Comparing bullying to ACEs in the national survey of children's health: Examining 2016-2019 prevalence trends among children and adolescents.

OBJECTIVES: To estimate adverse childhood experience (ACE) prevalence among children and adolescents aged 6-17 years in the United States, to examine factors influencing the prevalence of ACEs over the time period 2016-2019, and to examine the difference in bullying trends compared to ACEs in the NSCH. PARTICIPANTS AND SETTING: The National Survey of Children's Health (NSCH) is a cross-sectional survey. Participants included respondents who completed the separate surveys for ages 6-11 and 12-17 from 2016 to 2019. METHODS: Cumulative ACEs were analyzed to determine the change in prevalence of having at least one ACE, overall and stratified by age group. RESULTS: Overall prevalence was highest among income difficulties (16-26 %); parent/guardian divorced or separated (29-31 %); and bullying (21-48 %). There was a significant time trend for income difficulties (decreased; p < 0.001), lived with anyone with a mental illness (increased; p = 0.004), racial/ethnic mistreatment (increased; p = 0.004), and bullying (increased; p < 0.001). Cumulative prevalence trends without bullying decreased significantly from 2016 to 2019 while prevalence trends for bullying increased significantly during this time frame. Sex, age, and race/ethnicity were significantly associated with some of the ACEs. CONCLUSIONS: Trend of ACEs varies as prevalence of some ACEs increased while decreasing for others over time. Also, ACEs appear to affect children and adolescents differently according to sex, age group, and racial/ethnic background, which warrants the need to prioritize efforts to decrease the exposure to ACEs.

Preventing Job Burnout: Could Workplace Support Protect Maternal and Child Health Professionals Who Are Doing Public Health Equity Work?

PURPOSE: To assess the potential of workplace support to protect public health equity workers against job burnout and to identify key workplace support components. DESCRIPTION: This mixed-methods, explanatory sequential study analyzed survey and interview data collected between August 2020 and June 2021. Participants included governmental and non-governmental public health employees whose programs largely focus on Maternal and Child Health populations and who reported that their jobs involved working to reduce health inequities ("equity work"). Regression analysis tested the effect of emotional labor on job burnout, and whether workplace support modified that effect. Qualitative analysis of interview transcripts explored possible components of needed workplace support. ASSESSMENT: Emotional labor was positively associated with job burnout (p < .001), and there was a significant negative interaction between emotional labor and workplace support, meaning workplace support appeared to reduce the effect of emotional labor on burnout (p = .036). Qualitative analysis identified four support components: peer-to-peer mentoring connections, workplace accommodations, engaged and empathetic supervision, and mental health resources. CONCLUSION: Workplace support is associated with reduced job burnout for public health equity workers, especially those whose jobs involve high levels of emotional labor. Few public health employers are providing needed emotional supports for their equity workers, but certain supports appear to be helpful in reducing job burnout.

Utilizing Advocacy to Promote the Adoption and Implementation of Medicaid Policies That Increase Insurance Coverage Among Adolescents.

PURPOSE: The Promise of Adolescence: Realizing Opportunity for All Youth report recommends several Medicaid policies to increase insurance coverage among adolescents: approve Medicaid expansion; eliminate the 5-year Medicaid waiting period for lawfully present adolescent immigrants; increase Medicaid reimbursement rates for adolescent health services to the level of Medicare; and ensure coverage and sufficient reimbursement of comprehensive health services. We designed this study to identify key advocates and factors relevant to adoption and implementation of the recommended Medicaid policies in Nebraska to highlight opportunities for additional advocacy. METHODS: We conducted semistructured interviews January 2022 with 28 adolescent health and health-care access experts in Nebraska, including representatives from health care, education, government, and nonprofit sectors. We recorded the interviews and transcribed them verbatim, then coded data using NVivo software and identified key themes. RESULTS: Participants were unable to identify any Medicaid advocates or advocacy work focused on adolescents, but they did identify 35 organizations working to improve insurance coverage in Nebraska. Coordinated multisector, statewide coalitions secured the adoption of Medicaid expansion through a citizen-supported ballot initiative. Barriers to successful implementation include limited Medicaid outreach to citizens and lawfully present immigrants. Low state government support for increasing Medicaid reimbursement rates and providing comprehensive health services, coupled with the absence of coordinated advocacy, hinder the adoption of these recommendations. DISCUSSION: Advocacy efforts should be implemented to increase adoption and implementation of Medicaid policies recommended to increase adolescents' insurance coverage. These efforts must be built on a foundation of knowledge of state government practices and must utilize sustained partnership among multisector advocates, including adolescent-serving professionals.

