Asian Children Research Articles

Epidemiological and Clinical Features of Kawasaki Disease During the COVID-19 Pandemic in the United States

Public health measures implemented during the COVID-19 pandemic had widespread effects on population behaviors, transmission of infectious diseases, and exposures to environmental pollutants. This provided an opportunity to study how these factors potentially influenced the incidence of Kawasaki disease (KD), a self-limited pediatric vasculitis of unknown etiology. To examine the change in KD incidence across the United States and evaluate whether public health measures affected the prevalence of KD. This multicenter cohort study included consecutive, unselected patients with KD who were diagnosed between January 1, 2018, and December 31, 2020 (multicenter cohort with 28 pediatric centers), and a detailed analysis of patients with KD who were diagnosed between January 1, 2002, and November 15, 2021 (Rady Children's Hospital San Diego [RCHSD]). For the multicenter cohort, the date of fever onset for each patient with KD was collected. For RCHSD, detailed demographic and clinical data as well as publicly available, anonymized mobile phone data and median household income by census block group were collected. The study hypothesis was that public health measures undertaken during the pandemic would reduce exposure to the airborne trigger(s) of KD and that communities with high shelter-in-place compliance would experience the greatest decrease in KD incidence. A total of 2461 KD cases were included in the multicenter study (2018: 894; 2019: 905; 2020: 646), and 1461 cases (median [IQR] age, 2.8 years [1.4-4.9 years]; 900 [61.6%] males; 220 [15.1%] Asian, 512 [35.0%] Hispanic, and 338 [23.1%] White children) from RCHSD between 2002 and 2021 were also included. The 28.2% decline in KD cases nationally during 2020 (646 cases) compared with 2018 (894 cases) and 2019 (905 cases) was uneven across the United States. For RCHSD, there was a disproportionate decline in KD cases in 2020 to 2021 compared with the mean (SD) number of cases in earlier years for children aged 1 to 5 years (22 vs 44.9 [9.9]; P = .02), male children (21 vs 47.6 [10.0]; P = .01), and Asian children (4 vs 11.8 [4.4]; P = .046). Mobility data did not suggest that shelter-in-place measures were associated with the number of KD cases. Clinical features including strawberry tongue, enlarged cervical lymph node, and subacute periungual desquamation were decreased during 2020 compared with the baseline period (strawberry tongue: 39% vs 63%; P = .04; enlarged lymph node: 21% vs 32%; P = .09; periungual desquamation: 47% vs 58%; P = .16). School closures, masking mandates, decreased ambient pollution, and decreased circulation of respiratory viruses all overlapped to different extents with the period of decreased KD cases. KD in San Diego rebounded in the spring of 2021, coincident with lifting of mask mandates. In this study of epidemiological and clinical features of KD during the COVID-19 pandemic in the United States, KD cases fell and remained low during the period of masking and school closure. Mobility data indicated that differential intensity of sheltering in place was not associated with KD incidence. These findings suggest that social behavior is associated with exposure to the agent(s) that trigger KD and are consistent with a respiratory portal of entry for the agent(s).

Correlates of sedentary behavior in Asian preschool-aged children: A systematic review.

This systematic review aims to identify the multilevel correlates of sedentary behavior (SB) and its sub-domains among preschool-aged children aged 0-7years in Asia. We systematically searched for studies published from 2000 onwards using terms related to SB correlates and Asia in six databases. Eligible studies were observational and used quantitative methods to examine correlates of total, and domain-specific SB (screen viewing [SV] and non-screen-based SB) in Asian children living in Asia. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis to summarize the evidence on the intrapersonal, interpersonal, environmental correlates of total and domain-specific SB (PROSPERO: CRD42018095268). Twenty-two studies from 4 regions and 12 countries/territories were included. Out of the 94 correlates explored, the following associations were consistent: older age, being a boy, non-Chinese ethnicity (Southeast Asia), younger maternal age, higher maternal and paternal television-viewing time with higher SV; higher SV at earlier age with higher SV and total SB; and presence of TV/computer in the bedroom with higher leisure-time SB. We encourage more studies from low- and middle-income Asian countries with an increased focus on different SB domains, further exploration of environmental correlates, and the use of objective measurements to capture SB.

