Predictors of getting a residency interview: Differences by medical specialty.

OBJECTIVES: Gaining medical residency interviews has become more competitive and costly for medical students. Although limited evidence from residency programme directors indicates predictors for successfully matching into a programme, past research has not sufficiently explored the application components necessary to receive an interview offer. The present study will identify which application components are most helpful in obtaining interview offers for different medical specialties. METHODS: Data were sourced from the Texas Seeking Transparency in Application to Residency (STAR), a survey of recently matched fourth-year American medical students who self-reported information on their residency application components and interview offers. Multi-level logistic regression analyses were employed to predict the odds of interview offer according to applicants' academic, research and extracurricular characteristics. Sub-analyses were conducted for each medical specialty. RESULTS: Nearly 10 000 students reported information on over 419 010 applications submitted, which resulted in 164 696 interview offers. Across the sample, applicants had greater odds of receiving an interview offer if they had a geographic connection to the programme (odds ratio [OR] = 4.10, 95% confidence interval [CI] 4.00-4.20), had completed an away rotation at the programme (OR = 16.00, 95% CI 14.92-17.15), were Alpha Omega Alpha Honor Medical Society members (OR = 1.49, 95% CI 1.36-1.64), or had been inducted into the Gold Humanism Honor Society (OR = 1.50, 95% CI 1.39-1.62). Applicants had reduced odds of getting an interview if they had been required to remediate a course in medical school (OR = 0.73, 95% CI 0.64-0.83) or had failed the US Medical Licensing Examination Step 1 or Step 2 examination on their first attempt (OR = 0.40, 95% CI 0.33-0.47). Predictors of obtaining an interview varied by specialty. CONCLUSIONS: The present findings can assist senior medical students as they prepare residency applications and identify programmes to which they will apply. Knowledge of the significant factors can help applicants more efficiently use resources to maximise their number of interview offers. Completing away rotations and selecting programmes with which applicants have geographic connections may increase their odds of receiving interview offers.

School health class associated with reduced odds of eating disorder symptoms in American adolescents.

OBJECTIVE: Eating disorder symptoms, including eating disorder diagnosis, binge eating, and unhealthy weight loss, are associated with health risks, and adolescence may be an optimal time to provide education on healthy alternatives. This research explored whether in-school health information during adolescence is associated with eating disorder symptoms in young adulthood. METHOD: Data were used from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of American youth, including information from Wave I, when participants were in Grades 7-12, and from Wave III, when participants were aged 18-26. Logistic regression analyses predicted eating disorder symptoms from in-school health information, adjusting for demographic and educational covariates. In-school health information and eating disorder symptoms were based on participant self-report. RESULTS: In-school health information about both diet (the foods you should and should not eat) and the importance of exercise compared to no health information reduced the odds of youth-reported eating disorder history odds ratio ((OR) = 0.23, 95% CI = 0.11-0.48). Individuals who received information on exercise alone compared to no health information were also less likely to use weight pills to control weight (OR = 0.26, 95% CI = 0.11-0.61). There was no difference in binge-eating symptoms based on school health class. DISCUSSION: Findings from this exploratory research study indicate that in-school receipt of information on diet and exercise has modest associations with eating disorder symptoms, including lower odds of a self-reported eating disorder and lower odds of using weight loss pills. Further research is needed to definitely test the role of school health class on eating disorder symptoms.

Truancy in the United States: Examining Temporal Trends and Correlates by Race, Age, and Gender.

BACKGROUND: Truancy has long been regarded a common problem in urgent need of effective intervention. Knowledge about factors associated with truancy can guide the development and implementation of interventions. METHOD: This paper examined trends in truancy rates between 2002-2014 and correlates of truancy across racial/ethnic groups. Variables of interest included sociodemographic factors (e.g., age, gender, socio-economic background), behavioral factors (e.g., substance use, violence), and psychosocial factors (e.g., academic engagement, grades, parental control). Using data from a large sample of adolescents (n=209,393; 12-17 years) we estimated truancy prevalence rates and examined trends and correlates via regression analyses. RESULTS: Truancy rates remained constant between 2002 (10.8%) and 2014 (11.1%). Rates were highest among older youth, females, and Hispanic youth. For all racial/ethnic groups, truancy was significantly correlated with alcohol and marijuana use, fighting, the propensity to take risks, and lower academic engagement and school grades. Other factors were differentially associated with racial/ethnic groups. This divergence in risk patterns for different racial/ethnic groups points to some heterogeneity amongst truant youth. DISCUSSION: Despite truancy reduction efforts, truancy rates have remained stable. Efforts to prevent truancy and to intervene with truant youth may need to target risk factors more prevalent in specific racial/ethnic groups.

