Pacific Island Children Research Articles

Prevalence and Correlates of Unstable Housing Among US Children

Housing instability is an important public health issue, particularly for children. This study provides nationally representative estimates of unstable housing among US children. To examine unstable housing prevalence; differences by sociodemographic characteristics, health, and state of residence; and associations with other hardships. This survey study examined data from the 2022 National Survey of Children's Health, a population-based, nationally representative survey of randomly selected children whose parent or caregiver responded to an address-based mail or web-based survey. Participants were children aged 0 to 17 years living in households in the 50 US states and District of Columbia (N = 54 103). Bivariate analyses tested for observed differences in unstable housing between groups; logistic regression models tested for significant disparities. Associations between unstable housing and health care and food-related hardships, neighborhood conditions, and adverse childhood experiences were examined. Unstable housing experiences. Unstable housing, comprising 3 indicators: inability to pay mortgage or rent on time in the past 12 months, 2 or more moves in the past 12 months, and homelessness in the child's lifetime. Analyses were adjusted for child age and family poverty ratio. Secondary analyses examine caregiver-reported stress or worry about eviction, foreclosure, or condemned housing in the past 12 months. Weighted prevalence estimates accounted for probability of selection and nonresponse. In 2022, 17.1% (95% CI, 16.4%-17.8%) of children living in US households, representing more than 12.1 million children, experienced 1 or more forms of unstable housing: 14.1% (95% CI, 13.4%-14.7%) lived in households that were unable to pay mortgage/rent, 2.9% (95% CI, 2.6%-3.3%) moved frequently, and 2.5% (95% CI, 2.2%-2.8%) experienced lifetime homelessness. Additionally, 9.0% (95% CI, 8.5%-9.5%) of children had caregivers who reported stress/worry over housing. Prevalence of unstable housing varied across states (range, 12.0%-26.6%). Unstable housing was highest among American Indian or Alaska Native children (27.9%; 95% CI, 21.3%-35.6%), Black or African American children (30.4%; 95% CI, 27.8%-33.1%), and Native Hawaiian or Pacific Islander children (27.6%; 95% CI, 16.6%-42.1%) and also differed by special health care needs, family poverty ratio, caregiver education and unemployment status, and whether the family rented or owned their home. Unstable housing was associated with all other types of hardships examined. This study found that 1 in 6 US children experienced unstable housing, varying by state and sociodemographic factors. The prevalence is likely underestimated because the sample excluded children who are currently institutionalized or experiencing homelessness. Results may help move the field toward a unified national definition of unstable housing for families with children and lead to clinically appropriate and evidence-based screening and interventions to support housing stability and improve children's health.

Pubertal Timing Across Asian American, Native Hawaiian, and Pacific Islander Subgroups

Earlier puberty is associated with adverse health outcomes, such as mental health issues in adolescence and cardiometabolic diseases in adulthood. Despite rapid growth of the Asian American, Native Hawaiian, and Pacific Islander populations in the US, limited research exists on their pubertal timing, potentially masking health disparities. To examine pubertal timing among Asian American, Native Hawaiian, and Pacific Islander children and adolescents by disaggregating ethnic subgroups. This retrospective cohort study included Asian American, Native Hawaiian, and Pacific Islander youths aged 5 to 18 years assessed for pubertal development at Kaiser Permanente Northern California, a large, integrated health care delivery system. Follow-up occurred from March 2005, through December 31, 2019. Data were analyzed in October 2023. Race and ethnicity, categorized into 11 ethnic subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Native Hawaiian and Pacific Islander, Other South Asian, Other Southeast Asian, Vietnamese, multiethnic, and multiracial. Pubertal timing was determined using physician-assessed sexual maturity ratings (SMRs). Outcomes included the median age at transition from SMR 1 (prepubertal) to SMR 2 or higher (pubertal) for onset of genital development (gonadarche) in boys, breast development (thelarche) in girls, and pubic hair development (pubarche) in both boys and girls. In this cohort of 107 325 Asian American, Native Hawaiian, and Pacific Islander children and adolescents (54.61% boys; 12.96% Asian Indian, 22.24% Chinese, 26.46% Filipino, 1.80% Japanese, 1.66% Korean, 1.96% Native Hawaiian and Pacific Islander, 0.86% Other South Asian, 3.26% Other Southeast Asian, 5.99% Vietnamese, 0.74% multiethnic, and 22.05% multiracial), the overall median ages for girls' pubarche and thelarche were 10.98 years (95% CI, 10.96-11.01 years) and 10.13 years (95% CI, 10.11-10.15 years), respectively. For boys' pubarche and gonadarche, median ages were 12.08 years (95% CI, 12.06-12.10 years) and 11.54 years (95% CI, 11.52-11.56 years), respectively. Differences between subgroups with earliest and latest median age at onset were 14 months for girls' pubarche, 8 months for thelarche, 8 months for boys' pubarche, and 4 months for gonadarche. In general, Asian Indian, Native Hawaiian and Pacific Islander, and Other South Asian subgroups had the earliest ages at onset across pubertal markers, while East Asian youths exhibited the latest onset. Restricting to those with healthy body mass index did not substantially change the findings. In this cohort study of Asian American, Native Hawaiian, and Pacific Islander children and adolescents, pubertal timing varied considerably across ethnic subgroups. Further investigation is warranted to assess whether these differences contribute to observed health disparities in adulthood, such as type 2 diabetes and cardiovascular diseases.

