Positive Early Childhood Experiences and School Readiness among US Preschoolers.

OBJECTIVES: To characterize the relationship between positive early childhood experiences (PECEs) and school readiness, and assess whether the PECEs-school readiness relationship was robust to and/or differed across levels of adverse childhood experiences (ACEs). METHODS: We analyzed national data on children ages 3-5 from 2016 to 2020 (n = 26 871) to examine associations between key PECE domains (nurturing relationships, home learning opportunities, safe and stable environments, and family routines) with being on track for school readiness, defined using a pilot, multidimensional measure called "healthy and ready to learn". Weighted univariate, bivariate, and multivariable analyses were conducted to generate nationally representative estimates. Multivariable models adjusted for sociodemographic factors and were assessed both with and without cumulative ACE exposure. RESULTS: Two-fifths of children were healthy and ready to learn. Exposure to PECEs was associated with higher school readiness, irrespective of relative ACE exposure. Compared with those with low PECEs, children with moderate (aOR, 2.19; 95% CI, 1.86-2.58) and high (aOR, 4.37; 95% CI, 3.58-5.34) PECEs had greater odds for being healthy and ready to learn, net of both sociodemographic factors and ACE exposure. Significant associations were robust across demographic groups (eg, race and ethnicity), ACE levels, and ACE types (eg, parental incarceration). CONCLUSIONS: Increasing PECEs correspond with greater likelihood of possessing capacities key for school functioning, even amidst ACEs. In concert with efforts to ameliorate early life trauma, caregivers, health care providers, educators, and systems can consider boosting PECEs to foster healthy development in childhood and beyond.

Applying a Reproductive Justice Lens to Enhance Research Engagement Among Systematically Underrepresented Childbearing Women.

BACKGROUND: Historically, childbearing women from diverse and systematically hard-to-reach populations have been excluded from nursing research. This practice limits the generalizability of findings. Maximizing research strategies to meet the unique needs of these populations must be a priority. OBJECTIVES: The aim of this study was to provide methodological context for the comprehensive application of reproductive justice strategies to guide research methods and promote engagement of underrepresented childbearing women while decreasing systemic bias. METHODS: In this article, we use a reproductive justice lens to characterize and define strategies for enhancing ethical and equitable engagement in research involving childbearing women who are often systematically underrepresented using a case study approach. Using a specific case study exemplar, the core tenets of reproductive justice are outlined and affirm the need to advance research strategies that create ethical engagement of diverse populations, transform oppressive social structures, and shift research paradigms so research objectives intentionally highlight the strengths and resiliency inherent to the targeted communities. RESULTS: We begin by describing parallels between the tenets of reproductive justice and the ethical principles of research (i.e., respect for persons, beneficence, and justice). We then apply these tenets to conceptualization, implementation (recruitment, data management, and retention), and dissemination of research conducted with childbearing women from diverse backgrounds who are systemically underrepresented. We highlight our successful research strategies from our case study example of women with histories of incarceration. DISCUSSION: To date, outcomes from our research indicate the need for multilevel strategies with a focus on respectful, inclusive participant and key community partner engagement; the time investment in local communities to promote equitable collaboration; encouragement of the patient's autonomous right to self-determination; and mitigation of power imbalances. Nurse researchers are well positioned to advance research justice at the intersection of reproductive justice and ethics to fully engage diverse populations in advancing health equity to support the best health outcomes.

Medications for opioid use disorder among pregnant women referred by criminal justice agencies before and after Medicaid expansion: A retrospective study of admissions to treatment centers in the United States.