Vitamin D deficiency in South-East Asian children: a systematic review

ObjectiveTo describe the prevalence and determinants of vitamin D deficiency (VDD) among healthy children aged between 0 and 18 years living in South-East Asia (SEA).DesignWe systematically searched Ovid MEDLINE and...

The Mediating Effect of Sleep Duration on the Association between Food Insecurity and Childhood Obesity.

Background: Childhood obesity has increased globally during the past four decades. Food insecurity could heighten the risk of obesity. However, little is known about the underlying mechanism. This study aims to investigate the mediating role of sleep duration in the association between food insecurity and childhood obesity and whether there are differences by age, sex, and race/ethnicity. Method: Data from the National Survey of Children's Health for the years 2016-2020 were used, including children 10-17 years of age. We employed causal mediation analysis within a counterfactual framework to decompose the total effect of food insecurity into natural direct and indirect effects and estimate the proportion mediated. Result: The prevalence of obesity was 15.8% in our study sample. Children with food insecurity had 78% higher odds [odds ratio (OR) = 1.78, 95% confidence interval (CI): 1.70-1.86] of having obesity compared with children who were food secure. Overall, only 6.13% of this association was mediated by sleep duration. The association between food insecurity and obesity was stronger in females (OR = 1.96, 95% CI: 1.84-2.10) than males (OR = 1.66, 95% CI: 1.56-1.75), but the proportion mediated by sleep duration was larger in males (7.13%) than females (5.22%). Evidence of mediation was more pronounced in children 10-11 years of age and non-Hispanic Asian children (proportion mediated = 14.85% and 11.21%, respectively). Conclusion: Food insecurity is associated with an increased prevalence of obesity among children. Although a small proportion of this association is mediated by sleep duration, these results suggest that sleep should be considered when assessing the link between food insecurity and childhood obesity.

8 More Than an Outcome of War: Adoptions from Asia to the United States

8 More Than an Outcome of WarAdoptions from Asia to the United States Kimberly D. McKee (bio) When adoptions from Asia to the United States began in earnest in the mid twentieth century, it's doubtful that the primarily white adoptive parents caring for children from Hong Kong, Japan, and South Korea saw themselves or their children as part of a broader immigration movement or as part of the growing Asian American population in the United States. Transnational adoptions operated outside of restrictive and racist immigration laws, allowing families to bypass immigration quotas as they brought home "their" children. Adoption agencies also instructed adoptive parents to "raise them as their very own" and, in cases of adoptions from Asia, underscored the assimilability of Asian children into white American families. These early adoptions paved the way toward reshaping the category of Asian American in similar yet distinct ways like mixed-race and mixed-ethnic Asian American families, even if adoptive parents of monoracial and mixed-race Asian children did not see themselves as raising Asian American children. To trace the earliest adoptions of Asian children, scholars often point to the first wave of Korean War orphans as laying the groundwork for not only South Korea's more than seven-decade-long participation in international adoption, but also establishing the transnational adoption of Asian children to the United States. Yet, Chinese children from Hong Kong also entered the United States in the 1950s and 1960s, and preceding those adoptions were adoptions [End Page 247] of mixed-race Filipino children following the Spanish American War and mixedrace Japanese children following the Second World War.1 The history of Asian adoption thus tells the story of US militarism. It is woven into US empire and expansion, as US servicemen play a seminal role in transnational adoptions of mixed-race children. Adoption cannot, however, be seen only as an artifact of the past, not only because adoptions from Asia persist in the twenty-first century. Rather, the lingering effects of adoption tell a profoundly Asian American story. Catherine Ceniza Choy notes, "In Asian American studies, the word 'adoption' is increasingly significant for elucidating the breadth and depth of Asian American demographics, cultural expression, contemporary issues, and history."2 The interdiscipline must attend to the ways adoption indelibly shapes Asian American communities and histories of belonging, citizenship, and kinship. Korean adoptees were one of the largest immigration streams of Koreans to the United States in the mid twentieth century. In the mid-1990s, adoptions from China surpassed those from South Korea, and the mass movement of Vietnamese children as part of Operation Babylift in 1975 remains one of the more notable transfers of children to the United States in modern history.3 While these three countries are not the only nations sending Asian children for adoption, adoptees from Korea, China, and Vietnam are overrepresented in memoirs, documentaries, and scholarship on Asian adoption due to markedly lower rates of adoption from other Asian nations. When examining Asian adoptions, broadly, in the last two decades (1999–2019), adoptions from Asia represent 49 percent of all US international adoptions, with Korean, Vietnamese, and Chinese adoptees representing 80.5 percent of adoptions from Asia.4 The shift from the adoption of mixed-race Asian children to monoracial Asian children in the early and mid twentieth century illustrates the intersections of adoption and capitalism. The markets of adoption injected much needed monies into national economies, while simultaneously alleviating the state from providing social welfare supports to support low-income, working-class families and single mothers. These adoptions also reflected the tiered nature of adoption economies, whereby Asian children were sought-after due to their "honorary white" status and assumptions about assimilability into American society, as well as the way antiblackness shaped adoptive parents' investments in certain children of color over others.5 In creating new family formations, these transracial, transnational families upended notions of family as predicated not only on genetic relatedness, but also race- and religion-matching as seen in previous iterations of domestic adoptions.6 These Asian adoptees thus found themselves negotiating what it meant to be Asian (American) in non-Asian families, as most of these adoptions...