Children With Special Health Care Needs: An Analysis of National Survey of Children's Health Database.

Background Children with Special Health Care Needs (CSHCN) represent a diverse pediatric population requiring healthcare services beyond typical childhood needs. This study analyzes data from the 2016-2020 National Survey of Children's Health Database to elucidate demographic patterns, prevalence rates, and nuanced factors influencing the health and well-being of CSHCN. Methods This retrospective observational study focuses on children aged 0-17 who are identified as CSHCN based on Maternal and Child Health Bureau criteria. A comprehensive analysis of the National Survey of Children's Health (NSCH) database examines key variables, including health outcomes, healthcare utilization, parental-reported health status, and socio-demographic factors. Stratified random sampling ensures national representation. Results The study encompassed 40,335 patients, revealing that 14.6% (CI: 14.0-15.3, n=6,445) of CSHCN received care in a well-functioning system. Across age groups, 19.1% (CI: 14.0-15.3, n=6,445) of CSHCN aged 0-5 received ongoing treatment, contrasting with 5.7% (CI: 5.2-6.2, n=1,599) in the 12-17 years group. Males exhibited a prevalence of 15% (CI: 14.1-15.9, n=3,674), and females had 14.2% (CI: 13.2-15.2, n=2,771). Racial disparities were noted; non-Hispanic Native Hawaiian/Other Pacific Islander children had a 3% (CI: 1.1-8.1, n=6) prevalence. Across Federal Poverty Level categories, prevalence ranged from 12.5% (CI: 11.5-13.6, n=1,753) to 17.7% (CI: 16.6-18.9, n=2,856). Notably, 18.5% (CI: 17.4-19.7, n=3,515) of children without adverse experiences were CSHCN. Among CSHCN in two-parent currently married households, 15.9% (CI: 15.0-16.8, n=4,330) received treatment, while those in unmarried households had a prevalence of 12.9% (CI: 10.5-15.7, n=335). CSHCN with parents born in the United Statesshowed a prevalence of 15.4% (CI: 14.7-16.1, n=5,257). Conclusion This study provides valuable insights into the prevalence and demographic patterns of CSHCN. Limitations include potential recall bias and the retrospective study design. Despite these constraints, the findings lay a foundation for future research and targeted interventions, fostering a deeper understanding of the evolving landscape of pediatric healthcare in the United States.

Abstract 66: US Asian and Pacific Islander Adolescents With Obesity Have Triple the Risk of Prediabetes When Compared to Non Hispanic White Children

