State Children's Health Research Articles

Academic Medicine and Rural Health System Partnerships: Enhancing Education While Advancing Physician Workforce Priorities.

A worsening shortage of rural physicians paralleling increasing health disparities demands attention. Past and ongoing efforts to address this shortage have had positive effects and can inform new strategies to achieve even greater impact. Interventions have included the development of regional medical school campuses and rural-focused tracks to recruit medical students from rural areas, expansion of rural-based graduate medical education (GME) programs and tracks, and use of institutional and individual financial incentives for rural-based training and/or practice. National policy has also taken aim at this challenge with provisions aimed at expanding rural GME in the Medicare, Medicaid, and State Children's Health Insurance Program Balanced Budget Refinement Act of 1999 and the Consolidated Appropriations Act of 2021. Additionally, several states have funded growth in GME, and supportive pathways for Medicare reimbursement and for Veterans Administration funding have been implemented. The authors recommend a new strategy for bolstering the rural physician workforce, focused on using academic-rural partnerships to incorporate rural rotations as a routine part of GME. They explain how the current health care landscape supports this approach and outline additional steps toward implementation. Centralized data collection and analysis are noted as essential to guide future efforts.

Association of School Infrastructure on Health and Achievement Among Children With Asthma.

To determine whether school infrastructure is associated with health and academic outcomes among elementary school children with asthma. We conducted a retrospective cohort study of linked medical, academic, and facilities data from a large mid-Atlantic school district of the United States. All K-5 students with asthma who were enrolled under the state's Children's Health Insurance Program were included. We estimated associations of the infrastructure quality of the student's school, as assessed by an engineering firm in Summer 2011 and represented by the Facility Condition Index (FCI), with asthma health outcomes, absenteeism, and standardized test scores in math and reading in the 2 academic years thereafter. A total of 6558 students were identified, the majority non-Hispanic Black, across 130 schools. Most schools (97/130, 75%) were in very poor or worse condition. In cluster-adjusted models accounting for demographics, grade, school-specific area deprivation, and inhaled corticosteroid use, a one standard deviation increase in FCI, corresponding to greater infrastructure deficiency, was associated with higher rates of asthma-related hospitalizations (incidence rate ratio [IRR] 1.16; 95% confidence interval [CI] 1.03, 1.32), more absenteeism (IRR 1.05; 95% CI 1.01, 1.08), and lower scores in math (mean difference [MD] -3.3; 95% CI -5.5, -1.2) and reading (MD -3.0; 95% CI -5.1, -0.9). There were no differences in rates of asthma-related emergency visits or steroid prescriptions. Children with asthma attending schools with poorer infrastructure had worse health and academic outcomes. Public policy emphasizing reinvestment in school infrastructure may be a potential means of addressing asthma disparities.

Eviction as a social determinant of pregnancy health: County-level eviction rates and adverse birth outcomes in the United States.

Access to housing is an important manifestation of structural racism and discrimination, and birth outcomes show wide health disparities, but few studies have examined eviction and birth outcomes. This multilevel study merged data from the Eviction Lab on 2015 eviction judgements and records with the National Center for Health Statistics natality dataset. The analytic sample included 2,950,965 births across 5924 counties in 45 states. Outcomes of interest were low birthweight (<2500 g; LBW) and preterm birth (<37 weeks gestation; PTB). We fit generalised estimating equations to account for clustering within county and a logistic distribution to estimate the odds ratio of LBW or PTB associated with the county-level eviction rate, with control for individual- and county-level characteristics. Results were calculated separately for non-Hispanic white, non-Hispanic black and Hispanic mothers. After adjustment for covariates, living in the counties in the highest quartile of eviction was associated with a 12-13% increased odds of LBW. The magnitude of association with PTB was not as large. Non-Hispanic black women were more likely to live in counties in the highest quartile of eviction rate (43%, vs. 23% for white women and 23% for Hispanic women) or filing rate (44%, vs. 23% for white and 18% for Hispanic). The association between eviction rate and LBW/PTB was strongest for black women, while there was essentially no association among Hispanic women. Housing instability may be a key social determinant of poor birth outcomes and should be considered in state and local maternal and child health policy and programming.

Why Aren't We Achieving High Vaccination Rates for Rotavirus Vaccine in the United States?

