Black Children Research Articles

A Review of Official Documents and Literature on the Forgotten Victims of Parental Incarceration in South Africa

This article is a literature synthesis of the living conditions of black children after their parent's imprisonment. In Africa, the prison population currently stands at 1,194,497, while in South Africa, 147,922 people were being held in correctional facilities as of January 2021. Parental incarceration has affected all children, regardless of race, age, or cultural background. An increasing amount of research indicates that children with incarcerated parents are prone to internalized behaviors such as depression, anxiety, and withdrawal, as well as externalized behaviors including criminality and substance use. They may also experience cognitive delays, academic struggles, and insecure attachments in their relationships with both their imprisoned parents and primary caregivers. The term "caregiver" denotes the individual who assumes the role of the child's main caregiver while the parents are incarcerated. It is important to note that the literature focusing on child-headed households in South African informal settlements and townships may be limited. This paper is a narrative synthesis of the literature review and uses secondary sources.

Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child: a case report and review of literatures

BackgroundCongenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension pneumothorax, complicating diagnosis and management.Case presentationA two-year old male black child from Ethiopia presented to the emergency department with sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion of chest tube, the child’s condition did not improve, raising suspicion of alternative diagnosis. Careful observation of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative recovery was uneventful, and the child was discharged with no significant long-term complications.ConclusionThis case underscores the importance of considering CDH in the differential diagnosis of acute respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes. Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in our case.

Characterization of pesticide exposures and their associations with asthma morbidity in a predominantly low-income urban pediatric cohort in Baltimore City

BackgroundPesticides may impact respiratory health, yet evidence of their impact on pediatric asthma morbidity is limited, particularly among urban children. ObjectiveTo characterize pesticide biomarker concentrations and evaluate their associations with pediatric asthma morbidity among predominantly low-income, Black children in Baltimore City, USA. MethodsWe measured urinary concentrations of 10 biomarkers for pyrethroid insecticides (cyfluthrin:4F-3PBA, permethrin:3PBA), organophosphate insecticides (chlorpyrifos:TCPY, malathion:MDA, parathion:PNP, diazinon:IMPY), and herbicides (glyphosate:AMPA, GPS; 2,4-dicholorphenoxyacetic acid:2,4-D; 2,4,5-tricholorphenoxyacetic acid:2,4,5-T) among 148 children (5–17 years) with established asthma. Urine samples and asthma morbidity measures (asthma symptoms, healthcare utilization, lung function and inflammation) were collected every three months for a year. Generalized estimating equations were used to examine associations between pesticide biomarker concentrations and asthma morbidity measures, controlling for age, sex, race, caregiver education, season, and environmental tobacco smoke. In sensitivity analyses, we assessed the robustness of our results after accounting for environmental co-exposures. ResultsFrequently detected (≥90% detection) pesticide biomarker concentrations (IMPY, 3PBA, PNP, TCPY, AMPA, GPS) varied considerably within children over the follow-up period (intraclass correlation coefficients: 0.1–0.2). Consistent positive significant associations were observed between the chlorpyrifos biomarker, TCPY, and asthma symptoms. Urinary concentrations of TCPY were associated with increased odds of coughing, wheezing, or chest tightness (adjusted Odds Ratio, aOR, TCPY:1.60, 95% Confidence Interval, CI:1.17–2.18). Urinary concentrations of TCPY were also associated with maximal symptom days (aOR:1.38, CI:1.02–1.86), exercise-related symptoms (aOR:1.63, CI:1.09–2.44), and hospitalizations for asthma (aOR:2.84, CI:1.08–7.43). We did not observe consistent evidence of associations between the pesticide exposures assessed and lung function or inflammation measures. ConclusionAmong predominantly Black children with asthma, we found evidence that chlorpyrifos is associated with asthma morbidity. Further research is needed to assess the contribution of pesticide exposures to pediatric respiratory health and characterize exposure sources among vulnerable populations to inform targeted interventions against potentially harmful pesticide exposures.

Sickle Cell Disease and Lead Poisoning in New York City, 2005-2019.

