Reduced covariation between brain morphometry and local spontaneous activity in young children with ASD.

While disruptions in brain maturation in the first years of life in ASD are well documented, little is known about how the brain structure and function are related in young children with ASD compared to typically developing peers. We applied a multivariate pattern analysis to examine the covariation patterns between brain morphometry and local brain spontaneous activity in 38 toddlers and preschoolers with ASD and 31 typically developing children using T1-weighted structural MRI and resting-state fMRI data acquired during natural sleep. The results revealed significantly reduced brain structure-function correlations in ASD. The resultant brain structure and function composite indices were associated with age among typically developing children, but not among those with ASD, suggesting mistiming of typical brain maturational trajectories early in life in autism. Additionally, the brain function composite indices were associated with the overall developmental and adaptive behavior skills in the ASD group, highlighting the neurodevelopmental significance of early local brain activity in autism.

Wilms tumor characteristics, surgical management, outcomes, and chronic kidney disease in children with WAGR syndrome: A report from the International WAGR Syndrome Association survey.

INTRODUCTION: Children with WAGR (Wilms tumor, aniridia, genitourinary anomalies, and range of development delays) syndrome are predisposed to Wilms tumor (WT) and intrinsic kidney disease. Using the comprehensive International WAGR Syndrome Association (IWSA) survey of children with WAGR syndrome, we analyzed tumor characteristics, treatment and congenital risk factors, and kidney function in children with WAGR and WT. METHODS: Descriptive statistics were utilized including demographics, treatment strategies, and patient outcomes. Comparisons were made between patients with WAGR and WT to those with WAGR alone. A multivariable logistic regression was completed for risk of developing WT and to identify predictors of chronic kidney disease (CKD). RESULTS: Sixty-four of 145 children with WAGR developed WT (44.1%). Three relapsed and one died. CKD developed in five children with WAGR without WT (5/81, 6.2%), and in 34 with WAGR and WT (34/64, 28.3%). Children with WAGR and WT were younger (p = .017), and had a greater association with CKD than WAGR children without WT (p < .0001). Two children with WT required hemodialysis, and one underwent kidney transplantation. By univariate analysis, CKD at any stage was associated with complete nephrectomy for the WT surgery (p < .0001), chemotherapy duration greater than 12 months, and three-drug therapy. Upon multivariate analysis, prior nephrectomy was the only significant variable (p = .0002). CONCLUSIONS: Epidemiological analysis of children with WAGR demonstrated favorable oncologic outcomes, but high rate of early CKD in those who developed WT. Further study of the use of nephron-sparing surgery in children with WAGR and strategies to delay or treat early CKD are needed.

Using Crowdfunding Campaigns to Examine Financial Toxicity and Logistical Burdens Facing Families of Children With Wilms Tumor.

INTRODUCTION: Treatment for pediatric solid tumors is often intense and multidisciplinary and can create a substantial financial burden for families. Assessing these burdens, termed the financial toxicity of treatment, can be difficult. Using Wilms tumor as an example, we evaluated crowdfunding campaigns in an attempt to better understand the impact of economic and logistic challenges associated with pediatric solid tumor care and identify features associated with successful fundraising with this method. METHODS: We used a webscraping algorithm to identify crowdfunding campaigns on GoFundMe.com for pediatric patients with Wilms tumor in the United States. We conducted a cross-sectional analysis to describe the patients and families seeking crowdfunding support for cancer care. After fundraizing information was extracted using the webscraping algorithm, each fundraiser was verified and examined by two independent reviewers to assess demographic, qualitative, disease, and treatment variables. Successful fundraisers, defined as those meeting stated financial goals, were compared to unsuccessful campaigns to identify variables associated with successful crowdfunding campaigns. RESULTS: We identified 603 children with Wilms tumor and an associated crowdfunding campaign. The median age was 4 y. The majority lived in two-parent households (68.5%). Patients mentioned siblings in 35.5% of fundraisers. While motivations for crowdfunding varied, hardships endured by families included loss of employment (52.2%), need for childcare for other children (9.8%), direct costs of care [co-payments, insurance, pharmaceuticals, out-of-pocket care costs, etc.] (80.9%), indirect costs associated with seeking care [transportation, parking, lodging, lost opportunity cost, etc.] (56.2%), and need for relocation to pursue complex cancer care (6.8%). Disease characteristics in this cohort were limited to self-reports by families. However, fundraisers mentioned disease characteristics, including tumor stage (47.6%), size (11.4%), positive nodal status (9.6%), metastatic disease (3.6%), pathology (11.8%), upstaging (4.6%), and disease recurrence (8.6%). No individually examined demographic, support, disease, or hardship-related factors varied significantly between successful and unsuccessful crowdfunding campaigns (all P > 0.05). However, successful campaigns requested less money ($11,783.25 successful versus $22,442.2 unsuccessful, <0.001), received more money ($16,409.5 successful vs 7427.4 unsuccessful, P < 0.001), and solicited larger donor numbers (170.3 successful versus 86.3 unsuccessful, P < 0.001). CONCLUSIONS: Families whose children undergo multimodal cancer care have significant expenses and burdens and can use crowdfunding to support their costs. Careful consideration of the financial and logistic strains associated with pediatric solid tumor treatment, including thorough analysis of crowdfunding sites, may support better understanding of nonclinical burdens, supporting therapeutic relationships and patient outcomes.

