non-Hispanic African American Children Research Articles

Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting.

This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting. Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children's hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering. There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric patients. There was also a main effect of health insurance payer type on non-opioid orders. Patients with government-sponsored plans (e.g., Medi-Cal, Medicare) received fewer non-opioid prescriptions compared with patients with both HMO and PPO coverage. Additionally, there was a significant race/ethnicity by insurance interaction on opioid orders. Non-Hispanic White patients with "other" insurance coverage received the greatest number of opioid orders. In non-Hispanic African American patients, children with PPO coverage received fewer opioids than those with government-sponsored and HMO insurance. For non-Hispanic Asian patients, children with PPO were prescribed more opioids than those with government-sponsored and HMO coverage. Findings suggest that the relationship between race/ethnicity, insurance type, and physician decisions opioid prescribing is complex and multifaceted. Given that consistency in opioid prescribing should be seen regardless of patient background characteristics, future studies should continue to assess and monitor unequitable differences in care.

The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States

This study on a nationally representative sample of US households with children expands on the results of an earlier study from 2009 to 2010 by the same group that comprehensively describes the current public health impact of childhood food allergy.In total, surveys were completed by 51 819 US households. Half (51.1%) of the population-weighted sample was male, with 52.8% white, 24.1% Hispanic, 13.2% African American, and 3.2% Asian American. The majority of children were >5 years of age (68% were 6–17 years). Approximately 16% came from homes with annual incomes <$25 000, and 10% came from homes making >$150 000.The survey added additional questions to the core 2009 to 2010 survey to assess emerging research issues relating to the etiology and management of food allergy and was tested on 345 pilot interviewees. Study participants were recruited first through NORC at the University of Chicago’s probability-based AmeriSpeak Panel, and then participation was expanded by using Survey Sampling International. The survey was administered in English or Spanish via telephone or the Internet. The primary outcome measure was the prevalence of overall and food-specific convincing childhood food allergy. Parent-reported food allergies were considered convincing if the most severe reaction reported to that food included at least 1 symptom on the stringent symptom list developed by an expert panel: hives, swelling (lip and/or tongue or other), difficulty swallowing, throat tightening, chest tightening, trouble breathing, wheezing, vomiting, chest pain, rapid heartbeat, fainting, and low blood pressure. A reaction was considered severe if at least 2 symptoms were reported from 2 different body systems. Isolated itchy mouth or throat after ingestion of associated foods (nuts, seafood, grains, seeds, spice, fruit, vegetable) were considered indicative of oral allergy syndrome and were not considered convincing food allergies.The estimated prevalence of convincing childhood food allergy was 7.6%, although 11.4% of children’s caregivers reported a current food allergy before stringent symptom criteria were used to filter out those lacking a convincing history of food allergy. Food-specific rates included peanut (2.2%), milk (1.9%), shellfish (1.3%), tree nut (1.2%), egg (0.9%), fin fish (0.6%), and sesame (0.2%), with 40% of children reporting multiple food allergies. Among children with convincing food allergy, 42.3% reported severe reactions, which were more common in children with allergy to peanut (59.2%), tree nut (56.1%), and shellfish (48.7%). However, only 40.7% of children with convincing food allergy reported a current prescription for an epinephrine autoinjector. Having multiple food allergies, a current epinephrine prescription, a history of 1 or more lifetime food allergy–related emergency department visits, or comorbid asthma was also significantly associated with increased odds of a severe allergic reaction. Non-Hispanic African American children were at significantly elevated risk of having a convincing food allergy relative to non-Hispanic white children (odds ratio: 1.4 [95% confidence interval: 1.1–1.7]). Rates of other physician-diagnosed atopic conditions were significantly higher (P < .05) among children with convincing food allergy compared with all other children in the study.Food allergy is a major public health concern, affecting ∼8% of US children or 5.6 million children. In addition to the top 8 food allergens recognized by the US Food and Drug Administration, sesame is the ninth most common food allergy and affects ∼150 000 US children. All foods have the potential to cause severe reactions; however, currently only 40% of children with convincing food allergies have an epinephrine autoinjector.This study confirms the epidemiology of childhood food allergy previously reported; however, by eliminating children with symptoms isolated to the mouth or the gastrointestinal tract only (other than vomiting) (especially if they have a history of physician diagnosis of food allergy), the rates may be underestimated. The PRACTALL guidelines offer a standardized scoring system for allergic reactions in the context of oral food challenges and could be adapted as a survey tool. Of note, these guidelines include gastrointestinal or subjective symptoms that last longer than 40 minutes or recur consistently after 3 exposures as indicative of a convincing allergic reaction. Because the National Institutes of Health guidelines changed in 2017 to recommend early, rather than delayed, introduction of peanut into an infant’s diet, this study will serve as an important baseline to which prevalence rates may be compared.

Prevalence of adverse childhood experiences (ACEs) among US children.

The purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs. Data were drawn from the nationally representative 2016 National Survey of Children's Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs. The study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child's age, family structure, poverty, type of health insurance, and SHCN status. We found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level.