Previous analyses of New York City (NYC) health department's lead registry indicated that, among children with lead poisoning, an increased prevalence of sickle cell disease (SCD) exists. However, SCD is not considered a risk factor for lead poisoning. We assessed the association between SCD and childhood lead poisoning to determine if specific lead poisoning prevention efforts are needed for children with SCD. We analyzed NYC's lead registry data for children with venous blood lead levels (BLLs) ≥15 mcg/dL during 2005 to 2019. t tests and χ2 tests were performed to compare demographic characteristics, BLLs, and lead exposure risks in non-Hispanic Black children with and without SCD. A t test was used to compare observed SCD prevalence among Black children with BLLs ≥15 mcg/dL with an estimated 0.43% SCD prevalence among Black NYC children. Among 1728 Black children with BLLs ≥15 mcg/dL identified, 37 (2.14%) had SCD. When comparing children with and without SCD, both mean age at peak BLL (62.8 versus 42.7 months; P = .003) and peak BLL (42.59 versus 23.06 mcg/dL; P = .008) were higher for children with SCD. Among risk factors for lead exposure, children with SCD had higher prevalence of pica. Observed SCD prevalence was 1.71% higher than estimated SCD prevalence among Black NYC children (P < .001). We found a potential association between SCD and childhood lead poisoning. Pica emerged as a potentially important risk factor. Our findings might have implications for lead poisoning prevention guidelines for children with SCD.

Percent Final Height Is a Novel Method That Identifies Differences Between the Rate of Development in American Children of Different Races.

The Greulich & Pyle (G&P) Radiographic Atlas of Skeletal Development uses hand x-rays obtained between 1926 and 1942 on children of Caucasian ancestry. Our study uses modern Caucasian, Black, Hispanic, and Asian children to investigate patterns of development as a function of percent final height (PFH). A retrospective review, at a single institution, was conducted using children who received a hand x-ray, a height measurement taken within 60 days of that x-ray, and a final height. BA and CA were compared between races. PFH was calculated by dividing height at the time of the x-ray by their final height. To further evaluate differences between races in CA or BA, PFH was then modeled as a function of CA or BA using a fifth-degree polynomial regression, and mean ages at the 85th PFH were compared. Patients were then divided into Sanders stages 1, 2-4, and 5-8 and the mean PFH, CA, and BA of the Asian, Black, and Hispanic children were compared with the White children using Student t test. P values less than 0.05 were considered significant. We studied 498 patients, including 53 Asian, 83 Black, 190 Hispanic, and 172 White patients. Mean BA was significantly greater than CA in Black males (1.27y) and females (1.36y), Hispanic males (1.12y) and females (1.29y), and White females (0.74y). Hispanic and Black patients were significantly more advanced in BA than White patients ( P <0.001). At the 85th PFH, White and Hispanic males were older than Black males by at least 7 months ( P <0.001), and White females were significantly older than Hispanic females by 6.4 months ( P <0.001). At 85th PFH for males, Hispanic and Black males had greater BA than White males by at least 5 months ( P <0.001), and Asian females had a greater BA than Black females by at least 5 months ( P <0.001). Compared with White children, Hispanic children were significantly younger at Sanders 2-4 than White children, and Black children were skeletally older at Sanders 5-8. BA was greater than CA by ≥1 year in Black and Hispanic children, and that these children had a significantly greater BA than their White counterparts. Black males and Hispanic females reached their 85th PFH at younger ages, and Hispanic males and Asian females were the most skeletally mature at their 85th PFH. Our results suggest that BA and CA may vary as a function of race, and further studies evaluating growth via the 85th PFH may be necessary. Therapeutic Study - Level IV.

Association of Exposure to Interpersonal Racism and Racial Disparities in Inadequate Sleep Risk

To examine the association between caregiver-report of their child's inadequate sleep and exposure to interpersonal racism within racially minoritized subpopulations. We conducted cross-sectional analysis among racially minoritized 21,924 school-aged children and 27,142 adolescents using a National Survey of Children's Health (NSCH) sample from 2016 through 2021. Multivariable logistic regression models were fit to estimate predicted probabilities for the adjusted associations between caregiver-report of their child's inadequate sleep and prior exposure to interpersonal racism. In bivariate models, caregiver report of child exposure to interpersonal racism was significantly associated with a higher probability of inadequate sleep within non-Hispanic Asian American/Pacific Islander (AAPI) school-aged children, Hispanic adolescents, and non-Hispanic multiracial adolescents. After adjusting for covariates, only the association within Hispanic youth remained significant though attenuated. Unexpectedly, non-Hispanic Black school-age children exposed to racism had a lower probability of inadequate sleep than non-Hispanic Black children without exposure to racism after adjusting for covariates. Nationally representative pooled data that showed caregiver-report of Hispanic adolescents' inadequate sleep was associated with their exposure to interpersonal racism, although an association with inadequate sleep was not found in other racially minoritized subpopulations. Examining within-race associations helps to assess more accurately risk and target efforts that seek to address racism-related stress among racially minoritized subpopulations.