Rotavirus vaccine (RV) coverage levels for US infants are <80%. We surveyed nationally representative networks of pediatricians by internet/mail from April to June, 2019. Multivariable regression assessed factors associated with difficulty administering the first RV dose (RV#1) by the maximum age. Response rate was 68% (303/448). Ninety-nine percent of providers reported strongly recommending RV. The most common barriers to RV delivery overall (definite/somewhat of a barrier) were: parental concerns about vaccine safety overall (27%), parents wanting to defer (25%), parents not thinking RV was necessary (12%), and parent concerns about RV safety (6%). The most commonly reported reasons for nonreceipt of RV#1 by 4 to 5 months (often/always) were parental vaccine refusal (9%), hospitals not giving RV at discharge from nursery (7%), infants past the maximum age when discharged from neonatal intensive care unit/nursery (6%), and infant not seen before maximum age for well care visit (3%) or seen but no vaccine given (4%). Among respondents 4% strongly agreed and 25% somewhat agreed that they sometimes have difficulty giving RV#1 before the maximum age. Higher percentage of State Child Health Insurance Program/Medicaid-insured children in the practice and reporting that recommendations for timing of RV doses are too complicated were associated with reporting difficulty delivering the RV#1 by the maximum age. US pediatricians identified multiple, actionable issues that may contribute to suboptimal RV immunization rates including lack of vaccination prior to leaving nurseries after prolonged stays, infants not being seen for well care visits by the maximum age, missed opportunities at visits and parents refusing/deferring.

The effect of public health insurance expansions on the mental and behavioral health of girls and boys

This paper examines the effects of public health insurance expansions on the mental health care utilization and mental and behavioral health of children 6–17 years old. We leverage major expansions in public health insurance eligibility for children and adolescents under Medicaid and the State Children's Health Insurance Program during 1997–2002 to examine mental health care utilization and outcomes for children in the National Survey of America's Families. The study examines these dynamics by gender of children due to their distinct mental health care patterns and risks. The expansions are associated with an estimated 30% reduction in mental health care utilization for girls, but no measurable effect for boys, which may partly be accounted for by increased well-child visits for girls. Mental health improves only for teenagers; boys in particular have an estimated 22 percent increase in their probability of the highest level of health. Parents experience spillovers of lower insurance coverage for themselves – likely from dropping private family coverage for public child-only coverage – but slightly better mental health.

Federal, State, and Local Immigrant-Related Policies and Child Health Outcomes: a Systematic Review.

The passage of US immigrant-related policies at the federal, state, and local level is on the rise. These policies may affect child health through several mechanisms. We performed a systematic review of English-language, peer-reviewed, quantitative studies examining US immigrant-related policies and the mental and physical health of youth in immigrant families. We searched PubMed and five social science databases for studies published between 1986 and 2019. Two independent reviewers screened the studies and appraised study quality. Of the final 17 studies, ten studies examined birth outcomes and seven studies examined other outcomes in childhood and adolescence (e.g., self-rated health). Generally, exclusionary policies were associated with worse health outcomes and inclusive policies were associated with better health outcomes. Several studies did not observe an association, but only one study found an association of the opposite direction. In that study, similar trends in different policy environments and across foreign-born and US-born women suggest alternative causes for the observed association. Overall, we find that exclusionary policies are, at best, neutral, but likely harmful towards child wellbeing, while inclusive policies can be beneficial.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-021-00978-w.

Supply of immigrant entrepreneurs and native entrepreneurship

Abstract Using nationally representative data from the United States, the author estimates the causal impact of immigrant entrepreneurship on entrepreneurial propensities of natives. The author draws data from the Annual Social and Economic Supplement of the Current Population Survey and uses within-state variation in supply of immigrant entrepreneurs for identification. To address concerns of endogeneity in the supply of immigrant entrepreneurs, the author takes advantage of a quasi-experiment provided by the State Children's Health Insurance Program. While the Ordinary Least Squares estimates indicate a positive effect, the Two Stage Least Squares estimates suggest that, on average, there is no significant effect of immigrant entrepreneurs on native entrepreneurship. Moreover, there is no net effect on subgroups of natives separated by skill level. There is also some evidence that immigrant entrepreneurs may “crowd-in” Blacks into certain types of self-employment. These results are in contrast to the significant negative impact suggested by the previous literature.

The association of area deprivation and state child health with respiratory outcomes of pediatric patients with cystic fibrosis in the United States.

