Curriculum Enrichment Across the Medical Education Continuum Using e-Delphi and the Community Priority Index.

OBJECTIVE: To describe the use of the e-Delphi combined with the Community Priority Index (CPI) to support medical curriculum enrichment. METHODS: This mixed-methods study was conducted from December 2017 to May 2018 at Baylor College of Medicine in Houston, Texas. First, a nominal group identified a topical list. Second, to refine the curriculum content and achieve consensus, an e-Delphi was implemented with healthcare experts regarding the following target cohorts (N = 40): transformed postbaccalaureate premedical scholar students, medical students, clinical fellows, and junior faculty. Third, the CPI incorporated multicriteria decision making and calculation of standardized prioritization scores (range 0-1) with bootstrap 95% confidence intervals (CIs). RESULTS: Among transformed postbaccalaureate premedical scholar students, medical students, and clinical fellows, the e-Delphi-CPI system's highest ranked topic was in the domain of leadership skills and competence for transformed postbaccalaureate premedical scholar students (CPI 0.87, 95% CI 0.58-0.94), medical students (CPI 0.85, 95% CI 0.36-0.91), and clinical fellows (CPI 0.86, 95% CI 0.32-0.92), respectively. For junior faculty, the highest ranked topic was introductory research methods (CPI 0.90, 95% CI 0.65-1.00). In each cohort, the top three ranked topics also contained leadership skills and competence and introductory research methods. The system ranked practical issues in health disparity as the third most valued domain among transformed postbaccalaureate premedical scholar students. CONCLUSIONS: The integrated e-Delphi-CPI system identified the highest ranked options across all of the domains and established comparability across cohorts. We recommend the e-Delphi-CPI system to advance medical curriculum enrichment processes.

Ethics and the Treatment of the Mentally Ill, Homeless Person: a Perspective on Psychiatry Resident Training.

OBJECTIVE: The authors outline the unique ethical challenges that psychiatry residents face in working with individuals who are homeless and mentally ill. The authors also propose steps to develop effective teaching methods with residents working with these patients. METHODS: The authors reviewed literature relevant to the training of psychiatry residents in ethics and treating individuals who are homeless and mentally ill. RESULTS: The authors summarize current literature and, with the use of case examples, provide guidelines for effective teaching. CONCLUSIONS: Teaching psychiatry residents who are working in the community with individuals who are mentally ill and homeless needs to address a number of unique ethical conflicts that arise in this area. The authors outline approaches to this teaching.

Perceptions Revisited: Pediatric Chief Resident views on Minority Housestaff Recruitment and Retention in Pediatric Residency Programs.

PURPOSE: This study examined institutional strategies among pediatric residency programs for recruitment and retention of underrepresented minorities (URM) housestaff. PROCEDURES: A questionnaire developed by the authors in a 1992 study was modified and then mailed to 185 pediatric chief residents at non-military pediatric training programs in the United States. Descriptive statistics (means and frequency) were calculated for each question. There were three rounds of mailings and a telephone follow-up. MAIN FINDING: The response rate was 39% (n=73). Thirty-eight percent reported that URM housestaff recruitment and retention was a priority for their program directors, 37% reported that it was a priority for themselves, 25% reported it was a priority for the hospital administration, and 36% reported that they were not sure about the priority of URM housestaff recruitment and retention within their organization. Sixty-seven percent stated that their housestaff selection committees do not have defined recruitment goals, 6% indicated that their committees have specifically defined recruitment goals, and 27% were not sure. CONCLUSIONS: Despite numerous initiatives from government agencies, medical institutions, and institutions of higher education, a critical gap remains among institutions in their recruitment efforts for URM at the level of residency training. Our study suggests that pediatric chief residents may not be adequately educated or primed regarding the importance of recruitment and retention of URM. As individuals involved with both medical training and hospital hierarchy, they are uniquely positioned to influence and carry out program goals and objectives.

A national survey of medical student suicides.

