Islander Children Research Articles

Yarning for a purpose: Listening to how First Nations People define safety and wellbeing

AbstractDefining safety and wellbeing measurements for Aboriginal and Torres Strait Islander children and young people can be difficult due to its subjectivity. This article discusses findings from yarning circles held with Aboriginal and Torres Strait Islander peoples discussing these very definitions. It is argued through the findings; Aboriginal and Torres Strait Islander knowledge must be incorporated when defining safety and wellbeing measures such as connection to culture, family and housing.

More women, young adults being diagnosed with autism

A large analysis of autism spectrum disorder diagnoses over more than 10 years finds significant increases in young adults, women, and children in some racial or ethnic groups. Led by Kaiser Permanente researchers, the study was published in JAMA Network Open. The analysis covered the years 2011 to 2022 at 12 integrated delivery sites of the eight health systems that participate in the Mental Health Research Network, covering up to 12 million people, Kaiser's Division of Research reported Oct. 30. The study found increases in autism diagnosis across the study period for all groups, and faster increases among certain groups. The autism diagnosis rate was highest among 5‐ to 8‐year‐olds and rose during the study period, from 2.3 per 1,000 in 2011 to 6.3 per 1,000 in 2022. Increases in diagnosis in children by ethnicity were higher among Hispanic children (315% increase) than non‐Hispanic children (146%). By race, increases were greater among Native Hawaiian/Pacific Islander (428%), Black/African American (307%), and Asian (259%) children compared to white children (161%). Among adults, increases in diagnosis rates from 2011 to 2022 were greater among white adults (275%) than any other group. The study authors said the findings likely reflect both increased screening for autism along with other potential factors that should be explored in future research.

Development, construct validity and utility of a cross-culturally adapted Otitis Media-6 (OM-6) questionnaire for urban Aboriginal and/or Torres Strait Islander children: A community consulted project

Development, construct validity and utility of a cross-culturally adapted Otitis Media-6 (OM-6) questionnaire for urban Aboriginal and/or Torres Strait Islander children: A community consulted project

Well-Being and Healthcare Inequality on Bulon-Don Island in Southern Thailand-Results of a Pre-Intervention Field Survey.

Children living in an area distant from or associated with barriers to travelling to health service centres usually experience health and well-being disparities. This is a survey of child health and well-being on Bulon-Don Island, located 22 kms. from the southern mainland of Thailand, to gather essential background data before activating responses from local service provider agencies. Demographic data, physical and crude psychological health, harm to health, and living conditions of Bulon-Don children aged 1-14 years were studied and compared with the results of the corresponding national child health survey. Descriptive statistics were used for the statistical analysis of significance (p < 0.05). A total of 21 male and 41 female children (N = 62) participated in the survey after obtaining consents from parents or care providers. The islanders are Indigenous people who use their own languages and have traditional beliefs. Comparing with the children of the national survey, most children aged <5 years were found to have significantly lower height and weight according to their age (p = 0.044 and p = 0.043, respectively), whereas those aged >5 years had a similar nutritional status. In addition, there is a lack of facilities for healthy living. However, the mean total psychological and ethical standards scores were significantly higher in the 1-5 and 6-9-year-old children. Disparity of socio-political status, cultural beliefs and practices, socioeconomic basis, and geographic distance from the mainland were the social determinants and barriers of low health service accessibility for the islander children. Comprehensive child health and well-being evaluation in an enclave of isolation like this is mandatory before an integrated intervention carried out by the local healthcare and living facilities providers is implemented.

Sharing the Care: One Aboriginal Community-Controlled Organisation’s Approach to Out-of-Home Care of Aboriginal and Torres Strait Islander Children

ABSTRACT This article critically examines safety and innovation in out-of-home care, with a particular focus on addressing the entrenched overrepresentation of Aboriginal and Torres Strait Islander children and young people in the child welfare system. Grounded in the practical insights of safe house workers and managers, the purpose of this article is to share an innovative practice case study—the Tangentyere Safe House in Alice Springs, Northern Territory, Australia. As a case study within an Aboriginal Community-Controlled Organisation, Tangentyere Safe House emerges as a site for understanding the confluence of cultural safety, familial connections, and strategies to mitigate overrepresentation. Key themes explored include promoting cultural safety and supporting connections with the family of origin. Through a methodological lens that privileges practice-based knowledge, this article captured the on-the-ground experiences of those actively engaged in child safety. The findings underscore the innovative practices employed by Tangentyere Safe House in navigating out-of-home care within an Indigenous context to argue for a holistic and culturally informed approach to child protection interventions, drawing attention to the practical strategies employed by safe house workers. The article showcases the central role of Aboriginal Community-Controlled Organisations in providing care alongside families in out-of-home care. IMPLICATIONS The innovative approach of the Tangentyere Safe House highlights the importance and unique role of Aboriginal Community-Controlled Organisations in out-of-home care. The role of Aboriginal Community-Controlled Organisations should be formally recognised in the Aboriginal and Torres Strait Islander Child Placement Principle hierarchy. Frontline safe house workers’ knowledge and expertise regarding Aboriginal and Torres Strait Islander children in out-of-home care can inform all stakeholder involvement including police interventions.

