Low-income Children Research Articles

Age of Emergence of Disparities in Asthma Prevalence and Morbidity among US Children.

Early-life exposures may precipitate asthma, but their contribution to disparities in asthma is less clear. To elucidate racial, ethnic, and socioeconomic status (SES) disparities in the age trajectory of asthma burden among US children. We analyzed three datasets: (1) 2016-2021 National Children's Health Survey (NCHS) (n=223,551); (2) 2015-2017 Child Asthma Call-Back Survey (ACBS) (n=4,289); and (3) 2018-2019 National Inpatient Sample (NIS) (n=23,713 children with asthma). We examined cumulative asthma prevalence by individual-year of age and children's race and ethnicity or SES (NCHS); mean age at asthma diagnosis by race and ethnicity and SES, unadjusted and adjusted for confounders (ACBS); and asthma hospitalization rates overall and per child with asthma by individual year of age and race and ethnicity (NIS). Among White children, cumulative asthma prevalence rises gradually through childhood, to 6.6% at age 5 and 16.1% by age 17. Prevalence rises more sharply in early childhood among Black children, reaching 17.6% at age 5 (RR 2.6;95%CI 1.9,3.8), but plateaus after age 9, with a consequent decline in Black-White relative disparities into adolescence. Disparities according to SES follow a similar trajectory, emerging early and subsequently narrowing. Similarly, Black, Hispanic and low-income children with asthma are diagnosed at an earlier age than White (or high-income) children. The asthma hospitalization rate rises in the first years of life among all children, but most rapidly among Black children, with a peak absolute Black-White gap at age 4; the relative gap remains wide throughout childhood and peaks at age 10. However, per child with asthma, relative disparities in White-Black hospitalizations rise through age 15. Disparities in asthma prevalence emerge in early childhood and then narrow, suggesting that reducing early-life adverse environmental exposures may be key to asthma prevention. Policies to improve the social determinants of health during gestation and childhood, e.g. environmental equity and family income support, are needed.

Infant diet quality index predicts nutrients of concern and ultra-processed food intake in low-income U.S. children

BackgroundDiet quality during infancy can influence nutrient intake and ultra-processed foods (UPF) consumption throughout later childhood. ObjectiveThis study investigated the predictive validity of Infant Diet Quality Index (IDQI) scores from 0-1 years of age and consumption of select nutrients and UPFs at different time points in low-income children ages 2-5 years. MethodsDietary surveys and 24-hour dietary recalls collected between ages 0-12 months from 2,613 Special Supplemental Women, Infants, and Children (WIC) Infant Toddler Feeding Practices Study-2 (ITFPS-2) participants were used to assess infant diet quality by final IDQI score ranging from 0 (non-adherence to dietary guidelines) to 1 (complete adherence to guidelines). Single 24-hour recalls collected across multiple time points per child between ages 2 and 5 years were used to determine nutrient intakes: vitamin B12 (μg), vitamin D (μg), calcium (mg), iron (mg), zinc (mg), potassium (mg), saturated fat (g), and dietary fiber (g), added sugars (g). Likewise, Nova was used to classify foods (to estimate the percentage of energy from foods) by level of industrial processing at each point in time across ages 2-5. Survey-weighted regression analyses estimated associations between total IDQI score and nutrient intake and percentage of energy consumption from each Nova food group at each age between 2-5 years. ResultsIDQI scores based on diet quality from 0-1 years of age were positively associated with children’s dietary fiber and potassium intake at ages 2-5. Additionally, IDQI was negatively associated with added sugar intake. No associations were observed between IDQI and saturated fat consumption. IDQI scores at age 1 were positively associated with the percentage of energy attributed to unprocessed/minimally processed foods (20% to 23%) and negatively associated with UPF consumption at ages 2-5 (-24% to -29%). ConclusionIDQI predicts intake of select nutrients and UPF consumption among low-income U.S. children ages 2-5. Clinical Trial RegistrationFeeding My Baby – A National WIC Study, NCT02031978, https://clinicaltrials.gov/study/NCT02031978. De-identified individual participant data from the WIC ITFPS-2 study is publicly available through USDA Ag Data Commons.

Medicaid/CHIP Coverage for Immigrants During Pregnancy, Childhood, and Adulthood: A Discussion of Relevant Policies and Evidence.

