Underserved Children Research Articles

Considering the Control Group: The Influence of Follow-Up Assessments on Asthma Symptoms

ObjectiveIt is unclear whether research participation effects contribute to an improvement in asthma symptoms during clinical trials in the absence of any active intervention. We examined the impact of additional follow-up surveys on caregiver-reported symptoms among control subjects in a series of randomized controlled asthma trials. MethodsWe analyzed baseline and follow-up data for children (3–10 years) with poorly controlled persistent asthma that participated as control subjects in 1 of 3 randomized trials of urban school-based asthma care (study duration: 7–10 months). We compared mean symptom-free days (SFD) per 2 weeks between baseline and final follow-up; performed bivariate regressions to explore associations between demographics and changes in SFD; and performed multivariate random-effects generalized least square regression to examine the relationship between number of follow-ups beyond baseline (range: 1–10) and changes in SFD over time. ResultsFive hundred and sixteen children were enrolled as controls across the 3 trials (mean age 7.5 years, 61% Black, 28% Hispanic, 81% Medicaid). Mean SFDs increased significantly from baseline to final follow-up (7.8–11.4 days, P < .001). In adjusted analyses, significant improvements in SFD were observed with all follow-up contacts in comparison with baseline. Symptom improvement showed a dose-response relationship with the number of follow-up assessments completed (1, 2–3, 4–5, and 6–10 assessments). ConclusionsChildren with uncontrolled asthma who participate as controls in clinical trials experience a significant increase in SFD with additional follow-up assessments. This improvement should be considered when designing/analyzing asthma interventions, and may help guide clinical outreach efforts for underserved children with persistent asthma.

Comparative Effectiveness Trial of an Obesity Prevention Intervention in EFNEP and SNAP-ED: Primary Outcomes.

There is a need to disseminate evidence-based childhood obesity prevention interventions on a broader scale to reduce obesity-related disparities among underserved children. The purpose of this study was to test the comparative effectiveness of an evidence-based obesity prevention intervention, Hip-Hop to Health (HH), delivered through Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) versus the standard curriculum delivered by the programs (Standard Nutrition Education (NE)). A nonequivalent control group design was delivered to compare the effectiveness of HH to NE on weight gain prevention and health behavior outcomes at EFNEP and SNAP-Ed sites. One hundred and fifty-three caregiver–child dyads (n = 103 in the HH group; n = 50 in the NE group) participated in the study. HH is an evidence-based dietary and physical activity intervention for low-income preschool children. The NE curriculum provided lessons for children that are consistent with the Dietary Guidelines for Americans 2010. Data were collected on demographics, anthropometrics, and behavioral variables for parent–child dyads at baseline and postintervention. Mixed model methods with random effects for site and participant were utilized. No differences in child or caregiver diet, physical activity, or screen time by group were found. No between-group differences in child BMI z-score were found; however, caregivers in the HH group lost significantly more weight than those in the NE group. Results from this trial can inform future dissemination efforts of evidenced-based programs for underserved families.

Describing a Public-health Summer Camp for Underserved Children: Healthy 2B Me

Healthy 2B Me aims to educate and empower underserved children ages seven to 11 years old to improve their health and well-being through a supportive, educational and entertaining public health-themed summer day camp. Qualitative data collected through camper exit slips, final posters/presentations, and parent surveys were analyzed to identify salient themes demonstrating the impact of camp participation on children's health. Both camper and parent responses suggested improvements in participant knowledge, attitude and behavior in relation to diet, physical activity, sun safety, hand washing, smoking and kindness. This article describes how the Healthy 2B Me camp contributes to our understanding of how to design and assess a health-themed, positive youth-development summer camp for underserved children.