OBJECTIVE: Because there is no current information on medical student suicides, the authors surveyed US medical schools about deaths by suicide of medical students from June 2006 to July 2011. METHODS: In spring through summer of 2012, the authors sent electronic surveys to the 133 accredited US allopathic medical schools at the time, excluding Puerto Rican schools. The 15-item survey included questions about deaths by suicide and deaths by means other than suicide. In the case of a reported suicide, the survey obtained information regarding demographic characteristics and method of suicide. RESULTS: The 90 responding schools (response rate 69 %) reported a total of six suicides (four males, two females; five Caucasians, one Asian) from July 2006 to June 2011. Two deaths by suicide occurred in first year, two in second year, and two in third year. Two of the suicides occurred by gunshot, two by hanging, one by overdose, and for one, the cause of death was unknown. Three of the six students left a suicide note. CONCLUSION: Although the number and rate of suicides among medical students may be lower than a prior survey that was conducted more than 15 years ago, these data affirm the importance of suicide prevention programs for medical students.

Increasing Diversity in Academic Medicine Via a Strategic Intermural Housestaff Leadership Development Program.

PROBLEM: By 2055, the United States will no longer have a single race or ethnic majority. As the nation's demographics change, the field of medicine must also change to meet the needs of diverse patients. APPROACH: In 2013, UT Southwestern Medical Center implemented the Housestaff Emerging Academy of Leaders (HEAL) program, which provides leadership development skills and training to underrepresented in medicine physician residents in preparation for academic medicine careers. Program leaders hypothesized that by providing housestaff with structured mentorship, career coaching, and individualized development plans, HEAL would increase interest in pursuing academic careers and prepare residents for faculty positions. HEAL has since expanded to graduate medical education programs nationwide. OUTCOMES: From 2013 to 2018, HEAL included housestaff at UT Southwestern and other Texas medical centers, totaling 392 enrollees. In 2019, the program increased to include housestaff from around the country. The first HEAL USA program had 39 housestaff, which increased to 173 in 2019, including 60 faculty from 31 U.S. academic medical centers. The 2019 HEAL USA preassessment survey (32 trainee responses) revealed that 10 (31%) of the housestaff were "extremely interested" in academic medicine, but only 1 (3%) felt "extremely confident" to pursue an academic medicine career. Postassessment responses to these same items (5 trainee responses) were 3 (60%) and 1 (20%), respectively, with 3 (60%) also feeling "extremely prepared" (1 [20%]) or "very prepared" (2 [40%]) to pursue an academic medicine career. Of 70 evaluable participants who attended at least 2 sessions and have graduated from residency, 47 (67%) have attained academic faculty positions, whereas 23 (33%) have pursued positions at nonacademic centers. NEXT STEPS: The next steps for HEAL USA will be continued expansion to additional medical centers and effective delivery of career development and leadership training to encourage participants to pursue academic medical careers.

A systematic review of stress-management programs for medical students.

OBJECTIVE: Because medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions. METHOD: The authors searched the published English-language articles on PsycINFO and PubMed, using a combination of the following search terms: stress-management, distress, burnout, coping, medical student, wellness. Both randomized, controlled trials and controlled, non-randomized trials of stress-management programs were selected and critically appraised. RESULTS: A total of 13 randomized, controlled trials or controlled, non-randomized trials were identified. Interventions included self-hypnosis, meditation, mindfulness-based stress-reduction, feedback on various health habits, educational discussion, changes in the length and type of curriculum, and changes in the grading system. Only one study was identified to be of very high quality, although several had described group differences at baseline, used blinding, had good follow-up, and used validated assessment tools. There was a wide heterogeneity of outcome measures used. Interventions that were supported by a reduction in stress and anxiety in medical students included mindfulness-based stress-reduction or meditation techniques, self-hypnosis, and pass/fail grading. CONCLUSIONS: Significant opportunities to advance educational research in this field exist by developing more high-quality studies with particular attention to randomization techniques and standardizing outcome measures.

Power Reimagined: Advancing Women Into Emerging Leadership Positions.

