Black Children Research Articles

From Striving to Thriving: Mitigating Anti-Black Family Racism to Maximize Health Outcomes in Black Children

Certain inequities and injustices represent long-standing, recurring challenges that disproportionately affect many Black communities in the United States. Despite decades of efforts to eliminate these problems and improve outcomes in health, housing, education, and employment, a significant number of Black families are still “surviving” and not “thriving.” The effects of historical and ongoing discriminatory policies continue to increase risk for adverse outcomes among Black people and their families. These systemic conditions also help perpetuate negative myths and stereotypes associated with the Black family unit, and particularly, Black fathers. In striving to achieve equitable child health outcomes, it is vital for health care professionals to comprehend the tangible traumas that result from experiencing racism. This specific type of harm also acts as a driver for manifestation of developmental, physical, behavioral, and mental health issues in Black children. This review highlights the intersecting dynamics of structural racism, Black family units, and adverse outcomes on child health, development, and behavior. Health care professionals seeking to provide culturally attuned and appropriate anticipatory guidance need to address the effects of racism on social-emotional, language, and cognitive development in children. This includes centering Black family perspectives and advocating for antiracist programs and policies that protect Black children, such as increased support of Black children with special education needs, more equitable funding for neighborhoods where Black families reside, and meaningful efforts to reform criminal justice system practices that unfairly target Black men. By actively mitigating anti-Black racism, Black children and families can shift from surviving to thriving.

Depression Part 1: Evaluation.

By young adulthood, 1 in 5 teens will experience an episode of major depression. The second leading cause of death among youths aged 15 to 24 years is suicide, most of which will have been caused by untreated or undiagnosed depression. Depression is a highly heritable condition: depressed children often have depressed parents. Support to caregivers is important because depressed parents can have negative effects on children's development and future mental health. Groups more vulnerable to mental health disorders such as depression include Black, Indigenous, and persons of color and lesbian, gay, bisexual, transgender, or queer/questioning, who in recent years have the highest rate of suicide attempts (Black teens, sexual minority youth), the highest increases in suicide rates (Black children and youths), and the highest suicide rates (American Indian/Alaskan native). They frequently experience more adverse childhood events, which increases the risk of depression and suicide attempts. Pediatricians are most likely to care for these vulnerable youths, who often are less engaged in specialty mental health care for a variety of reasons, including stigma and barriers to access. By offering behavioral and mental health care to vulnerable populations in primary care, mental health equity may be achieved. Screening for depression and assessment for suicide are within the scope of pediatric practice and among the competencies recommended by the American Academy of Pediatrics and The American Board of Pediatrics.

“They Were Married in Heart”: Race, Inheritance, and Interracial Common-Law Marriage in Reconstruction Era Mississippi

Abstract: In 1869, Mississippi voters ratified a radical new constitution that eliminated distinctions of race, including in its provision formalizing the unions of cohabiting couples as legal common law marriages at the time of ratification. Although white men had long established relationships of concubinage with Black women, the new constitution made it possible for interracial couples to claim the status of legal families. This article examines how Black women and their biracial children employed the 1869 state constitution to situate themselves as legal wives and legitimate children and the lawful heirs of dead white men. In response, white supremacists sought to deny them legitimacy by casting all relationships between Black women and white men as forms of concubinage that could never constitute legal marriages. This article examines how judges used the classification of concubine to distinguish Black common-law wives from white ones, undermining the radicalism of the new state constitution. By making it more difficult for Black widows and children to claim to be the rightful heirs of white men, the courts channeled inheritances toward more distant white relatives.

“Black (W)holes” and the Propagation of New Possibilities

The starting point of this essay is the author’s acknowledgment that Evelynn Hammonds’s “Black (W)holes and the Geometry of Black Female Sexuality” has been a throughline for her scholarly and personal development. That relationship to Hammonds’s text and its author shifts, and the changing nature of these connections marks important milestones in Bailey’s academic and adult life. The essay waxes poetic about the substance of Hammonds’s “Black (W)holes” as its meanings exceed its arguments: its very writing serves as a possibility model both in terms of the kind of scholarship Bailey imagined she could write and the kind of life she could live as one keen to bridge Black feminism and medicine. “Black (W)holes” is one of the first academic writings where Bailey saw herself reflected, both in the content presented and in the identities held by Hammonds. Black alphabet children of Spelman College, straddling the line between medical science and feminism, Hammonds and Bailey have much in common. Hammonds’s essay inspired Bailey to want to get to know the now legendary alumna, and this essay recounts how she embarked on a campaign to do so.