Understanding the Emotional Labor of Public Health Equity Work: a Mixed Methods Study.

BACKGROUND: Rectifying historic race-based health inequities depends on a resilient public health workforce to implement change and dismantle systemic racism in varied organizations and community contexts. Yet, public health equity workers may be vulnerable to job burnout because personal investment in the continual struggle against inequality exacts an emotional toll. Our study sought to quantify the presence of emotional labor in public health equity work and better understand its dimensions. METHODS: We conducted a mixed methods study of public health equity workers focused on maternal and child health in the USA. Participants completed a survey on the emotional demands of their public health equity work. A subset of survey respondents was interviewed to gain a better understanding of the emotional toll and support received to cope. RESULTS: Public health equity work was found to involve high levels of emotional labor (M = 5.61, range = 1-7). A positive association was noted between personal efficacy (i.e., belief in one's ability to do equity work well) and increased job satisfaction. However, burnout increased when equity workers did not receive adequate support for their emotional labor. Qualitative analysis revealed eight themes depicting the emotional burden, benefits and drawbacks, and coping strategies of public health equity work. CONCLUSIONS: Public health equity workers report high degrees of emotional labor and inadequate workplace support to cope with the demands. In our study, workplace support was associated with higher job satisfaction and lower burnout. Research is urgently needed to develop and scale an effective model to support public health equity workers.

The Most Important Skills Required by Local Public Health Departments for Responding to Community Needs and Improving Health Outcomes.

In 2017, Public Health 3.0 was introduced, providing recommendations that expand traditional public department functions and programs. Operationalizing the framework requires that local health departments invest in the requisite professional skills to respond to their community's needs. The purpose of this paper is to determine the professional skills that are most important for local health departments to respond to large public health issues and challenges that are having a major impact on their communities. The study used a cross-sectional assessment of the education and training needs of local public health departments in Nebraska following the principles of practice-based systems research. The assessment was designed to assess the training and education needs of local health department staff members. The questions measured the perceived importance of and respondent's capacity across 57 core competencies for public health professionals modified from the Council on Linkages Between Academia and Public Health Practice. A total of 104 staff members from seven local health departments were requested to complete the assessment and 100% of the individuals responded to and completed the assessment. Twenty-eight skills were identified as the most important skills needed for local health departments. The skills were themed and categorized into four domains. (1) Data, Evaluation, and Quality Improvement, (2) Community Engagement and Facilitation, (3) Systems Thinking and Leadership, and (4) Policy and Advocacy. The results from this analysis provide direction to strengthen and transform the public health system into one that is connected, responsive, and nimble. Additionally, it also highlighted a glaring omission that Equity, Diversity, and Inclusion should be included as the fifth domain.

Factors associated with giving birth at advanced maternal age in the United States.