To what extent could eliminating racial discrimination reduce inequities in mental health and sleep problems among Aboriginal and Torres Strait Islander children? A causal mediation study

BackgroundRacism is a fundamental cause of health inequities for Aboriginal and Torres Strait Islander children. We estimated the potential reduction in inequities in Aboriginal and Torres Strait Islander children’s mental health and sleep problems if interpersonal racial discrimination was eliminated. MethodsWe drew on cross-sectional data from the Speak Out Against Racism (SOAR; N=2818) and longitudinal data from the Longitudinal Study of Australian Children (LSAC; N=8627). The SOAR was completed in 2017 and the LSAC followed children from 2004 to 2014 in the kindergarten cohort and from 2008 to 2018 in the birth cohort. Exposure: Aboriginal and Torres Strait Islander status (Aboriginal and Torres Strait Islander/Anglo-European), a proxy measure of structural racism (SOAR: 10-15 years; LSAC: 4-5 years); Mediator: interpersonal racial discrimination (yes/no) (SOAR: 10-15 years; LSAC: 12-13 years); Outcomes: mental health problems (yes/no) and sleep problems (yes/no) (SOAR: 10-15 years; LSAC: 14-15 years). An interventional effects causal mediation approach was used. FindingsAboriginal and Torres Strait Islander children had higher prevalence of mental health problems (SOAR: 40·1% versus 13·5%; LSAC: 25·3% versus 7·6%) and sleep problems (SOAR: 28·5% versus 18·4%; LSAC: 14·0% versus 9·9%) than Anglo-European children. Hypothetical interventions eliminating Aboriginal and Torres Strait Islander children’s experiences of interpersonal racial discrimination could reduce 42·4% and 48·5% of mental health and sleep inequities in SOAR (equivalent to 11·2% and 4·7% absolute reductions) and 25·6% and 1·6% of mental health and sleep inequities in LSAC (equivalent to 5·5% and 0·1% absolute reductions). Absolute remaining inequities were similar across both studies for both outcomes. InterpretationTargeted policy interventions that eliminate racial discrimination against Aboriginal and Torres Strait Islander children could have high potential to reduce inequities in mental health and sleep problems. Addressing racism and racial discrimination needs a multi-component and multi-level approach directed by Aboriginal and Torres Strait Islander communities.Funding: National Health and Medical Research Council of Australia and Medical Research Future Fund of Australia

A scoping review of early childhood support for Aboriginal and Torres Strait Islander children living with a disability in regional, rural and remote settings.

Many experts and communities have concerns about how National Disability Insurance Scheme services are provided to Aboriginal and Torres Strait children. This study was undertaken at the request of the NPY Women's Council in partnership with the researchers, to explore supports for Aboriginal and Torres Strait Islander children living with a disability in their remote areas. This scoping review aims to (a) explore the barriers and enablers to accessing disability support services for families of young Aboriginal and Torres Strait Islander children (0-8 years) living in regional, rural and remote settings, and (b) summarise best practice approaches for accessing support for young children in these settings. The search was run in three electronic databases, as well as grey literature sources. We assessed the quality of included publications using the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange tool. A narrative synthesis was supported by thematic analysis. From an initial search (557 citations), we identified 13 eligible documents. Most documents were peer-reviewed articles of qualitative studies. Key themes identified included the following: (1) Holistic approach, (2) Understanding disability, (3) Consistent relationships, (4), Flexibility, (5) Simplify system and (6) Enhance communication. This scoping review has revealed gaps in the provision of quality, culturally responsive disability services for families of Aboriginal and Torres Strait Islander children living in regional, rural and remote areas of Australia. A family-centred, flexible approach will help address their needs. Future research is required to design and evaluate models of care for Aboriginal and Torres Strait Islander children.