Data, Patient Narratives Must Be Integrated to Address Racial Inequities

Data, Patient Narratives Must Be Integrated to Address Racial Inequities

Association of Race and Ethnicity with Pediatric Postoperative Pain Outcomes.

Inequitable variability in healthcare practice negatively affects patient outcomes. Children of color may receive different analgesic medications in the perioperative period, resulting in different outcomes. Medical records of children 0 to ≤ 18years old from May 2014 to August 2019 were reviewed. The exposure was racial or ethnic groups: Asian, Black, Hispanic, Pacific Islander, and White non-Hispanic (reference). post-anesthesia care unit mean pain score. inpatient mean pain score; opioid, antiemetic, and antipruritic administration in the post-anesthesia care unit and inpatient ward. The association of race or ethnicity with outcomes was modeled using multilevel logistic regression, adjusting for confounders and covariates. Twenty-nine thousand six hundred fourteen cases are included. In the post-anesthesia care unit, Black, Hispanic, and Pacific Islander children had no significant difference in the odds of receiving opioids or having moderate-severe pain as compared to White non-Hispanic patients; Asian children had lower odds of receiving opioids and lower odds of having a moderate-severe mean pain score. In the inpatient setting, Black, Hispanic, and Pacific Islander children had no significant difference in the odds of receiving opioids or having moderate severe-pain as compared to White non-Hispanic children, but Asian children had lower odds of receiving opioids and of having a moderate-severe mean pain score. Asian children had lower odds of receiving opioids and having moderate-severe pain postoperatively compared to the White non-Hispanic children. These differences may be a function of variation in patient/caregivers culture or healthcare provider care and warrant further investigation.

Pediatric Research Challenge, Alignment with the National Research Agenda

Pediatric Research Challenge, Alignment with the National Research Agenda

Black-White Risk Differentials in Pediatric COVID-19 Hospitalization and Intensive Care Unit Admissions in the USA.

