African American Children Research Articles

High Olfactory Receptor-Rich 11q11 Copy Number in Girls and African American Children.

Copy number variants (CNVs) provide numerous genetic differences between individuals, and they have been linked with multiple human diseases. Obesity is one of the highly heritable complex disorders, which is associated with copy number variance (CNV). A recent report shows that the 11q11 gene, a novel olfactory receptor, and its copy number variants are involved in the early onset of obesity. In the current study, we analyzed the 11q11 gene copy number variance (CNV) based on gender in White/European American (EA) and African American (AA) normal weight and overweight/obese children. Sixty-nine boys and fifty-eight girls between the ages of 6 and 10 years belonging to either EA or AA ethnicity were involved in this study. As per World Health Organization (WHO) guidelines, each participant’s body weight and height were recorded. DNA was extracted from saliva, and the copy number variants for the 11q11 gene were measured using digital PCR. The descriptive analysis of the 11q11 copy number showed significantly more copies in girls compared to boys; similarly, AA participants had significantly increased CNV compared to EA. The normal weight (NW) and overweight/obese (OW/OB) girls were significantly less likely to belong to the low copy number variant (LCNV) group of 11q11 compared to boys; similarly, NW and OW/OB AA children were significantly less likely to belong to the LCNV group. The AA girls in LCNV had significantly higher BMI z-scores. Our findings suggest that the 11q11 copy number in children is race and gender-specific.

Nationwide tracheostomy among neonatal admissions – A cross-sectional analysis

ObjectiveTo describe characteristics and outcomes of infants admitted as neonates requiring tracheostomy placement. MethodsA cross-sectional analysis of the Kids’ Inpatient Database (KID) between 2003 and 2016 included all children admitted within the first 28 days of life that had a tracheostomy placed prior to discharge. Patient characteristics and surgical outcomes were compared between term (≥37 weeks gestation) and preterm (<37 weeks gestation) infants. A subset analysis for Black or African American neonates was performed given disproportional preterm births. ResultsAn estimated 4268 (95% CI: 4123–4414) tracheostomies were performed in infants admitted as a neonate with preterm infants accounting for 47% (1998/4268). Among preterm children, 20% were Black or African American compared to 12% in the term group (P < .001). More preterm infants had bronchopulmonary dysplasia (46% vs. 14%, P < .001), cardiac defects (66% vs. 58%, P < .001) and developed pneumonia, newborn sepsis, or sepsis during admissions (P < .001). Laryngotracheal anomalies (25% vs. 18%, P < .001) and vocal cord paralysis (11% vs. 4.9%, P < .001) were more common in term infants. Median length of stay (LOS) (154 vs. 100 days, P < .001) and total charges ($1,395,106 vs. $917,478, P < .001) were greater among preterm infants. Mortality was no different between groups (13% vs. 15%, P = .07). Characteristics strongly associated with preterm status were newborn sepsis (OR: 2.31, 95% CI: 1.97–2.72, P < .001), bronchopulmonary dysplasia (OR: 2.17, 95% CI: 1.77–2.65, P < .001) and Black or African American race (OR: 1.78, 95% CI: 1.46–2.17, P < .001). The following factors increased among all neonates between the baseline year 2003 to the final study year 2016: complications of care (OR: 1.9, 95% CI: 1.5–2.5, P < .001); sepsis (OR: 4.1, 95% CI: 3.0–5.5, P < .001); congenital cardiac anomalies (OR: 5.8, 95% CI: 4.5–7.4, P < .001); and respiratory failure (OR: 1.9, 95% CI: 1.5–2.4, P < .001). Compared to other races, median LOS and total charges were greater among Black or African American infants. ConclusionTracheostomies among preterm infants admitted as neonates reflect a growing and complex group with increased costs and hospitalization lengths. Black or African American children are disproportionately born preterm with higher costs and LOS compared to other racial cohorts. Future work will be necessary to design quality-improvement initiatives to improve outcomes for this vulnerable population.