Characteristics of inner-city children with life-threatening asthma

BackgroundIntensive care unit (ICU) admission is a risk factor for fatal asthma. Little is known about risk factors for pediatric ICU admissions for asthma. ObjectiveTo examine characteristics of underserved minority children with prior ICU admissions for asthma. MethodsBaseline survey data, salivary cotinine levels, and allergen specific IgE serologic test results were obtained from children with uncontrolled asthma enrolled in a randomized clinical trial of a behavioral education environmental control intervention. Characteristics of children with and without prior ICU admission were compared using χ2 and t tests. Logistic regression assessed significance of higher odds of prior ICU admission comparing factor-level categories. ResultsPatients included 222 primarily African American (93.7%), male (56%), Medicaid-insured (92.8%) children with a mean (SD) age of 6.4 (2.7) years with uncontrolled asthma. Most (57.9%) had detectable cotinine levels, 82.6% were sensitized to more than 1 environmental allergen, and 27.9% had prior ICU admissions. Prior ICU patients were more likely to be very poor (<$10,000 per year) and sensitized to more than 1 allergen tested (most importantly mouse) (P < .05). Allergen sensitization in the groups did not differ for cockroach, cat, dog, Alternaria, Aspergillus, dust mite, grass, or tree. Although more ICU patients received combination controller therapy, they also overused albuterol. Only 27.4% of ICU patients received specialty care in the previous 2 years, which was not significantly different from non-ICU patients. ConclusionChildren with high mortality risk, including history of ICU admission, were twice as likely to live in extreme poverty, have atopy (particularly mouse allergen), use combination controller therapy, and overuse albuterol. Trial RegistrationClinicalTrials.gov Identifier: NCT01981564.

Obesity in Adolescents and Youth: The Case for and against Bariatric Surgery

Obesity in Adolescents and Youth: The Case for and against Bariatric Surgery

Immunization coverage among children aged 12-23 months: A cross sectional study in low performing blocks of Bihar, India.

Introduction:Immunization is one of the most cost-effective measures in public health to date, preventing at an approximately 2 to 3 million fatalities in young children every year. As per recent World Health Organisation (WHO) bulletin, these lifesaving vaccines have been successfully averted around 20 million premature deaths and 500 million disease cases. Inspite of this progress the routine vaccine coverage is slow to rise as challenges still live for the underserved, inaccessible and vulnerable children. It is therefore essential to evaluate the coverage of immunization at periodic intervals and to take the required measures to enhance the vaccination status in the State Bihar.Aims and Objective:This study aims to find out the vaccination coverage in different Blocks of study area.Material and Methods:The study was community based cross sectional study which was conducted between January to March 2019 in the selected villages of 59 low performing blocks of Bihar. The study subjects were all the children aged 12-23 month old from selected low performing blocks of the Bihar. Results-Corrected FIC of the study was 90.85%. Close to nine percent (8.8%) children thou have started vaccination could not able to complete it. Rest of the beneficiaries are completely left out. The most common reason for incomplete immunization was unavailability of child on the day of vaccination followed by sickness of the child.Conclusion:The overall Immunization coverage of Bihar is less than the National Immunization coverage as per NFHS-4. This study shows higher rate of immunization as far as Corrected Immunization Coverage is concerned.

In-home obesity prevention in low-income infants through maternal and social transmission

BackgroundExtant obesity efforts have had a limited impact among low-income underserved children, in part because existing programs are limited in terms of their short duration and low dosage, limited accessibility and sustainability; and failure to address barriers faced by diverse low-income families. MethodsThis two-arm, parallel, randomized controlled trial (RCT) tests whether delivering obesity prevention, as part of an ongoing home visitation program (HVP), is an effective approach for primary (infants) and secondary (mothers) obesity prevention among low-income, underserved families. This RCT further examines the role of maternal and social factors as key mechanisms of transmission of infants' obesity risk, and the real-life costs of delivering obesity prevention as part of HVPs. Specifically, 300 low-income mothers/infants (6mo at baseline) participating in the Healthy Families America home visitation program in Antelope Valley (CA) will be recruited and enrolled in the study. Home visitors serving families will be randomly assigned to deliver the standard HVP curriculum with or without obesity prevention as part of their weekly home visits for two years. Anthropometric, metabolic and behavioral assessments of mothers/infants will be conducted at enrollment and after 6 and 18 months of intervention. DiscussionThis study addresses the need to develop interventions targeting at-risk infants before they become obese. The proposed research is timely as the Institute of Medicine, the United States Department of Agriculture, and the Department of Health and Human Services are revising their recommendations to address key factors influencing obesity risk in children from birth to 24 months of age.

How Telehealth Stopped A Contagious Outbreak At A School.

A school-based telehealth program helps identify a disease outbreak before it gets out of hand.

Advancement Of Teledentistry At The University Of Rochester's Eastman Institute For Oral Health.

Dental caries is the most prevalent infectious disease among US children. National surveys have shown that poor and minority-group children are not only disproportionately affected by dental caries but also have limited access to oral health care. Following successful exploratory applications of both synchronous and asynchronous models at the Eastman Institute for Oral Health, teledentistry has been demonstrated to be a practical and cost-effective way to improve oral health care for rural and disadvantaged children. These models support the role of teledentistry in reducing the costs of and barriers to accessing oral health care, improving oral health outcomes, increasing use of oral health care resources, and leading to the establishment of a dental home for underserved children. The advancement of teledentistry underscores the need for its integration with local, regional, and national telehealth programs and the role of policy makers in establishing a balanced framework for teledentistry within the overarching health care system.