Differences in socioenvironmental exposures influence overall child health, but their association with pediatric cystic fibrosis (CF) outcomes is less clear. This observational study investigated the relationship between area-level socioeconomic deprivation, state child health, and CF respiratory outcomes in a national cohort. We assessed relationships between the 2015 area deprivation index, a composite measure of socioeconomic disadvantage; the 2016 child health index, a state-specific measure of overall child health; and CF respiratory outcomes in the 2016 CF Foundation Patient Registry. The sample included 9934 individuals with CF, aged 6-18 years. In multiple regression analysis adjusted for demographic and clinical covariates, those residing in the worst tertile for area deprivation had 2.8% lower percent predicted forced expiratory volume in 1 s(ppFEV1 ; 95% confidence interval [CI]: -4.1 to -1.5), 1.2 more intravenous (IV) treatment nights (CI: 0.1-2.4), and 20% higher odds of≥2 pulmonary exacerbations (odds ratio [OR]: 1.2, CI: 1.0-1.5) than best-tertile counterparts. Children with CF in states at the worst tertile for child health had 2.3% lower ppFEV1 (CI: -4.5 to -0.2), 2.2 more IV treatment nights (CI: 0.5-3.6), and 40% higher odds of≥2 exacerbations (OR: 1.4, CI: 1.1-1.8) than best-tertile counterparts. State child health accounted for the association between area deprivation and multiple exacerbations and more IV treatment nights. Both area socioeconomic characteristics and state child health play a role in pediatric CF outcomes. The residual association of the state child health with CF outcomes after controlling for area deprivation reflects the ability of state programs to mitigate the effect of poverty.

Regional variation in Black infant mortality: The contribution of contextual factors.

BackgroundCompared to other racial/ethnic groups, infant mortality rates (IMR) are persistently highestamong Black infants in the United States, yet there is considerable regional variation. We examined state and county-level contextual factors that may explain regional differences in Black IMR and identified potential strategies for improvement.Methods and findingsBlack infant mortality data are from the Linked Birth/Infant Death files for 2009–2011. State and county contextual factors within social, economic, environmental, and health domains were compiled from various Census databases, the Food Environment Atlas, and the Area Health Resource File. Region was defined by the nine Census Divisions. We examined contextual associations with Black IMR using aggregated county-level Poisson regression with standard errors adjusted for clustering by state. Overall, Black IMR varied 1.5-fold across regions, ranging from 8.78 per 1,000 in New England to 13.77 per 1,000 in the Midwest. In adjusted models, the following factors were protective for Black IMR: higher state-level Black-White marriage rate (rate ratio (RR) per standard deviation (SD) increase = 0.81, 95% confidence interval (CI):0.70–0.95), higher state maternal and child health budget per capita (RR per SD = 0.96, 95% CI:0.92–0.99), and higher county-level Black index of concentration at the extremes (RR per SD = 0.85, 95% CI:0.81–0.90). Modeled variables accounted for 35% of the regional variation in Black IMR.ConclusionsThese findings are broadly supportive of ongoing public policy efforts to enhance social integration across races, support health and social welfare program spending, and improve economic prosperity. Although contextual factors accounted for about a third of regional variation, further research is needed to more fully understand regional variation in Black IMR disparities.

Institutional births analysis from labour room registries in North Indian hilly state

Background: India is the second most populous country in the world contributing to one fifth of global deaths among under 5-year-old children. Of these under 5 deaths, Infant mortality contributes to more than 89% and neonatal mortality is responsible for 70% of IMR. Of the many proximal determinants of neonatal mortality, inadequate utilization of health services and poor skills of health care providers contribute significantly. The lack of data constrains targeted interventions for these. This study is an attempt to analyze the existing data quality along with gaps in the reporting system to initiate timely course correction for improved programmatic outcomes.Methods: The labour room birth registries from 12 District hospitals and two Government Medical Colleges in the state of Himachal Pradesh (India) were analyzed. The data was extracted from archives in the State Child health Nodal Officer for the year 2017-2018 and 2018-2019.Results: Over these two years the proportion of institutional delivery has improved. The number of newborns resuscitated remained constant at 4.5%. There was an improved coverage of birth dose immunization. Improvement in Antenatal Corticosteroids coverage among preterm laboring mothers was also observed.Conclusions: Continuous data analysis for improving its quality to take evidence informed decisions is needed. Hands on skill improvement for staff is need of the hour to ensure timely and maximum returns on investment in reproductive and Child Health program.

Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions

Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions

Impact of Children's Health Insurance Bene fit on Labor Supply: Evidence from Newly Arrived Immigrants in the United States

This paper exploits the State Children's Health Insurance Program of the United States to investigate impact of a publicly funded health insurance benefit for children on work behavior of adult men and women. Drawing data from the Annual Social and Economic Supplement of the Current Population Survey and employing a triple- difference identification strategy, I find that public health insurance benefit for children decreases labor supply of women but increases that of men. Estimates suggest that, on average, labor force participation rate of women decreased by 7.4 percentage points while that of men increased by 5.5 percentage points as their families became eligible for State Children's Health Insurance Program. The findings are supported by a number of robustness checks and a falsification exercise.

Developing a Framework to Promote Children's Health Insurance Enrollment in Florida.

Florida Covering Kids & Families (FL-CKF) at the University of South Florida's Chiles Center for Healthy Mothers and Babies advocates for uninsured children and promotes outreach and enrollment in the state's children's health insurance program, Florida KidCare. FL-CKF facilitates the development of local coalitions to reach children and families throughout the state. Coalitions are provided with one-on-one training and a wide array of tools to increase effectiveness such as coalition-building resources, membership guides, and assistance in building strong local partnerships. FL-CKF places emphasis on creating formalized membership structures so each member knows his or her responsibilities and is accountable for them, partnering with other organizations in the community, and training on how to create and maintain partnerships in the community at large. These approaches help create lasting coalitions and offer an easily replicable approach for others to enhance children's health insurance outreach and enrollment.

State-Sponsored Health Insurance and State Economic and Employment Growth

While there is a clear relationship between better health and better economic outcomes, the effects of increasing health insurance on the economy remain understudied. We employ two datasets, one on health insurance coverage in the contiguous 48 U.S. states and one for countries in the Organisation for Economic Co-operation and Development, to model the effect of expanding health insurance on state and country economic and employment growth over the last two decades. We find that increased health insurance coverage of the working age population, especially through government programs like Medicaid, is associated with faster gross domestic product and employment growth. However, we also find that these results may be contingent on controlling the per-enrollee cost of these programs. These findings are informative for future health insurance reforms both federally and in the U.S. states. Related Articles Bernick, Ethan M., and Nathan Myers. 2012. “Issue Salience, Party Strength, and the Adoption of Health-Care Expansion Efforts.” Politics & Policy 40 (1): 131-159. http://onlinelibrary.wiley.com/doi/10.1111.1747-1346.2011.00340.x/abstract Kreier, Rachel. 2006. “Economic Theory and Political Reality: Managed Competition and U.S. Health Policy.” Politics & Policy 34 (3): 579-605. http://onlinelibrary.wiley.com/doi/10.1111/j.1747-1346.2006.00029.x/abstract Mcgrath, Robert J. 2009. “Implementation Theory Revisited … Again: Lessons from the State Children's Health Insurance Program.” Politics & Policy 3 (2): 309-336. http://onlinelibrary.wiley.com/doi/10.1111/j.1747-1346.2009.00174.x/abstract Related Media CBO Report. https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/50252-Effects_of_ACA_Repeal.pdf Original CEA Report. http://www.whitehouse.gov/assets/documents/CEA_Health_Care_Report.pdf John Oliver on Medicaid Expansion. https://www.youtube.com/watch?v=5d3nASKtGas Robert Wood Johnson Foundation on Medicaid Expansion. https://www.youtube.com/watch?v=fGEU0a75tiw

National Survey of State Children's Mental Health Directors: Current Status and Future Directions.

State agencies play a critical role in addressing the mental health needs of children and youth. Significant changes underway throughout the nation at the federal and state levels have led to questions about the role of state children's mental health (CMH) agencies and the effects of these changes on children's services. The purpose of this study was to examine the current status of state offices for CMH with regard to structure and responsibilities and to identify what state CMH directors express as opportunities and challenges for CMH at the state level. CMH directors or their representatives from 46 states, 1 US territory, and D.C. completed an online survey developed to address the specific aims of this study. Findings highlight the importance of a strong state structure to support CMH and opportunities for reform and system change, particularly related to the Affordable Care Act and expansion of Systems of Care.

The health capability paradigm and the right to health care in the United States.