Breastfeeding and child development outcomes: an investigation of the nurturing hypothesis.

This study investigated whether the nurturing hypothesis - that breastfeeding serves as a proxy for family socio-economic characteristics and parenting behaviours - accounts for the association of breastfeeding with children's academic abilities. Data used were from the Child Development Supplement of the Panel Study of Income Dynamics, which followed up a cohort of 3563 children aged 0-12 in 1997. Structural equation modelling simultaneously regressed outcome variables, including three test scores of academic ability and two subscales of behaviour problems, on the presence and duration of breastfeeding, family socio-economic characteristics, parenting behaviours and covariates. Breastfeeding was strongly related to all three tests scores but had no relationships with behaviour problems. The adjusted mean differences in the Letter-Word Identification, Passage Comprehension) and Applied Problems test scores between breastfed and non-breastfed children were 5.14 [95% confidence interval (CI): 3.14, 7.14], 3.46 (95% CI: 1.67, 5.26) and 4.24 (95% CI: 2.43, 6.04), respectively. Both socio-economic characteristics and parenting behaviours were related to higher academic test scores and were associated with a lower prevalence of externalising and internalising behaviour problems. The associations of breastfeeding with behaviour problems are divergent from those of socio-economic characteristics and parenting behaviours. The divergence suggests that breastfeeding may not be a proxy of socio-economic characteristics and parenting behaviours, as proposed by the nurturing hypothesis. The mechanism of breastfeeding benefits is likely to be different from those by which family socio-economic background and parenting practices exert their effects. Greater clarity in understanding the mechanisms behind breastfeeding benefits will facilitate the development of policies and programs that maximise breastfeeding's impact.

Behavior problems and children's academic achievement: A test of growth-curve models with gender and racial differences.

The aim of this study was to examine the longitudinal association between externalizing and internalizing behavior and children's academic achievement, particularly in terms of whether these variables varied as a function of gender and race. Data pertaining to externalizing and internalizing behavior, academic achievement, gender, and race from three waves of the Child Development Supplement of the Panel Study of Income Dynamics (N = 2028) were used. Results indicate that behavior problems had a negative relationship with academic performance and some of these associations endured over time. Externalizing behavior impacted reading scores more negatively for females compared to males at baseline, but the impact of externalizing behavior on long-term reading outcomes did not vary by gender. Externalizing behavior impacted reading scores more negatively for Black children than White children at multiple points in time. Differences between males, females, Black, and White children concerning behavior and achievement are explained. Implications, limitations, and ideas for future research are also presented.

Effects of after-school programs with at-risk youth on attendance and externalizing behaviors: a systematic review and meta-analysis.

The popularity, demand, and increased federal and private funding for after-school programs have resulted in a marked increase in after-school programs over the past two decades. After-school programs are used to prevent adverse outcomes, decrease risks, or improve functioning with at-risk youth in several areas, including academic achievement, crime and behavioral problems, socio-emotional functioning, and school engagement and attendance; however, the evidence of effects of after-school programs remains equivocal. This systematic review and meta-analysis, following Campbell Collaboration guidelines, examined the effects of after-school programs on externalizing behaviors and school attendance with at-risk students. A systematic search for published and unpublished literature resulted in the inclusion of 24 studies. A total of 64 effect sizes (16 for attendance outcomes; 49 for externalizing behavior outcomes) extracted from 31 reports were included in the meta-analysis using robust variance estimation to handle dependencies among effect sizes. Mean effects were small and non-significant for attendance and externalizing behaviors. A moderate to large amount of heterogeneity was present; however, no moderator variable tested explained the variance between studies. Significant methodological shortcomings were identified across the corpus of studies included in this review. Implications for practice, policy and research are discussed.

Patient Perspectives of the Hospital Discharge Process: A Qualitative Study.