Introduction: Race and ethnicity and elevated body mass index (BMI) are risk factors for pre-diabetes (preDM) among adolescents. We recently observed high preDM prevalence among aggregated US Asian and Pacific Islander (API) children with obesity, but data pertaining to disaggregated API subgroups remain limited. Aim: To examine the risk of preDM among API subgroups compared to non-Hispanic White (NHW) adolescents with obesity. Methods: This retrospective study included 3233 API and 4150 NHW children age 13-17y with obesity and without DM who were identified at preventive health well-child visits in 2016-2019 and had hemoglobin A1c (HA1c) measured within 1 year of the visit. Visit data included self-reported diet/lifestyle behaviors and BMI measurement. PreDM (outcome) was defined by HA1c 5.7-6.4%. Obesity was categorized as Class 1-3 based on BMI percent of the 95th BMI percentile (obesity threshold). Four obesogenic behaviors were ascertained from clinic data: Fruit/vegetable consumption <5 servings/day; juice/sugary beverage intake >12 ounces/day; exercising <60 minutes/day; and screen time 2+ hours/day. A neighborhood deprivation index (NDI) was calculated using area of residence and 2010 US Census data. Log binomial regression was used to examine the association of API ethnicity and preDM, reporting relative risk (RR) and 95% confidence intervals [CI]. Results: The cohort included 210 Chinese, 900 Filipino, 200 South Asian, 132 Southeast Asian, 283 Native Hawaiian/Pacific Islander (NHPI), 1508 other/unspecified API ethnicity, and 4150 NHW children. Overall, 22.4% of API vs 9.4% NHW (p<0.001) children had preDM. PreDM prevalence ranged from 19.1% for Chinese, 21.7% for Filipino, 22.5% for South Asian, 24.2% for Southeast Asian, to 26.5% for NHPI subgroups. After adjusting for age, sex, NDI, obesity class, and obesogenic health behaviors, risk of preDM was about 3-fold higher (RR 2.9 [2.6-3.4] for API compared to NHW adolescents, ranging from RR 2.5 [1.8-3.6] for Chinese, RR 2.8 [2.3-3.4] for Filipino, RR 3.1 [2.2- 4.4] for South Asian, RR 3.2 [2.1-4.9] for Southeast Asian, RR 3.3 [2.5-4.4] for NHPI, and RR 3.0 [2.5-3.5] for other/unspecified API children. Obesity severity (RR 1.4 [1.2-1.6] for Class 2 and RR 2.1 [1.7-2.6] for Class 3 compared to Class 1 obesity) was also associated with preDM risk. Conclusion: PreDM risk was about 3-fold higher for API compared to NHW children with obesity even after adjusting for sociodemographic, lifestyle, and BMI differences. The risk of preDM ranged from 2.5-fold to 3.3-fold higher for the major API subgroups, especially Southeast Asian and Filipino groups compared to NHW children. These findings highlight the importance of preDM screening among API children and demonstrate heterogeneity of risk among API subgroups. Future efforts should focus on effective screening and monitoring of at-risk populations to prevent progression to Type 2 DM.

Alanine aminotransferase elevation varies by ethnicity among Asian and Pacific Islander children with overweight or obesity.

Limited research on alanine aminotransferase (ALT) screening for metabolic dysfunction-associated steatotic liver disease (MASLD) among US Asian/Pacific Islander (PI) children necessitates investigation in this heterogeneous population. Examine ALT elevation among Asian/PI children with overweight or obesity. Elevated ALT prevalence (clinical threshold) and association with body mass index ≥85th percentile were compared among 18 402 Asian/PI and 25 376 non-Hispanic White (NHW) children aged 9-17 years using logistic regression. ALT elevation was more prevalent among Asian/PI (vs. NHW) males with overweight (4.0% vs. 2.7%), moderate (7.8% vs. 5.3%) and severe obesity (16.6% vs. 11.5%), and females with moderate (5.1% vs. 3.0%) and severe obesity (10.2% vs. 5.2%). Adjusted odds of elevated ALT were 1.6-fold and ~2-fold higher for Asian/PI (vs. NHW) males and females (with obesity), respectively. Filipino, Chinese and Southeast Asian males had 1.7-2.1-fold higher odds, but Native Hawaiian/PI (NHPI) and South Asian males did not significantly differ (vs. NHW). Filipina and Chinese females with obesity had >2-fold higher odds, Southeast and South Asian females did not differ and NHPI findings were mixed (vs. NHW). High elevated ALT prevalence among Asian/PI children with overweight and obesity emphasizes the need for MASLD risk assessment and examination of ethnic subgroups.