PurposeThe COVID-19 morbidity with SARS-CoV-2 as a causative pathogenic microbe remains a pandemic with children experiencing less mortality but with severe manifestations. The current study aimed to assess SARS-CoV-2 cumulative incidence, COVID-19 hospitalization, and ICU admission with respect to racial differentials.Materials and MethodsA cross-sectional nonexperimental epidemiologic design was used to examine pediatric COVID-19 data from CDC during 2020. The variables assessed were ICU admissions, hospitalization, sex, race, and region. The Chi-Square (X2) statistic was used to examine the independence of the variables by race, while the binomial regression model was used to predict racial risk differentials in hospitalization and ICU admissions.ResultsThe pediatric COVID-19 data observed the cumulative incidence of hospitalization to be 96,376, while ICU admission was 12,448. Racial differences were observed in hospitalization, ICU admissions, sex, and region. With respect to COVID-19 hospitalization, Black/African American (AA) children were two times as likely to be hospitalized compared to their White counterparts, prevalence risk ratio (pRR) = 2.20, 99% confidence interval (CI = 2.12–2.28). Similarly, Asians were 45% more likely to be hospitalized relative to their White counterparts, pRR = 1.45, 99% CI = 1.32–1.60. Regarding ICU admission, there was a disproportionate racial burden, implying excess ICU admission among Black/AA children relative to their White counterparts, pRR = 5.18, 99% CI = 4.44–6.04. Likewise, Asian children were 3 times as likely to be admitted to the ICU compared to their White counterparts, pRR = 3.36, 99% CI = 2.37–4.77. Additionally, American Indians/Alaska Natives were 2 times as likely to be admitted to ICU, pRR = 2.54, 99% CI = 0.82–7.85.ConclusionRacial disparities were observed in COVID-19 hospitalization and ICU admission among the US children, with Black/AA children being disproportionately affected, implying health equity transformation.

AB1235 MULTISYSTEM INFLAMMATORY DISEASE IN CHILDREN (MIS-C) IN SINGAPORE CHILDREN: ARE WE DIFFERENT?

BackgroundMultisystem Inflammatory Syndrome in Children (MISC) is a hyper-inflammatory state with similarities to Kawasaki Disease, 4 to 6 weeks after Covid-19 infection1. Literature describes a 11:1 Relative Risk for Asian children versus Caucasians2. Since the start of the pandemic, 17,699 children under 12 years were infected with Covid-193.ObjectivesTo describe presentation and short term outcomes, for a cohort of children with MIS-C at the sole Children’s Hospital in Singapore.MethodsDemographic and clinical/lab data were collected from children diagnosed with MIS-C accrording to the WHO criteria4 at KK Woman’s and Children’s Hospital, Singapore. Nonparametric descriptive statistics were used to describe and analyse data.ResultsEleven patients were diagnosed with MIS-C between October 2021 and Jan 2022. Seven (64%) were male and 4 (36%) were Chinese, with median age at presentation was 8.08 years (IQR 4.54 - 9.79). All patients had positive COVID-19 serology at the time of diagnosis. Median duration of fever prior to diagnosis was 5 days (IQR 4 - 5); Nine (82%) had gastrointestinal symptoms and median number of Kawasaki Disease (KD) features were 2 (IQR 2 - 3.5); common manifestations were conjunctivitis (90%), red lips (55%) and rash (36%). Of note, 8 (70%) patients had KD type peeling on follow-up. No BCGitis was found during acute phase. Seven (64%) were admitted to higher dependency care.Table 1, all patient received IVIG and IV steroids; 6 (55%) as pulse (30mg/kg/day) therapy. Patient 8, additionally received Anakinra. Median duration of admission was 6 days (IQR 5-13). One patient developed complications post therapy and was re-admitted to hospital for hematochezia. Treatment involved stopping Enoxaparin and Prednisone. Aspirin was resumed as soon as bleeding ceased. Laboratory characteristics and outcomes are denoted in Table 1. All patients had a monophasic course during the median of 10 weeks (IQR 8 - 11.5) of follow-up.Table 1.NoAge (yr)GI symptomsKD featuresHemoglobin (g/DL)Absolute Lymphocyte (10x9/L)Platelet (10x9/L)CRP (mg/L)D-Dimer (mg/L FEU)Ferritin (ug/L)Enoxaparin startedPeelingAbnormal echo110YES212.20.2367173.2323179.1YESYESYES211NO214.8116694.92.51350NOYESYES34.25YES210.41.02241134.66.05277.2YESNOYES47.67YES5110.41102250.69.323607.6YESYESNO58.58YES411.40.5693105.61.31846.6NOYESNO64.58YES210.33.09198137.41.87291NONONO79.58YES312.21.311191842.51244.3NOYESNO84.5YES411.90.45102181.811.121798.4YESNOYES911YES110.11.235974.24.531445.8YESYESNO103.42NO29.11.09138153.98.66609.4YESYESNO118.08YES211.41.2510166.81.31521.8NOYESYESConclusion1.Asian prevalence of MIS-C is not as high as that reported from the West. Similarities in presentation as to age and gender were noted.2.Most of our MIS-c patients developed periungual peeling at follow up, similarly to Kawasaki Disease.3.Different from our typical KD population, no BCG site inflammation was found.