Research Priorities in Pediatric Asthma Morbidity: Addressing the Impacts of Systemic Racism on Children with Asthma in the United States. An Official American Thoracic Society Workshop Report.

Background: In the United States, Black and Latino children with asthma are more likely than White children with asthma to require emergency department visits or hospitalizations because of an asthma exacerbation. Although many cite patient-level socioeconomic status and access to health care as primary drivers of disparities, there is an emerging focus on a major root cause of disparities-systemic racism. Current conceptual models of asthma disparities depict the historical and current effects of systemic racism as the foundation for unequal exposures to social determinants of health, environmental exposures, epigenetic factors, and differential healthcare access and quality. These ultimately lead to biologic changes over the life course resulting in asthma morbidity and mortality. Methods: At the 2022 American Thoracic Society International Conference, a diverse panel of experts was assembled to identify gaps and opportunities to address systemic racism in childhood asthma research. Panelists found that to examine and address the impacts of systemic racism on children with asthma, researchers and medical systems that support biomedical research will need to 1) address the current gaps in our understanding of how to conceptualize and characterize the impacts of systemic racism on child health, 2) design research studies that leverage diverse disciplines and engage the communities affected by systemic racism in identifying and designing studies to evaluate interventions that address the racialized system that contributes to disparities in asthma health outcomes, and 3) address funding mechanisms and institutional research practices that will be needed to promote antiracism practices in research and its dissemination. Results: A thorough literature review and expert opinion discussion demonstrated that there are few studies in childhood asthma that identify systemic racism as a root cause of many of the disparities seen in children with asthma. Community engagement and participation in research studies is essential to design interventions to address the racialized system in which patients and families live. Dissemination and implementation studies with an equity lens will provide the multilevel evaluations required to understand the impacts of interventions to address systemic racism and the downstream impacts. To address the impacts of systemic racism and childhood asthma, there needs to be increased training for research teams, funding for studies addressing research that evaluates the impacts of racism, funding for diverse and multidisciplinary research teams including community members, and institutional and financial support of advocating for policy changes based on study findings. Conclusions: Innovative study design, new tools to identify the impacts of systemic racism, community engagement, and improved infrastructure and funding are all needed to support research that will address impacts of systemic racism on childhood asthma outcomes.

Reframing Child Protection in Emergency Medicine

Child maltreatment remains a concerning source of morbidity and mortality in the United States, where more than 600,000 children are victims of abuse each year, with well-described, long-term consequences for physical and mental health. However, the US child welfare system is characterized by systemic racism and inequity. Black and Native American children are more likely to be evaluated and reported for suspected abuse despite evidence that race does not independently change their risk of being abused. Once reported to child protective services (CPS), these children are more likely to be removed from their homes and less likely to be reunited with their families than White children. Much of the inequity in this system starts at the front door, where a growing body of research demonstrates that bias regularly infiltrates decision-making in the initial clinical evaluation and management of suspected abuse. Minority children presenting to emergency departments (ED) are more likely to receive diagnostic testing and are more likely to be referred to CPS. In this editorial, we argue for the application of an equity lens to child protection in the ED. We discuss how emergency physicians can balance efforts to protect children from abuse with the imperative to protect children and families from the harms of an inequitable child welfare system. Our discussion concludes with concrete recommendations for emergency clinicians to participate in active bias mitigation and thoughtfully navigate their responsibilities as mandated reporters.

What factors are associated with children being taken into care by the state after initial contact with services? A survival analysis of Children’s Social Care data in Liverpool

BackgroundIncreasing numbers of children in the UK are being taken into care, with adverse consequences for children and unsustainable costs for local government. It is crucial that local authorities better...

Incidence and Risk of Coronavirus Disease 2019 Hospitalization Among Unvaccinated Children.