Her Fierce Faith: Contextualizing Ellen Tarry as a Catholic Convert and Foremother of Black Lives Matter Activism

Abstract: This article contextualizes the timely significance of Ellen Tarry as an African American teacher, writer, activist, and Catholic convert who engaged in interracial justice before, during, and after the Civil Rights Movement. It similarly presents her as a foremother of present-day Black Lives Matter (BLM) activism. Locating her divergences from other Black writers across time, this analysis features the distinctive admixture of secular and sacred values pervading her writings and work as a Harlem Renaissance journalist, autobiographer, and pioneering author of picture books for Black children and youth that promoted collaborative Catholic social action on behalf of her race.

Associations Between Administrative Burden and Children’s ECE Stability During the Covid-19 Pandemic

The Covid-19 pandemic caused widespread closures of early care and education (ECE) facilities that negatively impacted children’s socioemotional, behavioral, and academic development. Policies permitting child care centers to remain open by obtaining waivers from closure directives involved varying levels of administrative burden. This study examined administrative burden within waiver policies and its association with ECE stability, as measured by children’s enrollment in waiver-obtaining child care centers. I found Black children were significantly less likely than White children to be enrolled in a waiver-obtaining center, and also far less likely to have a center that obtained a waiver very early on in the pandemic. Analyses showed rates of enrollment in waiver-obtaining centers were far lower among children whose centers experienced more administrative burden, and suggested racial disparities in ECE stability were driven by Black children’s concentrated residence in communities where the waiver application process was more burdensome.

Racial Disparities in Palliative Care at End-of-Life in Children with Advanced Heart Disease in the South

To examine specialty pediatric palliative care (SPPC) and end-of-life (EOL) care for children with advanced heart disease in Alabama, including rates of and disparities in SPPC involvement. We performed a retrospective study from electronic health records of children (≤21 years at death) who died with advanced heart disease at a single institution between 2012 and 2019 (n=128). The main outcome was SPPC consult; we assessed clinical and sociodemographic factors associated with SPPC. The median age at death was 6 months (IQR=1-25 months) with 80 (63%) ≤1 year; 46% were Black and 45% non-Hispanic White. Seventy (55%) children had critical congenital heart disease, 45 (35%) non-critical congenital heart disease, and 13 (10%) acquired heart disease. Twenty-nine children (22%) received SPPC. Children ≤1 year at time of death and Black children were less likely to receive SPPC (adjusted odds ratio [95% confidence interval]: 0.2 [0.1-0.6], reference >1 year; 0.2 [0.1-0.7], reference non-Hispanic White). SPPC was associated with death while receiving comfort-focused care (30.6 [4.5-210]), do not resuscitate orders (8.2 [2.1-31.3]), and hospice enrollment (no children without SPPC care were enrolled in hospice) but not medically intense EOL care (ICU admission, mechanical ventilation, hemodialysis, or CPR) or death outside the ICU. Children dying with advanced heart disease in Alabama did not have routine SPPC involvement; infants and Black children had lower odds of SPPC. SPPC was associated with more comfort-focused care. Disparities in SPPC utilization for children with advanced heart disease need further examination.

Beyond physical and representational violence: the violence of Black children’s invisibility in public spaces

ABSTRACT George Floyd’s May 2020 murder by police underscored the interconnectedness of violence, systemic racism, and white supremacy in the US. This essay explores violence against Black children as an historical extension of the violence against Black adults and communities that is often at the centre of social justice and anti-racism work. We connect recent social media posts of Black children being ignored, waved away, or pushed by public amusement park performers with the current conservative political climate legislating the erasure or censoring of US history in K-12 schools allegedly to ‘save the [white] children’ from the misnamed ‘Critical Race Theory’.