Examining the role of wide excision margins in pediatric melanoma: A National Cancer Database analysis.

BACKGROUND: Although adult guidelines are often applied to children, age-specific surgical margins have not been defined for pediatric melanoma. PROCEDURE: Patients <20 years of age with invasive, cutaneous melanoma were identified using the 2004-2016 National Cancer Database and categorized as undergoing wide (>1 cm) or narrow (≤1 cm) excision. Unadjusted overall survival (OS) was compared using the Kaplan-Meier method and log-rank test. Multivariable Cox proportional hazard models were used to estimate the effect of excision margin on OS after adjustment for available covariates. RESULTS: In total, 2081 patients met study criteria: 1338 (64.3%) patients underwent wide excision whereas 743 (35.7%) underwent narrow excision. Unadjusted OS was improved in the narrow-excision group (log-rank p = .01), which was consistent among patients with thicker (>1 mm) and thinner (≤1 mm) tumors. After adjustment for patient and tumor characteristics, we found no evidence of a difference in OS for patients who underwent narrow excision compared to patients who underwent wide excision (adjusted hazard ratio 0.57, 95% confidence interval 0.32-1.01, p = .053). There was no interaction between excision margin width and Breslow depth (p = .85), indicating that the effect of excision margin width on OS does not differ based on Breslow depth. CONCLUSIONS: In this analysis, wide excision (>1 cm) does not appear to be associated with improved survival in children with melanoma regardless of tumor characteristics. Although further studies are needed to define optimal excision margins in pediatric melanoma, this study suggests that more narrow margins (≤1 cm) may be acceptable.

Changes in retail sales of tobacco products in Ontario after a menthol sales restriction.

BACKGROUND: Ontario, Canada prohibited menthol tobacco product sales beginning 1 January 2017. We measured retail sales of menthol cigarettes and possible substitute products before and after policy implementation in Ontario. METHODS: We licensed retail scanner data for tobacco product sales in Ontario and British Columbia (BC), a comparison province without a menthol tobacco policy at that time. We assessed changes in per capita unit sales (per 1000 people) from pre-policy (January-June 2016) to post-policy (January-June 2017) periods. Classification of cigarettes as menthol or non-menthol, or having menthol-suggestive descriptors ('green', 'blue', 'silver' and 'fresh'), was based on scanner data. RESULTS: Ontario menthol cigarette sales decreased 93%, from 596 to 40 packs per capita compared with a 2% decrease (696 to 679 packs per capita) in BC. Menthol capsule cigarette sales remained low in Ontario (<1% of total cigarette sales) but rose sixfold in BC. Although cigar sales data were unavailable, substitution appeared minimal; sales of non-menthol cigarettes increased 0.4% in Ontario (11 470 to 11 519 packs per capita) while vaping product sales decreased. Ontario had a larger increase in sales of cigarettes with menthol-suggestive descriptors (11% increase) than BC (3% increase). In Ontario, nearly all (>99%) pre-policy sales of cigarettes with 'green' menthol-suggestive descriptors were menthol cigarettes, but post-policy, 94% of 'green' cigarettes sold were non-menthol. CONCLUSIONS: Ontario's menthol policy was associated with a decrease in retail sales of cigarettes classified as menthol, with little evidence of product substitution. Understanding changes in sales of cigarettes with menthol-suggestive descriptors would be informative.