Bringing Dance Experiences to Underserved Children Through the “I Have A Dream” Foundation

ABSTRACTOver the last decade, I have built a program and course at a private New York City university, bringing more than 200 university students to public schools in East Harlem to teach dance to underserved populations. I work alongside the “I Have a Dream” Foundation, a nonprofit that selects first-grade students from an underprivileged community and mentors them until their graduation from high school. One unique feature of the course is that although my university students might change from year to year, I see the “I Have A Dream” children for multiple years, getting to know them and nurture their growth as people and artists. In this article, I provide information about the development and content of my community-based experiential course in hopes that it might serve as a model for others to connect university students to children from underserved populations in dance-based learning experiences.

Subspecialty pediatric neurosurgery training: a skill-based training model for neurosurgeons in low-resourced health systems.

There is inadequate pediatric neurosurgical training to meet the growing burden of disease in low- and middle-income countries (LMIC). Subspecialty expertise in the management of hydrocephalus and spina bifida-two of the most common pediatric neurosurgical conditions-offers a high-yield opportunity to mitigate morbidity and avoid unnecessary death. The CURE Hydrocephalus and Spina Bifida (CHSB) fellowship offers an intensive subspecialty training program designed to equip surgeons from LMIC with the state-of-the-art surgical skills and equipment to most effectively manage common neurosurgical conditions of childhood. Prospective fellows and their home institution undergo a comprehensive evaluation before being accepted for the 8-week training period held at CURE Children's Hospital of Uganda (CCHU) in Mbale, Uganda. The fellowship combines anatomy review, treatment paradigms, a flexible endoscopic simulation lab, daily ward and ICU rounds, radiology rounds, and clinic exposure. The cornerstone of the fellowship is the unique operative experience that includes a high volume of endoscopic third ventriculostomy with choroid plexus cauterization, myelomeningocele closure, and ventriculoperitoneal shunting, among many other procedures performed at CCHU. Upon completion, fellows return to their home institution to establish or rejuvenate a robust pediatric practice as part of a worldwide network of CHSB trainees committed to the care of underserved children. To date, the fellowship has graduated 33 surgeons from 20 different LMIC who are independently performing thousands of hydrocephalus and spina bifida operations each year.

Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index

ImportancePrevention of obesity during childhood is critical for children in underserved populations, for whom obesity prevalence and risk of chronic disease are highest.ObjectiveTo test the effect of a multicomponent behavioral intervention on child body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) growth trajectories over 36 months among preschool-age children at risk for obesity.Design, Setting, and ParticipantsA randomized clinical trial assigned 610 parent-child pairs from underserved communities in Nashville, Tennessee, to a 36-month intervention targeting health behaviors or a school-readiness control. Eligible children were between ages 3 and 5 years and at risk for obesity but not yet obese. Enrollment occurred from August 2012 to May 2014; 36-month follow-up occurred from October 2015 to June 2017.InterventionsThe intervention (n = 304 pairs) was a 36-month family-based, community-centered program, consisting of 12 weekly skills-building sessions, followed by monthly coaching telephone calls for 9 months, and a 24-month sustainability phase providing cues to action. The control (n = 306 pairs) consisted of 6 school-readiness sessions delivered over the 36-month study, conducted by the Nashville Public Library.Main Outcomes and MeasuresThe primary outcome was child BMI trajectory over 36 months. Seven prespecified secondary outcomes included parent-reported child dietary intake and community center use. The Benjamini-Hochberg procedure corrected for multiple comparisons.ResultsParticipants were predominantly Latino (91.4%). At baseline, the mean (SD) child age was 4.3 (0.9) years; 51.9% were female. Household income was below $25 000 for 56.7% of families. Retention was 90.2%. At 36 months, the mean (SD) child BMI was 17.8 (2.2) in the intervention group and 17.8 (2.1) in the control group. No significant difference existed in the primary outcome of BMI trajectory over 36 months (P = .39). The intervention group children had a lower mean caloric intake (1227 kcal/d) compared with control group children (1323 kcal/d) (adjusted difference, −99.4 kcal [95% CI, −160.7 to −38.0]; corrected P = .003). Intervention group parents used community centers with their children more than control group parents (56.8% in intervention; 44.4% in control) (risk ratio, 1.29 [95% CI, 1.08 to 1.53]; corrected P = .006).Conclusions and RelevanceA 36-month multicomponent behavioral intervention did not change BMI trajectory among underserved preschool-age children in Nashville, Tennessee, compared with a control program. Whether there would be effectiveness for other types of behavioral interventions or implementation in other cities would require further research.Trial RegistrationClinicalTrials.gov Identifier: NCT01316653