The aim of this study is to determine the incidence and risk factors associated with COVID-19 hospitalization among unvaccinated children. Children aged 0- < 18 years, members of Kaiser Permanente Northern California (KPNC), were followed from March 1, 2020, until the earliest occurrence of: chart-confirmed COVID-19 hospitalization, disenrollment from KPNC, age 18 years, receipt of COVID-19 vaccine, death, or study end (December 31, 2022). We calculated the incidence rate of hospitalization by SARS-CoV-2 variant period and by age group. We determined risk factors for hospitalization using Poisson regression. We also conducted descriptive analyses of hospitalized cases. Among 1,107,799 children, 423 were hospitalized for COVID-19 during follow-up. The incidence of hospitalization increased with each new SARS-CoV-2 variant and was highest among children aged < 6 months. Among the < 6-month-olds, the incidence rate per 100,000 person-months was 7 during predelta, 13.3 during delta, and 22.4 during omicron. Black (RR = 2.05, 95% CI: 1.33-3.16) and Hispanic children (RR = 1.82, 95% CI: 1.34-2.46) and children with any comorbidities were at high risk of hospitalization (RR = 3.81, 95% CI: 2.94-4.95). Overall, 20.3% of hospitalized children were admitted to an intensive care unit (ICU), but ICU admission was 36.1% among 12- < 18-year-olds. The majority of ICU admits (91.8%) had no comorbidities. Children too young to be vaccinated had the highest incidence of COVID-19 hospitalization, while adolescents had the highest proportion of ICU admissions. To prevent severe disease in children and adolescents, everyone eligible should be vaccinated.

The role of school safety perceptions in childhood asthma diagnosis disparities.

Childhood racial and ethnic asthma disparities in the United States are the consequence of structural inequities such as those in socioeconomic status (SES) and exposure to violence, but little research has explored the role of the school environment in perpetuating racial and ethnic disparities. This study examines associations between perceptions of unsafe school environments (USEs) and subsequent asthma diagnosis for elementary-aged children and the extent to which USE mediates relations from SES and race/ethnicity to asthma diagnosis for Black, Latinx, and non-Latinx White children. We conducted a secondary analysis of data from the Early Childhood Longitudinal Study. Structural equation modeling was used to evaluate the association between USE and subsequent asthma diagnosis, controlling for child sex, and indirect effects of SES and race/ethnicity on asthma diagnosis via USE. For 6,532 children, USE in second grade positively predicted new asthma diagnoses in third grade and mediated the association between SES and new asthma diagnosis. SES and USE serially mediated the relationship between race/ethnicity and asthma diagnosis. Identifying as non-Latinx White was associated with a lower likelihood of subsequent asthma diagnosis via higher SES and lower USE while identifying as Black or Latinx was associated with a higher likelihood of subsequent asthma diagnosis via lower SES and higher USE. USE was associated with pediatric asthma diagnosis and mediated the relationship between SES and asthma diagnosis as well as race/ethnicity and asthma diagnosis. Findings highlight the need to consider USE as a social determinant of health for pediatric asthma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence and Impact of Recurrent Rejection on Pediatric Heart TransplantRecipients: APHTS Multi-Institutional Analysis.

Studies evaluating the prevalence and impact of recurrent rejection (RR) in pediatric heart transplant (HT) are sparse. The purpose of this study was to describe prevalence and impact of RR on cardiac allograft vasculopathy (CAV) and graft loss after pediatric HT. Data on HT from January 1, 2000, to June 30, 2020, in the Pediatric Heart Transplant Society database were included. Freedom from RR (≥2 rejection episodes) was compared by era (early: 2000-2009; current: 2010-2020). Outcomes for children experiencing RR were compared with those experiencing 0 or 1 rejection episodes and by type of RR (antibody-mediated rejection [AMR], acute cellular rejection [ACR], mixed [ACR/AMR]). Of 6,342 HT recipients, 1,035 (17%) experienced RR. In the current era, pediatric HT recipients were less likely to experience RR (P< 0.001). Freedom from CAV was similar for those experiencing RR to those experiencing 0 or 1 episode (96.6% vs 95.3% vs 96.6%); and similar regardless of the type of RR (AMR, ACR, or mixed) (65.5% vs 82.9% vs 100%) (P > 0.05). Freedom from graft loss was significantly lower for those experiencing RR to those experiencing 0 or 1 episode (56.3% vs 72.3% vs 82.3%) and lower for those experiencing recurrent mixed rejection or recurrent AMR compared with those experiencing recurrent ACR (65.3% vs 50% vs 81.8%). Black children experiencing RR subsequently had lower freedom from CAV and graft loss than White children (P< 0.05 for all). Although prevalence of RR has decreased, children experiencing RR are at greatly increased risk for losing their graft, particularly those who have recurrent mixed or antibody-mediated rejection.

