Food insecurity and childhood outcomes: a cross-sectional analysis of 2016-2020 National Survey of Children's Health data.

CONTEXT: Racial inequalities across social determinants of health (SDOHs) are often influenced by discriminatory policies that reinforce systems that further uphold these disparities. There is limited data describing the influence of food insecurity (FI) on childhood racial discrimination. OBJECTIVES: Our objective was to determine if the likelihood of experiencing racial discrimination was exacerbated by FI. METHODS: We conducted a cross-sectional analysis of the 2016-2020 National Survey of Children's Health (NSCH) to extract data on childhood racial discrimination and food security. We extracted sociodemographic variables to utilize as controls and constructed logistic regression models to determine associations, via odds ratios (ORs), between food security and whether the child experienced racial discrimination. RESULTS: We found statistically significant associations between experiencing FI and childhood racial discrimination. Individuals who experienced food shortages were significantly more likely to experience racial discrimination compared to those without food limitations when controlling for race, food voucher usage, age, and % federal poverty guidelines (FPG, adjusted odds ratio [AOR]: 3.34; 95 % CI: 2.69-4.14). CONCLUSIONS: Our study found that parents of minority children all reported high rates of racial discrimination, which was exacerbated by concurrent FI. Children of families that were the most food insecure reported the highest percentage of racial discrimination at 11.13 %, compared with children who always had enough nutritious meals to eat at 2.87 %. Acknowledging the intersection that exists between FI, race, gender, and socioeconomic status (SES), might be a way forward in addressing the adverse health effects experienced by food-insecure children and adults.

Association and disparities of food insecurity and exposure to violence: analysis of the National Survey of Children's Health.

CONTEXT: Lack of access to food is a significant concern for child well-being, and it creates many health disparities and adverse social outcomes. Food insecurity and its many associated risk factors increase parental stress, which are strongly correlated with an increased risk of child abuse and maltreatment. Research now identifies being witness to domestic abuse as a form of child maltreatment, and exposure to violence in the community has been shown to result in similar long-term impacts. OBJECTIVES: Given the potential for lifelong adverse effects from experiencing adverse childhood events involving violence and food insecurity, our primary objective was to assess the relationship between the two and disparities among demographic factors. METHODS: We conducted an observational study utilizing data from the National Survey of Children's Health (NSCH) 2016-2021. The NSCH is a United States nationally representative survey completed by primary caregivers of one child per home aged 0-17 years. We determined population estimates (n=216,799; n=83,424,126) and rates of children experiencing food insecurity and parent-reported exposure to violence. We then constructed logistic regression models to assess associations, through odds ratios (ORs), between food security and exposure to violence including demographic factors. RESULTS: Among the sample, 5.42 % of children experienced low food security and 7.4 % were exposed to violence. The odds of exposure to violence are 5.19 times greater for children with low food security compared to food-secure children (95 % confidence interval [CI]: 4.48-6.02). Indigenous and Black children were 7.8 and 6.81 times more likely to experience or witness violence when food insecure compared to food secure White children, respectively (95 % CI: 3.18-19.13, 5.24-8.86 respectively). CONCLUSIONS: Food insecurity was associated with increased odds of children experiencing and/or witnessing violence compared to those who were food secure. The interaction between exposure to violence and food insecurity also disproportionately impacts children with specific demographic factors, notably race/ethnicity including multiracial, Indigenous, and Black children. By developing and adapting strategies to improve food security, it is possible to indirectly reduce the rates of childhood exposure to violence and the long-term impacts that result.

Comparing Self-Reported and Aggregated Racial Classification for American Indian/Alaska Native Youths in YRBSS: 2021.

Objectives. To identify how race and ethnicity were reclassified with survey variables for children self-reporting as American Indian/Alaska Native (AI/AN) using the 2021 Youth Risk Behavior Surveillance System (YRBSS). Methods. We conducted a cross-sectional analysis of the US Centers for Disease Control and Prevention's 2021 YRBSS. YRBSS collects behaviors and demographics of students in grades 9 through 12, including race and ethnicity via self-report, and then reclassifies data into a "raceeth" variable. To examine the classification of AI/AN in YRBSS, we compared AI/AN composition between self-report and raceeth variables. Results. A total of 816 adolescents self-reported as AI/AN alone (145; 17.70%), AI/AN alone with Hispanic/Latino background (246; 30.15%), or AI/AN in combination with 1 or more race (425; 52.08%). Of those, only 145 were classified as being AI/AN in the calculated raceeth variable. With YRBSS survey weighting, the percentage of AI/AN in the raceeth variable was 13.4%. Conclusions. Misclassification, noncollection, or the use of categories such as "other" and "multirace" without allowing disaggregation can misrepresent disease burden, morbidity, and mortality. Consequently, it is critical to disaggregate data to adequately capture race/ethnicity in self-report surveys and data sources. (Am J Public Health. 2024;114(4):403-406. https://doi.org/10.2105/AJPH.2023.307561).