BACKGROUND: Criminal justice involvement is common among pregnant women with opioid use disorder (OUD). Medications for OUD improve pregnancy-related outcomes, but trends in treatment data among justice-involved pregnant women are limited. We sought to examine trends in medications for OUD among pregnant women referred to treatment by criminal justice agencies and other sources before and after the Affordable Care Act's Medicaid expansion. METHODS AND FINDINGS: We conducted a serial, cross-sectional analysis using 1992-2017 data from pregnant women admitted to treatment facilities for OUD using a national survey of substance use treatment facilities in the United States (N = 131,838). We used multiple logistic regression and difference-in-differences methods to assess trends in medications for OUD by referral source. Women in the sample were predominantly aged 18-29 (63.3%), white non-Hispanic, high school graduates, and not employed. Over the study period, 26.3% (95% CI 25.7-27.0) of pregnant women referred by criminal justice agencies received medications for OUD, which was significantly less than those with individual referrals (adjusted rate ratio [ARR] 0.45, 95% CI 0.43-0.46; P < 0.001) or those referred from other sources (ARR 0.51, 95% CI 0.50-0.53; P < 0.001). Among pregnant women referred by criminal justice agencies, receipt of medications for OUD increased significantly more in states that expanded Medicaid (n = 32) compared with nonexpansion states (n = 18) (adjusted difference-in-differences: 12.0 percentage points, 95% CI 1.0-23.0; P = 0.03). Limitations of this study include encounters that are at treatment centers only and that do not encompass buprenorphine prescribed in ambulatory care settings, prisons, or jails. CONCLUSIONS: Pregnant women with OUD referred by criminal justice agencies received evidence-based treatment at lower rates than women referred through other sources. Improving access to medications for OUD for pregnant women referred by criminal justice agencies could provide public health benefits to mothers, infants, and communities. Medicaid expansion is a potential mechanism for expanding access to evidence-based treatment for pregnant women in the US.

Adverse Childhood Experiences and Youth Cigarette Use in 2013 and 2016: Emerging Disparities in the Context of Declining Smoking Rates.

INTRODUCTION: Cigarette use has dropped dramatically among youth since 2013, but smoking-related disparities persist. We examine who still smokes in the context of declining smoking rates. Using the Minnesota Student Survey, we examine adverse childhood experiences (ACEs) and cigarette use in 2013 and 2016. We assess how cigarette use rates changed, how ACEs relate to cigarette use, and the degree to which youth with ACEs comprise the current smoking population. METHODS: Data came from the 2013 and 2016 Minnesota Student Survey. We assessed past 30-day any and daily cigarette use statewide and among youth with no ACEs, high cumulative ACEs, and seven separate ACEs. We used descriptive statistics and multivariate logistic regression analyses. RESULTS: Cigarette use significantly declined for all groups from 2013 to 2016. Youth with no ACEs exhibited the highest percent decrease in any and daily cigarette use. Youth with ACEs were more likely to report any and daily cigarette use in 2013 and 2016, adjusting for demographics. Among youth with any 30-day use, the rate of ACEs increased from 2013 to 2016. Youth with ACEs disproportionately accounted for youth smoking populations in 2013 and 2016. For example, although 16% of all youth experienced parental incarceration, approximately 43% and 55% of youth with any and daily cigarette use experienced parental incarceration in 2016, respectively. CONCLUSIONS: Cigarette use declined from 2013 to 2016 for all Minnesota youth, but the decline among youth with no ACEs was faster than those with ACEs. Youth with ACEs now account for an increasingly high percent of youth smokers. IMPLICATIONS: Even though cigarette use is declining among Minnesota youth, the decline among youth without ACEs is faster than the decline among youth with ACEs. Youth with ACEs disproportionately account for all youth smokers, and this disproportionality has increased since 2013. Tobacco control efforts should focus on youth with ACEs, and parental incarceration is a specific ACE that warrants attention. Rates of parental incarceration remain high in the United States and youth who experience parental incarceration now account for a near majority of current youth smokers. Future research should consider mechanisms for the ACE-smoking relationship and emerging tobacco products (eg, electronic cigarettes).

Adverse Childhood Experiences and Weight Status among Adolescents.