Racism May Interrupt Age-related Brain Growth of African American Children in the United States

Background: Considerable research has documented age-related growth in brain size as a marker of normal brain development. This is particularly important because brain volume has a significant role in overall cognitive performance. However, less research is done on whether age-related changes in the global brain volume differ across diverse racial and ethnic groups. We hypothesized that age-related growth in brain size would be disrupted in African American children who are historically affected by racism. Purpose: Considering race as a proxy of racism rather than genetics, this study tested racial and ethnic differences in the effects of age on global brain volume using structural brain imaging data. Built on a sociological, rather than a biological theory, we built our study on Marginalization-related Diminished Returns (MDRs) framework, which argues that under racism, resources and assets are less effective for social groups that are historically racialized, discriminated against, marginalized, and segregated. Considering age as an asset/resource that increases the global brain volume, we expected weaker effects of age on overall brain size of African American and Hispanic children, than White and non-Hispanic children, again as a result of racism. Methods: We borrowed the structural Magnetic Resonance Imaging (sMRI) data from the Children Brain Cognitive Development (ABCD) study, which included 9,311 9-10 year old children. The independent variable was the child’s age treated as a continuous measure (in months). The primary outcome was global brain volume. Sex, parental employment, parental education, household income, and parental marital status were the covariates. Race and ethnicity, as proxies of racism, were the moderators. To analyze the data, we used linear regression models. Results: Age was positively associated with the global brain size in children. In line with the MDRs, the positive association between age and global brain volume was weaker for African American than White children, while family structure, sex, and family socioeconomic status was controlled. Conclusions: Under racism, age has unequal effects on global brain size of diverse racial groups. In line with the MDRs, we observe diminished agerelated growth of the brain for African American children, which documents detrimental effects of racism. For White children who are not affected by racism, age makes a large difference regarding global brain volume. Age-related growth of global brain size is diminished in African American children, whose daily lives are shaped by racism. School and residential segregation may have a role in reducing the effect of age on children’s brain growth in African American families. The results should not be interpreted as inferiority of one group but social processes that hinder normal development of a historically oppressed group.

Acute Lymphoblastic Leukaemia in Johannesburg, South Africa: The State-Sector Experience

IntroductionLymphoblastic leukemia (ALL) is a neoplasm of immature lymphoid cells of either B- or T-cell lineage. B-ALL is the more common (particularly in childhood), and has a number of described recurrent genetic abnormalities with distinct clinic-pathological associations. T-ALL comprises a larger proportion of adult ALL (18-23%) than childhood cases (7-15%) in high income countries, and is genetically heterogeneous without clear prognostic associations with genetic subtypes. The frequency of T-ALL and the genetic landscape of B-ALL show regional variation. T-ALL is common among African American children (~25%), but seen infrequently in Asia (~7% of childhood cases). In B-ALL, the translocation t(12;21) and hyperdiploidy predominate among children in Europe and the USA, while KMT2A rearrangement and the translocation t(9;22) are relatively more common in Asia. There is a paucity of literature regarding ALL in Africa; the distribution of its subtypes (B vs T), its genetic composition and outcomes are not known. This study aimed to characterize ALL diagnosed in the state-sector hospitals of Johannesburg, South Africa (SA).MethodsCases diagnosed with ALL in the flow cytometry laboratory at Charlotte Maxeke Johannesburg Academic Hospital (which provides diagnostic immunophenotyping services to all state-sector hospitals of the southern Gauteng region of SA) between 2016-2019 (42 months) were identified and recorded in a database. Pertinent information was documented from the laboratory information system.ResultsALL was diagnosed in 181 patients over the time period; pertinent clinical information is reported in Table 1. T-ALL was substantially more common than reported elsewhere, comprising 31.5% and 35.2% of childhood and adult ALL, respectively. Differences were evident in the cytogenetic patterns seen in both B- and T-ALL as compared to other parts of the world. In B-ALL the translocation t(1;19) (which occurs in <10% of cases elsewhere) was the most common recurrent genetic abnormality (23.7%), and the t(9;22) had a relatively high frequency in children <13 years (8.8%) (Figure 1). In T-ALL, karyotypic abnormalities were more common than typical (seen in 80.0% of cases vs 50-70% elsewhere), with derangements of chromosome 6q being the most frequent (19%). The translocation t(10;11) (PICALM-MLLT10) and abnormalities involving the TLX1 (HOX11) and TLX3 (HOX 11L2) genes (which are among the more frequent genetic abnormalities reported internationally) were all uncommon, each occurring in only 2.4% of the cases.Disease outcomes were substantially poorer compared to those reported in high income countries, where survival rates in childhood T-ALL range from 60-80% and exceed 90% in B-ALL. At a median follow-up time of 36 months, only 68.2% (B-ALL) and 27.8% (T-ALL) of children <10 years were alive, while mortality rates among adults exceeded 80% in both T- (86.7%) and B-ALL (83.3%). Survival in patients with T-ALL did not differ between those with high vs low risk clinical features (age >10 years, white cell count >100 x10 9/L), and was significantly worse as compared to those with B-ALL (p = 0.01). Relapse was the dominant cause of death in children <10 years (more so in those with T-ALL), while death due to chemotherapy-related neutropenic sepsis was more common in older patients (particularly those with B-ALL) (Figure 2). Factors associated with disease relapse in B-ALL included KMT2A rearrangement and measurable residual disease (MRD) after induction chemotherapy (as defined by non-quantitative, non-allele specific PCR of IgH/T-cell receptor gene rearrangement status and 4 color flow cytometry (both with sensitivities >0.1%)). Notably, the high risk of relapse associated with MRD was not seen in patients with t(9;22), likely due to the use of targeted molecular therapy in these cases. No significant predictors of survival were identified in T-ALL, but the presence of MRD post-induction was associated with early death due to relapse (<12 months).ConclusionALL in SA shows distinct differences in the cytogenetic landscape, disease patterns and outcomes. The cause of the poor survival rates likely includes differences in tumour/host biology, late presentation, restricted access to haemopoietic stem cell transplantation in the SA state-sector, and suboptimal neutropenic support. Although rudimentary, available MRD testing is a valuable risk predictor in both B- and T-ALL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Ending Child Poverty by Investing in Children and Families.