Prevalence of uncorrected refractive errors among school-aged children in the School District of Philadelphia

Uncorrected refractive error increases a child's risk for visual, academic, and cognitive challenges. Conducting vision screening directly in schools has the potential to effectively reach underserved children. We developed an on-site pediatric vision screening program to detect and correct refractive errors and refer those with non-refractive eye disease to a pediatric ophthalmologist.

Efficacy and outcomes of a summer-based pediatric vision screening program

To investigate the prevalence of decreased visual acuity and uncorrected refractive error in school-aged children participating in summer programs. During the summers of 2014-2016, Wills Eye Hospital collaborated with summer programs in Philadelphia to provide vision screenings for underserved children. Parental consent was obtained prior to vision screening. Fail criteria included children in grades K-1 (ages 5-6) with visual acuity worse than 20/40 in either eye, children in grades 2-6 (ages 7-13) with visual acuity worse than 20/30 in either eye, or children with ≥2 lines of interocular difference. If decreased visual acuity was correctable to ≥20/30 by the onsite optometrist, two pairs of free eyeglasses were provided. Children with other ocular abnormalities were referred to pediatric ophthalmology. Of 1,627 children screened, 360 children (22.1%) did not pass vision screening, and 64 (3.9%) were referred. The prevalence of decreased distance visual was 34.1%. Younger children were more likely to have worse visual acuity than older children (OR=0.943; P=0.023; 95% CI, 0.896-0.992). Myopia (73%), astigmatism (56.8%), hyperopia (15.5%), spherical anisometropia (12.5%), and cylindrical anisometropia (11.9%) presented in the 303 children who underwent a manifest refraction. Myopia increased with age (OR=0.818; P=0.001; 95% CI, 0.724-0.922), whereas astigmatism decreased (OR=0.817; P<0.001; 95% CI, 0.728-0.913) with age. Two pairs of glasses were provided to 301 children. Partnership with summer programs and other community initiatives to provide vision screenings facilitates access to eye care ultimately aimed at improving social functioning and academic performance.

The effect of losing federal coverage through the Affordable Care Act on ear tube placements at an urban children's hospital

Purpose15–31% of the population in a large Mid-western city is between 100 and 400% of the Federal Poverty Level, thus qualifying for health care coverage under the Affordable Care Act (ACA). Coverage for their children would potentially be available under Children's Health Insurance Program (CHIP) or Medicaid programs. Loss of funding for these programs could be devastating for this community. MethodsWe retrospectively reviewed 1162 charts of pediatric patients with tympanostomy tube (TT) placement pre-ACA from November 2012 to December 2013 and 1606 charts post-ACA from January 2014 to July 2015. We filtered demographics by health insurance (Medicaid/CHIP/Other), residential zip codes, identified race/ethnicity within those zip codes as well as gender and age of patients getting TT during these periods. ResultsBivariate analysis of these demographics between the two periods showed statistical significance (p = 0.0098) between White Hispanic/Latino children receiving ear tubes (pre-ACA = 3.8%, post-ACA = 6.4%). However, there was no statistical significance for insurance enrollment (Medicaid or non-Medicaid) and other races (White-not Hispanic/Latino (nHL), African American, Other/Unknown/Refused) with respect to TT placement. Using pre-ACA period and White nHL females as arbitrary reference, a multivariate logistic regression showed that patients requiring TT surgery were equally likely to be covered on Medicaid either before or after ACA. ConclusionWe demonstrated that the pre and post ACA Medicaid coverage for TT surgery did not change. Underserved children did not obtain other forms of insurance during this time. This demonstrates a potentially catastrophic loss of coverage for children should Medicaid/CHIP benefits be lost to sole coverage under the ACA.