OBJECTIVE: To investigate the relationship between adverse childhood experiences (ACEs) and weight status among adolescents. STUDY DESIGN: Data were drawn from the Minnesota Student Survey, a large (n = 105 759), statewide, anonymous survey of public school students in eighth, ninth, and eleventh grades. Self-reported height and weight were used to calculate body mass index. Multinomial logistic regression was used to examine associations between self-reported ACEs and weight status, controlling for key sociodemographic characteristics. RESULTS: ACEs were positively associated with weight status; adolescents with more ACEs were more likely to have overweight, obesity, and severe obesity than adolescents with no ACEs. Adolescents who reported an ACE were 1.2, 1.4, and 1.5 times as likely to have overweight, obesity, and severe obesity, respectively, compared with their peers with no ACEs. There was no relationship between ACEs and underweight. CONCLUSIONS: The results of this large sample of adolescents with anonymous data support the hypothesis that ACEs and obesity are strongly associated. The directionality of this relationship needs to be understood. Moreover, these findings suggest that child health professionals may need to screen for ACEs as an important aspect of clinical weight management.

Reproductive justice for incarcerated mothers and advocacy for their infants and young children.

The United States has seen unprecedented growth in the number of incarcerated women, most of whom are mothers with minor children. Major public health concerns relate to the reproductive health of women in prisons and jails and the well-being of their infants and young children. In the current article, we use a reproductive justice framework to examine the intersection of incarceration and maternal and child health. We review (a) current research on the reproductive health of incarcerated women, (b) characteristics and experiences of pregnant incarcerated women, (c) outcomes of infants and young children with incarcerated parents, (d) implications of research findings for policy and practice, and (e) the need for increased research, public education, and advocacy. We strongly recommend that correctional policies and practices be updated to address the common misconceptions and biases as well as the unique vulnerabilities and health needs of incarcerated women and their young children.

Estados Unidos ha visto un crecimiento sin precedentes en el número de mujeres encarceladas, la mayoría de las cuales son madres con niños menores. Mayores preocupaciones de salud pública conciernen a la salud reproductiva de mujeres en prisiones y cárceles y el bienestar de sus infantes y niños pequeños. En el presente artículo, usamos un marco de trabajo de justicia reproductiva para examinar la intersección del encarcelamiento y la salud materno-infantil. Revisamos 1) la investigación actual sobre la salud reproductiva de mujeres encarceladas, 2) las características y experiencias de mujeres embarazadas encarceladas, 3) lo que resulta de infantes y niños pequeños con progenitores encarcelados, 4) las implicaciones de los resultados de la investigación en cuanto a políticas y prácticas, y 5) la necesidad de aumentar la investigación, la educación pública y la defensoría. Recomendamos fuertemente que se actualicen las políticas y prácticas correccionales para incluir los conceptos erróneos y prejuicios acerca de mujeres encarceladas y sus niños pequeños, así como también sus distintivas vulnerabilidades y necesidades de salud.

Les Etats-Unis d'Amérique ont été les témoins d'une augmentation sans précédent dans le nombre de femmes incarcérées, la plupart étant des mères avec des enfants mineurs. De grands problèmes de santé publique sont liés à la santé reproductive des femmes en prison et au bien-être de leurs nourrissons et de leurs jeunes enfants. Dans cet article nous utilisons une structure de justice reproductive afin d'examiner l'intersection de l'incarcération et de la santé maternelle et de l'enfant. Nous passons en revue: 1) les recherches actuelles sur la santé reproductive des femmes incarcérées, 2) les caractéristiques et les expériences de femmes incarcérées enceintes, 3) les résultats de nourrissons et de jeunes enfants avec des parents incarcérés, 4) les implications des résulats de recherche pour les lois et la pratique, et 5) le besoin de plus de recherches, plus d'éducation publique, plus de promotion et défense. Nous recommandons fortement que les lois correctionnelles et les pratiques correctionnelles soient mises à jour afin de traiter et de faire face aux conceptions erronées et à la partialité communes, ainsi qu'aux vulnérabilités uniques et aux besoins de santé des femmes incarcérées et de leurs jeunes enfants.

Mental health of adolescents with currently and formerly incarcerated parents.

Reliable information about children of incarcerated people is difficult to obtain, and major gaps exist in our understanding of their well-being. This study aims to determine whether adolescents with incarcerated parents report higher levels of mental health problems than those without an incarcerated parent, and whether the relationship between parental incarceration and adolescent mental health is moderated by parent-child relationships. Using a statewide survey from one US state, we compared adolescents with a currently incarcerated parent to those with a formerly incarcerated parent and those with no history of parental incarceration on self-reported indicators of mental health, and examined whether strong parent-child relationships were protective against mental health concerns. Results indicate that adolescents with incarcerated parents are at elevated risk for mental health problems, and strong parent-child relationships partially buffer children from risk. Findings underscore the need for more investment in effective early interventions for adolescents in highly adverse contexts.