Rezoning Educational Opportunities: The Relationship Between School Attendance Zone Boundary Changes and Access to Schools of Varying Quality

U.S. public schools provide substantially different educational opportunities to students—even within school districts, where attendance zone boundaries (AZBs) shape most children’s access to schools. The (re)drawing of AZBs is therefore a highly consequential policy decision. In this paper, I study how AZB changes in the Washington, D.C. metropolitan area affect children of different races between 2000 and 2020, including how they alter children’s travel times to school and access to school-level educational opportunities. Findings are starkly unequal, with rezoning disproportionately negatively affecting Black and Hispanic children. Results highlight the need for educational leaders to explicitly consider how AZB changes will redistribute opportunity within their districts.

Assessing the environmental justice implications of decarbonizing the US electric grid: estimating changes in asthma exacerbation by race and income

Abstract This paper examines how air quality improvements due to the 100% decarbonization of the US power sector in 2040 can reduce asthma exacerbation among children disaggregated by poverty status, race, and geography. Using spatial datasets that differentiate asthma prevalence by income, race, and state, we find that children living in households with income below the poverty line receive a disproportionate share of the benefits. To obtain these results, we employ several different federally administered datasets: American Community Survey, Behavioral Risk Factor Surveillance System (BRFSS), and Poverty Thresholds as provided by the US Census. We find that Black children and poor children, on average, have higher reductions in exposure to PM2.5. Nationally, close to 235 372 asthma exacerbation cases will be averted in 2040 under the decarbonization policy compared with Business-as-Usual. States with significant gains in asthma cases averted per 100 000 are Indiana, Kentucky, Ohio, Missouri, Pennsylvania, Texas, and Wisconsin. Furthermore, since the asthma portion of the BRFSS is not conducted in South Carolina, Colorado, Arkansas, and South Dakota, these states were omitted from the analysis. Across all states with significant gains, children living below the poverty line have larger health benefits than children above the poverty line. Households with child poverty have 50% larger reductions in asthma exacerbations than households without childhood poverty. Black children below the poverty line experience 33% higher health gains compared to Black children per 100 000 above the poverty line, 50% higher health gains compared to White children below the poverty line, and 159% higher than White children above the poverty line. We also provide general methodological insights for quantifying the environmental justice impacts of regulatory policies. We demonstrate why using race and poverty status-based prevalence rates is critical for understanding the distribution of health improvements and evaluating whether policies contribute to environmental justice goals.

Access to Laparoscopic Pediatric Surgery: Do Ethnic and Racial Disparities Exist?

IntroductionDisparate access to laparoscopic surgery may contribute to poorer health outcomes among racial and ethnic minorities, especially among children. We investigated whether racial and ethnic disparities in laparoscopic procedures existed among four common surgical operations in the pediatric population in the United States. MethodsUsing the American College of Surgeons National Surgical Quality Improvement Program–Pediatrics, we conducted a retrospective review of pediatric patients, aged less than 18 y old, undergoing appendectomy, fundoplication, cholecystectomy, and colectomy from 2012 to 2021. To compare the surgical approach (laparoscopy or open), a propensity score matching algorithm was used to compare laparoscopic and open procedures between non-Hispanic Black with non-Hispanic White children and Hispanic with non-Hispanic White children. Results143,205, 9,907, 4,581, and 26,064 children underwent appendectomy, fundoplication, colectomy, and cholecystectomy, respectively. After propensity score matching, non-Hispanic Black children undergoing appendectomy were found to be treated laparoscopically less than non-Hispanic White children (93.5% versus 94.4%, P = 0.007). With fundoplication, Hispanic children were more likely to be treated laparoscopically than White ones (86.7% versus 80.9%, P < 0.0001). There were no statistically significant differences between Black or Hispanic children and White children in rates of laparoscopy for other procedures. ConclusionsThough some racial and ethnic disparities exist with appendectomies and fundoplications, there is limited evidence to indicate that widespread inequities among common laparoscopic procedures exist in the pediatric population.

Applying a Racial Lens to the "Cycle of Violence".

