Disparities in Unmet Health Care Needs Among US Children During the COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic disrupted pediatric health care in the United States, and this disruption layered on existing barriers to health care. We sought to characterize disparities in unmet pediatric health care needs during this period. METHODS: We analyzed data from Wave 1 (October through November 2020) and Wave 2 (March through May 2021) of the COVID Experiences Survey, a national longitudinal survey delivered online or via telephone to parents of children aged 5 through 12 years using a probability-based sample representative of the US household population. We examined 3 indicators of unmet pediatric health care needs as outcomes: forgone care and forgone well-child visits during fall 2020 through spring 2021, and no well-child visit in the past year as of spring 2021. Multivariate models examined relationships of child-, parent-, household-, and county-level characteristics with these indicators, adjusting for child's age, sex, and race/ethnicity. RESULTS: On the basis of parent report, 16.3% of children aged 5 through 12 years had forgone care, 10.9% had forgone well-child visits, and 30.1% had no well-child visit in the past year. Adjusted analyses identified disparities in indicators of pediatric health care access by characteristics at the level of the child (eg, race/ethnicity, existing health conditions, mode of school instruction), parent (eg, childcare challenges), household (eg, income), and county (eg, urban-rural classification, availability of primary care physicians). Both child and parent experiences of racism were also associated with specific indicators of unmet health care needs. CONCLUSIONS: Our findings highlight the need for continued research examining unmet health care needs and for continued efforts to optimize the clinical experience to be culturally inclusive.

Disparities in Implementing COVID-19 Prevention Strategies in Public Schools, United States, 2021-22 School Year.

During the COVID-19 pandemic, US schools have been encouraged to take a layered approach to prevention, incorporating multiple strategies to curb transmission of SARS-CoV-2. Using survey data representative of US public K-12 schools (N = 437), we determined prevalence estimates of COVID-19 prevention strategies early in the 2021-22 school year and describe disparities in implementing strategies by school characteristics. Prevalence of prevention strategies ranged from 9.3% (offered COVID-19 screening testing to students and staff) to 95.1% (had a school-based system to report COVID-19 outcomes). Schools with a full-time school nurse or school-based health center had significantly higher odds of implementing several strategies, including those related to COVID-19 vaccination. We identified additional disparities in prevalence of strategies by locale, school level, and poverty. Advancing school health workforce and infrastructure, ensuring schools use available COVID-19 funding effectively, and promoting efforts in schools with the lowest prevalence of infection prevention strategies are needed for pandemic preparedness.

Associations Between Sexual Risk-Related Behaviors and School-Based Education on HIV and Condom Use for Adolescent Sexual Minority Males and Their Non-Sexual-Minority Peers.

PURPOSE: With HIV and sexually transmitted disease (STD) rates disproportionately high among adolescent sexual minority males (ASMM), it is important to understand how school-based sexual health education may relate to sexual risk-related behavior among this population. This analysis explores reported HIV/AIDS- and condom-related education and sexual risk-related behaviors among ASMM and their adolescent non-sexual-minority male (non-ASMM) peers. METHODS: Students (n = 11,681) from seven Florida high schools completed paper-and-pencil questionnaires. A matched analytic sample of ASMM and non-ASMM students was created by using propensity score-matching techniques (n = 572). Logistic regressions controlling for individual and school characteristics examined reporting having been taught about AIDS or HIV in school, having been taught in school about using condoms, condom use at last sex, HIV/STD testing, and associations between these variables. RESULTS: Compared with matched non-ASMM peers, ASMM students were less likely to report having been taught about AIDS or HIV in school (odds ratio [OR] = 0.58, P = 0.04) and having used a condom at last sex (OR = 0.39, P < 0.01), but were more likely to report having been tested for HIV or STDs (OR = 1.88, P = 0.02). There were no significant differences for reporting having been taught in school about using condoms. Among non-ASMM, reporting having been taught in school about using condoms was associated with a greater likelihood of condom use at last sex (OR = 4.78, P < 0.01); this was not seen for ASMM. CONCLUSIONS: Differential reports of receiving HIV/AIDS education and differential associations between condom-related education and condom use in ASMM and non-ASMM suggest that sexual health education in schools may not be resonating with ASMM and non-ASMM in the same way.