Statewide Dissemination of Sesame Street Resources for Families Affected by Incarceration.

The number of children with an incarcerated parent has increased nearly 80% in the past 20 years. Despite the growing need, few educational resources exist to promote the emotional health of young children with incarcerated parents. To address this need, Sesame Street recently released developmentally appropriate, multimedia resources, and piloted the dissemination of those resources in 10 states. The current study describes the process used in one pilot state to disseminate the resources; documents the reach of those dissemination efforts, including the number of resource kits distributed, number of community-based and clinical providers reached, and location of providers across the state; and examines providers' impressions of the utility of the resources and their perspectives on how the resources support children and families affected by incarceration. This study has important implications for translating research evidence for community providers and practitioners who aim to promote the emotional health of young children affected by incarceration.

Substance Use among Youth with Currently and Formerly Incarcerated Parents.

Parental incarceration impacts millions of children in the U.S. and has important consequences for youths' adjustment. Children of incarcerated parents are at risk for a host of negative psychosocial outcomes, including substance abuse problems. Using data from a statewide survey of youth behavior, the effect of both present and past parental incarceration on youths' report of their substance use behaviors was examined. Both present and past parental incarceration was significantly associated with use of alcohol, tobacco, marijuana, and prescription drugs, as well as substance abuse and dependence. Implications for practice and research are discussed.

Better Communication for Better Public Health: Perspectives From an Interdisciplinary Training Program.

Myriad factors determine the health of young people-biological, psychological, familial, contextual, environmental, and political, to name a few. Improving the health of adolescents means that leaders in health care and public health must have the requisite skills for translating research into priorities, practices, and policies that influence a wide array of health determinants. While adolescent health training programs may give emphasis to effective communication with adolescents as patients or as priority populations in health education/promotion efforts, are we adequately preparing our future leaders with the skill sets necessary for moving scientific evidence into practice, programs, and policies? Internship and fellowship programs may invest heavily in teaching skills for conducting research and health education/promotion, but they may not focus enough on how to translate scientific evidence into practice, programs, and policy. In this commentary, we share our experiences equipping professionals working with adolescents in health care and public health settings with skills for scientific writing, public speaking, and advocacy on behalf of young people, and discuss the need for more collaboration across disciplines.

Visiting Mom: A pilot evaluation of a prison-based visiting program serving incarcerated mothers and their minor children.

We describe an evaluation of a prison visiting program, Extended Visiting (EV), for incarcerated mothers and their children. Mothers (N = 24) and caregivers (N = 19) were interviewed regarding experiences with the program. Mothers identified benefits including maintaining a relationship with children, physical contact, motivation, privacy, peer support, and personal growth. Caregivers echoed mothers' appreciation for the opportunity to maintain mother-child relationships and physical contact. Mothers identified barriers including desire for overnight visits and more age-appropriate activities. Caregivers perceived travel time and costs and children's adverse reactions as barriers. When comparing EV to typical visiting, participants unanimously preferred EV.

Longitudinal associations between adult attachment states of mind and parenting quality.

Much of the current evidence regarding the associations between attachment states of mind and parenting quality is based on concurrent or short-term longitudinal studies with samples of adults. Using data from the Minnesota Longitudinal Study of Risk and Adaptation, we examined the predictive significance of the coherence of participants' discourse during the Adult Attachment Interview, assessed at ages 19 and 26 years, for parenting quality measured using observations (administered when participants' children were 24 and 42 months old) and interview ratings (collected when parents were 32 years old). Results indicated that associations between AAI coherence and parenting quality varied based on when adult attachment was assessed, as well as when and how parenting quality was assessed. Coherence of mind measured at age 19 years predicted observed supportive parenting when it was assessed when participants were in their late-20s and early-30s, a developmental period when parenting can be conceptualized as a salient developmental task, but not before. In contrast, coherence of mind measured at age 26 years predicted both observed and interview-ratings of supportive parenting.