Despite major expansions in public health insurance under Medicaid and CHIP over the last 60 years, many immigrants remain ineligible for coverage. We discuss the existing federal and state policies that extend public health eligibility to low-income pregnant immigrants, children, and nonelderly adults. We also conduct a literature review and summarize quasi-experimental evidence examining the impact of public health insurance eligibility expansions on insurance coverage, healthcare use, and health outcomes among immigrants. Public health insurance eligibility for immigrants varies widely across states due to the implementation of different federal and state policy options. Previous studies on expanded eligibility identified positive effects on insurance coverage and healthcare utilization among pregnant and child immigrants, as well as some evidence indicating improved health outcomes. Further research is required to understand the longer-term impacts of expanded coverage, as well as to examine impacts of recent state expansions for adults. A complicated patchwork of federal and states policies leads to major differences in immigrant access to publicly-funded insurance coverage across states and population groups. These policies likely have important implications for immigrant access to healthcare and health.

Children’s exposure to chemical contaminants: Demographic disparities and associations with the developing basal ganglia

Children are regularly exposed to chemical contaminants that may influence brain development. However, relatively little is known about how these contaminants impact the developing human brain. Here, we combined silicone wristband exposure assessments with neuroimaging for the first time to examine how chemical contaminant mixtures are associated with the developing basal ganglia—a brain region key for the healthy development of emotion, reward, and motor processing, and which may be particularly susceptible to contaminant harm. Further, we examined demographic disparities in exposures to clarify which children were at highest risk for any contaminant-associated neurobiological changes. Participants included 62 community children (average age 7.00 years, 53% female, 66% White) who underwent structural neuroimaging to provide data on their basal ganglia structure and wore a silicone wristband for seven days to track their chemical contaminant exposure. 45 chemical contaminants—including phthalates and their alternatives, brominated flame retardants, organophosphate esters, pesticides, polycyclic aromatic hydrocarbons, and polychlorinated biphenyls—were detected in over 75% of wristbands. Notable demographic disparities in exposure were present, such that Non-White and lower-income children were more exposed to several contaminants. Exposure to chemical contaminant mixtures was not associated with overall basal ganglia volume; however, two organophosphate esters (2IPPDPP and 4IPPDPP) were both associated with a larger globus pallidus, a basal ganglia sub-region. Results highlight demographic disparities in exposure and suggest possible risks to a brain region key for healthy emotional development.

The Role of Language and Literacy Skills in Science Learning from Kindergarten to 5th Grade: Mitigating Gender, Racial/Ethnic, and Socio-Economic Disparities

Despite the acknowledged impact of early science achievement on future success, there is a noticeable gap in research focused on understanding the dynamic longitudinal patterns of children attaining science learning milestones in their early years, as well as few investigations of potential factors that may mitigate gender, racial/ethnic, and socio-economic disparities. This study analyzed nationally representative data from the Early Childhood Longitudinal Study of Kindergarten Cohort 2011 (ECLS-K: 2011), involving 18,174 children from 1328 schools across the United States, selected through a multistage probability sampling process and spanning kindergarten through 5th grade. Using survival analysis with the dependent variable as the time required to attain a specific milestone, the study revealed that boys, non-Black, non-Hispanic, and high-income children reached the science learning threshold earlier than their counterparts—girls, Black, Hispanic, and low-income children. Furthermore, the study underscored the crucial role of language and literacy skills in mitigating these disparities. The study’s implications stress the importance of targeted interventions to address early science education disparities, emphasizing professional development and integrating language and literacy with science learning. The research also enriches the global discourse on educational standards by introducing innovative methodologies to assess both the frequency and duration of science learning milestones.

Measure What Matters: Toward Multi-Sectoral Action to Improve Child and Youth Health and Well-being