Ending Child Poverty by Investing in Children and Families.

Crisis response among essential workers and their children during the COVID-19 pandemic

Limited research has been conducted on the mental health concerns of frontline and essential workers and their children during the COVID-19 pandemic in the United States (U.S.). This study examined the association between working on the frontlines in the U.S. during the COVID-19 pandemic (March to July 2020) and personal crisis text concerns (e.g., self-harm, suicidal thoughts, anxiety/stress, and substance abuse) for frontline essential workers and the children of frontline workers. We used a novel data set from a crisis texting service, Crisis Text Line (CTL), that is widely used throughout the U.S. Generalized Estimating Equations examined the individual association between eight specific crisis types (Depression, Stress/Anxiety, Self-Harm, Suicidal Thoughts, Substance Abuse, Isolation, Relationship Issues, and Abuse) and being in frontline work or being a child of a frontline worker during the early phase of the pandemic. Using CTL concerns as a proxy for the prevalence of mental health issues, we found that children of workers, specifically the youngest demographic (13 years and under), females, and non-conforming youth had a higher risk of specific crisis events during the COVID-19 pandemic. Additionally, Hispanic children of workers reported higher rates of stress/anxiety, whereas African American children of workers had higher rates of abuse and depression. Frontline workers had a higher risk of suicidal thoughts, and the risk of crisis events was generally highest for non-binary, transgender, and male users. Increases in CTL usage among frontline workers were noted across 7–28 days after spikes in local COVID-19 cases. The research to date has focused on the mental health of frontline essential workers, but our study highlights troubling trends in psychological stress among children of these workers. Supportive interventions and mental health resources are needed not only for frontline essential workers, but for their children too.

Stratification by obesity class, rather than age, can identify a higher percent of children at risk for non-alcoholic fatty liver disease and metabolic dysfunction.

An increasing number of clinical practice guidelines recommend screening children with obesity for non-alcoholic fatty liver disease (NAFLD). However, there is limited evidence regarding what parameters should be used to initiate the screening. The objective of this study was to determine whether obesity class rather than age group can identify a higher percent of children at risk of NAFLD as assessed by abnormal alanine aminotransferase (ALT). This is a cross-sectional study in a regional referral clinic for evaluation of obesity. Children were stratified by age group or by obesity class, and data obtained at first visit were analysed. Of the 784 children, 482 were ≥10, 209 were 6 to 9 and 93 were 2 to 5 years of age. Abnormal ALT was observed in 32.1%, 46.9% and 61.0% of children with class I, II or III obesity, respectively (p< 0.001), while the risk of abnormal ALT did not differ in very young (2-5), young (6-9), or children older than 10 years. A multivariable analysis showed that class II and class III obesity were associated with 2.1-fold (1.27-3.72) and 4-fold (2.41-6.96) greater odds of abnormal ALT compared with class I obesity. African-American children had lower risk of abnormal ALT (0.27), whereas Hispanic children had higher risk (2.37). Obesity class was a better predictor of abnormal ALT than age, especially in girls. Furthermore, 66.7% of boys (p= 0.009) and 69% of girls (p< 0.001) with abnormal ALT exhibited additional signs of metabolic dysfunction. Obesity class is more strongly associated with abnormal ALT than age.