Racial Inequities in Mortality Rate in Hospitalized Children

Background and ObjectivesRacial/ethnic inequities for inpatient mortality in children at a national level in the U.S. have not been explored. The objective of this study was to evaluate differences in inpatient mortality rate among different racial/ethnic groups, using the Kids' Inpatient Database. MethodsA cross-sectional study of children of ages greater than 28 days and less than 21 years discharged during 2012 and 2016. Racial/ethnic groups - White, Black, Hispanic, Asian and Pacific Islander and Native Americans were analyzed in two cohorts, Cohort A (all discharges) and Cohort B (ventilated children). ResultsA total of 4,247,604 and 79,116 discharges were included in cohorts A and B, respectively. Univariate analysis showed that the inpatient mortality rate was highest among Asian and Pacific Islander children for both cohorts: A (0.47% [0.42–0.51]), B (10.9% [9.8–12.1]). Regression analysis showed that Asian and Pacific Islander and Black children had increased odds of inpatient mortality compared to White children: A (1.319 [1.162–1.496], 1.178 [1.105–1.257], respectively) and B (1.391 [1.199–1.613], 1.163 [1.079–1.255], respectively). Population-based hospital mortality was highest in Black children (1.17 per 10,000 children). ConclusionsInpatient mortality rates are significantly higher in U.S. children of Asian and Pacific Islander and Black races compared to White children. U.S. population-based metrics such as hospitalization rate, ventilation rate, and hospital mortality rate are highest in Black children. Our data suggest that lower median household income alone may not account for a higher inpatient mortality rate. The causes and prevention of racial and ethnic inequities in hospitalized children need to be explored further.

Risk of Incident Asthma Among Young Asian American, Native Hawaiian, and Pacific Islander Children from Age 3 to 7 Years in a Northern California Healthcare System

Incident childhood asthma risk has not been examined among diverse Asian American, Native Hawaiian, and Pacific Islander subgroups. In a large California healthcare system, incident asthma was higher among young Filipino/a, Native Hawaiian/Pacific Islander, and South Asian children compared with non-Hispanic White children, whereas Chinese and Japanese children were similar.

Healthier Together: Implementation and evaluation of a co-designed, culturally tailored childhood obesity community prevention program for Māori and Pacific Islander children and families.

Co-designed and culturally tailored preventive initiatives delivered in childhood have high potential to close the cross-cultural gap in health outcomes of priority populations. Māori and Pacific Islander people living in Australia exhibit a higher prevalence of overweight and obesity and higher rates of multimorbidity, including heart disease, cancer and diabetes. This mixed-methods, pilot implementation and evaluation study, aimed to evaluate the implementation of a community-based, co-designed and culturally tailored childhood obesity prevention program, using quantitative (pre-post anthropometric measurement, pre-post health behaviour questionnaire) and qualitative (semi-structured interview) methods. Sessions relating to healthy eating, physical activity and positive parenting practices were delivered to families residing in Brisbane (Australia) over 8-weeks. Data were collected from a total of 66 children (mean age 11, SD 4) and 38 parents (mean age 40, SD 8) of Māori and Pacific Islander background, from July 2018 to November 2019. Anthropometric changes included a reduction in Body Mass Index (BMI) z-score among 59% of children (median change -0.02, n = 38, p = 0.17) and BMI among 47% of adults (median change +0.06 kg/m2, n = 18, p = 0.64). Significant improvements (p < 0.05) in self-reported health behaviours from pre- to post-program included increased vegetable consumption among children, decreased discretionary food intake of children, decreased discretionary drink consumption among both children and adults, increased minutes of daily physical activity among adults and increased parental confidence in the healthy diets of their children. Qualitative data revealed participants valued the inclusion of all family members, learning of practical skills and cultural tailoring delivered by the Multicultural Health Coaches. This study provides preliminary evidence that the Healthier Together program improved self-reported health behaviours and physical activity levels among Māori and Pacific Islander children and their families in the short-term; however, due to the small sample size, these results must be interpreted carefully. The program empowered change via cultural tailoring and accessibility; however, long-term implementation and evaluation with a larger cohort is needed to validate the observed health behaviour improvements and their sustainability. SO WHAT?: The co-design framework that informed program development and key learnings of implementation will provide guidance to health practitioners, health workers, public health professionals and policy makers to develop inclusive and pragmatic co-design solutions for priority cultural populations in Australia. Health outcomes will improve as a result, promoting health equity for future generations.

Racial and Ethnic Differences in Factors Associated With Delayed or Missed Pediatric Preventive Care in the US Due to the COVID-19 Pandemic