One overlooked result in a 1989 Science paper on the "cycle of violence" was a race-specific increase in risk for arrest for violence among Black maltreated children, but not White maltreated children. We examine whether race differences in the cycle of violence are explained by risk factors traditionally associated with violence. Using a prospective design, maltreated and non-maltreated children were matched on age, sex, race, and approximate family social class and interviewed at mean age 28.7years (N = 1196). Arrest histories were obtained through age 50.5. Regression analyses included maltreatment, race, self-reported violent behavior, and risk factors (e.g., family, school, neighborhood variables). For arrests for violent crime, race was a significant predictor, whereas childhood maltreatment was not significant. For violent arrests, there was a significant race × maltreatment interaction when the total number of risk factors were included controlling for self-reported violent behaviors. For self-reported violent behaviors, childhood maltreatment remained significant for some risk factors. However, race did not predict self-reported violent behaviors. Offending behavior and traditional risk factors did not explain the disproportionate arrests among Black maltreated children. This disparity in the cycle of violence may reflect complex processes influenced by racial bias or structural racism.

Epidemiology of Brachial Plexus Birth Injury and the Impact of Cesarean Section on Its Incidence.

While prior research provided thorough analysis of the epidemiology of brachial plexus birth injury (BPBI) from 1997 to 2012, recent trends are unknown. The goal of this study was to update the understanding of the epidemiology and risk factors for BPBI. Installments of the Kids' Inpatient Database (1997 to 2019) were used to estimate BPBI incidence in the United States in comparison to several independent variables over time. An interaction between cesarean (C-) section and newborn weight was explored by defining BPBI rates in a stratified manner. A logistic regression model accounting for this interaction was developed to produce odds ratios for independent factors. Lastly, the temporal relationship between BPBI rates and C-section rates was explored using linear regression. BPBI rates were steady around 0.9 to 1.1 per 1000 live births between 2006 and 2019. C-section rates were similarly stable between 32.3% and 34.0% over this period. Stratified analysis indicated C-section delivery was protective against BPBI across newborn weight classes, but the magnitude of this protective value was highest among newborns with macrosomia. Shoulder dystocia was the strongest risk factor for BPBI in the logistic regression model [adjusted odds ratio (AOR): 56.9, P<0.001]. The AOR for a newborn with macrosomia born through C-section (AOR: 0.581, 95% CI: 0.365-0.925) was lower than that for a normal weight newborn born vaginally (AOR: 1.000, P=0.022). Medicaid insurance coverage (AOR: 1.176, 95% CI: 1.124-1.230, P<0.001), female sex (AOR: 1.238, 95% CI: 1.193-1.283, P<0.001), and non-White race (AOR: 1.295, 95% CI: 1.237-1.357, P<0.001) were independent risk factors for BPBI. Over time, the rate of BPBI correlated very strongly with the rate of C-section (R2=0.980). While BPBI and C-section rates were relatively stable after 2006, BPBI incidence strongly correlated with C-section rates. This highlights the need for close surveillance of BPBI rates as efforts to lower the frequency of C-section evolve. Female, Black, and Hispanic newborns and children with Medicaid insurance experience BPBI at a higher rate, a finding which could direct future research and influence policy. Level IV-case series.

Experiences of Family Peer Advocates Supporting Black Families Raising Autistic Children

Professionals play an important role in when and how families access autism services. Black families often experience disparate access to autism services compared to White families. Family Peer Advocates (FPAs) are professionals who have personal experience with the diagnostic process, school-based supports, and community-based services, and provide training and support to families. Understanding the experiences of FPAs may help researchers and practitioners better address the needs of Black autistic children and their families. The purpose of this qualitative study was to explore FPAs’ experiences providing autism-related services and resources for Black families with autistic children. We conducted focus groups with 32 FPAs from two agencies in one southeastern state. Three themes emerged from our inductive data analysis regarding FPA experiences: (a) serving multiple roles; (b) working with “zero resources”; and (c) variations in racial responsivity. Given our findings, we call for FPAs to ensure they are considering and responding to the intersecting impact of race on families’ experiences with autism diagnosis and services.

Navigating the changing trends of Black enrollment

Quick quiz: What are the five states with the highest percent increase of Black children from 2010 to 2019? Answer: North Dakota, Hawaii, South Dakota, Wyoming, and Montana.