Factors informing funding of health services for Aboriginal and Torres Strait Islander children: perspectives of decision-makers.

Background The factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children are unclear. This study's objective aimed to describe decision-makers' perspectives on factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children. Methods We conducted semi-structured interviews with 13 participants experienced in making funding decisions at organisational, state, territory and national levels. Decision-makers were from New South Wales, Northern Territory, Queensland, Victoria and Western Australia. Transcripts were analysed thematically following the principles of grounded theory. Results We identified five themes, each with subthemes. First, prioritising engagement for authentic partnerships (opportunities to build relationships and mutual understanding, co-design and co-evaluation for implementation). Second, valuing participant experiences to secure receptiveness (cultivating culturally safe environments to facilitate acceptability, empowering for self-determination and sustainability, strengthening connectedness and collaboration for holistic care, restoring confidence and generational trust through long-term commitments). Third, comprehensive approaches to promote health and wellbeing (linking impacts to developmental milestones, maintaining access to health care, broadening conceptualisations of child health). Fourth, threats to optimal service delivery (fractured and outdated technology systems amplify data access difficulties, failure to 'truly listen' fuelling redundant policy, rigid funding models undermining innovation). Fifth, navigating political and ideological hurdles to advance community priorities (negotiating politicians' willingness to support community-driven objectives, pressure to satisfy economic and policy considerations, countering entrenched hesitancy to community-controlled governance). Conclusion Decision-makers viewed participation, engagement, trust, empowerment and community acceptance as important indicators of service performance. This study highlights factors that influence decisions to fund health services for Aboriginal and Torres Strait Islander children.

Small Area Estimation of Maluku and Papua Island Child Poverty Levels in 2023

Child welfare issues such as child poverty pose a challenge for Indonesia. The provinces in Maluku and Papua have the highest rates of child poverty. Data on child poverty at regencies/municipalities level is needed to address this issue through targeted policies. The direct estimations have a Relative Standard Error (RSE) value of more than 25 percent, necessitating the use of an indirect method, Small Area Estimation (SAE). This study aims to compare the results of indirect estimates of the percentage of children aged 0-17 living in poverty at the regencies/municipalities level in Maluku and Papua using SAE Empirical Best Linear Unbiased Prediction (EBLUP) and Hierarchical Bayes Beta (HB Beta) methods. Susenas KOR March 2023 data is used to produce direct estimates, while Podes 2021 data is used to form auxiliary variables. The results indicate that the SAE HB Beta method provides estimates with better RSE compared to SAE EBLUP. All regencies/municipalities in the Maluku and Papua have a fairly good level of accuracy.

Understanding the Wellbeing Needs of First Nations Children in Out-of-Home Care in Australia: A Comprehensive Literature Review.

Despite the increasing overrepresentation of Aboriginal and Torres Strait Islander (hereafter respectfully referred to as First Nations) children living in out-of-home care (OOHC) in Australia, little is known about their wellbeing needs. This comprehensive literature review aimed to identify these needs and the features of care required to meet them. MEDLINE, CINAHL, Scopus, Informit, PsycINFO, and Embase databases and relevant grey literature were searched from inception to December 2023 for articles presenting qualitative accounts and perspectives relevant to the wellbeing needs of First Nations children in OOHC. These included reports from First Nations children in OOHC; First Nations adults with lived experience of OOHC; carers, caseworkers, and organizational stakeholders; and First Nations community members with relevant lived and/or professional experience. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Braun and Clarke's reflexive thematic analysis method for data analysis. Thirty-five articles (19 peer-reviewed, 16 grey literature) met the inclusion criteria. Our analysis revealed six wellbeing needs of First Nations children in OOHC: Being seen, being heard; a sense of stability; holistic health support; social and cultural connections; culturally safe OOHC providers; and preparedness for transitioning out of care. A range of features of OOHC were also identified as critical for supporting these needs. Our findings suggest that First Nations children in OOHC have unique wellbeing needs in addition to safety, security, and health. Attention to the development and maintenance of social and cultural connections is an important concern that must be addressed by OOHC providers (caseworkers and organizations) and carers and supported by OOHC policy and the associated systems in Australia as part of providing culturally safe and supportive care.

Cohort profile: The Aboriginal Families Study – a prospective cohort of Aboriginal children and their mothers and caregivers in South Australia

PurposeThe Aboriginal Families Study is a prospective, intergenerational cohort study with well-established Aboriginal governance arrangements and community partnerships to support all research processes including data collection, interpretation and knowledge translation.Participants344...