The COVID-19 pandemic has disrupted medical care use. Yet information on how the pandemic has affected pediatric preventive care use in the US is lacking. To examine the prevalence of and risk and protective factors for delayed or missed pediatric preventive care in the US due to the COVID-19 pandemic, further stratified by race and ethnicity to assess associations by groups. This cross-sectional study used data from the 2021 National Survey of Children's Health (NSCH) collected between June 25, 2021, and January 14, 2022. Weighted data from the NSCH survey are representative of the population of noninstitutionalized children aged 0 to 17 years in the US. For this study, race and ethnicity were reported as American Indian or Alaska Native, Asian or Pacific Islander, Hispanic, non-Hispanic Black, non-Hispanic White, or multiracial (≥2 races). Data analysis was performed on February 21, 2023. The Andersen behavioral model of health services use was used to assess predisposing factors, enabling factors, and need factors. The main outcome was delayed or missed pediatric preventive care due to the COVID-19 pandemic. Bivariate and multivariable Poisson regression analyses were performed using multiple imputation with chained equations. Of the 50 892 NSCH respondents, 48.9% were female and 51.1% were male; their mean (SD) age was 8.5 (5.3) years. With regard to race and ethnicity, 0.4% were American Indian or Alaska Native, 4.7% were Asian or Pacific Islander, 13.3% were Black, 25.8% were Hispanic, 50.1% were White, and 5.8% were multiracial. More than one-fourth of children (27.6%) delayed or missed preventive care. In multivariable Poisson regression using multiple imputation, Asian or Pacific Islander children (prevalence ratio [PR], 1.16 [95% CI, 1.02-1.32]), Hispanic children (PR, 1.19 [95% CI, 1.09-1.31]), and multiracial children (PR, 1.23 [95% CI, 1.11-1.37]) were more likely to have delayed or missed preventive care compared with non-Hispanic White children. Among non-Hispanic Black children, risk and protective factors included age 6 to 8 years (vs 0-2 years [PR, 1.90 (95% CI, 1.23-2.92)]) and difficulty covering basic needs somewhat or very often (vs never or rarely [PR, 1.68 (95% CI, 1.35-2.09)]). Among multiracial children, risk and protective factors included age 9 to 11 years (vs 0-2 years [PR, 1.73 (95% CI, 1.16-2.57)]), lower household income (<100% vs ≥400% federal poverty level: 0.52 [0.35-0.79]), and 2 or more vs 0 health conditions (PR, 1.54 [95% CI, 1.14-2.08]). Among non-Hispanic White children, risk and protective factors included older age (9-11 years vs 0-2 years [PR, 2.05 (95% CI, 1.78-2.37)]), 4 or more children vs 1 child in the household (PR, 1.22 [95% CI, 1.07-1.39]), fair or poor vs excellent or very good caregiver health (PR, 1.32 [95% CI, 1.18-1.47]), difficulty covering basic needs somewhat or very often (vs never or rarely [PR, 1.36 (95% CI, 1.22-1.52)]), good vs excellent or very good perceived child health (PR, 1.19 [95% CI, 1.06-1.34]), and 2 or more vs 0 health conditions (PR, 1.25 [95% CI, 1.12-1.38]). In this study, the prevalence of and risk factors for delayed or missed pediatric preventive care varied by race and ethnicity. These findings may guide targeted interventions to enhance timely pediatric preventive care among different racial and ethnic groups.

Pacific Island children: The use of maps in helping better understand children's lives

Children's voices have been little heard in the Pacific research. The United Nations Convention on the Rights of the Child 1989 asserts the child's right to have a say on matters that affect them and for their views to be considered. There has been massive growth in technologically assisted participative research; however, we argue the value of hand drawn maps should not be underestimated in the rush to engage with more advanced techniques. We present data from 267 neighbourhood maps drawn by children in Fiji, Kiribati, Samoa and New Zealand. To better understand the social construction of knowledge in children's everyday lives, we propose two models to conceptualise the complexity of their world, a social connection and a spatial connection model. These models reveal how Pacific Island children negotiate different levels of social connection from home, family, and community through to transnational kinship relations. People, specifically family, provide the geographic basis on which their spatial encounters are overlaid. Irrespective of country or rural/urban/atoll setting, it is social space that is the strongest connector for children as displayed in their maps. Application of our models can be used to reveal how knowledge is socially constructed in Pacific children's everyday lives.

The Prevalence and Characteristics of Children With Profound Autism, 15 Sites, United States, 2000-2016.