Contribution of ethnicity, area level deprivation and air pollution to paediatric intensive care unit admissions in the United Kingdom 2008–2021

There is emerging evidence on the impact of social and environmental determinants of health on paediatric intensive care unit (PICU) admissions and outcomes. We analysed UK paediatric intensive care data to explore disparities in the incidence of admission according to a child's ethnicity and the degree of deprivation and pollution in the child's residential area. Data were extracted on children <16 years admitted to UK PICUs between 1st January 2008 and 31st December 2021 from the Paediatric Intensive Care Audit Network (PICANet) database. Ethnicity was categorised as White, Asian, Black, Mixed or Other. Deprivation was quantified using the 'children in low-income families' measure and outdoor air pollution was characterised using mean annual PM2.5 level at local authority level, both divided into population-weighted quintiles. UK population estimates were used to calculate crude incidence of PICU admission. Incidence rate ratios were calculated using Poisson regression models. There were 245,099 admissions, of which 60.7% were unplanned. After adjusting for age and sex, Asian and Black children had higher relative incidence of unplanned PICU admission compared to White (IRR 1.29 [95% CI: 1.25-1.33] and 1.50 [95% CI: 1.44-1.56] respectively), but there was no evidence of increased incidence of planned admission. Children living in the most deprived quintile had 1.50 times the incidence of admission in the least deprived quintile (95% CI: 1.46-1.54). There were higher crude admission levels of children living in the most polluted quintile compared to the least (157.8 vs 113.6 admissions per 100,000 child years), but after adjustment for ethnicity, deprivation, age and sex there was no association between pollution and PICU admission (IRR 1.00 [95% CI: 1.00-1.00] per 1μg/m3 increase). Ethnicity and deprivation impact the incidence of PICU admission. When restricting to unplanned respiratory admissions and ventilated patients only, increasing pollution level was associated with increased incidence of PICU admission. It is essential to act to reduce these observed disparities, further work is needed to understand mechanisms behind these findings and how they relate to outcomes. There was no direct funding for this project. HM was funded by an NIHR Academic Clinical Fellowship (ACF-2022-18-017).

Poverty reduction and childhood opportunity moves: A randomized trial of cash transfers to low-income U.S. families with infants

Black and Hispanic children have a higher likelihood of experiencing neighborhood poverty than white children. This study uses data from the Baby's First Years (BFY) randomized trial to examine whether an unconditional cash transfer causes families to make opportunity moves to better quality neighborhoods. We use Intent to Treat linear regression models to test whether the BFY treatment, of receiving $333/month (vs. $20/month) for three years, leads to moves to neighborhoods of greater childhood opportunity. Overall, we find no relation between the BFY treatment and neighborhood opportunity across time. However, we find effect modification by maternal baseline health. High-cash receipt among mothers with poor health at baseline corresponds with moves to neighborhoods of greater childhood opportunity.

Racial and Socioeconomic Disparities in Pediatric Asthma Emergency Care

The aim of this paper is to build a model to compare the relative impact of race and ethnicity and insurance type on pediatric Emergency Department utilization for asthma. A binary logistic regression model using relevant variables from 2022 NHIS survey data was conducted to compare asthma ED visit odds ratios of racial and ethnic minorities and publicly insured children. The results suggest that insurance type has slightly greater influence over asthma ED visits than race and ethnicity. Publicly insured children had the highest unadjusted odds ratio (1.88 [CI 95% 1.09-3.24)]) followed by Non-Hispanic Black children (1.80 [0.92-3.52]) and Hispanic children (1.51 [0.80-2.86]). The data are possibly biased toward exclusion of well-controlled asthmatics that may affect the resulting odds ratios. More socioeconomic variables would provide a more complete analysis. The paper has direct implications for health service providers and policymakers. Providers are encouraged to provide equitable, culturally competent care to asthmatics and policymakers are encouraged to embrace policies that promote better access for Medicaid beneficiaries, improved air quality and housing conditions for low-income children, and better racial representation in the provider workforce. The paper collates many existing sources of research on asthma disparities as a backdrop for examination of recent survey data pertaining to differences in asthma ED utilization between populations. It supports existing theories and work being done to mitigate poor asthma outcomes in children that are exacerbated by biological and systemic factors.