Uniting the Nation- Rethinking Adversity of the Poor

A root cause of today’s social tensions and divisions rest with poverty. Studies suggest that that individuals who grow up in poverty-stricken families are much more likely to be in poverty during their early adulthood, and the poverty rate in African American children is astoundingly high. This paper adopts data science approaches to identify drivers behind childhood poverty in the United States, and finds that these factors tend to reinforce each other and go hand in hand with poverty. Specifically, common factors are found to be driving childhood poverty, a weak healthcare system, inadequate education resources, lack of public safety infrastructure and insufficient job opportunities.&#x0D; The current social safeguard framework, supported by both the government and private institutions, appears fragmented and lacks the necessary alignment across healthcare, education, public safety and job creation. The study shows that barring a systematic approach to address the drivers of childhood poverty, the poverty problem is unlikely to be fundamentally addressed. Building on these findings, the paper calls for a number of mutually coherent policies, including introducing a more effective financing scheme for the children in poverty, creating an enabling job market environment for the poor, reforming the funding pattern of schools, creating a safe environment for all children, and enhancing health services for those living in poverty.

Speaking of Race: Language, identity, and schooling among African American Children. Jennifer B.Delfino, London: Lexington Books. 2021. 202pp. Hb (9781793606488) $36.55, Ebk (9781793606495) $34.72

Speaking of Race: Language, identity, and schooling among African American Children. Jennifer B.Delfino, London: Lexington Books. 2021. 202pp. Hb (9781793606488) $36.55, Ebk (9781793606495) $34.72

Assessing Racial and Ethnic Discrimination in Children: A Scoping Review of Available Measures for Child Health Disparities Research.

Objectives: To characterize the availability, content, and psychometric properties of self-reported measures that assess race/ethnicity-related discrimination or psychosocial stress and have potential relevance to studies of health disparities in children and adolescents.Design: Using PRISMA extension guidelines for scoping reviews, we searched Ovid Medline, CINAHL, PsychInfo, and Scopus databases from 1946 to April 20, 2020, using the search terms “stress,” “child,” “adolescents,” “discrimination,” and “psychometrics.” We limited the search to articles in English, with children and adolescents, in the United States. For each measure, we extracted information about the content, reliability, and construct validity.Results: The 12 measures that met inclusion criteria assessed discrimination or stress from racial discrimination in African American children and adolescents (n=8), acculturative stress in Hispanic/Latino children (n=1), or bicultural stress in Mexican American adolescents (n=2), and one measure assessed both discrimination-related and acculturative stress in Hispanic/Latino children. The majority (n=7) articles were published between 2001 and 2010. All discrimination measures evaluated individual experiences of discrimination and one also evaluated stressfulness of discrimination and coping. The acculturative stress measures assessed general stress and immigration-related discrimination, and the bicultural stress measures evaluated many different aspects of biculturalism.Conclusions: Despite the recent increased interest in the racial discrimination and stress as a contributor to racial or ethnic health disparities affecting U.S. children and adolescents, the small number of eligible measures identified and incomplete coverage of various types of racial and ethnic discrimination within and across population groups indicates a currently inadequate capacity to conduct child health disparity studies on this issue.