Screening and management of bladder and bowel dysfunction in general pediatric outpatient clinic: a prospective observational study

BackgroundBladder and bowel dysfunction (BBD) is a common disorder in children that is often associated with psychosocial and behavioral problems. Data specific to BBD in Asian children are comparatively scarce. Accordingly, this study aimed to investigate the prevalence of BBD and the response to standard urotherapy among Thai children attending the general pediatric outpatient clinic of Siriraj Hospital – Thailand’s largest national tertiary referral center. MethodsChildren aged 4–12 years were recruited to complete the Dysfunctional Voiding Symptom Score (DVSS) questionnaire to screen for BBD during 2018 to 2020. Standard urotherapy, which consists of education and behavior management, was prescribed to those with a DVSS score that suggests the presence of BBD. Enrolled children and their caregivers were followed-up at 3 and 6 months. The Strengths and Difficulties Questionnaire (SDQ) was completed at baseline. DVSS scores at baseline, and at 3 months and 6 months after standard urotherapy were compared using repeated measures analysis of variance (ANOVA).ResultsA total of 1,042 children completed the DVSS during the study period, and 90 (8.6%) were deemed to have BBD. The mean age of BBD children was 6.9 ± 2.2 years, and the female to male ratio was 2.9:1. The most common symptoms were defecation frequency (80.0%), difficult defecation (80.0%), curtsying (74.4%), urgency (68.9%), infrequent voiding (43.3%), and daytime incontinence (32.2%). Forty-one BBD children completed the SDQ, and 32.5% had scores suggestive of hyperactivity problems. Among the 24 BBD patients who were followed-up after 3 and 6 months of standard urotherapy, there was a significant improvement in DVSS results (9.5 ± 3.1 at baseline vs. 6.9 ± 3.4 at 3 months vs. 4.4 ± 3.9 at 6 months; p < 0.01). Nine of 12 patients with urinary incontinence showed complete response at 6 months. The overall Bristol stool score significantly improved from 2.6 ± 0.7 at baseline to 3.2 ± 1.0 at 6 months (p = 0.03).ConclusionsBBD is a prevalent condition among Thai children that is often associated with emotional and behavioral problems. Standard urotherapy prescribed in a general pediatric outpatient clinic setting yielded favorable outcomes in Thai children with BBD.

Navigating Stigma and Discrimination: Experiences of Migrant Children with Special Needs and Their Families in Accessing Education and Healthcare in Hong Kong

This paper explores the barriers to supporting South Asian (Pakistani, Nepalese and Indian) migrant children with special needs and their families encountered navigating Hong Kong’s special needs system and accessing education and healthcare services. It adopts concepts of stigma and disability rights. It draws on semi-structured interviews with fifteen South Asian children and young people with special needs (age 5–21; M = 10; F = 5) and their families, and seven professional practitioners based on the qualitative descriptive method. Informants experienced intersecting stigmatization that included (1) institutional exclusion, (2) daily life microaggressions, and (3) misunderstandings and a lack of awareness education. Simultaneously, some were empowered through (4) support and accommodation, and (5) spiritual support from religion. This paper reveals a paradox embodied by Hong Kong; it is an Asian multicultural city committed to embracing the vision of disability inclusion while failing to ensure necessary support to reduce the stigma experienced by culturally diverse children with a disability. It makes recommendations based on a socioecological framework and concludes that concerted efforts by relevant authorities and organizations should be made to reduce stigma by taking into consideration the intersecting stigmas, specific resources unique to migrant communities, disability rights and cultural sensitivity.