“Stay in a Child’s Place”: Adult Authority in Schooling in the Louisiana Delta

It is well documented that Black children are disproportionately suspended and expelled in schools, but less explored is the importance of place in shaping disciplinary decision-making and student experiences of punishment. Drawing on over a year of ethnographic work at Abundance Junior High School (AJHS), a predominantly Black school of 150 students, I argue that school discipline in the rural northeast Louisiana Delta is shaped by racial, spatial, and social dimensions of place. Specifically, I argue that treatment and punishment of Black children in schools is shaped by (1) cultural expectations that they remain in “a child’s place,” a social position characterized by obedience and deference, and (2) socialization reinforcing respectability and compliance with authority informed by historical and contemporary threats of racial violence and Louisiana’s carceral logics. I conclude by discussing how these disciplinary and socialization practices, while motivated in part by the desire to protect Black children, ultimately reproduce forms of social control and harm students.

Implication of Exclusive Breastfeeding in Early Childhood Dental Disorders: Large Cohort Evidence, US National Survey of Children Health.

Purpose/Objective: Frequent consumption of fermented carbohydrates and bottle feeding contribute to the development of early childhood caries (ECC). There are no substantial findings on the effects of breastfeeding patterns on oral health conditions in children in the United States. We aimed to assess the nexus between exclusive breastfeeding during the first 6 months and oral health disorders, namely toothache, decayed teeth, or unfilled cavities in early childhood. Materials and Methods: Design: Cross-sectional epidemiologic design of nationally representative data collected via telephone surveys in the United States was utilized. Setting: National Survey of Children's Health, 2012 Participants: Population-based random sample of parents/guardians of 24,655 children aged 6 months to 5 years. Main Outcome and Measure: The primary outcome was the presence of oral health disorders (OHD) in children, defined as the parent-reported occurrence of one or more of the following conditions in the past 12 months: toothache, decayed teeth, or an unfilled cavity. This was assessed through a single composite question in the survey, asking parents/guardians if their child had experienced any of these specific oral health issues within the previous year with a binary (yes/no) response option. Results: Among 24,655 children aged 6 months to 5 years, 2392 (9.7%) had experienced an oral health disorder (OHD) in the previous 12 months. In unadjusted analysis, children exclusively breastfed for 6 months were 28% less likely to present with OHD compared to never-breastfed children (OR = 0.72, 95% CI, 0.52-0.98). However, after adjusting for key factors, including maternal health and race/ethnicity, this association was no longer statistically significant (aOR = 1.11, 95% CI 0.79-1.57). Significant predictors of OHD included maternal health (aOR for fair/poor vs. excellent/very good maternal health = 1.79, 95% CI 1.08-2.69) and race/ethnicity, with a higher prevalence among non-Hispanic Black (12.9%) and multi-racial children (12.6%) compared to non-Hispanic White children (7.7%). Conclusions and Relevance: While exclusive breastfeeding for the first six months of life was not found to be a significant predictor of pediatric oral health outcomes after adjustment, maternal health and race/ethnicity were significant determinants of oral health disorders. These findings underscore the importance of comprehensive healthcare approaches that consider maternal well-being and socio-demographic factors. Future research should explore interventions targeting these factors to improve pediatric oral health outcomes.

Racial Disparities and Achievement of the Low Lupus Disease Activity State (LLDAS): A CARRA Registry Study.