Associations of social determinants of health and childhood obesity: a cross-sectional analysis of the 2021 National Survey of Children's Health.

CONTEXT: Childhood obesity is a growing health problem in the United States, with those affected having an increased likelihood of developing chronic diseases at a younger age. Social determinants of health (SDOH) are known to influence overall health. Families who are of low socioeconomic status (SES) have also been shown to be more likely to experience food insecurity. OBJECTIVES: Our primary objective was to utilize the National Survey of Children's Health (NSCH) 2021 data to determine the current associations between childhood obesity and SDOH. Secondarily, we estimated the prevalence of select SDOH among children with obesity. METHODS: We conducted a cross-sectional analysis of 2021 NSCH to extract data related to the SDOH domains. We extracted sociodemographic variables to utilize as controls and constructed logistic regression models to determine associations, via odds ratios, between SDOH and childhood obesity. RESULTS: Within the binary regression models, children with obesity (≥95th percentile) were more likely than children without obesity to experience SDOH in all domains. After controlling for sociodemographic variables, children with obesity were significantly more likely to experience food insecurity when compared to children without obesity (adjusted odds ratio [AOR]=1.39; 95 % confidence interval [CI]: 1.13-1.17). CONCLUSIONS: In line with the current American Academy of Pediatrics (AAP) Clinical Practice Guidelines (CPG), improving policies for nutrition programs and addressing the lack of access to nutritious foods may alleviate some food insecurity. Ensuring that children have access to sufficient nutritious foods is critical in addressing childhood obesity and thus decreasing risk of chronic disease.

The Impact of Montelukast's Black Box Warning on Pediatric Mental Health Adverse Event Reports.

OBJECTIVE: In March 2020, the US Food and Drug Administration (FDA) required a black box warning for montelukast due to serious mental health side effects. We hypothesized the warning would lead to an overall decrease in reports of mental health symptoms and disorders related to montelukast in both -pre-adolescent and adolescent groups. METHODS: Adverse events of pre-adolescent and adolescent children taking montelukast sodium were reviewed from March 1, 2018 to March 3, 2020 and March 4, 2020 to February 28, 2022 using the FDA's Adverse Events Reporting System. The objective was to determine if mental health adverse event reports were influenced by placement of a Boxed Warning. Adverse reactions were grouped into 8 categories deemed to be related to mental health guided by the research team's interpretation of the FDA Sentinel Report. Chi-square tests were used to compare time periods and reports of the mental health categories. RESULTS: Of the 1570 reports assessed, 1295 (82.5%) included ≥1 mental health concern. Nine hundred ninety-six (84.2%) of the 1183 reports involving pre-adolescents and 299 (77.3%) of the 387 reports involving adolescents included ≥1 mental health reaction. Statistically significant changes for pre-adolescents were found in reports related to depression (χ2 (1) = 4.30, p = 0.044), and sleep (χ2 (1) = 5.74, p = 0.019), which both decreased between the pre and post periods. The only statistically significant change across categories for adolescents was a reduction in aggression reports between time periods (χ2 (1) = 8.5, p = 0.004). CONCLUSIONS: After placement of an FDA black box warning on montelukast, total number of reports -including mental health adverse events decreased in pre-adolescents; however, several categories -assessed increased for adolescents.

Trends and forecasted rates of adverse childhood experiences among adults in the United States: an analysis of the Behavioral Risk Factor Surveillance System.

CONTEXT: Many studies have shown increases in negative social aspects in the United States that may increase the likelihood of a child experiencing adversity. These rising trends include household dysfunction, poor mental health and substance use, crime rates, and incarceration. Additionally, the pathway of adverse childhood experiences (ACEs) may also perpetuate intergenerational trauma. OBJECTIVES: Given these increased trends, our objective was to determine the mean ACEs reported among adults by year of birth to assess trends of ACEs over time. METHODS: To assess ACEs trends in the United States, we utilized data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative survey. We summed individuals' reported ACEs and then calculated the mean ACE score within age cohorts (in 1-year increments) by year of birth. We utilized an auto-regressive integrated moving average (ARIMA) model to forecast mean ACEs through 2030. RESULTS: Respondents to the ACEs module (n=116,378) represented 63,076,717 adults in the United States, with an average age cohort of 1715 individuals. The mean reported ACEs among individuals 80 years or older (born in or before 1940) was 0.79, while the highest mean ACEs (2.74) were reported among the cohort born in 1998-an average increase of 0.022 ACEs per year. The ARIMA model forecasted that individuals born in 2018 will, on average, surpass a cumulative of three ACEs. CONCLUSIONS: Given the connection of ACEs to poor health outcomes and quality of life, this trend is alarming and provides evidence for the necessity of child maltreatment prevention. Multigenerational trauma-informed care and education are warranted for individuals with ACEs and may even prevent the cycle from recurring.