Expanding local sales restrictions on flavoured tobacco products to include menthol: retail sales changes in two Minnesota cities.

BACKGROUND: In 2018, Minneapolis and St. Paul, Minnesota, expanded existing local sales restrictions on flavoured (non-menthol/mint/wintergreen) tobacco products ('flavour policies') to include menthol/mint/wintergreen-flavoured tobacco products ('menthol policies'). All policies included exemptions for certain store types. METHODS: We obtained weekly retail tobacco product sales for 2015 through 2019 from NielsenIQ for convenience stores and other outlets in the policy jurisdictions and two comparison areas (rest of the state of Minnesota and total USA). We standardised unit sales across product categories and used NielsenIQ-provided descriptors to classify products as menthol (including mint/wintergreen) or flavoured (non-menthol/non-tobacco). Using single group interrupted time series models, we analysed unit sales by product category and by flavour separately for each geography to assess associations between menthol policy implementation and trends in tobacco product unit sales. RESULTS: Following menthol policy implementation, unit sales of menthol cigarettes and menthol smokeless tobacco decreased in both cities, with smaller decreases in comparison areas. Flavoured cigar sales-which decreased following the flavour policies-further decreased after the menthol policies, while sales of menthol electronic nicotine delivery systems (ENDS) increased in both cities and sales of flavoured ENDS increased in St. Paul. CONCLUSION: Expanding flavour policies to include menthol/mint/wintergreen was associated with significant decreases in unit sales of most menthol products and in total unit sales by tobacco product category. Increases in menthol and flavoured ENDS sales in these cities may be associated with legal sales by exempted retailers and/or illicit sales by non-compliant retailers, highlighting opportunities for retailer education and enforcement.

Greater functional connectivity between sensory networks is related to symptom severity in toddlers with autism spectrum disorder.

BACKGROUND: Symptoms of autism spectrum disorder (ASD) emerge in the first years of life. Yet, little is known about the organization and development of functional brain networks in ASD proximally to the symptom onset. Further, the relationship between brain network connectivity and emerging ASD symptoms and overall functioning in early childhood is not well understood. METHODS: Resting-state fMRI data were acquired during natural sleep from 24 young children with ASD and 23 typically developing (TD) children, aged 17-45 months. Intrinsic functional connectivity (iFC) within and between resting-state functional networks was derived with independent component analysis (ICA). RESULTS: Increased iFC between visual and sensorimotor networks was found in young children with ASD compared to TD participants. Within the ASD group, the degree of overconnectivity between visual and sensorimotor networks was associated with greater autism symptoms. Age-related weakening of the visual-auditory between-network connectivity was observed in the ASD but not the TD group. CONCLUSIONS: Taken together, these results provide evidence for disrupted functional network maturation and differentiation, particularly involving visual and sensorimotor networks, during the first years of life in ASD. The observed pattern of greater visual-sensorimotor between-network connectivity associated with poorer clinical outcomes suggests that disruptions in multisensory brain circuitry may play a critical role for early development of behavioral skills and autism symptomatology in young children with ASD.

Changes in cigar sales following implementation of a local policy restricting sales of flavoured non-cigarette tobacco products.