Emergency Allotments in SNAP and Food Hardship Among Households With Children

Households with children and minoritized racial and ethnic groups experience a disproportionate burden of food hardship. During the COVID-19 pandemic, the US federal government implemented emergency allotments in the Supplemental Nutrition Assistance Program (SNAP), increasing the amount of food purchasing assistance received by many participating households. To examine the association of implementing emergency allotments in SNAP with food hardship among households with children overall and for households with Black, Hispanic, and White children by comparing income-eligible households that did and did not participate in SNAP. This ecologic cross-sectional study used 2016-2022 National Survey of Children's Health data and a difference-in-differences approach to compare changes in the risk of food hardship from before implementation of emergency allotments in SNAP (2016-2019) to during implementation (2020-2022). Households with children younger than 18 years and incomes 130% or less of the federal poverty level (FPL) in all 50 states and Washington, DC, were included. Implementation of emergency allotments in SNAP. The primary outcome was caregiver report of household food hardship during the past 12 months. Of 44 753 households with incomes 130% or less of the FPL, a weighted 23.4% had Black children, 56.7% had White children, and 19.9% had children of other races. More than one-third of households (37.8%) had Hispanic children, and 31.8% had young children aged 0 to 5 years. The percentage of households that experienced food hardship decreased from 2016 to 2021 (from 62.9% to 48.2% among SNAP-participating households and from 44.3% to 38.9% among income-eligible nonparticipating households) but increased in 2022 (to 58.0% among SNAP-participating households and to 47.5% among nonparticipating households). Adjusting for confounders, implementing emergency allotments in SNAP was associated with a decreased risk of food hardship among SNAP-participating compared with nonparticipating households (risk ratio [RR], 0.88; 95% CI, 0.81-0.96). Implementing emergency allotments in SNAP was associated with a decreased risk of food hardship among SNAP-participating households with Hispanic (RR, 0.86; 95% CI, 0.72-1.02) and White (RR, 0.85; 95% CI, 0.76-0.94) children compared with nonparticipating households but not among households with Black children (RR, 1.04; 95% CI, 0.87-1.23). In this ecologic cross-sectional study, implementing emergency allotments in SNAP was associated with a decreased risk of food hardship among households with children. Efforts are needed to ensure that all populations benefit from economic policies.

Trends in Children’s Exposure to Food and Beverage Advertising on Television

Reducing children's exposure to advertisements promoting unhealthy foods and beverages has been recognized by the World Health Organization as a key strategy to improve children's diets and reduce childhood obesity. To examine changes in children's exposure to food-related (food, beverage, and restaurant) television advertising, including for products high in nutrients to limit (NTL; ie, saturated fat, trans fat, total sugars, and sodium) based on federal Interagency Working Group guidelines, following changes in the voluntary industry self-regulatory Children's Food and Beverage Advertising Initiative (CFBAI). This repeated cross-sectional study used US television ratings data on advertising exposure from The Nielsen Company for 2013, 2014, 2015, 2018, and 2022. Food and beverage product advertisements were assessed for nutritional content. Participants included 2- to 5-year-old and 6-to 11-year-old children. Data analysis was performed from July 2023 to January 2024. Changes in CFBAI standards in 2014 and 2020. The primary outcome was the number of food-related advertisements seen per year and percentage of food and beverage product advertisements high in NTL, on all programming and children's programming (defined as ≥35% child audience share). From 2013 to 2022, total advertisements seen per year declined by 77.6% (from 4611 to 1035) for 2- to 5-year-olds and by 78.5% (from 4860 to 1046) for 6- to 11-year-olds. Advertisements seen on children's programming decreased by 95.1% (from 1703 to 84 per year) for 2- to 5-year-olds and by 97.0% (from 1745 to 52 per year) for 6- to 11-year-olds. The percentages of advertisements for products high in NTL decreased from 2013 to 2022 but were still high: 68.9% for all programming and 63.9% for children's programming for 2- to 5-year-olds, and 68.4% for all programming and 60.6% for children's programming for 6- to 11-year-olds. The majority (51%-52%) of CFBAI-member food and beverage advertisements on children's programming remained high in NTL. Black children saw more food-related television advertisements than White children (58% more for 2- to 5-year-olds and 72% more for 6- to 11-year-olds); however, the percentage of advertisements for food and beverage products high in NTL seen was similar by race. In this repeated cross-sectional study of children's exposure to food-related television advertisements, exposure via children's programming decreased substantially. However, most advertisements seen were still for unhealthy products, and exposure from all programming remained substantial. Findings of more than 90% of advertising exposure not from children's programming and more than 1000 food-related advertisements seen per year suggest the need for government regulations based on time of day rather than programming.