Multidimensional poverty and children’s behavioral trajectories in immigrant families: Beating the odds?

Despite a large body of scholarship examining the relation between poverty and child behavioral outcomes, little is known about how such a relation may differ when poverty is viewed through a multidimensional lens. In addition, the evidence is mixed on the behavioral well-being of children of immigrants relative to their counterparts with U.S.-born parents under various poverty conditions. Using data from the ECLS-K (N ≈ 16,660), this study examines the relation among three dimensions of poverty—depth, volatility, and duration—and internalizing and externalizing behavioral trajectories from kindergarten through eighth grade, paying particular attention to children of immigrants with diverse racial-ethnic backgrounds. Growth-curve analysis results indicate that under the same poverty conditions, children of immigrants received more favorable ratings by teachers on internalizing and externalizing behaviors, but self-reported worse internalizing scores than children with U.S.-born parents. Among children of immigrants, Black and Hispanic children had relatively worse teacher-reported externalizing behaviors, while Hispanic and Asian children reported unfavorable internalizing behaviors. The results shed light on the intersectional forces of poverty, immigration, and race-ethnicity in shaping children’s behavioral trajectories, confirming aspects of the immigrant risk and immigrant paradox stories. The discrepancy between teacher- and youth-reported outcomes highlights the importance of using multiple informants.

Neighborhood Context and Parent Perspectives on Practical Considerations Related to Preschool Location

ABSTRACT Research Findings: We examined the association between neighborhood median income, child race/ethnicity, and parental perspectives and practical considerations regarding preschool program location. We conducted a cross-sectional survey of parents in Boston, Massachusetts planning to enroll in preschool (N = 1171). Questions measured parental preferences regarding program location, number of care transitions, safety, and transportation. We used adjusted logistic regression models to calculate the association between these factors and race/ethnicity and zip code median household income. Compared to the second quartile, parents living in zip codes within the two highest quartiles of median neighborhood income were more likely to prefer preschool near home. Parents living in zip codes within the highest quartile were less likely to be willing to use school transportation. Compared to parents identifying their child’s race as white, parents of Asian, Black, and Hispanic children were more likely to prefer preschool near work and parents of Black children were less likely to prefer preschool near home. Practice or Policy: Neighborhood median income had a graded association with preference for preschool near home. Transportation and location preferences varied by neighborhood context and socio-demographic factors. These findings can inform efforts to address disparities in preschool enrollment, preschool program design, and family engagement.

Epidemiological characteristics of Asian children with inflammatory bowel disease at diagnosis: Insights from an Asian-Pacific multi-centre registry network.

BACKGROUNDThere remains a dearth of Asian epidemiological literature for paediatric inflammatory bowel disease (PIBD).AIMTo describe the presenting features of PIBD from 7 Asia-Pacific pediatric gastroenterology centers via a central standardised electronic data platform.METHODSClinical, endoscopic and radiologic data at diagnosis from the registry were extracted between 1st January 1995 to 31st December 2019. Disease phenotypic characteristics were classified as per the Paris classification system.RESULTSThere was a distinct rise in new PIBD cases: Nearly half (48.6%) of the cohort was diagnosed in the most recent 5 years (2015-2019). The ratio of Crohn’s disease (CD):Ulcerative colitis (UC):IBD-Unclassified was 55.9%:38.3%:5.8%. The mean age was 9.07 years with a high proportion of very early onset IBD (VEO-IBD) (29.3%) and EO-IBD (52.7%). An over-representation of the Indian/South Asian ethnic group was observed which accounted for 37.0% of the overall Singapore/Malaysia subcohort (6.8%-9.0% Indians in census). Indian/South Asian CD patients were also most likely to present with symptomatic perianal disease (P = 0.003). CD patients presented with significantly more constitutional symptoms (fever, anorexia, malaise/fatigue and muscle-wasting) than UC and higher inflammatory indices (higher C-reactive protein and lower albumin levels).CONCLUSIONWe observed a high incidence of VEO-IBD and an over-representation of the Indian ethnicity. South Asian CD patients were more likely to have symptomatic perianal disease.