INTRODUCTION: On 3 January, 2013, the city of Providence, Rhode Island, began enforcing a restriction on the retail sale of all non-cigarette tobacco products with a characterising flavour other than tobacco, menthol, mint or wintergreen. We assessed the policy impact on cigar sales-which comprise 95% of flavoured non-cigarette tobacco products sold through conventional tobacco retail outlets (eg, convenience stores, supermarkets) in Providence-over time and in comparison to the rest of the state (ROS). METHODS: Weekly retail scanner sales data were obtained for January 2012 to December 2016. Cigar sales were categorised into products labelled with explicit-flavour (eg, Cherry) or concept-flavour (eg, Jazz) names. Regression models assessed changes in prepolicy and postpolicy sales in Providence and ROS. RESULTS: Average weekly unit sales of flavoured cigars decreased prepolicy to postpolicy by 51% in Providence, while sales increased by 10% in ROS (both p<0.01). The Providence results are due to a 93% reduction in sales of cigars labelled with explicit-flavour names (p<0.01), which did not change significantly in ROS. Sales of cigars labelled with concept-flavour names increased by 74% in Providence and 119% in ROS (both p<0.01). Sales of all cigars-flavoured and otherwise-decreased by 31% in Providence (p<0.01). We detected some evidence of product substitution and cross-border purchasing. CONCLUSIONS: The Providence policy had a city-specific impact on retail sales of flavoured cigars, which was attenuated by an increase in sales of concept flavour-named cigars. Products with concept-flavour names may avoid enforcement agency detection, and their continued sale undermines the intent of the policy.

Transient states of network connectivity are atypical in autism: A dynamic functional connectivity study.

There is ample evidence of atypical functional connectivity (FC) in autism spectrum disorders (ASDs). However, transient relationships between neural networks cannot be captured by conventional static FC analyses. Dynamic FC (dFC) approaches have been used to identify repeating, transient connectivity patterns ("states"), revealing spatiotemporal network properties not observable in static FC. Recent studies have found atypical dFC in ASDs, but questions remain about the nature of group differences in transient connectivity, and the degree to which states persist or change over time. This study aimed to: (a) describe and relate static and dynamic FC in typical development and ASDs, (b) describe group differences in transient states and compare them with static FC patterns, and (c) examine temporal stability and flexibility between identified states. Resting-state functional magnetic resonance imaging (fMRI) data were collected from 62 ASD and 57 typically developing (TD) children and adolescents. Whole-brain, data-driven regions of interest were derived from group independent component analysis. Sliding window analysis and k-means clustering were used to explore dFC and identify transient states. Across all regions, static overconnnectivity and increased variability over time in ASDs predominated. Furthermore, significant patterns of group differences emerged in two transient states that were not observed in the static FC matrix, with group differences in one state primarily involving sensory and motor networks, and in the other involving higher-order cognition networks. Default mode network segregation was significantly reduced in ASDs in both states. Results highlight that dynamic approaches may reveal more nuanced transient patterns of atypical FC in ASDs.

E-Cigarette Policies on College Campuses: Student Use Behaviors, Awareness, and Policy Support.

This study examined e-cigarette use and attitudes toward e-cigarette policies among students at colleges and universities with and without policies prohibiting e-cigarette use on campus. In April 2015, we fielded an online survey with a convenience sample of 930 students at 14 North Dakota colleges and universities. The survey included questions about e-cigarette use, observed e-cigarette use on campus, awareness of school e-cigarette policy, and support for policies prohibiting e-cigarette use on campus. Over 40 % of respondents had used e-cigarettes at least once, and most current users reported using them rarely (36 %). Nearly 29 % of respondents reported observing e-cigarette use on campus, and more than half of these reported seeing e-cigarette use indoors. More than 42 % did not know whether their school's policy prohibited e-cigarette use on campus, and students at schools with a policy were more likely to identify their campus policy correctly. Sixty-six percent of respondents were in favor of policies prohibiting e-cigarette use on campus, and those at schools with policies prohibiting e-cigarette use were more likely to support a campus e-cigarette policy. Policies prohibiting e-cigarette use on campus intend to restrict use, reduce prevalence, and shape social norms. This study indicates that support for campus e-cigarette policies is high, although awareness of whether e-cigarettes are included in college and university policies is low. These findings demonstrate the need for coordinated policy education efforts and may guide college administrators and student health services personnel as they consider how to implement and evaluate campus e-cigarette policies.

Differential Diagnosis of Autism and Other Neurodevelopmental Disorders.