Resilience-Based Intervention with Underserved Children: Impact on Self-Regulation in a Randomized Clinical Trial in Schools

ABSTRACTResilience and emotion regulation are crucial for optimal psychosocial functioning in children. This study assessed whether a group-based intervention, the Resilience Builder Program (RBP), improved student report of emotion regulation when administered in elementary schools. Sixty-seven students aged 9–12 years (M = 10.50, SD =.74; 82.1% male, 98.5% ethnic/racial minority) were randomly assigned to receive the RBP intervention immediately or following a semester delay. Participants reported their emotional control using the How I Feel scale. Students who received the RBP reported a significant increase in their emotional control and a significant decrease in negative emotion compared to those students in the delayed treatment sample who had not yet received the intervention. Further, students indicated a strongly positive perception of the therapy.

The Collaborative Role of North American Departments of Pediatrics in Global Child Health.

Appeals for health equity call for departments of pediatrics to improve the health of all children including those from underserved communities in North America and around the world. Consequently, North American (NA) departments of pediatrics have a role in global child health (GCH) which focuses on providing health care to underserved children worldwide. In this review, we describe how NA departments of pediatrics can collaboratively engage in GCH education, clinical practice, research, and advocacy and summarize best practices, challenges, and next steps for engaging in GCH in each of these areas. For GCH in low- and middle-income countries (LMICs), best practices start with the establishment of ethical, equitable, and collaborative partnerships with LMIC communities, organizations, and institutions engaged in GCH who are responsible for the vast majority of work done in GCH. Other best practices include adequate preparation of trainees and clinicians for GCH experiences; alignment with local clinical and research priorities; contributions to local professional development and ongoing monitoring and evaluation. Challenges for departments include generating funding for GCH activities; recruitment and retention of GCH-focused faculty members; and challenges meeting best practices, particularly adequate preparation of trainees and clinicians and ensuring mutual benefit and reciprocity in NA-LMIC collaborations. We provide examples of how departments have overcome these challenges and suggest next steps for development of the role of NA departments of pediatrics in GCH. Collaborative implementation of best practices in GCH by LMIC-NA partnerships can contribute to reductions of child mortality and morbidity globally.

Providing care for underserved children and adults

Providing care for underserved children and adults

Effects of a Kundalini Yoga Program on Elementary and Middle School Students' Stress, Affect, and Resilience.

The Your Own Greatness Affirmed (YOGA) for Youth program delivers yoga to urban inner-city schools with the goal of providing practical benefits that support underserved children at high risk of behavioral and emotional problems. A 10-week YOGA for Youth program delivered 1 to 2 times per week was implemented in 3 schools in urban neighborhoods to examine the effect of the program on student stress, affect, and resilience. Thirty children were administered the Perceived Stress Scale, the Positive and Negative Affect Schedule, and the Resilience Scale before and after the yoga program. After the program, informal qualitative interviews were conducted with school teachers, yoga teachers, and students to determine the overall impact of the yoga program. The quantitative results of this study indicated that the yoga program significantly improved students stress (p < 0.05), positive affect (p < 0.05), and resilience (p < 0.001). The qualitative results indicated that students, school teachers, and yoga teachers all found the program to be beneficial for students' well-being. Taken together, these data suggest that the YOGA for Youth program may provide students in low-income urban schools with behavioral skills that will protect against risk factors associated with the development of behavioral and emotional problems.

The treatment efficacy of multiple opposition phonological approach via telepractice for two children with severe phonological disorders in rural areas of West Texas in the USA

The goals of the present study were to (1) examine the effects of the multiple opposition phonological approach on improving phoneme production accuracy in children with severe phonological disorders and (2) explore whether the multiple opposition approach is feasible for the telepractice service delivery model. A multiple-baseline, single-participant design replicated across two children, was implemented. Two male children who resided in rural areas of West Texas in the USA participated. One child was 4 years and 10 months old and the other child was 6 years old. Both of the children were diagnosed with phonological disorders without any sensory, motoric, or intellectual disabilities. The children’s articulation was tested using Goldman–Fristoe Articulation Test-2 and probes were administered across the period of the study. The children received a 30-minute phonological intervention via telepractice twice a week for 12 or 16 weeks. An increasing trend for production accuracy for target sounds was observed during intervention for both children. Maintenance also was observed at 2-week and 2-month follow-ups. Standard scores from a standardized articulation test increased during posttest compared to pretest. The multiple opposition phonological approach can lead to improved speech production accuracy in children with severe phonological disorders. Telepractice may be an effective context for a phonological intervention approach as has been found for other domains of speech and language intervention and a useful service delivery model to underserved children with speech disorders who are unable to access a speech pathologist due to various circumstances.