6.3 SPECIFYING OPPORTUNITY TO RESOLVE RACE-BASED MENTAL HEALTH INEQUITY IN EARLY CHILDHOOD

Identifying opportunities to resolve racial inequities in mental health outcomes is an urgent national priority. In this presentation, the impact of current racial inequities on early childhood development will be traced in: 1) a large national sample of African American children affected by autism spectrum disorder (ASD); 2) an epidemiologic cohort of Hispanic twins in the state of California; and 3) a court-referred sample of over 600 infants and toddlers consecutively enrolled with their parents into a 2-generation clinical psychiatric service (the SYNCHRONY Project) after having been placed in protective custody for child abuse in St. Louis, Missouri. In these analyses: 1) a grossly disproportionate burden of cognitive impairment—accounting for hundreds of thousands of excess cases of intellectual disability in the United States—was traced to systematic (structural) delays in both diagnosis and service access among African American children with ASD; 2) untreated mental health conditions of Hispanic parents were shown to exert more deleterious effects than poverty on early childhood mental health; and 3) a missed opportunity to support parents with documented mental health conditions resulted in catastrophic inequities in the integrity of minority households and the adaptive outcomes of young children. In a diverse sample of high-risk pregnant women—for whom prediction algorithms estimated future risk of child abuse to their newborns to be comparable to the recidivism risk in the court sample—prospective engagement into a program of resource navigation for evidence-based supports demonstrated the feasibility of migrating preventive intervention from the social service sector into the health system. Strategies to resolve race-based mental health inequity in the United States must seriously consider starting at the beginning of life, when excess adverse experience, and deficiency in mental health support, exact disproportionate and enduring consequences on minority children and their families. Judicious adherence to clinical standards of care in the field of psychiatry, broadly defined, represents a potent opportunity to level the playing field for all children, at a critical node in the historically inexorable transfer of racial injustice and its impact across generations.

PARENTAL ADHD AND THEIR OFFSPRING FROM THE PERINATAL PERIOD TO EARLY CHILDHOOD

ADHD is a common neurodevelopmental disorder that has been increasingly recognized as persisting into adulthood. ADHD has high heritability, and parental behaviors influence child ADHD symptoms and impairment. In fact, parent behavior training is the primary treatment modality for preschool-aged children with ADHD. Thus, examining offspring at familial risk for ADHD from infancy to preschool and the impact of parental ADHD on early parenting could elucidate potential intervention targets to decrease the prevalence of ADHD and/or reduce impairment for children born to parents with ADHD. Allison Baker, MD, will present the trajectory of ADHD symptoms across pregnancy. Heather Marie Joseph, DO, will describe findings regarding predictors of parental distress across the first year of parenthood for parents with ADHD and their co-parents. Mai Uchida, MD, will report on ADHD symptoms among preschool-aged offspring of parents with ADHD. Joyce Lui, PhD, will review thematic analyses from stakeholder meetings regarding identification and treatment of African American families, both parents and children, with ADHD in pediatric primary care. Pregnant women with ADHD had a significant increase in symptom scores across pregnancy, regardless of medication (p = 0.027), and women returning to work postpartum had an increase in total functional impairment score (p = 0.043). A cohort of mother-father-infant triads found that families with parent ADHD experienced greater parental distress (p < 0.05). Both parent sleep (p < 0.01) and infant temperament, surgency (p = 0.03) and effortful control (p < 0.01), were associated with parental distress. Among a sample of preschool-aged children, those born to parents with ADHD had significantly higher rates of attention problems compared to the children of control parents (OR = 2.37, p = 0.04). Stakeholders identified 6 themes of importance when approaching African American families in pediatric primary care settings regarding screening for parent ADHD and treatment of both the parent and child. The impact of parent ADHD on early parenting and offspring development has been underrecognized. These presentations provide new insights into potential intervention targets to reduce the familial transmissions of ADHD as well as early markers of risk for developing childhood ADHD.

Impact of guideline adherence and race on asthma control in children.

Asthma control in African Americans (AA) is considered more difficult to achieve than in Caucasian Americans (CA). The aim of this study was to compare asthma control over time among AA and CA children whose asthma is managed per NAEPP (EPR-3) guidelines. This was a one-year prospective study of children referred by their primary care physicians for better asthma care in a specialty asthma clinic. All children received asthma care per NAEPP guidelines. Results were compared between CA and AA children at baseline and then at three-month intervals for one year. Of the 345 children, ages 2-17years (mean = 6.2 ± 4), 220 (63.8%) were CA and 125 (36.2%) were AA. There were no significant differences in demographics other than greater pet ownership in CA families. At baseline, AA children had significantly more visits to the Emergency Department for acute asthma symptoms (mean = 2.3 [Formula: see text] compared to CA (1.4±2.3, P = 0.003). There were no other significant differences in acute care utilization, asthma symptoms (mean days/month), or mean asthma control test (ACT) scores at baseline. Within 3-6months, in both groups, mean ACT scores, asthma symptoms and acute care utilization significantly improved (P < 0.05 for all) and change over time in both groups was comparable except for a significantly greater decrease in ED visits in AA children compared to CA children (P = 002). Overall, improvement in asthma control during longitudinal assessment was similar between AA and CA children because of consistent use of NAEPP asthma care guidelines.