Against a backdrop of non-ideal political and legal conditions, this article examines the health capability paradigm and how its principles can help determine what aspects of health care might legitimately constitute positive health care rights-and if indeed human rights are even the best approach to equitable health care provision. This article addresses the long American preoccupation with negative rights rather than positive rights in health care. Positive health care rights are an exception to the overall moral range and general thrust of U.S. legal doctrine. Some positive rights to health care have arisen from U.S. Constitutional Eighth Amendment cases and federal and state laws like Medicare, Medicaid, the State Children's Health Insurance Program, the Emergency Medical Treatment and Active Labor Act, and the Patient Protection and Affordable Care Act. Finally, this article discusses some of the difficulties inherent in implementing a positive right to health care in the U.S.

A framework for assessing outcomes from newborn screening: on the road to measuring its promise.

Newborn screening (NBS) is intended to identify congenital conditions prior to the onset of symptoms in order to provide early intervention that leads to improved outcomes. NBS is a public health success, providing reduction in mortality and improved developmental outcomes for screened conditions. However, it is less clear to what extent newborn screening achieves the long-term goals relating to improved health, growth, development and function. We propose a framework for assessing outcomes for the health and well-being of children identified through NBS programs. The framework proposed here, and this manuscript, were approved for publication by the Secretary of Health and Human Services' Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC). This framework can be applied to each screened condition within the Recommended Uniform Screening Panel (RUSP), recognizing that the data elements and measures will vary by condition. As an example, we applied the framework to sickle cell disease and phenylketonuria (PKU), two diverse conditions with different outcome measures and potential sources of data. Widespread and consistent application of this framework across state NBS and child health systems is envisioned as useful to standardize approaches to assessment of outcomes and for continuous improvement of the NBS and child health systems. Successful interventions for newborn screening conditions have been a driving force for public health newborn screening for over fifty years. Organizing interventions and outcome measures into a standard framework to systematically assess outcomes has not yet come into practice. This paper presents a customizable outcomes framework for organizing measures for newborn screening condition-specific health outcomes, and an approach to identifying sources and challenges to populating those measures.

Annual Report on Children's Health Care: Dental and Orthodontic Utilization and Expenditures for Children, 2010–2012

ObjectiveTo examine general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010–2012. MethodsNationally representative data from the Medical Expenditure Panel Survey (2010–2012) provided data on insurance status, public health insurance eligibility, and visits to dental providers for both general dental care and orthodontic care. ResultsOverall, 41.9% of US children reported an annual dental office–based visit for general (nonorthodontic) dental care. Fewer Hispanic (34.7%) and non-Latino black children (34.8%) received dental care compared to non-Hispanic whites (47.3%) and Asians (40.3%). Children living in families with the lowest income were also the least likely to have a visit (32.9%) compared to children in the highest-income families (54.7%). Among children eligible for public coverage, Medicaid-eligible children had the lowest percentage of preventive dental visits (29.2%). Socioeconomic and racial/ethnic disparities in use and expenditures for orthodontic care are much greater than those for general and preventive dental care. Average expenditures for orthodontic care were $1,823, of which 56% ($1,023) was paid out of pocket by families. ConclusionsOur findings provide a baseline assessment for examining trends in the future, especially as coverage patterns for children may change as the Affordable Care Act is implemented and the future of the State Child Health Insurance Program remains uncertain beyond 2017.

Improving Data, Enhancing Enrollment: Florida Covering Kids & Families CHIPRA Data System.

According to the Kaiser Family Foundation (2014), 502,866 (11.7 %) of Florida children under 19 years of age are uninsured, giving Florida the second largest number of uninsured children in the United States. Florida Covering Kids & Families (FL-CKF) is dedicated to developing innovative outreach methods for enrolling and retaining eligible children in Florida KidCare, the state's Children's Health Insurance Program. FL-CKF has developed a strong data system that allows it to evaluate the effectiveness and success of statewide enrollment and retention efforts. The data system was created using the Checkbox survey systems. Community and school outreach partners enter data each month on all completed Florida KidCare applications via a secure interface. The system requires data be entered in a uniform format and forces vital data points to be completed. These data are then transmitted to the state to obtain timely application determination information on enrollments. The data system helps FL-CKF to determine which outreach strategies are successful and where changes need to be made to increase effectiveness. The system also provides feedback to community outreach partners in order to enable follow up with families when needed. Organizations helping uninsured children apply for health insurance may benefit from creating data collection systems to monitor project efficacy and modify outreach and enrollment strategies for greater effectiveness.

Federal Expenditures on Children: What Budget Policy Means for Children's Policy and commentaries

Federal Expenditures on Children: What Budget Policy Means for Children's Policy and commentaries