This article discusses the diagnostic criteria for autism spectrum disorder (ASD), as well as other neurodevelopmental disorders that may be confused with or co-occur with ASD. Practitioners involved in diagnostic assessment of ASD must be well versed in the features that differentiate ASD from other conditions and be familiar with how co-occurring conditions may manifest in the context of ASD. ASD symptoms present differently across development, underscoring the need for training about typical developmental expectations for youth. Periodic reevaluations throughout development are also important because support needs for individuals with autism change over time.

Sleep Problems in Preschoolers With Autism Spectrum Disorder Are Associated With Sensory Sensitivities and Thalamocortical Overconnectivity.

BACKGROUND: Projections between the thalamus and sensory cortices are established early in development and play an important role in regulating sleep as well as in relaying sensory information to the cortex. Atypical thalamocortical functional connectivity frequently observed in children with autism spectrum disorder (ASD) might therefore be linked to sensory and sleep problems common in ASD. METHODS: Here, we investigated the relationship between auditory-thalamic functional connectivity measured during natural sleep functional magnetic resonance imaging, sleep problems, and sound sensitivities in 70 toddlers and preschoolers (1.5-5 years old) with ASD compared with a matched group of 46 typically developing children. RESULTS: In children with ASD, sleep problems and sensory sensitivities were positively correlated, and increased sleep latency was associated with overconnectivity between the thalamus and auditory cortex in a subsample with high-quality magnetic resonance imaging data (n = 29). In addition, auditory cortex blood oxygen level-dependent signal amplitude was elevated in children with ASD, potentially reflecting reduced sensory gating or a lack of auditory habituation during natural sleep. CONCLUSIONS: These findings indicate that atypical thalamocortical functional connectivity can be detected early in development and may play a crucial role in sleep problems and sensory sensitivities in ASD.

Risk of Surgical Intervention in Children with Diagnoses of Cancer and Preoperative Malnutrition: A National Analysis.

BACKGROUND: Perioperative nutrition is a critical component of appropriate healing and recovery after surgery. We sought to identify perioperative risk in children with cancer and low preoperative hypoalbuminemia undergoing surgical intervention. METHODS: We queried the 2015-2019 NSQIP-Peds datasets for children with a primary diagnosis of renal or hepatic malignancy undergoing surgical resection. Postoperative outcomes were evaluated for comparative risk between patients with low albumin (albumin<3.0 g/dL) and normal albumin within 30 days of their surgical procedure. Univariate analysis and multivariable logistic regression were conducted to identify perioperative risk in patients with hypoalbuminemia. RESULTS: We identified 360 children with primary diagnosis of hepatic malignancy and 896 children with renal malignancy undergoing surgical resection. Of these, 77 children had hypoalbuminemia. Patients with renal or hepatic malignancy diagnosis and low albumin levels were more likely to experience postoperative dehiscence, need for TPN at discharge, postoperative bleeding or transfusion, unplanned reoperation, and unplanned readmission, based on univariate analysis (all P > 0.05). Postoperative bleeding, need for nutritional support at discharge, and unplanned readmission were each associated with hypoalbuminemia. CONCLUSION: We demonstrate that low preoperative albumin is associated with significant perioperative risk. More attention should focus on perioperative nutritional status of children with cancer who are undergoing major resections.

Pathways to the therapist paragon: a decolonial grounded theory.

Introduction: While many professional associations within clinical and counseling psychology have made an aspirational call for clinician awareness of social position, there is a lack of research into how socially-conferred privilege impacts psychotherapy. Specifically of interest is the differences in race and gender within the therapeutic dyad, in which there is a BIPOC (Black, Indigenous, and Persons of Color)/white or male/female-identified dynamic. Method: The authors utilized a Grounded Theory approach to analyze qualitative interviews with practicing psychologists to construct a process model regarding how socially-conferred privileged identity domains impact the therapeutic relationship and the participants' professionalization process. Results: The analysis identified the core conceptual theme of the Therapist Paragon, representing an idealized version of what a perfect therapist should be. This replicated the foundational figures of our field - primarily older, white men. The process model consisted of two distinct pathways toward the Therapist Paragon, one for BIPOC psychologists and one for white psychologists. The female BIPOC pathway consisted of imposter syndrome, persistent feelings of inadequacy, and tendencies to over-credential their professional identity to seek credibility in the eyes of clients and colleagues. The white pathway consisted of down-playing whiteness and attempting to initially modify behavior toward client cultural norms. Discussion: The results point to a distinct professionalization and practice process for BIPOC psychologists compared to white counterparts. This dynamic may have implications beyond increasing support for BIPOC clinicians specifically, but instead indicate a lack of acknowledgement of the psychological impact of socially-conferred privilege in the psychotherapy enterprise overall. Recommendations are offered for revisions to training models, continuing education, and supervision/consultation.