Unveiling injustice: Disrupting child removal policies and upholding breastfeeding: An emancipatory framework.

Before colonization, Aboriginal and Torres Strait Islander communities had nurturing, holistic, and communitarian approaches that promoted extended and healthy lives for their children. Colonization, marked by policies of genocide and assimilation, has resulted in an alarming overrepresentation of Aboriginal and Torres Strait Islander children under the care of child protection agencies, resulting in compromised health outcomes and reduced life expectancies. We are conducting a study designed to enhance positive developmental outcomes for Aboriginal and Torres Strait Islander children by articulating and enabling the rights of mothers and children to breastfeed in the context of a child protection intervention and child removal. To understand and address this problem, it is critical to implement culturally safe, de-colonized, emancipatory research that is guided by and benefits Aboriginal and Torres Strait Islander communities. This article presents an emancipatory framework that we are applying to our study using an Aboriginal participatory action research approach, that serves as a guide for non-Indigenous researchers seeking to conduct research with Indigenous communities. We emphasize the importance of incorporating an Aboriginal participatory action research framework, using community consultation and codesign; culturally secure data collection methods, and paying attention to Indigenous data sovereignty. Developing trusting respectful relationships is conducive to knowledge acquisition, exchange, and use, when research approaches deeply rooted in community involvement are applied. A call to action by the critical midwifery studies collective, urges non-Indigenous researchers to become accountable allies that demonstrates respect for community leadership while actively striving to ensure research does not perpetuate further harm, and produces effective change. This article provides an overview of ways to conduct ethical emancipatory research with Indigenous participants, that is, of benefit to midwifery practitioners and is applicable to many areas of research, policy, and practice.

Risk of behavioural and developmental difficulties in early childhood in the Australian Capital Territory.

We aimed to estimate the prevalence of risk for developmental and behavioural problems for children in their first year of full-time primary education in the Australian Capital Territory (ACT). We conducted an analysis of the 2014-2017 Kindergarten Health Check (KHC), an annual series of complete enumeration surveys of all children in their first year of full-time primary education in the ACT. Risk for developmental and behavioural problems was determined using the Parents' Evaluation of Developmental Status (PEDS) questionnaire. 19 414 children (mean age 5.56 years; 51.4% boys; 2.3% Aboriginal and Torres Strait Islander; 18.4% quintile of greatest relative disadvantage) who participated in the 2014-2017 KHC were included in the study (87%). More than half of ACT children in their first year of primary education had low/no developmental risk identified through the PEDS questionnaire, with 1 in 10 at high risk. Those more likely to have a high risk PEDS score were boys, those from the areas experiencing relative disadvantage, and Aboriginal and Torres Strait Islander children. While we can identify children at risk through screening, the greater challenge remains to identify and address the underlying causes of healthy inequalities, even within highly socioeconomically advantaged communities.

Clinical profile of paediatric acute rheumatic fever and rheumatic heart disease in Western Australia: 1987 to 2020.

To describe the clinical profile of acute rheumatic fever (ARF) presentations to paediatric cardiology tertiary services in Western Australia (WA). A retrospective clinical audit of individuals with confirmed ARF referred to the only paediatric tertiary cardiac service in WA (1 January 1987 to 31 December 2020). Comparisons between inpatient, outpatient, remote and non-remote groups were assessed. Four hundred seventy-one episodes of ARF in 457 individuals (235 male; median age = 8 years) met clinical criteria. The majority were Aboriginal and Torres Strait Islander children (91.2%), with 62.1% living in remote areas. The number of ARF and rheumatic heart disease (RHD) diagnoses per year increased from 1987 to 2017 with notable peaks in 2013 and 2017. The average annual incidence of tertiary-referred ARF in WA of 4-15-year-olds from 1987 to 2020 was 4.96 per 100 000. ARF features included carditis (59.9%), chorea (31%), polyarthritis (30%) and polyarthralgia (24.2%). RHD was evident in 61.8% of cases and predominantly manifested as mitral regurgitation (55.7%). Thirty-four children (7.4%) with severe RHD underwent valvular surgery. 12% had at least one recurrent ARF episode. Remote individuals had more than double the rate of recurrence compared to non-remote individuals (P = 0.0058). Compared to non-remote episodes, remote presentations had less polyarthritis (P = 0.0022) but greater proportions of raised ESR (P = 0.01), ASOT titres (P = 0.0073), erythema marginatum (P = 0.0218) and severe RHD (P = 0.0133). The high proportion of Aboriginal and Torres Strait Islander Australians affected by ARF/RHD in WA reflects the significant burden of disease within this population. Children from remote communities were more likely to present with concurrent severe RHD. Our study reinforces the persisting need to improve primary and secondary ARF initiatives in rural and remote communities.