Doulas' Perspectives about Providing Support to Incarcerated Women: A Feasibility Study.

OBJECTIVE: To document the logistical feasibility of a doula program for pregnant incarcerated women and to assess doulas' perceptions of their achievements. DESIGN AND SAMPLE: Six doulas provided written case notes ("birth stories") about their experiences with 18 pregnant women in one Midwestern state prison. MEASURES: The birth stories were analyzed by two coders to identify major themes related to doulas' perceptions about providing support to incarcerated women. Analyses involved coder consensus about major themes and doula affirmation of findings. RESULTS: All doulas reported that they met key objectives for a successful relationship with each of their clients. Key themes were their ability to empower clients, establish a trusting relationship, normalize the delivery, and support women as they were separated from their newborns. CONCLUSIONS: The intervention was logistically feasible, suggesting that doulas can adapt their practice for incarcerated women. Doulas may need specific training to prepare themselves for institutional restrictions that may conflict with the traditional roles of doula care. It may be important for doulas to understand the level of personal and professional resources they may have to expend to support incarcerated women if they are separated from their infants soon after delivery.

Brief report: Associations between adolescent girls' social-emotional intelligence and violence perpetration.

This study examined associations between social-emotional intelligence (SEI) and two measures of violence perpetration (relational aggression and physical violence) in a cross-sectional sample of high-risk adolescent girls (N = 253). We evaluated three aspects of SEI: stress management, intrapersonal, and interpersonal skills. Results of a multiple linear regression model accounting for participants' age, race/ethnicity, and experiences of relational aggression victimization indicated that girls with better stress management skills were less likely to perpetrate relational aggression. A parallel model for perpetration of physical violence showed a similar pattern of results. Study findings suggest that SEI, and stress management skills in particular, may protect adolescent girls - including those who have been victims of violence - from perpetrating relational aggression and physical violence. Interventions that build adolescent girls' social and emotional skills may be an effective strategy for reducing their perpetration of violence.

Partnering to Address Health Inequities among Incarcerated Populations: Prisons, Jails, and COVID-19 Vaccination.

BACKGROUND: Incarcerated people have been disproportionately affected by the COVID-19 pandemic and face significant challenges to COVID-19 vaccine confidence. OBJECTIVES: (1) Describe our partnerships with community members directly impacted by incarceration, (2) discuss the partnership's process for co-developing and implementing project interventions to increase COVID-19 vaccine confidence, and (3) share lessons learned from this unique community-engaged partnership. METHODS: An advisory board of 14 formerly incarcerated community members participated in this project. Their wisdom and experience led to the development and implementation of interventions to increase confidence in COVID-19 vaccines among incarcerated people. LESSONS LEARNED: Valuable lessons learned were centering community, leaning into trusted sources of information, acknowledging historical and present harms, and investing in community-engaged work. CONCLUSIONS: Centering lived experiences of those directly impacted by incarceration has been crucial to increasing vaccine confidence among this population. Doing so reinforced the importance of long-term investments in community-based collaborations with communities impacted by incarceration.

Policy solutions to eliminate racial and ethnic child health disparities in the USA.

Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.