Autism spectrum disorder (autism) is a heterogeneous condition that poses challenges in describing the needs of individuals with autism and making prognoses about future outcomes. We applied a newly proposed definition of profound autism to surveillance data to estimate the percentage of children with autism who have profound autism and describe their sociodemographic and clinical characteristics. We analyzed population-based surveillance data from the Autism and Developmental Disabilities Monitoring Network for 20 135 children aged 8 years with autism during 2000-2016. Children were classified as having profound autism if they were nonverbal, were minimally verbal, or had an intelligence quotient <50. The percentage of 8-year-old children with profound autism among those with autism was 26.7%. Compared with children with non-profound autism, children with profound autism were more likely to be female, from racial and ethnic minority groups, of low socioeconomic status, born preterm or with low birth weight; have self-injurious behaviors; have seizure disorders; and have lower adaptive scores. In 2016, the prevalence of profound autism was 4.6 per 1000 8-year-olds. The prevalence ratio (PR) of profound autism was higher among non-Hispanic Asian/Native Hawaiian/Other Pacific Islander (PR = 1.55; 95 CI, 1.38-1.73), non-Hispanic Black (PR = 1.76; 95% CI, 1.67-1.86), and Hispanic (PR = 1.50; 95% CI, 0.88-1.26) children than among non-Hispanic White children. As the population of children with autism continues to change, describing and quantifying the population with profound autism is important for planning. Policies and programs could consider the needs of people with profound autism across the life span to ensure their needs are met.

Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020.

Autism spectrum disorder (ASD). 2020. The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code. For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites.Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range=17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota.Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months). For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates are higher than previous ADDM Network estimates during 2000-2018. For the first time among children aged 8 years, the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past. Black children with ASD were still more likely than White children with ASD to have a co-occurring intellectual disability. The continued increase among children identified with ASD, particularly among non-White children and girls, highlights the need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD. Similar to previous reporting periods, findings varied considerably across network sites, indicating the need for additional research to understand the nature of such differences and potentially apply successful identification strategies across states.

Racial and Ethnic Disparities in Length of Stay for Common Pediatric Diagnoses: Trends From 2016 to 2019.

Inequities in pediatric illness include unequal treatment and outcomes for children of historically marginalized races/ethnicities. Length of stay (LOS) is used to assess health care quality and is associated with higher costs/complications. Studies show LOS disparities for Black and Hispanic children in specific diagnoses, but it is unclear how broadly they exist or how they change over time. We examined the association between race/ethnicity and LOS longitudinally for the most common pediatric inpatient diagnoses. We used the 2016 and 2019 Kids' Inpatient Databases. The 10 most frequent diagnoses in 2016 were determined. For each diagnosis in each year, we assessed the association between race and LOS by fitting a generalized linear mixed effects model with a negative binomial distribution, accounting for clustering and confounding. Using descriptive statistics, we compared associations between the 2 years for trends over time. Our analysis included >450 000 admissions and revealed significantly longer LOS for Black, Hispanic, and/or Asian American or Pacific Islander, Native American, and other children in 8 of the 10 diagnoses in 2016, with mixed changes over time. Three new disparities emerged in 2019. The largest disparities were for Black children in most diagnoses. Kids' Inpatient Database data showed longer LOS for children of historically marginalized race/ethnicity with common pediatric inpatient diagnoses, which largely persisted from 2016 to 2019. There is no plausible biological explanation for these findings, and inequities in social needs, access to care, and quality of care likely contribute. Future directions include further study to understand and address contributing factors.

Returning Children to the ’Āina and Fanua: Indigenous Survivance in Pacifica Early Childhood

Researchers of child learning and development continue to hone understandings of cultural and social impacts on cognition, development, and education. Concurrently, Indigenous educators call for decolonizing schooling at all levels. Land-based education (LBE), as an instructional approach, responds to calls to decolonize education. The authors use LBE to understand the cultural and social nuances and complexities of Indigenous learning in preschool and primary school age Native Hawaiian and Pacific Islander children. Through ethnographic case studies in Hawai’i and Sāmoa, we expand conceptions of culture in learning to attune to the diversity and specificity of Indigenous contexts, argue that LBE must be place-based, and recognize land is an active and necessary coparticipant in the learning process.

Scoping review protocol of multicomponent interventions to address cardiometabolic disease risk among Pacific Islander children.

Multicomponent interventions can reduce cardiometabolic disease (CMD) risk factors in childhood; however, little synthesis of the literature has taken place in the Pacific region. Pacific Islanders experience a disproportionately high prevalence of CMD risk factors, yet interventions have been slow to reach many communities. We present this protocol for a scoping review to identify and summarize existing multicomponent interventions to address CMD risk in Pacific Islander children. Eligible interventions will (1) address CMD risk factors (including but not limited to obesity, hyperglycemia, dyslipidemia, elevated blood pressure, and/or health behaviors) in 2-to-12-year-old Pacific Islander children, and (2) be multi-component (including at least two lifestyle/behavior change strategies to address CMD risk factors). To investigate existing interventions for adaptation and potential use in Pacific Islander communities, we will search Scopus, MEDLINE ALL (Ovid), EMBASE (Ovid), Yale-licensed Web of Science Core Collection, Cochrane Library, CINAHL (EBSCOhost), ProQuest Dissertations & Theses Global, Global Health (EBSCO), non-indexed Pacific journals, grey literature, government reports, and clinical trial registrations. The Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Scoping Reviews will guide data extraction, evidence mapping, synthesis, and reporting of information including study population, intervention components, behavioral changes, health and implementation outcomes, theoretical frameworks, and evaluation measures. Formal ethical approval is not required. The dissemination strategy will include peer-reviewed journal publications and presentations. Synthesis of existing multicomponent interventions for Pacific Islander children will help to identify best practices that could be replicated, adapted, or combined.