Despite Canada’s strengths and widespread acknowledgment of the importance of children and youth, this country recently ranked 30th among 38 high-income countries on indicators of their well-being (UNICEF Innocenti 2020). While there are limited data readily available for monitoring within and across jurisdictions, Alberta compares worse than Canadian averages on indicators of early development vulnerability and child abuse (PHAC 2023a). The Alberta government convened a Child and Youth Well-being Review (GOA 2021) and Action Plan (GOA 2022a) to understand and address the pandemic’s adverse impacts. Indigenous and racialized children and youth, children in low-income families and children with disabilities were highlighted as being disproportionately impacted. In addition, the review found significant gaps in mental health, education, social data and evidence along with fragmentation of data within ministries and service systems (GOA 2021). Influences on child and youth health, well-being and health inequity have social, environmental and economic origins that extend beyond health policy boundaries (Lopez et al. 2021; Vargas-Barón, Diehl and Small 2022; Clark et al. 2020; Patton et al. 2016). Yet, public policy can be a powerful intermediary between children’s conditions and outcomes (UNICEF 2020). Cross-sectoral, whole-of-society approaches are required to improve child and youth health and well-being and government ministries have important roles to play (Akseer et al. 2020; De Montigny, Desjardins and Bouchard 2019; Leppo et al. 2013). Meaningful and accessible measurement and monitoring information is required to support co-ordinated, cross-sectoral decision-making and policy strategies to improve health outcomes and reduce health inequities (OECD 2021). Information is required about child and youth material living standards, physical and mental health, social lives and learning and education (OECD 2021). While definitions of child and youth well-being vary depending on diverse perspectives and cultural, social and local contexts, many established indicators and frameworks can be tailored to local community needs and priorities (OECD 2021).

Preventing Adverse Childhood Experiences in a Sample of Largely Indigenous Children.

The purpose of this study was to develop, pilot, and evaluate a culturally grounded, family-based program to prevent adverse childhood experiences (ACEs) among low-income and Indigenous children aged 10 to 14. The Tiwahe Wicagwicayapi program (TWP) is a 7-session program that teaches skills to prevent ACEs and is rooted in Lakota culture, language, and history. A total of 124 families (124 caregivers [96% Indigenous; 90% reported yearly income <$40 000] with 194 children aged 10 to 14 [93% Indigenous]) were randomly assigned to treatment (N = 66 families and 173 individuals) or waitlist (N = 58 families and 145 individuals) control groups. Caregivers and children completed a baseline, immediate posttest, and 6-month follow-up survey. Treatment effects were detected, indicating, compared with control participants, reductions in the incidence of child ACEs (incidence rate ratio [IRR] = 0.64), bullying victimization (odds ratio = 0.53), depression (d = -0.20), and externalizing behaviors (d = -0.23) and increased parent-child communication (g = 0.27) and child help-seeking behaviors (d = 0.28). For caregivers, the effects indicated that the program prevented intimate partner violence victimization (IRR = 0.36) and perpetration (IRR = 0.45), harsh parenting (g = -0.35), and depression (d = -0.24) and increased emotion regulation (d = 0.37), social support (d = 0.33), and cultural connection (d = 0.34). The TWP holds great promise in preventing ACEs among low-income, Indigenous children, showing potential promise for widespread public health impact. Future rigorous research on the TWP is warranted.

Teletherapy to address language disparities in deaf and hard-of-hearing children: study protocol for an inclusive multicentre clinical trial

IntroductionChildren who are deaf or hard-of-hearing (DHH) are at risk for speech and language delay. Language outcomes are worse in DHH children from lower socioeconomic backgrounds, due in part to...

Child Home Safety in Hispanic and Rural Communities Along the Texas–Mexico Border: A Community Health Worker Intervention

Low-income children are among the most affected by unintentional injuries. Although these injuries are preventable, outreach to low-income families in Hispanic and rural communities can be challenging. Community Health Workers (CHWs) are effective partners in reaching these populations. This study sought to determine whether a CHW-led intervention would reduce common hazards that increase the risk of unintentional injuries in low-income rural Hispanic homes along the Texas–Mexico border. CHWs conducted home visits to assess for injury hazards and distribute safety devices to 47 families with children ages 0 to 5 in five low-income rural border communities. CHWs provided follow-up assessments and support 30 days later. Analyses examined changes in the proportion of hazards from visits 1 to 2, with relative risks estimating the impact of safety devices on hazard reduction. Findings showed a 26.2% reduction in the total number of common hazards present in homes from visit 1 to visit 2 ( p &lt; .001). There was a 70% reduction in the overall risk of a hazard being present at visit 2, relative to visit 1 ( relative risk = 0.30, 95% CI [0.28, 0.33], p &lt; .001). This study suggests that tailored CHW interventions can reduce home safety hazards. CHWs are well suited to inform hard-to-reach Hispanic and rural populations, addressing feelings of distrust and promoting acceptance of recommended environmental changes. More rigorous evaluations of this intervention strategy are needed.

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.

Inequality in breastfeeding and complementary feeding practices in Argentina by household income level in 2018-2019.