Solutions for Asthma Disparities.

Childhood asthma prevalence has plateaued and may have declined for the first time since 1980.1 Although this news is promising, it is important not to lose sight of the significant disparities in asthma outcomes that remain by race, ethnicity, and socioeconomic status. We must reduce these disparities, and health care organizations’ increasing focus on population health presents a prime opportunity to do so. Now is a critical time to invest in research and quality improvement initiatives that directly target the persistent disparities in childhood asthma outcomes. Disparities in asthma outcomes have been documented since the 1980s. Children of racial or ethnic minorities face higher morbidity and mortality due to asthma when compared with white children. Non-Hispanic African American children have 2 to 3 times higher rates of hospitalization and emergency department visits compared with non-Hispanic white children. African American children face a 4.9-fold higher asthma mortality rate. In addition, Hispanic children are 2 times more likely to visit an emergency department and 1.5 times more likely to die due to asthma when compared with non-Hispanic children.2 Numerous individual- and system-level factors contribute to asthma disparities, including health care policies, health systems operations, and clinician, patient, family, and environmental factors. For example, minority children are less likely to be prescribed a controller medication when indicated and are less likely to adhere to therapy that is prescribed. Additional factors driving disparities include clinic-centric care, indoor allergen exposure, limited primary … Address correspondence to Anna Volerman, MD, Departments of Medicine and Pediatrics, University of Chicago, 5841 S Maryland Ave, MC 2007, Chicago, IL, 60637. E-mail: avolerman{at}uchicago.edu

Phenotypic Characterization of Juvenile Idiopathic Arthritis in African American Children.

Juvenile idiopathic arthritis (JIA) affects children of all races. Prior studies suggest that phenotypic features of JIA in African American (AA) children differ from those of non-Hispanic white (NHW) children. We evaluated the phenotypic differences at presentation between AA and NHW children enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, and replicated the findings in a JIA cohort from a large center in the southeastern United States. Children with JIA enrolled in the multicenter CARRA Registry and from Emory University formed the study and replication cohorts. Phenotypic data on non-Hispanic AA children were compared with NHW children with JIA using the chi-square test, Fisher's exact test, and the Wilcoxon signed-rank test. In all, 4177 NHW and 292 AA JIA cases from the CARRA Registry and 212 NHW and 71 AA cases from Emory were analyzed. AA subjects more often had rheumatoid factor (RF)-positive polyarthritis in both the CARRA (13.4% vs 4.7%, p = 5.3 × 10(-7)) and the Emory (26.8% vs 6.1%, p = 1.1 × 10(-5)) cohorts. AA children had positive tests for RF and cyclic citrullinated peptide antibodies (CCP) more frequently, but oligoarticular or early onset antinuclear antibody (ANA)-positive JIA less frequently in both cohorts. AA children were older at onset in both cohorts and this difference persisted after excluding RF-positive polyarthritis in the CARRA Registry (median age 8.5 vs 5.0 yrs, p = 1.4 × 10(-8)). Compared with NHW children, AA children with JIA are more likely to have RF/CCP-positive polyarthritis, are older at disease onset, and less likely to have oligoarticular or ANA-positive, early-onset JIA, suggesting that the JIA phenotype is different in AA children.

Parent and teacher ratings of attention-deficit/hyperactivity disorder symptoms: Factor structure and normative data.

Comprehensive assessment of attention-deficit/hyperactivity disorder (ADHD) symptoms includes parent and teacher questionnaires. The ADHD Rating Scale-5 was developed to incorporate changes for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). This study examined the fit of a correlated, 2-factor structure of ADHD (i.e., DSM-5 conceptual model) and alternative models; determined whether ADHD symptom ratings varied across teacher and child demographic characteristics; and presented normative data. Two samples were included: (a) 2,079 parents and guardians (1,131 female, 948 male) completed ADHD symptom ratings for children (N = 2,079; 1,037 males, 1,042 females) between 5 and 17 years old (M = 10.68; SD = 3.75) and (b) 1,070 teachers (766 female, 304 male) completed ADHD symptom ratings for students (N = 2,140; 1,070 males, 1,070 females) between 5 and 17 years old (M = 11.53; SD = 3.54) who attended kindergarten through 12th grade. The 2-factor structure was confirmed for both parent and teacher ratings and was invariant across child gender, age, informant, informant gender, and language. In general, boys were higher in symptom frequency than girls; older children were rated lower than younger children, especially for hyperactivity-impulsivity; and non-Hispanic children were rated higher than Hispanic children. Teachers also rated non-Hispanic African American children higher than non-Hispanic White, Asian, and Hispanic children. Non-Hispanic White teachers provided lower hyperactivity-impulsivity ratings than non-Hispanic, African American, and Hispanic teachers. Normative data are reported separately for parent and teacher ratings by child gender and age. The merits of using the ADHD Rating Scale-5 in a multimodal assessment protocol are discussed. (PsycINFO Database Record

The Association of Race With Childhood Uveitis.