31: CHILDHOOD OPPORTUNITY INDEX AMONG CRITICALLY ILL CHILDREN: A MULTICENTER, RETROSPECTIVE COHORT STUDY

Introduction: Children from impoverished neighborhoods have increased likelihood of severity of illness and pediatric intensive care unit (PICU) admission. Existing metrics to score environmental influences do not account for the diverse range of factors that could impact child health. The Childhood Opportunity Index (COI), a metric of local and regional neighborhood factors, highlights social disparities that impact childhood wellbeing. We sought to characterize COI among critically ill children and explore for potential relationships between COI and poor clinical outcomes. Methods: We performed a retrospective, multicenter cohort study including children (< 18 years) admitted to 47 PICUs from January 2018 through December 2019 using the Pediatric Hospital Information System registry. COI for each patient encounter was characterized by demographic data including race and United States Census Geographic Regions. For exploratory modelling, clinical outcomes were index mortality and hospital length of stay (LOS). Descriptive, comparative (chi-square, ANOVA, and Kruskal-Wallis tests), and associative (logistic/linear modelling) statistics were employed. Results: Of the 26,912 children studied, 44.8% resided in low or very low COI neighborhoods. Hispanic and Black children more frequently resided in very low COI areas (35.4% and 47.7%, respectively) as compared to White (15.7%), Asian (10.7%), and Pacific Islander (11.5%) children. COI varied by region with the East South-Central region having the greatest frequency of critically ill children from very low (27.1%) and low (28.5%) COI neighborhoods. The New England region showed the greatest proportion of PICU encounters from very high COI areas (35.5%) (p < 0.001). Exploratory models found COI to be inversely associated with mortality (odds ratio 0.91, 95% confidence interval 0.85-0.96) and LOS (p < 0.001). Conclusions: This large, multicenter study revealed racial and geographic variation in COI among hospitalized critically ill children. Those residing in lower COI neighborhoods experienced a greater risk of mortality and prolonged LOS. Our findings suggest that utilization of COI in identifying potentially modifiable environmental factors can inform public health initiatives and further research towards reducing health inequity.

The long-term outcome of New Zealand Maori and Pacific Island children diagnosed with childhood onset lupus nephritis.

To determine the long-term outcome of Maori and Pacific Island children diagnosed with childhood onset lupus nephritis. A chart review was conducted of children diagnosed with biopsy proven lupus nephritis seen by the Starship Hospital and Kidz First paediatric rheumatology and/or Starship renal services between January 1992 and January 2018. Baseline and follow-up kidney histology, adherence and response to therapy including partial or full renal remission, refractory disease, end-stage kidney disease (ESKD) and mortality were determined. In a New Zealand cohort of 42 with childhood onset lupus nephritis, Maori and Pacific Island children were significantly more likely to develop class 4 lupus nephritis (RR (95% CI), 11.3 (3.84-49.9), p < 0.0001), demonstrate medication nonadherence (RR (95% CI) 12.4 (3.48-85.7), p < 0.0001) and experience end stage kidney disease (RR (95% CI) 15.7 (2.97-389.3), p = 0.0003) and mortality (RR (95% CI) 11.1 (1.91-280.1), p = 0.005) compared to non-Maori and Pacific Island children. In addition, Maori children with childhood onset lupus nephritis developed chronic histological changes significantly more rapidly than Pacific or Asian children (p = 0.038). Lupus nephritis is more common among Maori and Pacific Island children in New Zealand associated with a significant incidence of end stage kidney disease and mortality, with some Maori children developing rapid histologic disease progression.