Introduction. Diet quality is a right related to survival, healthy growth, prevention of chronic diseases, and malnutrition in all its forms. The objective of this study was to analyze breastfeeding and feeding practices in children younger than 2 years from urban areas of Argentina in 2018-2019 according to their household income level. Population and methods. Secondary analysis of data of the Second National Survey on Nutrition and Health (ENNyS2) of 2018-2019. Breastfeeding and complementary feeding indicators proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) were analized. Data were stratified by household income level. Results. The analysis included 5763 children younger than 24 months old. Although 97% was ever breastfed, only 47% of infants younger than 6 months were exclusively breastfed the previous day and 48% continued with breastfeeding after 1 year old, with a higher prevalence in low-income children. The previous day, 23% of children aged 6 to 23 months did not eat any fruit or vegetable, 60% consumed unhealthy foods, and 50% consumed sweet beverages. The consumption of sweet beverages and the absence of fruit and vegetables were higher in low-income households. Conclusion. The quality of children's diet is far from the recommendations and is conditioned by income. Early initiation of breastfeeding, minimum dietary diversity, fruit and vegetable consumption are lower and sweet beverage consumption is greater in impoverished sectors.

Psychometric properties of the knowledge and understanding questionnaire of the canadian assessment of physical literacy-2 in low-income brazilian children

This study aimed to translate and cross-culturally adapt the Physical Literacy Knowledge (PLK) questionnaire from Canadian Assessment of Physical Literacy-2 for Portuguese version, and to evaluate its psychometric properties (construct validation, content, composite reliability, measurement invariance) in low-income Brazilian children. The sample comprised of 562 children (247 girls), aged between 8.00 and 12.99 years-old (10.20±1.20 years), enrolled in the 12 public-school in Lagoa do Carro city, Pernambuco, Brazil. A translation and cross-cultural adaptation of the PLK questionnaire was carried out. Content validity was determined by calculating the content validity coefficient, which assesses the relevance, clarity and pertinence of total (CVCt) and each question individually (CVCi). The dimensional structure of the PLK and alternative models were considered with first and second order models. Internal consistency was assessed using composite reliability. Structural invariance (configural, metric, scalar and strict) between sexes was also assessed using a multigroup factor analysis. Content validity was considered acceptable, varying between 0.88 and 1.00 for CVCi, and 0.91, 0.94 and 0.99 for clarity, pertinence and relevance in the CVCt, respectively. Construct validity was considered adequate, with 3 dimensions and 9 items model being the most appropriate [χ²(df)=34.01(24); CFI=0.92; TLI=0.87; RMSEA=0.03; SRMR=0.04; 90%CIRMSEA=0.00-0.05]. The questionnaire was structurally invariant (all ΔCFI&lt;0.05). Based on the findings, the PLK questionnaire has adequate psychometric properties to assess the cognitive domain of Physical Literacy in low-income Brazilian children. Key-words: Physical Literacy; Cognition; Children; Psychometry; Child Development.

Refined Feasibility Testing of an 8-Week Sport and Physical Activity Intervention in a Rural Middle School.

This study examines how the 8-week Hoosier Sport program impacts cardiovascular disease (CVD) risks by promoting physical activity (PA) among rural, low-income children. Using a human-centered participatory co-design approach, the program aimed to increase PA levels (e.g., total PA, daily steps) in at-risk children. The present study explored the feasibility of the intervention as well as physiological and psychological changes across the intervention using a hybrid type 2 design (a model that evaluates both the effectiveness of an intervention and its implementation in real-world settings). Favorable feasibility indicators like attendance, acceptability, and compliance, with a 23.3% recruitment rate and 94.3% retention rate, were observed. Moreover, participants attended over 80% of sessions across the 8 weeks. Accelerometers (AX3) tracked daily steps and total PA for 7 days before and after the intervention, revealing increased PA levels throughout. At post-intervention, notable improvements were observed in psychological factors such as autonomy, social competence, and global self-worth. This study highlights the importance of tailored PA interventions in schools, emphasizing their potential to improve PA levels among rural, low-income children.

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive. To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs). The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3). Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone. Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data. Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02). In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs. ClinicalTrials.gov Identifier: NCT03385629.

A Comparison of Three Executive Function Batteries in a Preschool-Aged Sample.