Facilitators and barriers to COVID-19 vaccination among incarcerated people and staff in three large, state prisons: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has disproportionately impacted individuals in carceral facilities - both incarcerated people and staff. Vaccination is an important tool in reducing the risk of COVID-19 infection, hospitalization, and death. While the importance of promoting vaccination is clear, there are considerable barriers to doing so. This study aims to better understand: (1) why individuals chose to receive the COVID-19 vaccine; (2) why individuals were hesitant to vaccinate; (3) what motivators might influence a person's decision to get vaccinated; and (4) what sources of information about COVID-19 vaccination people trust. METHODS: We conducted a survey of incarcerated people and facility staff in three, large state prisons in Minnesota to identify barriers and facilitators to COVID-19 vaccination. Facilities were recruited to participate through purposive sampling, and surveys were administered between November and December 2021. Descriptive statistics were calculated using Stata. RESULTS: Findings demonstrate that, for incarcerated individuals (N = 1,392), the most common reason for getting vaccinated was to return to normal activities in prison (61%, n = 801); the most common reason for being hesitant to get vaccinated was "other" (41%, n = 342), with individuals citing a variety of concerns. For staff (N = 190), the most common reason for getting vaccinated was to protect the health of family and friends (79%, n = 114); the most common reasons for being hesitant were disbelief that vaccination is necessary (55%, n = 23) and distrust of healthcare and public health systems (55%, n = 23). Incarcerated individuals reported that monetary and programmatic incentives would help motivate them to get vaccinated, while staff members said speaking with healthcare professionals and monetary incentives would help motivate them. Lastly, trusted sources of information for incarcerated individuals were healthcare professionals outside of prisons and jails, along with friends and family members. Staff members reported that they trusted healthcare professionals and national health organizations for information about COVID-19 vaccination. CONCLUSIONS: While considerable barriers to COVID-19 vaccination persist among both incarcerated individuals and staff members, these findings also highlight areas of intervention to increase COVID-19 vaccine confidence and promote health equity among those disproportionately impacted by the COVID-19 pandemic.

Parental Incarceration in the United States: 2016-2021.

BACKGROUND AND OBJECTIVES: Parental incarceration (PI) is both an adverse childhood experience (ACE) and an influencer of pediatric health. Despite evidence that rural America sees the highest incarceration rates and substantial inequities in pediatric health care access and services, it is unclear how the prevalence of PI and associated sociodemographic factors vary across urban, suburban, and rural regions of the United States. METHODS: This study used data from the National Survey of Children's Health (2016-2021; N = 145 281). Based on proximity and population, households were categorized as urban, suburban, or rural. Caregivers reported on household income, race/ethnicity, and living arrangements as well as children's exposure to ACEs, including PI. Chi-squared and t-tests compared the prevalence of PI across communities and assessed regional differences in ACEs and sociodemographic characteristics in the context of PI. RESULTS: PI was most common in rural (12%) versus urban (8%) and suburban (6%) areas. ACEs were more prevalent among PI children compared with non-PI peers across regions, with slight differences between PI children across locales. Within all regions, PI was highest for Black, Latinx, Native, and multiracial children; those in poverty; and those in nonparent caregiver placements. However, these prevalences were consistently highest among rural children. CONCLUSIONS: This study points to high rates of adversity and concern racial, economic, and residential disparities for PI children, particularly those in rural communities. Evidence from this study can be used as a foundation for future prevention and intervention pediatric health responses that address inequities and unmet needs for rural populations.

Health and care utilization among youth with a history of parental incarceration and homelessness.

INTRODUCTION: Despite widespread recognition of the health and social risks posed by parental incarceration (PI) and homelessness, these challenges are rarely considered in unison. We sought to (a) assess the experiences of homelessness among youth with and without a history of PI and (b) compare the health and healthcare utilization among youth with a combined history of PI and homelessness. METHOD: Examining data from eighth-, ninth-, and 11th-grade public school participants in the 2019 Minnesota Student Survey (N = 110,904), we calculated univariate and multivariate analyses to characterize the health status and care utilization of youth who have experienced PI, past-year homelessness, or both. RESULTS: We observed higher prevalence of homelessness among youth with a history of PI compared to those without. The group with dual PI-homelessness experience had a higher proportion of youth that were younger, male, and non-White; and living in poverty or urban areas compared to youth with PI history only. Even after accounting for demographic factors, the dual PI-homelessness group evidenced higher expected odds for several physical health conditions (e.g., asthma, diabetes), and differences in care utilization indicators relative to individual PI and homelessness groups. DISCUSSION: Findings suggest that PI may be overrepresented among recently homeless youth and that youth with such dual experience possess distinct, and often elevated, health service needs. Health, education, housing, and other systems may need intersectoral strategies to better identify and support this at-risk subset of youth through clinical and policy approaches. (PsycInfo Database Record (c) 2023 APA, all rights reserved).