Differential disease control may contribute to racial disparities in outcomes of childhood-onset systemic lupus erythematosus (cSLE). We evaluated associations of race and individual- or neighborhood-level social determinants of health (SDoH) with achievement of low lupus disease activity state (LLDAS), a clinically relevant treatment target. In this cSLE cohort study using the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, the primary exposure was self-reported race and/or ethnicity and collected SDoH included insurance status and area deprivation index (ADI). Outcomes included LLDAS, disease activity, and time-averaged prednisone exposure. Associations between race and/or ethnicity, SDoH, and disease activity were estimated with multivariable regression models, adjusting for disease-related and demographic factors. Among 540 children with cSLE, 27% identified as Black, 25% White, 23% Latino/a, 11% Asian, 9% more than one race, and 5% Other. More Black children (41%) lived in neighborhoods of highest ADI compared to White children (16%). Black race was associated with lower LLDAS achievement (adjusted OR 0.56, 95% CI: 0.38-0.82) and higher disease activity (adjusted β: 0.94, 95% CI: 0.11, 1.78). Highest ADI was not associated with lower LLDAS achievement upon adjustment for renal disease and insurance. However, renal disease was found to be a significant mediator (p=0.04) of the association between ADI and prednisone exposure. Children with cSLE identifying as Black are less likely to achieve LLDAS and have higher disease activity. Living in areas of higher ADI may relate to renal disease and subsequent prednisone exposure. Strategies to address root causes will be important to design interventions mitigating cSLE racial disparities.

Decline in Vaccination Coverage by Age 24 Months and Vaccination Inequities Among Children Born in 2020 and 2021 - National Immunization Survey-Child, United States, 2021-2023.

Data from the National Immunization Survey-Child (NIS-Child) were analyzed to estimate coverage with childhood vaccines recommended by the Advisory Committee on Immunization Practices among U.S. children by age 24 months. Coverage with nearly all vaccines was lower among children born in 2020 and 2021 than it was among those born in 2018 and 2019, with declines ranging from 1.3 to 7.8 percentage points. Analyses of NIS-Child data for earlier birth cohorts have not revealed such widespread declines in routine childhood vaccination coverage. Coverage among children born during 2020-2021 varied by race and ethnicity, health insurance status, poverty status, urbanicity, and jurisdiction. Compared with non-Hispanic White children, coverage with four of the 17 vaccine measures was lower among non-Hispanic Black or African American children as well as Hispanic or Latino (Hispanic) and non-Hispanic American Indian or Alaska Native children. Coverage was also generally lower among those covered by Medicaid or other nonprivate insurance, uninsured children, children living below the federal poverty level, and children living in rural areas. Coverage varied widely by jurisdiction, especially coverage with ≥2 doses of influenza vaccine. Children born during 2020-2021 were born during or after the period of major disruption of primary care from the COVID-19 pandemic. Providers should review children's histories and recommend needed vaccinations during every clinical encounter. Addressing financial barriers, access issues, vaccine hesitancy, and vaccine-related misinformation can also help to increase coverage, reduce disparities, and protect all children from vaccine-preventable diseases. Strategies that have been found effective include implementation of standing orders and reminder and recall systems, strong physician recommendations to vaccinate, and use of immunization information systems to identify areas of lower coverage that could benefit from targeted interventions to increase immunization rates.

"I Know How to Get Around Your 'No'": A Follow-Up of the FACES Psychoeducational Intervention.

Black children and their families encounter systemic disadvantages in their journey to and through an autism diagnosis. Black families often experience social and systemic barriers to service use. Providing family-centered, psychoeducational interventions can reduce barriers to service access and utilization for Black families raising autistic children. Fostering Advocacy, Communication, Empowerment, and Support (FACES) has demonstrated preliminary efficacy in strengthening outcomes among Black families, yet little is known about the long-term impact of the intervention. The purpose of this qualitative interview study was to understand the experiences of FACES graduates 16 months after the intervention. Four major themes emerged: (a) strengthened advocacy, (b) strengthened empowerment, (c) systemic barriers, and (d) home and community barriers. We provide implications for research and practice.

Roots and Refuge: A Critical Exploration of Nature in Black Visual Narratives

This article examined the underrepresentation of Black characters in children’s picture books, particularly in natural settings, and its effect on Black children’s relationship with nature. Through an analysis of four contemporary picture books, the study revealed how visual depictions challenge these exclusions and expand narratives about Black engagement with the natural world. Utilizing visual semiotics and the theory of Black Aliveness, this research underscores the transformative power of illustrations by Black artists in enriching children’s literature and advancing joy.