Before allyship: A model of integrating awareness of a privileged social identity.

Introduction: Although the American Psychological Association encourages clinical psychologists to recognize and understand the experience of social privilege both within themselves and the individuals and communities they serve, there is a dearth of research in the field to guide this pursuit. According to the available literature, an essential barrier to social privilege integration is its implicit and covert nature that prevents consistent consciousness due to hegemonic forces. Methods: This study explored the process, from initial social privilege awareness to the moment of the study, through individual interviews. A social-constructivist, grounded theory approach was utilized as it was aligned with the understudied phenomena oriented around social justice. Results: The result is a developmental model of social privilege integration that explicates accumulated exposures to privilege, the resultant threat to and protection of personal identity, and the conducive factors that lead to reconciliation. Discussion: Implications of this theoretical model include the importance of a developmental perspective to cultivate an understanding of individual prejudice attitudes and discriminatory behaviors, as well as a roadmap toward equitable change. This model may be used by clinical psychologists across multiple settings in response to the most recent APA multicultural guidelines.

Externalizing Behaviors are Associated with Increased Parenting Stress in Caregivers of Young Children with Autism.

Parents of children diagnosed with autism spectrum disorder (ASD) report higher levels of stress than parents of typically developing children. Few studies have examined factors associated with parental stress in early childhood. Even fewer have investigated the simultaneous influence of sociodemographic, clinical, and developmental variables on parental stress. We examined factors associated with stress in parents of young children with ASD. Multiple regression models were used to test for associations between socioeconomic indices, developmental measures, and parental stress. Externalizing behaviors, communication, and socialization skills accounted for variance in parental stress, controlling for ASD diagnosis. Results highlight the importance of interventions aimed at reducing externalizing behaviors in young children as well as addressing stress in caregivers of children with ASD.

Youth Tobacco Use Before and After Local Sales Restrictions on Flavored and Menthol Tobacco Products in Minnesota.

PURPOSE: Minneapolis and St. Paul, Minnesota, implemented sales restrictions on all flavored tobacco products in 2016 ("flavor policy") and expanded the restrictions to menthol tobacco products in 2018 ("menthol policy"). We examined data from surveys of Minnesota youth collected before and after the flavor and menthol policies. METHODS: We measured changes in youth tobacco use prevalence using data from the Minnesota Youth Tobacco Survey and the Minnesota Student Survey. We analyzed tobacco use overall and, where possible, by product category and flavor category among survey respondents in the Twin Cities area (including Minneapolis and St. Paul) and the rest of the state of Minnesota (ROS). RESULTS: In the Minnesota Youth Tobacco Survey, overall youth use of any tobacco product significantly increased in ROS (by 26.6%) but did not change in the Twin Cities after the flavor policies. Similarly, the Minnesota Student Survey showed the youth use of any tobacco product increased to a greater extent in ROS (by 44.6%) than that in the Twin Cities (by 34.6%) after implementation of the menthol policies. In both surveys, increases in youth use of particular tobacco products were less pronounced in the Twin Cities relative to the rest of the state. DISCUSSION: Policies restricting sales of all flavored and menthol tobacco products may be associated with attenuated increases in youth use of tobacco product categories. Policy exemptions and proximity to nonpolicy jurisdictions may have diluted the effect of policies on overall tobacco product use among youth tobacco users.

Cortical myelination in toddlers and preschoolers with autism spectrum disorder.