Care transitions after hospitalization require communication across care teams, patients, and caregivers. As part of a quality improvement initiative, we conducted qualitative interviews with a diverse group of 53 patients who were recently discharged from a hospitalization within a safety net hospital to explore how patient preferences were included in the hospital discharge process and differences in the hospital discharge experience by race/ethnicity. Four themes emerged from participants regarding desired characteristics of interactions with the discharge team: (1) to feel heard, (2) inclusion in decision-making, (3) to be adequately prepared to care for themselves at home through bedside teaching, (4) and to have a clear and updated discharge timeline. Additionally, participants identified patient-level factors the discharge planning team should consider, including the social context, family involvement, health literacy, and linguistic barriers. Lastly, participants identified provider characteristics, such as a caring and empathetic bedside manner, that they found valuable in the discharge process. Our findings highlight the need for shared decision-making in the discharge planning process to improve both patient safety and satisfaction.

Association Between Social Support and Mental Health of Incarcerated Individuals.

Mental illness occurs more frequently in incarcerated individuals than in the general population. This study examined whether social support during incarceration is associated with improved mental health outcomes. Data were used from the 2004 Survey of Inmates in State Correctional Facilities; the analytic sample was 3,451 incarcerated individuals. Linear regression models predicted current mental health functioning from frequency of visits and phone calls while incarcerated. Controlling for demographic characteristics, incarcerated individuals with more frequent contact from family and friends had improved mental health. Mental health functioning was particularly enhanced for individuals who received more calls and visits. Future research should explore opportunities to increase visits and phone calls during incarceration along with additional social support mechanisms that may enhance mental health.

Emergency Department Admissions for Physical Child Abuse: Evidence from the 2006-2017 Nationwide Emergency Department Sample.

Physical child abuse continues to be a serious public health issue in the United States. This study expands on previous research by exploring trends in physical child abuse diagnoses among children admitted to emergency departments (EDs) across the United States. The analysis aimed to explicate the association between physical child abuse and both sociodemographic and behavioral health covariates to better inform and identify risk factors associated with ED admissions for abuse. The study also explicated differences between confirmed and suspected physical child abuse cases. The study utilized a nationally representative sample of hospital-owned EDs that included 319,676,625 ED admissions between 2006 and 2017 for children under 18-years-old. The analysis included a trend analysis, bivariate descriptive statistics, and multivariate logistic regression models were employed. Children with a physical child abuse diagnosis were less likely to be from higher income communities (aOR = 0.61, 95% CI [0.53, 0.71]), less likely to be female (aOR = 0.93, 95% CI [0.90, 0.96]), and more likely to be uninsured (aOR = 1.65, 95% CI [1.48, 1.84]). Children with attention-deficit hyperactivity disorder (aOR = 1.36, 95% CI [1.14, 1.62]) and a conduct disorder (aOR = 1.28, 95% CI [1.04, 1.58]) were more likely to have a physical abuse diagnosis. The sex-stratified analyses found that the higher rates of physical abuse among children with attention-deficit hyperactivity disorder were driven by the male subsample, while higher rates of abuse for those with conduct disorders were the result of the female subsample. A supplemental analysis of suspected versus confirmed physical child abuse for the fourth quarter of 2015 through 2017 also revealed sociodemographic and behavioral health differences. This study supports the need to consider sociodemographic and behavioral risk factors associated with physical child abuse to inform treatment and potential reoccurrence of abuse.

Anxiety, Depression, and Trauma Among Immigrant Mexican Women up to Two-Years Post-partum.

Anxiety has significant consequences for maternal and infant health, and Mexican immigrant mothers are at significantly high-risk. This study examined whether maternal depressive symptoms and trauma are related to anxiety symptoms in perinatal Mexican immigrants. Data were collected from 103 Mexican women residing in the Midwestern United States who were pregnant or up to two years postpartum. Half were aged 30-34. The majority had two or more children and low socio-economic status. Linear regression analyses predicted current anxiety symptoms from current maternal depression symptoms, trauma history, and socio-demographics. Anxiety symptoms were significantly related to depressive symptoms (B = 0.87, 95% CI 0.73, 1.01) and trauma. Compared to women with no trauma history, women who experienced more than ten traumas had increased anxiety symptoms (B = 7.15, 95% CI 0.34, 13.96). Perinatal Mexican women with higher depression symptoms and trauma have increased anxiety symptoms, increasing the need for more comprehensive screening.

Discordance in Reporting of Maternal Aggression: Exploring Differences by Characteristics of Children, Mothers, and Their Environments.