McGirt v Oklahoma and What Clinicians Should Know About Present-Day Child Abuse and Legacies of Forced Migration.

In 1997, Jimcy McGirt was convicted by the State of Oklahoma for sex crimes against a minor. McGirt appealed his conviction, citing that Oklahoma lacked jurisdiction over the case due to his tribal citizenship, since the crime took place on tribal territory. On July 9, 2020, the Supreme Court of the United States (SCOTUS) reversed the Oklahoma Court of Criminal Appeals' original decision for the case, citing that Congress had failed to disestablish reservations with regard to the Major Crimes Act, which gave the federal government jurisdiction over major felony crimes perpetrated by Native Americans on reservations.This ruling has already caused sweeping changes in the investigations and prosecutions of child maltreatment in eastern Oklahoma, as such cases may fall under the jurisdiction of federal agencies or tribal law enforcement. This article details the historic significance of the decision and the experiences of 3 child abuse pediatricians working as part of a multidisciplinary team while jurisdictional changes were implemented following the SCOTUS ruling.

Racial discrimination among children in the United States from 2016 to 2020: an analysis of the National Survey of Children's Health.

CONTEXT: Sociological research has linked racism and discrimination among children to poorer health outcomes and social conditions later in life. OBJECTIVES: Given the change in the political climate in the United States, highly publicized deaths of Black men and women by police, and the rise in hate crimes against Asian Americans from 2016 through 2020, our primary objective was to assess trends in racial or ethnic discrimination among children in the United States. METHODS: We conducted a cross-sectional analysis of the National Survey of Children's Health (NSCH), a nationally representative survey, utilizing data from 2016 to 2020. We calculated yearly population estimates of whether a child had experienced discrimination based on race/ethnicity via a parent-reported item. We further divided the estimates by race/ethnicity and plotted linear trends over time. RESULTS: Data from the NSCH show that racial/ethnic discrimination reported by parents of children who are minorities increased from 6.7% in 2016 to approximately 9.3% in 2020. Indigenous children were reported to experience discrimination at high rates ranging from 10.8% in 2016 to 15.7% in 2020, as well as Black children ranging from 9.69% in 2018 to 15.04% in 2020. The percent of Asian, Hawaiian or Pacific Islander, and Hispanic children reported to have experience discrimination was between 4.4 and 6.8% during this time. CONCLUSIONS: Discrimination negatively impacts the developmental experiences of children, disproportionately affecting those identifying as Indigenous and Black. Therefore, addressing harmful stereotyping of Indigenous and Black cultures is necessary, especially in media targeted toward children. Providing culturally competent healthcare, critically in the Indigenous and Black pediatric population, may improve long-term outcomes by reducing discriminatory barriers to healthcare access.

Trends in public interest in child abuse in the United States: An infodemiology study of Google Trends from 2004 to 2022.

INTRODUCTION: More than 1 in 7 children in the United States experience abuse annually with rates remaining consistent over the past 2 decades. During this timeframe, several high-profile cases of child abuse and neglect were publicized in national media in addition to multiple investigations uncovering Indigenous children dying from abuse at Indian Boarding Schools. Increased media attention among other public health and medical topics has been linked to increased public interest, thus, our objective was to investigate trends in public interest from 2004 to 2022. METHODS: To assess trends in public interest, we extracted monthly relative search interest in child abuse from Google Trends. We constructed linear regression to determine the long-term trajectory of interest, and also compared the slope of the trend to other topics, such as domestic violence. Further, we compared mean relative search interest (RSI) from Child Abuse Awareness Month (April) to other months via t-test. Lastly, we assess by-state correlations of RSI and number of children abused. RESULTS: Since 2004, search interest in child abuse has significantly declined in the United States-more than other related search terms. Child Abuse Awareness Month showed spikes in RSI which were greater than other months. By-state correlations of RSI and abuse were moderate to weak. CONCLUSION: Despite heavy media attention covering stories of child abuse during the past 2 decades, search interest in child abuse has significantly declined. This trend may be related to aversion to secondary traumatic stress as news broadcasts often include stories of violence-of which child abuse stories may be most provoking. Following journalism guidance from the Centers for Disease Control and Prevention, reporting with focus on resiliency and prevention, rather than the individuals who perpetrated the crime, may provide more community support and increased public interest.