Academic medicine is evolving from the traditional model of a medical school and teaching hospital owned by the same entity to one with complex academic medical centers and health systems. This increased complexity is evident not only in the funding streams and organizational priorities of these growing health systems but also in the evolution of leadership roles toward more matrixed positions and more individuals who hold both medical school and health system roles. Given this changing landscape, the authors of this commentary raise the following questions: Will the levers of power remain in the hands of those in traditional academic roles? Or are they moving toward those in roles that are more aligned with the clinical enterprise and health system? Then, if this shift is occurring, what is needed to prepare women to be competitive candidates for these new roles? Because of the long history of and current gender imbalance in academic leadership roles, professional development programs have traditionally focused on preparing women to advance through the faculty ranks and for department chair and decanal roles. With the shift to more complicated health systems, the definitions, responsibilities, and types of leadership roles in academic medicine are also evolving to include nontraditional academic positions in the health system, such as c-suite and other senior executive roles. In parallel to the gender inequities in traditional roles, women are also underrepresented in health system leadership roles. Therefore, it is critical to explicitly identify emerging roles in health care leadership, address systemic barriers, and actively train and prepare women with the knowledge, skills, and experience required for these positions. Only with consistent attention to outcomes and the implementation of intentional systems to engage, prepare, and advance women will the gender gap be closed.

Establishing community partnerships to support late-life anxiety research: lessons learned from the Calmer Life project.

OBJECTIVES: This article outlines the development of the Calmer Life project, a partnership established between researchers and faith-based and social service organizations to examine the effectiveness of cognitive behavioral therapy (CBT) incorporating religious/spiritual components for older African Americans in low-income communities. METHOD: The program was designed to bypass several barriers to delivery of CBT within the specified community; it allows multimodal delivery (in person or by telephone) that occurs outside traditional mental health settings through faith-based organizations and neighborhood community centers. It includes religion/spirituality as an element, dependent upon the preference of the participant, and is modular, so that people can select the skills they wish to learn. Established relationships within the community were built upon, and initial meetings were held in community settings, allowing feedback from community organizations. RESULTS: This ongoing program is functioning successfully and has strengthened relationships with community partners and facilitated increased availability of education and services in the community. The lessons learned in establishing these partnerships are outlined. CONCLUSIONS: The growth of effectiveness research for late-life anxiety treatments in underserved minority populations requires development of functional partnerships between academic institutions and community stakeholders, along with treatment modifications to effectively address barriers faced by these consumers. The Calmer Life project may serve as a model.

Saturday Morning Science programs: a model to increase diversity in the biosciences.

PURPOSE: To examine a pathway program for middle and high school students from underrepresented backgrounds designed to foster career interest in the biomedical sciences. In 2002, the Institute of Medicine released a report entitled Unequal Treatment, which examined the racial and ethnic disparities in health and health care within the United States and encouraged the development of a diverse health care workforce as a means to reduce health care disparities. PROCEDURES: Saturday Morning Science (SMS) is a program model presented as a pipeline strategy that addresses this specific recommendation. SMS is a 10-week program that emphasized the importance of science and math. Post-SMS evaluations were conducted to assess biomedical career knowledge, attitudes regarding future career plans, and the effectiveness of the program. FINDINGS: A total of 87.5% of middle and high school students who were enrolled in SMS completed the program (113 of 130). Seventy percent of SMS participants were underrepresented minorities. Snapshot program evaluation data exposed new ideas about science (strongly agree/agree, 98%; 64 of 65), exposed new ideas about medicine (strongly agree/agree, 97%; 63 of 65, and increased desire to enter science related field (strongly agree/agree 82% (53 of 65). CONCLUSIONS: SMS was designed to motivate students of underrepresented ethnic backgrounds from middle through high school to attend college and prepare for careers in the health sciences. SMS students had the opportunity to interact with scientists, physicians, medical and graduate students, and other academicians. They provided direction and guidance to ensure that students had meaningful experiences specifically designed to expose them to opportunities in the biosciences.

Lessons learned: a "homeless shelter intervention" by a medical student.

OBJECTIVE: The authors explored the process of implementing a medical student-initiated program designed to provide computerized mental health screening, referral, and education in a homeless shelter. METHOD: An educational program was designed to teach homeless shelter staff about psychiatric disorders and culturally-informed treatment strategies. Pre- and post-questionnaires were obtained in conjunction with the educational program involving seven volunteer shelter staff. A computerized mental health screening tool, Quick Psycho-Diagnostics Panel (QPD), was utilized to screen for the presence of nine psychiatric disorders in 19 volunteer homeless shelter residents. RESULTS: Shelter staffs' overall fund of knowledge improved by an average of 23% on the basis of pre-/post-questionnaires (p=0.005). Of the individuals who participated in the mental health screening, 68% screened positive for at least one psychiatric disorder and were referred for further mental health care. At the 3-month follow-up of these individuals, 46% of those referred had accessed their referral services as recommended. CONCLUSIONS: Medical student-initiated psychiatric outreach programs to the homeless community have the potential to reduce mental health disparities by both increasing access to mental health services and by providing education. The authors discuss educational challenges and benefits for the medical students involved in this project.