Understanding burn injury among Aboriginal and Torres Strait Islander children – results of a two-year cohort study

BackgroundDespite known inequalities, little is understood about the burden and healthcare experiences of Aboriginal and Torres Strait Islander children who sustain a burn injury and their families. MethodsThe Coolamon Study recruited parents and carers whose children (aged <16 years) were Aboriginal and / or Torres Strait Islander children and had presented to burn units across four Australian states, New South Wales (Sydney), Northern Territory (Darwin), Queensland (Brisbane, Townsville) and South Australia (Adelaide), between 2015 and 2018. Consent was obtained and carers completed baseline and subsequent interviews at 3, 6, 12 and 24 months. Data were collected on the injury event, patient care and safety, sociodemographic factors, health related quality of life (PedsQual), and psychological distress (Kessler K-5). ResultsOf the 208 participants, 64 % were male; 26 % were aged less than 2 years and 37 % aged 2–4 years. The most common burn mechanisms were scalds (37 %), contact (33 %) and flame burns (21 %), with more severe burns and flame burns occurring in rural and remote settings. Most carers rated their child’s care as either excellent or very good (82 %). Family distress, measured by the K-5, lessened over the 24 months, however the changes were not statistically significant. While 77 % of carers reported that they received enough information, 18 % reported they would have liked more, and 3 % reported no information was provided before treatment. Parents described mixed access to information about the types of support available to them, such as accommodation, meals, travel or cultural support. ConclusionData from this cohort provide rich new information about risk factors and care received from point of injury through to rehabilitation for Aboriginal and Torres Strait Islander children with burns, providing unique insights into what is needed for appropriate, culturally safe care.

Associations between placental hydroxymethylation and birthweight.

5-hydroxymethylcytosine (5hmC), formed through the ten-eleven translocation (TET) methylcytosine dioxygenase mediated oxidation of 5-methylcytosine (5mC) at cytosine-phosphate-guanine (CpG) dinucleotides, is believed to mainly serve as an intermediate in the DNA demethylation pathway, though recent evidence suggests that 5hmC may also play a functionally relevant role. We have conducted an epigenome-wide association study (EWAS) to assess the association between placenta 5hmC, obtained through parallel bisulfite and oxidative bisulfite modification of DNA and array-based assessment, and newborn birthweight in the Rhode Island Child Health Study (RICHS). We also assessed whether the removal of 5hmC signal impacts the observed results from traditional epigenome-wide studies that rely on BS modification-based (combined 5mC and 5hmC) assessment alone. We identified 5hmC at one CpG in the CUBN gene to be significantly associated with birthweight (FDR < 0.05) and demonstrate that expression of that gene was also associated with birthweight. Comparison of 5hmC+5mC and 5mC EWAS effect estimates reveal a strong correlation (r = 0.77, p < 0.0001). Our study suggests that traditional assessment of 5mC through bisulfite modification alone provides an accurate assessment of CpG-specific DNA methylation for EWAS studies but was unable to provide evidence of widespread associations between placental 5hmC and birthweight.

‘He wants to play football but not available here … ’ Parent perspectives of Aboriginal and Torres Strait Islander child physical activity and sport participation

ABSTRACT Aboriginal and Torres Strait Islander children have higher physical activity participation levels than non-Aboriginal children. However, this trend reverses in adulthood. Data came from the Longitudinal Study of Indigenous Children (LSIC) at age 8–13 years. Using conventional content analysis, interviews with primary caregivers of Aboriginal and Torres Strait Islander children were analyzed to understand current sports and physical activity participation, what children would like to do, and associated barriers. Sport (individual and team) and play were identified as important; with football and water sports most frequently mentioned as activities that children enjoy. Dancing was frequently mentioned as an activity that children enjoy and would like to participate in … These findings identify preferences for physical activity and sports participation, including activities that have cultural significance for Aboriginal and Torres Strait Islander peoples in addition to exercise. These activities can act as mediums for family, kinship, community and cultural connection.

Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963-2020: an ANZDATA registry study.