There is great interest in the development of executive function (EF) in the preschool period. Accordingly, multiple performance-based measures of EF have been developed for this age group, yet little is known about how they compare to one another. This study used a large and diverse sample of 3-to-5-year-old children (N = 846), who completed subtests of the National Institutes of Health's Toolbox Cognition Battery (NTCB), the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV), and the EF Touch battery. Scores across the three batteries were compared and associations with age, income, and race/ethnicity were examined. Results revealed that (1) the three tasks were moderately correlated (r = 0.44-0.51, all p < 0.001), but children had higher mean accuracy scores on EF Touch than on the NTCB or the WPPSI-IV. (2) Mean accuracy scores on all batteries were linearly associated with child age (all F > 32.68, all p < 0.0001). (3) Comparisons by income and race/ethnicity showed lower accuracy for low-income children on the WPPSI-IV and lower accuracy for White children on the NTCB. Across all batteries, there was consistently lower accuracy for Hispanic children. In conclusion, the three batteries we examined performed similarly across several metrics. EF Touch may be more appropriate for younger children, while the NTCB performed well with older children.

Research on the Assessment Method of College Students' Financial Difficulty Index in the Context of Big Data Based on AHP Algorithm

The emergence of big data has allowed researchers to study people's financial struggles in greater detail. Among various kinds of difficulties, the financial barriers preventing low-income children from enrolling in higher education have received significant attention. Therefore, this paper uses the AHP algorithm and proposes a college student poverty index assessment method, aiming to provide a reference basis for the normal enrollment of children from low-income families by comprehensively analyzing various factors. This paper first constructs a hierarchical model to decompose the college student poverty problem into multiple influencing factors. Then, the AHP algorithm was utilized to calculate each factor's weights and consistency test, and each factor's relative importance was derived. As a result, each college student's poverty index was calculated using the comprehensive score method. The results show that the assessment method can reflect the degree of economic and social difficulties of college students from low-income families with better accuracy, providing a reliable reference value for promoting them in regular college enrollment. At the same time, the method can also be used in the government's formulation of poverty alleviation policies and the school's educational assistance work.

Enhancing interprofessional interagency collaboration for minoritized and low-income children with chronic illnesses.

Children with chronic illnesses present unique health, psychosocial, and learning challenges. Due to the complexities surrounding their needs, these children and their families often encounter multilayered barriers when accessing educational services and health care management. Medical-family-school interprofessional interagency collaborations (IIC) are needed to facilitate information sharing across institutions, treatment alignment among care partners, and equitable and high-quality school-based service delivery. This article presents a novel hospital-based school consultative liaison service, the Educational Achievement Partnership Program (EAPP), which conducts IIC with the families, schools, hospitals, and community care partners of children with chronic illnesses. We explore disproportionalities in IIC services among low-income and racially/ethnically minoritized children and examine ways to increase IIC service access and utilization. Results demonstrate that systematic changes targeting in-person communication with families significantly increased minoritized and low-income children's EAPP participation. Despite this increase, differences occurred between minoritized and White children's utilization through all stages of EAPP service delivery. These results underscore the importance of ongoing IIC service evaluation to examine the effectiveness of implementation components. We discuss implications and highlight opportunities for similar medical-family-school IIC under a school psychologist-led medical liaison consultative approach. We conclude that IIC is best fostered through innovations in communication models, graduate training, practice, and research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Household Income Disparities in Childhood Acute Lymphoblastic Leukemia Incidence and Mortality: A US Population-Based Analysis between 2000 and 2020

Introduction: Acute Lymphoblastic Leukemia (ALL) is the most common childhood cancer with an annual incidence of 3.7-4.9 cases per 100,000. There are no recent reports of the effect of socioeconomic status on pediatric ALL incidence and mortality class. Objective: Assess the association between ALL incidence and mortality and the socioeconomic status in children ages 21 years and younger. Methods: Retrospective analysis was conducted of the Surveillance, Epidemiology and End Results (SEER) database, which represents up to 48% of the general US population. We included patients with ALL up to 21 years of age during 2000-2020. Patients were categorized based on annual household income into three groups: low-income: &lt; $50,000; middle-income: $50,000-$75,000; high-income: &gt;$75,000. Incidence and mortality rates were expressed per 100,000 person-years. Annual Percentage Changes (APCs) were defined as the average year-over-year rate change. Student’s t test was used to determine if APCs were significantly different from zero with a significance level of 0.05. Results: We reviewed 30,852 cases, of which 9%, 54%, and 37% belonged to low-, middle-, or high-income families, respectively, and with incidence rates of 3.2, 3.4, and 3.1 per 100,000 person-years, respectively. Incidence in low-income children showed a statistically significant average increase of 1.1% (p = 0.003) per year during 2000-2020, while it showed a significant increased followed by stable rates since 2007 and 2010 in middle- and high-income children, respectively. ALL mortality was 0.5, 0.4, and 0.4 per 100,000 person-years, in low-, middle-, and high-income children, respectively. Mortality in low-income children has increased 2000-2007 (APC= 25.2%, p = 0.011); it did not significantly change after that. Conclusions: ALL incidence in low-income children has been increasing and remained the highest while mortality improved in middle-income children. Differences in healthcare access may be associated with the findings; further studies are needed to delineate this further.