Racial/Ethnic Disparity in Suicidal Ideation, Suicide Attempt and Non-suicidal Intentional Self-harm Among Pregnant Women in the United States.

We examined the prevalence of suicidal ideation, suicide attempt and non-suicidal intentional self-harm among pregnant women in the United States stratified by race/ethnicity. Data on hospital admissions among pregnant women 15-49 years during 2016-2017 compiled in the Nationwide Inpatient Sample were used for this study. We assessed the prevalence and factors of suicidal ideation, suicide attempt and non-suicidal intentional self-harm among different race/ethnicities. The prevalence of suicidal ideation, suicide attempt and non-suicidal intentional self-harm was greatest among hospitalized Non-Hispanic (NH) Black pregnant women. As compared to pregnant women who were routinely discharged, those who died during the course of hospitalization had about eight times the odds for NH-Whites, four times the odds for NH-Blacks and five times the odds for Hispanics of suicidal ideation or attempt. Appropriate measures are needed for prompt diagnosis and management of mental health issues in pregnant women belonging to vulnerable sub-groups.

Advancing Equity in Academic Medicine Through Holistic Review for Faculty Recruitment and Retention.

The Association of American Medical Colleges (AAMC) in 2007 developed the Holistic Review Framework for medical school admissions to increase mission-aligned student diversity. This approach balances an applicant's experiences, attributes, and metrics during the screening, interview, and selection processes. Faculty recruitment provides its own set of challenges, and there is persistent underrepresentation of certain racial and ethnic minority groups and women in faculty and leadership positions in U.S. academic health centers (AHCs). In 2019, the AAMC initiated a pilot program to adapt and implement the framework for use in faculty recruitment at AHCs. In this Invited Commentary, the authors describe the pilot implementation of the Holistic Review Framework for Faculty Recruitment and Retention and share lessons learned to date. Although the pilot proceeded during 2020, institutional implementation was impacted by the COVID-19 pandemic and racial justice movement. Pilot institutions encountered hiring freezes, reductions in funding, and restrictions on in-person meetings due to COVID-19 that resulted in both barriers and opportunities in implementing the framework. Renewed commitment to racial justice was associated with increased momentum and urgency for the implementation of faculty holistic review at the majority of pilot institutions. Common themes from the pilot leads' experiences included the importance of achieving "buy in," having a dedicated implementation team, and being explicit about core values. Other themes included the importance of adaptability and flexibility to meet the needs of different institutions and mission areas. The faculty holistic review framework has shown promise as an approach to advancing faculty diversity goals. The pilot institutions will continue to share best practices, track outcomes, implement quality improvement, and disseminate findings to assist other institutions and health care communities with their endeavors to recruit and retain diverse faculty.

Fourth Annual Summer Research Summit on Health Equity Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on May 20, 2021.

Strengthening Our Commitment to Racial and Social Justice to Improve Public Health The fourth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM) was held on May 20, 2021. The theme of this year's summit was 'Strengthening Our Commitment to Racial and Social Justice to Improve Public Health.' Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, individuals involved in talent acquisition and development such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States, India, Pakistan and the Demographic Republic of the Congo. The content in this Book of Abstracts encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows and junior faculty from BCM) as well as the external summit participants. The range of topics in this year's summit was quite diverse encompassing disparities in relation to maternal and child health (MCH), immigrant heath, cancers, vaccination uptakes and COVID-19 infections. Various solutions were ardently presented to address these disparities including community engagement and partnerships, improvement in health literacy and development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health. The summit received very positive response in terms of zealous participation and outstanding evaluations; and overall, it was a great success. Copyright © 2021 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

MPRO: A Professionalism Curriculum to Enhance the Professional Identity Formation of University Premedical Students.