To assess differences between Aboriginal and Torres Strait Islander and non-Indigenous Australian children and young adults in access to and outcomes of kidney transplantation. A cohort study based on prospectively collected data; analysis of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Children and young adults aged 0-24 years who commenced kidney replacement therapy in Australia during 1963-2020. Proportions of children and young adults who received kidney transplants within five years of commencing dialysis; 5- and 10-year death-censored graft survival; and 5- and 10-year survival of children and young adults who received kidney transplants or who remained on dialysis. During 1963-2020, 3736 children and young adults received kidney replacement therapy in Australia: 213 (5.8%) Aboriginal and Torres Strait Islander and 3523 (94.2%) non-Indigenous children and young adults. During follow-up (median, eight years; interquartile range [IQR], 2.6-15 years), 2762 children and young adults received kidney transplants: 93 Aboriginal and Torres Strait Islander (43.7% of those receiving kidney replacement therapy) and 2669 non-Indigenous children and young adults (75.8%). Smaller proportions of Aboriginal and Torres Strait Islander than of non-Indigenous children and young adults received transplants within five years of commencing dialysis (99, 46% v 2924, 83.0%), received living donor transplants (19, 20% v 1170, 43.9%), or underwent pre-emptive transplantation (one, 1.1% v 363, 13.6%). Five-year graft survival for Aboriginal and Torres Strait Islander recipients was similar to non-Indigenous recipients (61% v 75%; adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 0.02-2.05), but 10-year graft survival was lower (35% v 61%; aHR, 1.69; 95% CI, 1.25-2.28). Five- and 10-year survival after kidney transplantation was similar for Aboriginal and Torres Strait Islander and non-Indigenous people. Among those who remained on dialysis, 10-year survival was poorer for Aboriginal and Torres Strait Islander than non-Indigenous children and young adults (aHR, 1.50; 95% CI, 1.08-2.10). Five-year graft and recipient survival were excellent for Aboriginal and Torres Strait Islander children and young adults who received kidney transplants; however, a lower proportion received transplants within five years of dialysis initiation, than non-Indigenous children and young adults. Improving transplant access within five years of dialysis commencement should be a priority.

Administration of Burns First Aid Treatment to Aboriginal and Torres Strait Islander children in community settings

ObjectiveThis paper investigates Burn First Aid Treatment (BFAT) provided to Aboriginal and Torres Strait Islander children in Australia at the scene of injury using data from a population-based cohort study. Study DesignThe participants were 208 Aboriginal and Torres Strait Islander children aged < 16 years who sustained a burns injury between 2015–2018, and their carers. The primary outcome measure was gold standard BFAT, (defined as at least 20 min of cool, running water within 3 h of the injury); additional measures included type of first aid, length of first aid provided, and carer's knowledge of first aid. ResultsOf the 208 caregivers, 168 provided open-ended responses that indicated first aid was applied to their child; however, only 34 received gold standard BFAT at the scene of the injury, 110 did not receive correct BFAT, and 24 were unsure what first aid was applied. ConclusionThis study highlights an important need for communities to have access to appropriate evidence-based and co-designed BFAT education and training.

Patterns and drivers of disparities in pediatric asthma outcomes among Medicaid-enrolled children living in subsidized housing in NYC

ObjectiveThere are persistent disparities in pediatric asthma morbidity in the U.S. We linked claims data with information on neighborhood-level risk factors to explore drivers of asthma disparities among Medicaid-enrolled children in New York City subsidized housing. MethodsWe constructed a cohort of Medicaid-enrolled children living in public or other subsidized housing, based on residential address, in NYC between 2016 and 2019 (n = 108,969). We examined claims-derived asthma prevalence across age and racial and ethnic groups, integrating census tract-level information and using the Bayesian Improved Surname Geocoding (BISG) algorithm to address high rates of missing data in self-reported race and ethnicity. We used inverse probability weighting (IPW) to explore the extent to which disparities persisted when exposure to asthma risk factors – related to the built environment, neighborhood poverty, and air quality – were balanced across groups. This analysis was conducted in 2022–2023. ResultsClaims-derived asthma prevalence was highest among children <7 years at baseline and among non-Hispanic Black and Hispanic children. For example, among children aged 3–6 years at baseline, claims-derived prevalence was 17.3% and 18.1% among non-Hispanic Black and Hispanic children, respectively, compared to 9.3% and 9.0% among non-Hispanic White and non-Hispanic Asian American/Pacific Islander children. Using IPW to balance exposure to asthma risk factors across racial and ethnic groups attenuated, but did not eliminate, disparities in asthma prevalence. ConclusionsWe found high asthma burden among children living in subsidized housing. Modifiable place-based characteristics may be important contributors to pediatric asthma disparities.