To identify risk factors for a severe uveitis course among children with noninfectious uveitis. Retrospective cohort study. This was a retrospective analysis of a prospectively collected database. Records of 94 children with uveitis were reviewed at enrollment and every 3-6months (2011-2015). Severe uveitis was defined as a history of ocular complications or a visual acuity (VA) of ≤20/200. Children were compared by disease, VA, complications, and race. Regression models were used to model risk factors for severe disease. When examining race, we focused on non-Hispanic African-American and non-Hispanic white children only. Of 85 children with uveitis and complete ocular examinations, 27 (32%) had a history of a VA of ≤20/200. A subanalysis of non-Hispanic African-American and white children showed an increased prevalence of VA ≤20/200 in non-Hispanic African-Americans (18/25; 72% vs 4/43; 9%). Non-Hispanic African-Americans were more likely to be diagnosed at an older age (P= .030) and to have intermediate uveitis (P= .026), bilateral disease (P= .032), a history of VA ≤20/50 (P= .002), VA ≤20/200 (P< .001), and a higher rate of complications (P<.001). On multivariable analysis, non-Hispanic African-American race was a significant predictor ofblindness (OR= 31.6, 95% CI 5.9-168.5, P<.001), after controlling for uveitis duration. Non-Hispanic African-Americans also developed 2.2 times more unique complications per year of disease than non-Hispanic whites when controlling for uveitis type and duration. There appear to be racial differences in the outcomes of children with uveitis. Non-Hispanic African-American children with non-juvenile idiopathic arthritis-associated uveitis may have worse visual outcomes with increased vision loss and ocular complications. These findings highlight the need for future studies in minority populations.

Correlates of Fruit and Vegetable Intakes in US Children

The objective of this study was to assess the quality of the current intakes of fruits and vegetables compared to the Dietary Guidelines for Americans in US children and adolescents and identify factors related to low fruit and vegetable intake. This descriptive study examined differences in fruit and vegetable intakes by age, sex, ethnicity, poverty level, body mass index, and food security status utilizing data from the 1999-2002 National Health and Nutrition Examination Survey. Six thousand five hundred thirteen children and adolescents ages 2 to 18 years, who were respondents to the 1999-2002 National Health and Nutrition Examination Survey. Mean fruit and vegetable intakes were computed using 24-hour recalls for individuals and compared using analysis of variance. Leading contributors to fruit and vegetable intake were identified using frequency analysis. Children aged 2 to 5 years had significantly higher total fruit and juice intakes than 6- to 11- and 12- to 18-year-olds. Total vegetable and french fry intake was significantly higher among 12- to 18-year-old adolescents. Regarding sex differences, boys consumed significantly more fruit juice and french fries than girls. In addition, non-Hispanic African-American children and adolescents consumed significantly more dark-green vegetables and fewer mean deep-yellow vegetables than Mexican-American and non-Hispanic white children and adolescents. Total fruit consumption also differed significantly among race/ethnicities and household income. Children and adolescents most at risk for higher intakes of energy-dense fruits and vegetables (fruit juice and french fries) were generally boys, and adolescents, at risk for overweight or overweight and living in households below 350% of the poverty level.

Response to “Commentary on ‘Agricultural exposures and gastric cancer risk in Hispanic farm workers in California’”: (P.K. Mills, R.C. Yang, Environ. Res. 104 (2007) 282–289)

To identify risk factors for a severe uveitis course among children with noninfectious uveitis.Retrospective cohort study.This was a retrospective analysis of a prospectively collected database. Records of 94 children with uveitis were reviewed at enrollment and every 3–6 months (2011–2015). Severe uveitis was defined as a history of ocular complications or a visual acuity (VA) of ≤20/200. Children were compared by disease, VA, complications, and race. Regression models were used to model risk factors for severe disease. When examining race, we focused on non-Hispanic African-American and non-Hispanic white children only.Of 85 children with uveitis and complete ocular examinations, 27 (32%) had a history of a VA of ≤20/200. A subanalysis of non-Hispanic African-American and white children showed an increased prevalence of VA ≤20/200 in non-Hispanic African-Americans (18/25; 72% vs 4/43; 9%). Non-Hispanic African-Americans were more likely to be diagnosed at an older age (P = .030) and to have intermediate uveitis (P = .026), bilateral disease (P = .032), a history of VA ≤20/50 (P = .002), VA ≤20/200 (P < .001), and a higher rate of complications (P < .001). On multivariable analysis, non-Hispanic African-American race was a significant predictor of blindness (OR = 31.6, 95% CI 5.9–168.5, P < .001), after controlling for uveitis duration. Non-Hispanic African-Americans also developed 2.2 times more unique complications per year of disease than non-Hispanic whites when controlling for uveitis type and duration.There appear to be racial differences in the outcomes of children with uveitis. Non-Hispanic African-American children with non–juvenile idiopathic arthritis–associated uveitis may have worse visual outcomes with increased vision loss and ocular complications. These findings highlight the need for future studies in minority populations.