Mothers’ Perspectives on Co-Parenting with African American Non-Resident Fathers

Over half of African American (AA) children grow up in single-mother headed households. Strained relationships between co-parents can complicate and potentially thwart efforts for father engagement. Twelve mothers who served as data informants in a randomized control trial of a fatherhood intervention were recruited to describe their experiences co-parenting with nonresident AA fathers in semi-structured interviews. Qualitative descriptive content analysis of the data revealed three major themes that are used to identify innovative ways for researchers, policy makers, and mental health practitioners to support co-parents as they strive to engage in equitable shared parenting.

W34. BIAS IN THE USE OF POLYGENIC SCORES TO EXPLORE GENETIC NURTURING EFFECTS IN BIOLOGICAL PARENT-OFFSPRING TRIOS

This study examined the development of baseline autonomic nervous system (ANS) and hypothalamic–pituitary–adrenal (HPA) physiological activity from 12 to 36 months as well as antecedents (poverty) and consequents (behavior problems) of individual differences in physiological development. Children (N = 179; 50% poor; 56% African American; 52% male) provided saliva samples at 12, 18, 24, 30, and 36 months of age. Latent growth curve models indicated that nonlinear change was evident for both sAA and cortisol, with sAA increasing and cortisol decreasing with age. Children residing in poor households exhibited lower initial levels of sAA, but not cortisol. African-American children showed slightly smaller decreases in cortisol over time. Initial levels of sAA predicted higher levels of internalizing behaviors at 36 months and both initial levels of and total change in sAA predicted higher levels of externalizing behaviors at 36 months. There was no evidence that sAA or cortisol mediated the relationship between poverty and later behavior problems.

Factors Associated With Children Diagnosed With Attention-Deficit/Hyperactivity Disorder and 30-Day Follow-up Care With Practitioners Among Medicaid Recipients in Georgia.

Background and Objectives:It is important that children prescribed attention-deficit/hyperactivity disorder (ADHD) medication get timely follow-up care. In 2018, only 44% of US Medicaid recipients attended a follow-up visit within 30 days of their first ADHD prescription. The objective of this study was to identify the member and practitioner-related predictors that were associated with children who were diagnosed with ADHD and had a follow-up visit within 30 days (initiation phase) of their first prescription of ADHD medication (Index Prescription Start Date, or IPSD).Methods:A cross-sectional study was conducted to identify the independent predictors of a follow-up visit within 30 days and 2 follow-up visits within 270 days after the initiation phase (continuation and maintenance phase, or C&M phase) for Medicaid recipients. Predictive factors examined included race, school age group, gender, geography of residence, Medicaid service region, newly diagnosed ADHD, hospital admission, emergency department (ED) visit, types of ADHD medication, other psychosocial or behavioral diagnoses, psychosocial or behavioral therapy, prescriber specialty, and school season.Results:There were 2369 members eligible for the initiation phase measure, of whom 330 members were eligible for the C&M phase measure. Multiple regression analysis found that unmet 30-day follow-up was significantly associated with African American children with an existing diagnosis of ADHD (adjusted odds ratio [AOR] = 2.13; 95% confidence interval [CI], 1.64-2.76), middle school-aged children (AOR = 1.49; 95% CI, 1.23-1.80), rural residence (AOR = 1.27; 95% CI, 1.05-1.55), no ED visit (AOR = 1.57; 95% CI, 1.16-2.12), no psychosocial or behavioral therapy prior to the IPSD (AOR = 2.30; 95% CI, 1.65-3.21), and primary care practitioners (AOR = 1.88; 95% CI, 1.45-2.44).Conclusion:Pediatrics was the most common specialty prescribing ADHD medications. Managed care organizations can focus intervention efforts to improve compliance with 30-day follow-up among Medicaid children by targeting the high-risk categories identified above. They can also focus on facilitating communication between behavioral health practitioners and pediatricians about several key points: (1) the importance of using behavioral health therapy prior to prescribing medication; (2) the importance of timely follow-up care; and (3) the importance of medication management in combination with behavioral health therapy.