Abstract A051: Association of residential economic and racial segregation with pediatric cancer survival

Abstract Purpose: Studies have linked residential segregation to inferior outcomes in adult-onset cancers. However, its association with pediatric cancer outcomes remains poorly understood. Racial and ethnic disparities in pediatric cancer outcomes are well-documented, and residential segregation may contribute, at least in part, to these disparities. This study examines the association between residential economic and racial segregation and survival in a statewide, population-based cohort of pediatric oncology patients. Methods: We studied a cohort of children diagnosed with their initial cancer between 2009 and 2016 at age 21 or younger, who were treated at Children’s Healthcare of Atlanta. The Index of Concentration at the Extremes (ICE) was mapped to the ZIP Codes of patient residence at diagnosis to measure economic and racial segregation. ICE was calculated by the difference between the number of non-Hispanic White people with &amp;gt;80th percentile household income and non-Hispanic Black people with &amp;lt;20th percentile household income, divided by the total number of people in the ZIP Code. ICE tertiles were categorized from the most deprived/segregated (tertile 1) to the most privileged/least segregated (tertile 3). We used the Cox proportional hazards model to estimate 5-, 3-, and 1-year overall survival from diagnosis by ICE tertiles, or by ICE tertiles and patient race. All models adjusted for sociodemographic (age at diagnosis, sex, health insurance, rurality) and clinical factors (cancer type, year of diagnosis). Results: Of our cohort (N=2,790), a higher proportion of non-Hispanic Black patients (50.8% vs. 13.4%) and publicly insured patients (62.3% vs. 30.8%) was found in tertile 1 compared to tertile 3. Patients living in tertile 1 consistently exhibited a higher risk of death at 5 years (adjusted hazard ratio [aHR]=1.32, 95% confidence interval [CI]=1.03-1.69, p=0.026), 3 years (aHR=1.35, 95% CI=1.04-1.75, p=0.026), and 1 year (aHR=1.38, 95% CI=0.94-2.03, p=0.099) post diagnosis, compared to those in tertile 3. In addition, compared to non-Hispanic White patients living in ICE tertiles 2-3 (more privileged areas), no survival difference was found among non-Hispanic Black children living in the same tertiles, while non- Hispanic Black children living in ICE tertile 1 had a significantly higher risk of death at 5 years (aHR=1.46, 95% CI=1.11-1.90, p=0.006), 3 years (aHR=1.56, 95% CI=1.17-2.07, p=0.002), and 1 year (aHR=1.65, 95% CI=1.11-2.45, p=0.014) post diagnosis. Conclusion: Our data indicate that residence in more racially segregated and economically deprived neighborhoods is associated with poorer overall survival among children diagnosed with cancer. Further research should explore the mediation and moderation effects of residential segregation on racial disparities in pediatric cancer-specific survival. Citation Format: Xu Ji, Lu Zhang, Xuesong Han, Heeju Sohn, Kinsey Meggett, Rebecca Williamson Lewis, Sharon M Castellino. Association of residential economic and racial segregation with pediatric cancer survival [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A051.

Racial and ethnic disparities in dupilumab for pediatric atopic dermatitis in Florida

Dupilumab is an mAb that has been shown to decrease symptoms and severity of atopic dermatitis (AD). It was approved for use in adolescents and children in a stepwise manner from 2019 to 2022. Racial and ethnic disparities have been described in access to emerging therapies in many conditions, including treatment with dupilumab for AD in adult patients. We sought to assess racial and ethnic disparities in moderate to severe AD treatment with dupilumab in the pediatric population. This retrospective study identified 12,918 patients with AD aged 0 to 17 years who had at least a 6-month follow-up period between January 2020 and September 2023. The primary end point of dupilumab prescription was compared between racial and ethnic groups and a reference group of non-Hispanic White patients while adjusting for confounders. Among the patients, 18.1% were Black, 40.5% Hispanic, 28.9% non-Hispanic White, and 12.4% Other race. Black (odds ratio, 0.43; P= .006) and Hispanic (odds ratio, 0.46; P< .001) patients had significantly lower odds of receiving dupilumab compared with the reference group. This study may indicate a racial and ethnic disparity negatively affecting access to treatment with dupilumab for Black and Hispanic children and adolescents with AD. Because previous studies have not indicated decreased severity of AD in these patient populations, less frequent use is likely due to other underlying factors such as differential access to care, cultural differences, language barriers, and socioeconomic factors. The contributing factors must be further identified and addressed to ensure health equity in pediatric AD.