Native Hawaiian and Pacific Islander children in foster care: A descriptive study of an overlooked child welfare population

To date, little to nothing is known about Native Hawaiian and Pacific Islander (NHPI) children in foster care although they are overrepresented in some of the child welfare systems in the United States and experience challenges stemming from structural colonialism and displacement. To highlight this often-overlooked population in child welfare research, the current study applied an indigenous model to understand who the NHPI children are in foster care by descriptively examining their sociodemographic, family of origin, geographic characteristics, as well as their placement status with relatives or foster parents who identify as NHPI. Data came from the Adoption and Foster Care Analysis Reporting System with a focus on the 2018 entry cohort (N = 763). One-way analysis of variance and chi-square analysis were used. Results showed that NHPI children in foster care were school-aged, most commonly entered foster care due to neglect, and were most likely to be placed with relatives. Non-relative foster parents were more likely than relative foster parents to care for NHPI children with disabilities, sexual abuse histories, and parental incarceration. Within non-relative foster families, those where at least one foster parent identified as NHPI were more likely to care for NHPI children with behavior problems or parental illness, compared to non-relative foster families where no foster parent identified as NHPI. NHPI children in relative foster families experienced the least placement disruptions, but relative foster families tended to be more socioeconomically disadvantaged and a smaller proportion of them received monthly foster care payments than non-relative foster families. The results suggest that child welfare practitioners and policymakers should prioritize financially supporting relatives as part of ensuring NHPI children’s wellbeing and preserving their connections to family and culture.

Urban and Rural Child Deaths from Motor Vehicle Crashes: United States, 2015-2019

The objective of the study was to examine child deaths in motor vehicle crashes by rurality, restraint use, and state child passenger restraint laws. 2015-2019 Fatality Analysis Reporting System data were analyzed to determine deaths and rates by passenger and crash characteristics. Optimal restraint use was defined using age and the type of the restraint according to child passenger safety recommendations. Death rates per 100 000 population were highest for non-Hispanic Black (1.96; [1.84, 2.07]) and American Indian or Alaska Native children (2.67; [2.14, 3.20]) and lowest for Asian or Pacific Islander children (0.57; [0.47, 0.67]). Death rates increased with rurality with the lowest rate (0.88; [0.84, 0.92]) in the most urban counties and the highest rate (4.47; [3.88, 5.06]) in the most rural counties. Children who were not optimally restrained had higher deaths rates than optimally restrained children (0.84; [0.81, 0.87] vs 0.44; [0.42, 0.46], respectively). The death rate was higher in counties where states only required child passenger restraint use for passengers aged ≤6years (1.64; [1.50, 1.78]) than that in those requiring child passenger restraint use for passengers aged ≤7 or ≤8 years (1.06; [1.01, 1.12]). Proper restraint use and extending the ages covered by child passenger restraint laws reduce the risk for child crash deaths. Additionally, racial and geographic disparities in crash deaths were identified, especially among Black and Hispanic children in rural areas. Decision makers can consider extending the ages covered by child passenger restraint laws until at least age 9 to increase proper child restraint use and reduce crash injuries and deaths.

Association of Race and Ethnicity with Pediatric Postoperative Pain Outcomes.

Inequitable variability in healthcare practice negatively affects patient outcomes. Children of color may receive different analgesic medications in the perioperative period, resulting in different outcomes. Medical records of children 0 to ≤ 18years old from May 2014 to August 2019 were reviewed. The exposure was racial or ethnic groups: Asian, Black, Hispanic, Pacific Islander, and White non-Hispanic (reference). post-anesthesia care unit mean pain score. inpatient mean pain score; opioid, antiemetic, and antipruritic administration in the post-anesthesia care unit and inpatient ward. The association of race or ethnicity with outcomes was modeled using multilevel logistic regression, adjusting for confounders and covariates. Twenty-nine thousand six hundred fourteen cases are included. In the post-anesthesia care unit, Black, Hispanic, and Pacific Islander children had no significant difference in the odds of receiving opioids or having moderate-severe pain as compared to White non-Hispanic patients; Asian children had lower odds of receiving opioids and lower odds of having a moderate-severe mean pain score. In the inpatient setting, Black, Hispanic, and Pacific Islander children had no significant difference in the odds of receiving opioids or having moderate severe-pain as compared to White non-Hispanic children, but Asian children had lower odds of receiving opioids and of having a moderate-severe mean pain score. Asian children had lower odds of receiving opioids and having moderate-severe pain postoperatively compared to the White non-Hispanic children. These differences may be a function of variation in patient/caregivers culture or healthcare provider care and warrant further investigation.