This study investigated discordant reports of maternal aggression using the Fragile Families and Child Wellbeing Study (N = 1,606). Multinomial logistic regression models predicted discordant reports of hitting and shouting from child, mother, and environmental characteristics. Compared to dyads in which both mothers and children reported aggression, mothers with a college degree had higher child-only and mother-only reports of both hitting and shouting versus mothers with less than a high school diploma. High-income mothers had higher child-only reports of hitting, while families with past Child Protective Services involvement had higher child-only and mother-only reports of hitting. Additionally, children with lower reading test scores and whose fathers had history of incarceration had higher child-only reports of hitting. Families residing in neighborhoods for which mothers were scared to let children play outside also had higher child-only and mother-only reports of hitting and shouting.

Intergenerational Trauma among Families in El Salvador: an Exploratory Study.

Adverse childhood events have been shown to impact individuals through adulthood, particularly the impact on relationships. This study aimed to examine intergenerational trauma exposure among a sample of parents living in a semi-urban Salvadoran community and the relationship between child trauma exposure with maternal perceived discrimination, internal strengths and external support. Survey data was collected from 49 mothers residing in El Salvador. Bivariate analyses and multivariate linear regression analyses were used to examine the relationship between children's exposure to adverse childhood events and parents' exposure to adverse childhood events, while controlling for discrimination. The results of the regression analysis indicate that the maternal number of adverse childhood events and experience of discrimination as an adult explained 52.9% of the variance (R 2 = 0.59, F(6, 43) = 10.18, p < .0001). The number of adverse childhood events was significantly predicted by maternal number of adverse events (B = 0.32, 95% CI = 0.17-0.48, p < .0001) and experience of discrimination as adults (B = 5.79, 95% CI = 3.51-8.07, p < .0001). Results suggest that parent exposure to adverse childhood events and parent experience with discrimination are related to the exposure to adverse childhood events of their children. Further research in this area is warranted to better understand the experiences of parents who have been exposed to childhood trauma and the day-to-day parenting challenges. Greater understanding of the impact of childhood trauma also encourages service providers to explore intergenerational interventions.

Immigrant Youth Have Significantly Lower Rates of Externalizing Behavior than Native-Born Americans: Differences by Region of Birth.

A large proportion of Americans have the opinion that immigrants increase crime. Although past research has not found immigrant status to be associated with criminal behavior, American immigration policy has historically discriminated against certain groups based on their region of birth due to safety concerns. The purpose of the present study was to examine differences in externalizing behavior by immigrant's region of birth. Data was used from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), a nationally representative and longitudinal study of 21,260 kindergarteners. A series of Poisson regression models were used to predict externalizing behavior of fifth grade students from immigrant status and parent's region of birth. Analyses controlled for demographic characteristics of the child and family and were adjusted by probability weights and primary sampling unit provided by the ECLS-K. After controlling for family income and parents' educational status, immigrant youth had 0.04 lower externalizing behavior scores compared to native-born American youth (B = - 0.04, 95% CI - 0.06 to - 0.01). When considering differences by region of origin, youth from Asia (B = - 0.12, 95% CI - 0.17 to - 0.07) and Central America (B = - 0.10, 95% CI - 0.14 to - 0.05) had significantly lower externalizing behavior compared to native-born American youth, after controlling for covariates. In fifth grade, immigrant youth have significantly lower rates of externalizing behavior than native-born Americans. In particular, immigrant youth from Asia and Central America engaged in significantly less externalizing behavior than native-born Americans. No region of origin engaged in significantly more externalizing behavior than native-born youth.

Bully victimization and child and adolescent health: new evidence from the 2016 NSCH.

PURPOSE: To explore whether children with diagnosable health conditions are at greater risk of bully victimization and whether, among these children, bully victimization further elevates the risk of an array of health difficulties. METHODS: We examined a recent, nationally representative sample of children and adolescents aged 6-17 years who participated in the 2016 National Survey of Children's Health. Survey data pertaining to the children and adolescents covering bully victimization, health difficulties, and diagnosable health conditions were obtained from primary caregivers. RESULTS: The results suggest that children with diagnosable conditions are at significantly higher risk of being bullied, particularly among children with birth defects and developmental disorders (e.g., 50% or more are victims of bullying). Furthermore, the findings reveal that, among children with diagnosable conditions, those who are victims of bullying are significantly more likely to experience various health challenges, relative to nonvictims. While these findings are significant across age groups, 12- to 17-year-old youth are more likely to experience bullying in the presence of multiple developmental disorders, and when this occurs, these youth are more likely to manifest health difficulties than younger children. CONCLUSIONS: The findings suggest that children with disabilities and chronic health conditions, who are at a significantly greater risk of being bullied, also suffer from further health difficulties when they are victimized by their peers. In conjunction with school-based interventions, primary care physicians may be ideally positioned to assess youth for victimization risk, provide counseling to youth victims, and reduce future victimization through office-based youth violence interventions.