OBJECTIVE: In 2018, 17 percent of all births in the United States occurred to women of advanced maternal age (AMA.) While the outcomes of AMA pregnancies have been examined extensively, the drivers behind increasing rates of AMA pregnancies in the United States are less understood. Some scholars have asserted that women are increasingly delaying their first birth in favor of educational and career aspirations. Yet birth trends in the United States do not support this as the primary explanatory factor of AMA births. Other factors may also contribute to high rates of AMA in the United States. This study sought to identify main predictors of AMA birth using a cross-sectional retrospective sample. DESIGN: We employed a multivariate logistic regression analysis on a cross-sectional retrospective sample to identify significant independent predictors of giving birth at advance maternal age (AMA) in the United States. SETTING: Data was obtained from the Unites States Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7 Core Questionnaire and linked birth certificates. Questions are designed to assess maternal attitudes and experiences before, during and just after pregnancy. Surveys for Phase 7 were completed in 2017 and 2018. The study population represents mothers from 34 states that met the CDC's 55% response rate threshold and Puerto Rico. PARTICIPANTS: The PRAMS dataset comprises self-reported data and linked birth certificate data from women who recently gave birth. A total of 38,549 mothers are included in the Phase 7 dataset. State sample sizes ranged from 503 mothers in Wyoming to 1,897 mothers in Michigan. All mothers gave birth in the year 2017. MEASUREMENTS AND FINDINGS: The outcome of interest was AMA birth, defined as conceiving and subsequently giving birth to a baby at age 35 or older. Predictors for AMA birth were selected a priori and included: pregnancy intention, history of previous live birth, insurance status, income, education, race/ethnicity, marital status, and urban location. Previous live birth to at least one child was a significant independent predictor for AMA birth. Mothers with high parity, defined as 6 or more previous live births, were 17 times more likely to give birth at advanced maternal age. Mothers with an unwanted pregnancy were 1.9 times more likely to have an AMA birth. College attainment, high income, marital status, urbanicity, and race/ethnicity were also independent predictors of AMA birth. Health insurance was not a significant predictor of AMA birth after accounting for other factors. KEY CONCLUSIONS: Delayed and late childbirth may not be intentional for a significant group of older mothers. Converse to popular assumptions that women delay childbearing in favor of career aspirations, the majority of AMA mothers have previous children. Half of AMA mothers have two or more previous children. The findings in this paper suggests that multiple factors predict AMA births. There may be several subtypes of women who enter pregnancy at advanced maternal age. IMPLICATIONS FOR PRACTICE: As women weigh personal desire to bear children against competing social expectations, they may find themselves navigating their own unique path shaped in part by the region in which they live. Better characterization of the circumstances that lead to advanced maternal age in the United States, including exploration of unintended and unwanted AMA pregnancy, is necessary to develop policies and interventions that meet women's needs. This work should utilize a reproductive justice framework to ensure that women's preferences, particularly women of color, are upheld while promoting health and wellbeing for women.

The 'A' is the Weakest Link: What Local Health Departments are Doing to Improve Adolescent Health.

PURPOSE: Although adolescence is a critical developmental period, there has not been coordinated effort to comprehensively address adolescent health within the field of maternal and child health (MCH). In order to inform future adolescent health efforts, MCH leaders in local health departments were asked to reflect on the greatest health challenges facing adolescents in their communities, the causes of these health challenges, the interventions currently implemented to promote adolescent health, and additional intervention needs. DESCRIPTION: 15 interviews were conducted in 2018 with 13 city and county health departments and two community-based agencies (N = 19). Interviews were recorded and transcribed verbatim. Mutually agreed upon themes were determined by the research team and these themes were used to code the transcripts. RESULTS: Mental and behavioral health and sexual and reproductive health issues were perceived to be the greatest health challenges facing adolescents. Participants attributed these health issues to the social determinants of health and adverse childhood experiences. Although all health departments offered sexual and reproductive health interventions, few implemented mental and behavioral health interventions. Insufficient funding and collaboration challenges were the major barriers impeding the implementation of additional coordinated adolescent health interventions. CONCLUSION: Coordinated funding and technical assistance will be needed to enable MCH professionals in local health to realize their potential to improve the health of adolescents. Specific observations and opportunities were addressed in efforts to create conversation that would lead to an improvement in adolescent health services within local health departments, as well as communities and the field of MCH.

Gastric cancer: epidemiology, biology, and prevention: a mini review.

Gastric cancer is one of the most common causes of cancer-related mortality worldwide. The objective of this article is to review the epidemiology and biology of gastric cancer risk. This literature review explores the biological, clinical, and environmental factors that influence the rates of this disease and discuss the different intervention methods that may not only increase the awareness of gastric cancer but also increase screening in efforts to reduce the risk of gastric cancer. Helicobacter pylori infection is the primary risk factor for gastric cancer. Additional risk factors include geographical location, age, sex, smoking, socioeconomic status, dietary intake, and genetics. Primary and secondary prevention strategies such as dietary modifications and screenings are important measures for reducing the risk of gastric cancer. Interventions, such as H. pylori eradication through chemoprevention trials, have shown some potential as a preventative strategy. Although knowledge about gastric cancer risk has greatly increased, future research is warranted on the differentiation of gastric cancer epidemiology by subsite and exploring the interactions between H. pylori infection, genetics, and environmental factors. Better understanding of these relationships can help researchers determine the most effective intervention strategies for reducing the risk of this disease.