Limited opportunities exist for university premedical students to gain exposure to the realities of clinical practice through physician shadowing or through a formal curriculum. Medical Professionalism and Observership utilizes didactics, reflective writing, small- and large- group discussions, and clinical observerships to enhance the process of professional identity formation during a critical developmental window of late- adolescence. The pilot semester included a sample of 135 students, all in their sophomore, junior, or senior years of study at Rice University. Students were selected through an application process and paired with physicians at Houston Methodist Hospital based on specialty preference and availability. Students were required to participate in biweekly lectures and discussions and to submit a weekly reflection on topics discussed in the course and their shadowing experiences. Student evaluations were administered to survey changes in students' knowledge and perceptions of the curriculum. Selected reflections were read for evidence of professional identity formation. Lectures increased students' exposure to core competencies within the medical profession and influenced their desire to become physicians. Reflective writings demonstrated integration of these core competencies into the professional identity of students. Structured reflection and didactics, when coupled with physician shadowing, appear to promote integration of the values, beliefs, and attitudes of medical professionalism. Future studies should seek to demonstrate how such a curriculum affects professional identity formation through established measures, and to assess whether such a curriculum may influence students' preparedness for medical training and practice as they progress along their careers.

The emergence of a texas collaboration to improve well-being in learning health systems.

Prior models of well-being have focused on resolving issues at different levels within a single institution. Changes over time in medicine have resulted in massive turnover and reduced clinical hours that portray a deficit-oriented system. As developments to improve purpose and professional satisfaction emerge, the Texas Medical Association Committee on Physician Health and Wellness (PHW) is committed to providing the vehicle for a statewide collaboration and illuminating the path forward.To describe the existing health and wellness resources in Texas academic medical centers and understand the gaps in resources and strategies for addressing the health and wellness needs in the medical workforce, and in student and trainee populations.Various methods were utilized to gather information regarding health and wellness resources at Texas academic medical centers. A survey was administered to guide a Think Tank discussion during a PHW Exchange, and to assess resources at Texas academic medical centers. Institutional representatives from all Texas learning health systems were eligible to participate in a poster session to share promising practices regarding health and wellness resources, tools, and strategies.Survey responses indicated a need for enhancing wellness program components such as scheduled activities promoting health and wellness, peer support networks, and health and wellness facilities in academic medical centers. Answers collected during the Think Tank discussion identified steps needed to cultivate a culture of wellness and strategies to improve and encourage wellness.The Texas Medical Association Committee on Physician Health and Wellness and PHW Exchange provided a forum to share best practices and identify gaps therein, and has served as a nidus for the formation of a statewide collaboration for which institutional leaders of academic medical centers have affirmed the need to achieve the best result.

Evaluation and treatment of acute psychosis in children with Systemic Lupus Erythematosus (SLE): consultation-liaison service experiences at a tertiary-care pediatric institution.

BACKGROUND: Neurological and psychiatric manifestations of systemic lupus erythematosus (SLE) are prevalent in children with SLE. There are few data on the evaluation and management of psychotic features in children with this systemic autoimmune disorder. OBJECTIVE: The authors describe contemporary Child and Adolescent Psychiatry Consultation and Liaison service management of acute psychosis in children with lupus. METHOD: The authors reviewed the records (2003-2008) of all pediatric SLE inpatients who were administered a traditional or atypical antipsychotic agent. They describe clinical features, initial and discharge mental status examinations, and inpatient psychotropic medication usage. RESULTS: Ten pediatric SLE patients (age 10-19 years) required psychiatric management for psychosis during the review period. Paranoid delusions (70%), visual hallucinations (60%), and auditory hallucinations (60%) were the most common psychotic symptoms documented. All children were initially treated with an antipsychotic medication. Seven children were maintained on an atypical antipsychotic during their hospitalization. Two children had extrapyramidal signs, but no other adverse events were documented. All children were improved at discharge, and 40% had complete resolution of psychosis; 8 of the 10 patients were discharged on a psychotropic medication. DISCUSSION: Psychotic manifestations associated with severe disease presentations were successfully treated by child psychiatrists. Atypical antipsychotics were well-tolerated and used as an adjunct to immunosuppressive regimens in these patients. Prospective studies are necessary to improve the care of children and adolescents with SLE and severe psychiatric manifestations.