School-based caries prevention using silver diamine fluoride: A pragmatic randomized trial in low-income rural children.

Dental caries is the world's most prevalent noncommunicable disease, disproportionately affecting children from low-income families and rural geographic areas. The CariedAway 3.0 study was a cluster-randomized pragmatic non-inferiority trial comparing silver diamine fluoride (SDF) to sealants and atraumatic restorations (ART) for the prevention and control of dental caries. All participants also received fluoride varnish. Analysis consisted of mixed-effects logistic regression for caries prevalence and weighted least squares and mixed-effects negative binomial regression for caries incidence. A non-inferiority margin of 10% for the difference between groups was used. Dental caries was defined as an ICDAS score of four or greater. A total of 3345 children were enrolled across 35 schools; however there was a large proportion of children who were noncompliant and received external dental care over the course of the trial. In adjusted analyses of compliant participants (n=1083; 543 in the SDF group and 540 in the sealant and ART group), there was no difference in the weighted risk difference between treatment groups (B=0.003, 95% CI = -0.0001, 0.0008). The odds of caries prevalence was elevated in the SDF group in longitudinal analyses (OR = 1.35, 95% CI = 0.86, 2.11) but was not significant and was below the non-inferiority margin. There were no significant differences between groups for caries incidence in adjusted models (IRR = 1.19, 95% CI = 0.81, 1.74). Results for intent to treat analyses were similar to that of per-protocol. In this school-based clinical trial, the prevalence of dental caries in children treated with SDF and fluoride varnish was non-inferior compared to those treated with sealants, ART, and fluoride varnish, although the overall risk was slightly higher. Unfortunately, a high rate of dropout and participant noncompliance was observed, likely due to the impacts of COVID-19 on study procedures. As a result, observed effects may be unreliable beyond the short-term. NCT03448107.

Use of natural environments is associated with reduced inequalities in child mental wellbeing: A cross-sectional analysis using global positioning system (GPS) data

Exposure to natural environments may benefit child mental wellbeing whilst offering a lever to reduce health inequalities. However, understanding of these relationships is limited by evidence from indirect measures of exposure. We objectively measured children’s direct use of natural environments—and use in low or high physical activity (PA) states—and associated this with their mental wellbeing. We then examined moderation by sex and household income.Using global positioning system and accelerometry data from children (n = 640), we measured mean daily time in natural environments (‘total use’), which we stratified by PA level as ‘passive use’ (sedentary and light PA) and ‘active use’ (moderate and vigorous PA). Logistic regression associated exposures with dichotomised Strengths and Difficulties Questionnaire outcomes (internalising difficulties; externalising difficulties; prosocial behaviour), with interactions to examine moderation.A 10-minute increase in total use was associated with 10.5 % lower risk of abnormal internalising outcomes (OR: 0.895; 95 % CI 0.809, 0.990), and 13.2 % lower risk of abnormal externalising outcomes (OR: 0.868; 95 % CI 0.776, 0.990). This suggests that ∼ 60 min of daily total use was associated with 50 % lower risk of abnormal internalising and externalising outcomes. The relative effects of passive and active use were equal, but their associations were moderated by income independently for specific outcomes. For externalising outcomes, the risk of abnormal scores in lower-income children reduced as passive use increased (P = 0.027) but remained constant for higher-income children. For prosocial outcomes, the likelihood of normal scores increased with active use in lower-income children, but not higher-income children (P = 0.005). Sex did not moderate these associations.The findings suggest that targeted interventions supporting disadvantaged children to use natural environments could help address inequalities in mental wellbeing. Further, the moderated associations with types of use suggest the equigenic effects of natural environments may operate through multiple pathways.