Breastfeeding Is Associated with Decreased Childhood Maltreatment.

PURPOSE: Child maltreatment has serious implications for youth outcomes, yet its associations with early parenting practices are not fully understood. This study investigated whether breastfeeding practices are correlated with childhood maltreatment. MATERIALS AND METHODS: Data were utilized from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative and longitudinal study of adolescents. The analytic sample comprised 4,159 adolescents. The outcome variables included four subtypes of childhood maltreatment (neglect, inadequate supervision, physical abuse, and sexual abuse). The primary independent variable was breastfeeding duration. Covariates of the child, mother, and household were included in analyses. Logistic regression models were employed to predict odds of maltreatment subtypes from breastfeeding duration and covariates. RESULTS: Compared with adolescents never breastfed, adolescents breastfed 9 months or longer had a reduced odds of having experienced neglect (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.35-0.83) and sexual abuse (OR = 0.47; 95% CI = 0.24-0.93) after controlling for covariates. CONCLUSIONS: Breastfeeding duration is significantly associated with decreased childhood neglect and sexual abuse. Breastfeeding practices should be explored as a consideration among clinicians when assessing maltreatment risk. Further research should examine whether a causal relationship exists between breastfeeding and decreased maltreatment.

Poor sleep and reactive aggression: Results from a national sample of African American adults.

BACKGROUND: We know that poor sleep can have important implications for a variety of health outcomes and some evidence suggests a link between sleep and aggressive behavior. However, few studies have looked at this relationship among African-Americans in the United States. METHODS: Data from the National Survey of American Life (NSAL) and the NSAL Adult Re-Interview were used to examine associations between sleep duration and self-reported quality of sleep on reactive aggression among African American and Caribbean Black respondents between the ages of 18 and 65 (n = 2499). RESULTS: Controlling for an array of sociodemographic and psychiatric factors, sleep was found to be significantly associated with reactive aggression. Specifically, individuals who reported sleeping on average less than 5 h per night were nearly three times more likely to report losing their temper and engaging in a physical fight (AOR = 3.13, 95% CI = 1.22-8.02). Moreover, individuals who reported being "very dissatisfied" with their sleep were more than two times more likely to report losing their temper and engaging in physical fights (AOR = 3.32, 95% CI = 1.50-7.33). Persons reporting everyday discrimination and problems managing stress were more likely to sleep poorly. CONCLUSIONS: The present study is among the first to document an association between poor sleep and reactive violence among African-Americans. Findings suggest that reducing discrimination may lead to improved sleep and subsequently reduce forms of reactive violence.

Are homeschooled adolescents less likely to use alcohol, tobacco, and other drugs?

BACKGROUND: Nearly two million school-aged children in US are currently homeschooled. This study seeks to examine homeschooled adolescents' attitudes toward, access to, and use of alcohol, tobacco, and other drugs (ATOD) compared to their non-homeschooled peers. METHODS: The study uses data between 2002 and 2013 from the National Survey on Drug Use and Health (NSDUH) for school-attending respondents aged 12-17 (n=200,824). Participants were questioned regarding peer use of licit and illicit substances, ease of accessing illicit substances, and past 12-month substance use. Survey adjusted binary logistic regression analyses were systematically executed to compare non-homeschooled adolescents with homeschooled adolescents with respect to views toward, access to, and use of substances. RESULTS: Findings indicate that homeschooled adolescents were significantly more likely to strongly disapprove of their peers drinking (AOR=1.23) and trying (AOR=1.47) and routinely using (AOR=1.59) marijuana. Homeschooled adolescents were significantly less likely to report using tobacco (AOR=0.76), alcohol (AOR=0.50), cannabis (AOR=0.56) and other illicit drugs and to be diagnosed with an alcohol (AOR=0.65) or marijuana (AOR=0.60) use disorder. Finally, homeschooled adolescents were also less likely to report easier access to illicit drugs and to be approached by someone trying to sell drugs compared to non-homeschooled peers. CONCLUSIONS: Homeschooled adolescents' views, access, use and abuse of ATOD are uniquely different from those of non-homeschooled adolescents. Findings point to the need to more extensively examine the underlying mechanisms that may account for these differences.