2019 Health Equity Summer Research Summit Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on June 18th, 2019.

The 2nd annual Health Equity Summer Research Summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM), was a forum to catalyze the fertilization and exchange of cutting-edge ideas in the area of disparity research in medicine. The summit fosters understanding of current health equity research, training, clinical care, and outreach initiatives, in addition to offering an opportunity for connecting with allies and partners working in the field of health equity and health disparities. The summit provides opportunities for our COE Scholars (undergraduate/post-baccalaureate students and Baylor medical students, clinical fellows and junior faculty) to showcase their research findings which are reflective of their past year's endeavor as scholars at the center. Abstracts in this Book of Abstracts represent a summary of these research efforts. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health.

Third Annual Summer Research Summit on Health Equity Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on June 9, 2020.

This year's summit was unique given the COVID-19 pandemic: a major global outbreak that has imposed severe restrictions in all aspects of our life. At the outset, we were faced with three mutually exclusive options. First option was to cancel the summit in its entirety: this was the easiest and most obvious choice once the COVID-19 pandemic forced a near total lockdown all over the country with unprecedented disruptions of normal daily activities as the disease announced its thunderous touchdown on United States (US) soil. It was also the most-logical response faced with uncertainty regarding summit logistics and expected poor attendance due to the raging pandemic. Second option was to conduct a digital summit restricted to local audiences at Baylor College of Medicine: this option entailed implementing a virtual summit with attendance restricted to participants from our institution only. It sounded like a reasonable choice but that would impede the presence of diversity of topics, perspectives, insights and experiential learning opportunities, which are what render the summit exciting and worth attending. And finally, the last option was to conduct a digital unrestricted summit open to all interested audiences throughout the US. The conduct of a virtual summit open to all participants from around the country was initially considered daunting given the likelihood of amplified technical problems associated with an array of internet access differentials around the country, which would require a strong Information Technology (IT) presence throughout the sessions. Nonetheless, the attractiveness of going national with a virtual summit, despite the pandemic and logistical challenges, slowly gained converts and became the dominant choice. The response and level of participation in this first virtual summit showed an unanticipated surge despite the increase in registration fees to cover IT costs. This year, we had attendees from all regions of the US as well as from the United Kingdom. The range of topics was quite diverse encompassing health disparities in relation to cancers, nutrition, musculo-skeletal disorders, amputation rates, vaccination uptakes and COVID-19 infections. Various solutions were passionately presented to address these disparities including novel health technologies, community engagement and partnerships, improvement in health literacy and alternative therapeutics. There were no hitches despite the complex breakout sessions, and above all, attendees were satisfied and offered outstanding evaluation scores. This was definitely a summit that metamorphosed from pessimism to a triumphant success! Copyright © 2020 Salihu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Social Determinants of Overweight and Obesity Among Children in the United States.

BACKGROUND: Childhood obesity is one of the foremost threats to population health in the United States (U.S.) leading to the emergence of co-morbidities and increased healthcare cost. We explore the influence of selected social determinants of health (SDOH) on overweight and obesity among U.S. children. METHODS: We utilized the National Survey of Children's Health (NSCH) 2016-17 dataset for this analysis. Overweight was defined as Body Mass Index (BMI) ≥ 85th to<95th, while obesity was defined as BMI ≥95th percentile for age and sex. Based on the literature and pathway plausibility, we examined several SDOH variables as predictors of childhood overweight or obesity in the US. Survey log-binomial regression models were built to generate prevalence ratio (PR) estimates to capture the associations between SDOH and overweight or obesity. RESULTS: About 30.6 million children were surveyed of which 9.5 million (31.0%) were either overweight or obese. The likelihood of obesity was elevated among non-Hispanic Black and Hispanic children (PR = 1.53; 95% CI = 1.01-2.31) and (PR = 1.50; 95% CI = 1.18-1.90) respectively. Overweight was more frequent in younger children, children of single parents, and children who lived in a neighborhood with no amenities. Parental attainment of college education, health insurance coverage, female gender, and language spoken in home other than Spanish were protective against overweight or obesity. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: SDOH represent markers of overweight or obesity in children. We recommend the development of innovative interventions using SDOH risk and protective pathways as guide to address the current epidemic of childhood overweight and obesity.