Characteristics of responders to atropine 0.01% as treatment in Asian myopic children.

Recently, low-concentration atropine (0.01%) has gained increased attention in controlling myopia progression with satisfying effects and minimal side effects. However, studies concerning responders to 0.01% atropine are limited. This retrospective observational cohort study aimed to determine the responder characteristics of 0.01% atropine in Asian children. One hundred forty children (aged between 3 and 15 years) receiving 0.01% atropine were analyzed for the factors influencing annual spherical equivalent changes (SE). The mean age was 9.13 (2.6) years, the mean baseline SE was − 1.56 (1.52) diopters (D), and the mean annual SE change was − 0.52 (0.49) D. A 58.63% responder rate (146/249) of myopic control was achieved with 0.01% atropine in our entire cohort under the criteria of less than 0.5 D of myopic progression annually. The subjects were stratified into 4 subgroups based on a cut-off point of baseline SE of − 1.5 D and baseline age of 9 years. The responder rate differed significantly with the highest being the youngest with the lowest myopia subgroups. Our results demonstrated that children with myopia better than − 1.5 D and younger than 9 years had the highest potential to achieve successful myopic control under 0.01% atropine therapy.

Knowledge, risk perceptions and practices surrounding chronic inflammatory diseases among first and second generation South Asian immigrants parents and children

PurposeThe purpose of this study is to examine knowledge and perceptions of risk surrounding chronic inflammatory diseases (CIDs) and intergenerational development, as well as practices used to acquire CID information among unaffected first- and second-generation South Asian immigrant parents and children in the Greater Toronto Area, Ontario.Design/methodology/approachFifty-four in-depth interviews with parents and children (18 parents, 36 children) were conducted by trained facilitators, recorded, transcribed and analyzed qualitatively.FindingsFindings reveal that although CIDs disproportionately affect South Asian immigrants, this group has low knowledge and awareness of CID symptoms, risk factors and conditions. Yet when equipped with some knowledge about CIDs, participants linked their increased risk of CIDs to perceived risks in their broader environments such as climate variations, pollution, unhealthy food environments and health system neglect, that although yearning to change these factors, felt unable to modify their risks as factors were beyond their control. Although information is critical to manage CIDs, the findings reveal important and divergent knowledge pathways and practices used among first- and second-generation parents and children, particularly related to health-care settings and academic resources, underscoring generational disparities in knowledge acquisition.Originality/valueThe findings suggest that a multi-sector, multi-tiered approach built around a series of structural interventions, programs and policy changes is needed to address CID knowledge and awareness gaps and entrenched culturally insensitive health care to create more equitable access to healthy, safe and responsive environments and care systems for CID management.

The Effectiveness of the Buzzy Device for Pain Relief in Children During Intravenous Injection: Quasirandomized Study.

BackgroundIntravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children.ObjectiveThe main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan.MethodsWe applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the χ2 test.ResultsA total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=–3.551, P<.001 and Z=–3.880, P<.001, respectively). The children in the treatment group had a significantly more pleasant experience than those in the nontreatment group (Z=–2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=–3.643, P<.001).ConclusionsThe intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions.

Association of Social Determinants of Health and Vaccinations With Child Mental Health During the COVID-19 Pandemic in the US