Kinship navigation: Facilitating permanency and equity for youth in child welfare

Kinship care has come to be seen as a way to potentially minimize some risks of traditional foster care, provide an opportunity for youth to remain connected to their extended families, and facilitate ongoing relationships and development. Previous work has suggested potential benefits of kinship placements for youth, but also challenges in identifying viable kin caregivers and providing adequate supports and guidance for these families. Kinship Navigation has been developed to formally and systematically assure placement options and supports for caregivers. At present, however, there is relatively little empirical work on the benefits and outcomes of Kinship Navigation programs.This manuscript examines permanency outcomes for youth served by one kinship care agency: A Second Chance, Inc. (ASCI). Countywide data are used to compare episode-of-care permanency outcomes for youth served by ASCI’s Kinship Navigator program with those served by other agencies without Kinship Navigation, who were removed from their homes during the same 27-month period (January 2017 – March 2020). The sample includes 1108 youth (471 served via ASCI KN; 637 in non-KN programs). Kinship Navigation was associated with significantly higher rates of Permanent Legal Custodianship and decreased disparities in outcomes between African American and White youth. These results suggest that ASCI’s Kinship Navigator program is promising for securing family-centered permanency and increasing positive outcomes for African American children and adolescents. Additional work is needed to more fully explore the key processes, families’ experiences, and broader outcomes.

Diagnostic and Medication Treatment Disparities in African American Children with ADHD: a Literature Review

Despite a national focus on achieving health equity, limited attention has been paid to behavioral and pediatric health disparities. As the most common pediatric neurobehavioral disorder, attention-deficit/hyperactivity disorder (ADHD) provides an opportunity to assess the status of pediatric behavior health disparities. The purpose of this literature review is to provide a synthesis of existing research on ADHD diagnostic and treatment disparities between African American and White children. Studies were systematically identified through searches in PubMed, CINAHL, and APA PsycInfo using the terms attention-deficit/hyperactivity disorder, disparity, race, ethnicity, diagnosis, medication, and treatment. Summary calculations were conducted to report the proportions of studies with statistically significant differences in ADHD diagnosis and treatment between White and African American children, and to describe trends in disparities over time. Forty-one studies were included in this review. The majority of studies identified significant disparities in ADHD diagnosis and medication treatment between African American and White children. While diagnostic disparities show a trend toward reduction over time, a similar trend was not observed in medication treatment disparities. This synthesis provides a critique of the existing literature and recommendations for practice and future research.

Potential engineers: A systematic literature review exploring Black children's access to and experiences with STEM

AbstractBackgroundAs engineering remains central to the US economy, it is imperative that the innovators of this field reflect the world in which we live. Despite decades of concerted effort to broaden participation in engineering, representation continues to lack.PurposeThe purpose of this paper is to provide education researchers and practitioners with a clear understanding of barriers to the participation of Black American children in science, technology, engineering, and mathematics (STEM). Our interest is driven by the role that precollege STEM experiences play in children's likelihood of becoming potential engineering students.Scope/MethodWe conducted a systematic literature review of 41 articles focused on Black children in precollege STEM contexts. Each article underwent individual review to gain deeper insight into key contextual factors that enable and constrain these potential engineers.ResultsWe situate our research findings in Perna's college choice model to highlight the key factors that may influence one's career and college decisions. The contextual factors are associated with the (1) social, economic, and policy context (e.g., racism, sexism, and classism); (2) STEM educational and community context (i.e., social perceptions and access); and (3) the local support context (i.e., teachers and family).ConclusionsOur results represent the early workings of a “glass ceiling” above the heads of potential engineering students. The underrepresentation of Black Americans who thrive in engineering is a byproduct of the lack of accessibility to quality and advanced learning experiences that too often plague K–12 schools and communities that serve high populations of Black Americans. Such findings have implications for research and practice.

Diet Quality Differs by Race/Ethnicity Among Mothers and Their Children from Supplemental Nutrition Assistance Program-Education Households.

Purpose: To investigate diet quality by race/ethnicity among mothers and their children from low-income households throughout California.Methods: Cross-sectional telephone surveys of mothers and their children from randomly sampled households using a validated 24-h dietary assessment. Healthy Eating Index-2015 (HEI-2015) scores were calculated.Results: The mean HEI-2015 scores were lower for African American and white mothers and children compared with Latinx mothers and children.Conclusion: Addressing poor levels of overall diet quality among African American and white mothers and children from low-income households is of public health importance. Reasons for Latinxs' superior diet quality may include limited acculturation to U.S. culture.