST. Conclusions: Vigorous PA may prove useful as an adjunct treatment to improve EF in African American children with ADHD and DBD in low-income neighborhoods. Research using experimental and longitudinal designs, and examining qualitative features of PA experiences, will be critical for understanding relationships between PA, academic skills, and EF in this population.

Intergenerational Effects of Discrimination on Black American Children's Sleep Health.

Greater exposure to racial/ethnic discrimination among pregnant Black American women is associated with elevated prenatal depressive symptomatology, poorer prenatal sleep quality, and poorer child health outcomes. Given the transdiagnostic importance of early childhood sleep health, we examined associations between pregnant women’s lifetime exposure to racial/ethnic discrimination and their two-year-old children’s sleep health. We also examined women’s gendered racial stress as a predictor variable. In exploratory analyses, we examined prenatal sleep quality and prenatal depressive symptoms as potential mediators of the prior associations. We utilized data from a sample of Black American women and children (n = 205). Women self-reported their lifetime experiences of discrimination during early pregnancy, their sleep quality and depressive symptoms during mid-pregnancy, and their children’s sleep health at age two. Hierarchical linear multiple regression models were fit to examine direct associations between women’s experiences of discrimination and children’s sleep health. We tested our mediation hypotheses using a parallel mediator model. Higher levels of gendered racial stress, but not racial/ethnic discrimination, were directly associated with poorer sleep health in children. Higher levels of racial/ethnic discrimination were indirectly associated with poorer sleep health in children, via women’s prenatal depressive symptomatology, but not prenatal sleep quality. Clinical efforts to mitigate the effects of discrimination on Black American women may benefit women’s prenatal mental health and their children’s sleep health.

Pediatric head and neck burns increased during early COVID-19 pandemic

ObjectiveThe purpose of this study was to describe patterns of burns to the head and neck in children during the early COVID-19 pandemic.Study designThis cross-sectional study reviewed pediatric patients in the Burn Care Quality Platform Registry. Patients were included if they were ≤17.9 years old and had sustained burns to the head and neck. Patients were separated into the following groups: March 13 to September 13, 2019 (before COVID-19 pandemic, BC) or March 13 to September 13, 2020 (during the initial 6 months of the COVID-19 pandemic, C19). The study team collected patient-related variables, details regarding burn injury, burn severity, and hospital course. Univariate and bivariate analyses were calculated. The chi-squared test was used for categorical variables. Statistical significance was P < .05.ResultsFifty-five children with head and neck burn injuries were included. There was a 200% increase in burns to the head and neck region in children in April 2021 compared with previous year. Burns to head and neck in White children occurred more often during C19 (P = .03). The study revealed differences in timing of presentation (time of burn injury to emergency department admission) in different racial groups during (White children [P = .05]), and after the pandemic (African American children [P = .02]).ConclusionsThere was a transient increase in burns to the head and neck region in children during the early pandemic compared with the historic cohort.

Associations between APOL1 genetic variants and blood pressure in African American mothers and children from a U.S. pregnancy cohort: Modification by air pollution exposures

IntroductionCarriage of high-risk APOL1 genetic variants is associated with increased risks for kidney diseases in people of African descent. Less is known about the variants’ associations with blood pressure or potential moderators. MethodsWe investigated these associations in a pregnancy cohort of 556 women and 493 children identified as African American. Participants with two APOL1 risk alleles were defined as having the high-risk genotype. Blood pressure in both populations was measured at the child's 4–6 years visit. We fit multivariate linear and Poisson regressions and further adjusted for population stratification to estimate the APOL1-blood pressure associations. We also examined the associations modified by air pollution exposures (particulate matter ≤2.5 μ m in aerodynamic diameter [PM2.5] and nitrogen dioxide) and explored other moderators such as health conditions and behaviors. ResultsNeither APOL1 risk alleles nor risk genotypes had a main effect on blood pressure in mothers or children. However, each 2-μg/m3 increase of four-year average PM2.5 was associated with a 16.3 (95%CI: 5.7, 26.9) mmHg higher diastolic blood pressure in mothers with the APOL1 high-risk genotype, while the estimated effect was much smaller in mothers with the low-risk genotype (i.e., 2.9 [95%CI: -3.1, 8.8] mmHg; Pinteraction = 0.01). Additionally, the associations of APOL1 risk alleles and the high-risk genotype with high blood pressure (i.e., SBP and/or DBP ≥ 90th percentile) were stronger in girls vs. boys (Pinteraction = 0.02 and 0.005, respectively). ConclusionThis study sheds light on the distribution of high blood pressure by APOL1 genetic variants and informs regulatory policy to protect vulnerable population subgroups.

Peer-support intervention for African American and Latino parents to improve the glycemic control trajectory among school-aged children with type 1 diabetes: A pilot and feasibility protocol

BackgroundType 1 diabetes (T1D) is a common, chronic pediatric health condition with complicated management demands. African American and Latino children with T1D have troubling disparities in glycemic outcomes and acute complications. While there are empirically supported behavioral interventions to support disease management in youth with T1D, there are few that specifically aim to reduce health disparities in this population. While collaborative parent involvement with the child with T1D management tasks is important to promote optimal glycemic outcomes during childhood, our formative research identified multiple individual, family, and broader system factors that impede or facilitate collaborative parental involvement among African American and Latino parents of children with T1D.MethodsThis paper describes the development, design, and study protocol for the Type 1 Diabetes Empowerment And Management (TEAM) pilot trial. The TEAM intervention is a novel, group-based behavioral intervention designed to enhance collaborative involvement in T1D management for African American and Latino parents of children aged 5–10. This randomized pilot trial's primary aim is to evaluate the TEAM intervention's feasibility and acceptability. The secondary aim is to examine preliminary intervention outcomes (i.e., children's HbA1c, treatment adherence, collaborative parent involvement in T1D management, parent/child quality of life, and parent's diabetes-related distress, depressive symptoms, and self-efficacy) compared to usual T1D care.DiscussionThe trial will provide preliminary information about whether optimizing appropriate parent involvement during the school-age years may increase T1D treatment adherence and stabilize or improve glycemic control in African American and Latino school-aged children.