The COVID-19 pandemic disproportionately affected mental health in socioeconomically disadvantaged children in the US. However, little is known about the relationship of preexisting and time-varying social determinants of health (SDoH) at individual and structural levels, vaccination eligibility/rates, and the racial and ethnic differences to trajectories of child mental health during the COVID-19 pandemic. To estimate the association of trajectories of child mental health to multilevel SDoH and vaccination eligibility/rates. This prospective longitudinal cohort study, conducted from May 16, 2020, to March 2, 2021, integrated structural-level, pandemic-related data with the Adolescent Brain Cognitive Development (ABCD) cohort data (release 4.0). The ABCD study recruited 11 878 children (baseline) and conducted 6 COVID-19 rapid response surveys across 21 US sites (in 17 states) from May 16, 2020, to March 2, 2021. Preexisting individual (eg, household income) and structural (area deprivation) SDoH and time-varying individual (eg, food insecurity, unemployment) and structural (eg, social distancing, vaccination eligibility/rates) SDoH. Perceived Stress Scale, the National Institutes of Health-Toolbox emotion measures, and COVID-19-related worry. The longitudinal sample included 8493 children (mean [SD] age, 9.93 [0.63] years; 5011 girls [47.89%]; 245 Asian [2.34%], 1213 Black [11.59%], 2029 Hispanic [19.39%], 5851 White [55.93%], and 1124 children of other/multiracial ethnicity [10.74%]). Trajectories of stress, sadness, and COVID-19-related worry decreased after adult vaccination rollout. Compared with younger children, boys, White children, or those living with married parents, those who reported greater perceived stress included older children aged 12 to 15 years (β = 0.26; 95% CI, 0.12-0.41; P < .001); girls (β = 0.75; 95% CI, 0.61-0.89; P < .001); Hispanic children (β = 0.24; 95% CI, 0.01-0.47; P = .04); children living with separated parents (β = 0.50; 95% CI, 0.03-0.96; P = .04); children experiencing disrupted medical health care access (β = 0.19; 95% CI, 0.01-0.36; P = .04); children living in economically deprived neighborhoods (β = 0.28; 95% CI, 0.05-0.51; P = .02); children living in areas with more full-time working-class adults who were unable to social distance (β = 1.35; 95% CI, 0.13-2.67; P = .04); and children living in states with fewer fully vaccinated adults (β = 0.59; 95% CI, 0.16-1.02; P = .007). COVID-19 pandemic-related worry was higher among Asian children (β = 0.22; 95% CI, 0.08-0.37; P = .003), Black children (β = 0.33; 95% CI, 0.22-0.43; P < .001), children of other/multiracial ethnicity (β = 0.17; 95% CI, 0.09-0.25; P < .001), and children with disrupted medical health care (β = 0.15; 95% CI, 0.09-0.21) and disrupted mental health treatment (β = 0.11; 95% CI, 0.06-0.16). Inability to afford food was associated with increased sadness (β = 1.50; 95% CI, 0.06-2.93; P = .04). States with later vaccination eligibility dates for all adults were associated with greater COVID-19-related worry (β = 0.16; 95% CI, 0.01-0.31; P = .03) and decreased positive affect (β = -1.78; 95% CI, -3.39 to -0.18; P = .03) among children. Results of this study suggest a disproportionately adverse association of the COVID-19 pandemic with child mental health among racial and ethnic minority groups, which may be improved by addressing modifiable individual (food insecurity, unemployment, health services, parental supervision) and structural (area deprivation, job protection, vaccination) SDoH.

Racial/ethnic disparities in childhood obesity: The role of school segregation.

Recent studies have observed that racial or ethnic adult health disparities revealed in national data dissipate in racially integrated communities, supporting the theory that "place, not race" shapes the nature and magnitude of racial/ethnic health disparities. This study tested this theory among children. In 2020, the racial/ethnic childhood obesity disparities within integrated schools and between segregated schools were estimated using statewide cross-sectional data collected in 2019 on fifth, seventh, and ninth grade students from California public schools. School segregation accounted for a large part of the obesity disparities between White children and children of color (Latino, Black, and Filipino children). In racially integrated schools, obesity disparities were much smaller than those in statewide data, whereas racial or ethnic childhood obesity disparities were larger when comparing children in majority-White schools with those attending schools with a majority enrollment of children of color, except for Asian children, who generally had lower obesity rates than their White peers. School-level racial segregation is a salient contributor to racial/ethnic childhood obesity disparities. Reducing obesity disparities may be particularly effective if place-level interventions target socioeconomically disadvantaged integrated schools and segregated schools attended primarily by children of color.