Intracortical myelin is thought to play a significant role in the development of neural circuits and functional networks, with consistent evidence of atypical network connectivity in children with autism spectrum disorder (ASD). However, little is known about the development of intracortical myelin in the first years of life in ASD, during the critical neurodevelopmental period when autism symptoms first emerge. Using T1-weighted (T1w) and T2w structural magnetic resonance imaging (MRI) in 21 young children with ASD and 16 typically developing (TD) children, ages 1.5-5.5 years, we demonstrate the feasibility of estimating intracortical myelin in vivo using the T1w/T2w ratio as a proxy. The resultant T1w/T2w maps were largely comparable with those reported in prior T1w/T2w studies in TD children and adults, and revealed no group differences between TD children and those with ASD. However, differential associations between T1w/T2w and age were identified in several early myelinated regions (e.g., visual, posterior cingulate, precuneus cortices) in the ASD and TD groups, with age-related increase in estimated myelin content across the toddler and preschool years detected in TD children, but not in children with ASD. The atypical age-related effects in intracortical myelin, suggesting a disrupted myelination in the first years of life in ASD, may be related to the aberrant brain network connectivity reported in young children with ASD in some of the same cortical regions and circuits.

[Formula: see text] Neural correlates of socioeconomic status in early childhood: a systematic review of the literature.

It is now established that socioeconomic variables are associated with cognitive, academic achievement, and psychiatric outcomes. Recent years have shown the advance in our understanding of how socioeconomic status (SES) relates to brain development in the first years of life (ages 0-5 years). However, it remains unknown which neural structures and functions are most sensitive to the environmental experiences associated with SES. Pubmed, PsycInfo, and Google Scholar databases from January 1, 2000, to December 31, 2019, were systematically searched using terms "Neural" OR "Neuroimaging" OR "Brain" OR "Brain development," AND "Socioeconomic" OR "SES" OR "Income" OR "Disadvantage" OR "Education," AND "Early childhood" OR "Early development". Nineteen studies were included in the full review after applying all exclusion criteria. Studies revealed associations between socioeconomic and neural measures and indicated that, in the first years of life, certain neural functions and structures (e.g., those implicated in language and executive function) may be more sensitive to socioeconomic context than others. Findings broadly support the hypothesis that SES associations with neural structure and function operate on a gradient. Socioeconomic status is reflected in neural architecture and function of very young children, as early as shortly after birth, with its effects possibly growing throughout early childhood as a result of postnatal experiences. Although socioeconomic associations with neural measures were relatively consistent across studies, results from this review are not conclusive enough to supply a neural phenotype of low SES. Further work is necessary to understand causal mechanisms underlying SES-brain associations.

Medicaid coverage for tobacco dependence treatment: Enrollee awareness and use.

Medicaid-insured adults smoke at twice the rate of privately insured adults. Insurance coverage for tobacco dependence treatments (TDTs) has been shown to increase quit attempts, but few published studies have measured enrollees' awareness of Medicaid coverage. We assessed awareness of Medicaid coverage for and use of TDTs among New York State (NYS) Medicaid-insured smokers and recent quitters. In July-August 2017, we conducted a probability-based online survey of Medicaid enrollees in NYS aged 18 to 65 in fee-for-service and managed care plans (n = 266; AAPOR 4RR = 22.5%). In 2017, we estimated descriptive statistics and used Adjusted Wald tests to assess differences in awareness and use of TDTs (p < 0.05). We used logistic regression to assess correlates of coverage awareness and use of TDTs. Most participants (94.3%) were aware of TDTs, but fewer were aware that Medicaid covers them (59.7%). Most participants believed TDTs are effective in helping smokers quit, although many also believed non-evidence-based methods are effective. Awareness of Medicaid coverage was associated with awareness of a Medicaid-related antitobacco television ad (p < 0.05), moderate nicotine dependence (p < 0.05), and believing that TDTs are effective (p < 0.01). Although awareness of Medicaid coverage for TDTs was found to be high, there remains room for improvement, even in a state that actively promotes these benefits. It is important for states to not only expand Medicaid coverage of TDTs but to also promote the benefits to improve the chances of quit success. Understanding Medicaid enrollees' awareness of and perceptions of covered TDTs can inform messaging to maximize utilization of evidence-based benefits.