Children's Rights, Environmental Justice, and Environmental Health Policy in the United States.

Environmentalists have forewarned that our planet is in peril because of serious degradation and pollution of the earth's land, air, water, and food sources. Climate change is present and worsening at an alarming rate. Gaping disparities exist between high-income and low-income countries and high-income and low-income zip codes in the United States, resulting in marginalized and vulnerable populations bearing the greatest burden from the ill effects of pollution and environmental toxins. Infants and children carry the greatest risk for pollution-related diseases and exposure to chemical toxins as their bodies are rapidly developing. This review article provides a historical overview of children's rights to protection from environmental health risks, effects of environmental injustice, and U.S. statutory and regulatory policies responsible for protecting food, air, and water quality. The authors advocate for policy and clinical strategies to support children's health and the right to environmental protection.

Urban, Low-Income, African American Well-Child Care: Comparison of Parent and Healthcare Provider Experiences and Expectations.

OBJECTIVES: Urban, low-income, African American children and parents report lower quality primary care and face negative social determinants of health. High-quality well-child care is critical for this population. The purpose of this qualitative study was to compare and contrast parent and health care provider experiences of well-child care for urban, low-income, African American families to better understand the complex factors involved in care quality and health outcomes. METHODS: Two data sets were analyzed using conventional content analysis, parent focus group data, and provider interviews. After analysis, results were sorted into similar categories, and convergence coding was completed to identify areas of agreement, partial agreement, dissonance, and silence. RESULTS: Thirty-five parents took part in four focus groups, and nine providers were interviewed. Following convergence coding, five categories and 31 subcategories were identified. The five categories included: social determinants of health, sources of advice and support, challenges with the healthcare system, parent-provider relationships, and anticipatory guidance topics. CONCLUSIONS FOR PRACTICE: Triangulation demonstrated convergence between parents and providers understanding of the concepts and functions of well-child care, however the prominence and meaning varied within each category and sub-category. The variance in agreement, areas of silence, and dissonance shed light on why the population reports lower overall quality primary care.

Urban, Low-Income, African American Parents' Experiences and Expectations of Well-Child Care.

PURPOSE: Well-child care is the foundation of pediatric health promotion and disease prevention. Primary care quality is lower for low-income and African American children compared to white children, and social determinants have an increasingly acknowledged impact on child health. Ensuring that high-quality well-child care fulfills its potential to mitigate the negative effects of social determinants on African American children is imperative. This study provides an understanding of urban, low-income, African American well-child care experiences and expectations. DESIGN AND METHODS: A qualitative, focus group method was used. A purposive, volunteer sample of low-income, African American parents with children birth to age five was recruited from St. Louis and Milwaukee. Focus groups were held in convenient, community sites. Data was audio-digitally recorded. Transcribed data were coded and analyzed through inductive content analysis. RESULTS: Thirty-five caregivers, 86% females, participated in four focus groups. Categories (and sub-categories) identified include: Community factors (We want better schools, It's getting more rough where I live); Sources of parenting advice (Google it, Call your parent, Older remedies); System challenges (Cost, Frequent new faces, Politics); Challenges with providers (Couldn't help me, Missed something important, Treated differently, Are you really listening?); Anticipatory guidance (Breastfeeding, Discipline, Vaccines, Development); and What parents desire (Know them, trust). CONCLUSIONS: This study reveals the contexts that give rise to health care disparities and provides insight into parent's healthcare behaviors. PRACTICE IMPLICATIONS: Results offer providers guidance in providing well-child care for this population to improve pediatric care quality and child health.

Hepatitis a screening for internationally adopted children from hepatitis A endemic countries.

Screening for hepatitis A virus (HAV) infection is not currently routinely recommended in internationally adopted children. International adoptees seen at the University of Minnesota International Adoption Clinic from 2006 to 2010 were assessed for acute HAV infection (positive HAV immunoglobulin M). Thirty of the 656 children screened (4.6%) were acutely HAV infected. HAV-infected children emigrated from Ethiopia (16), Guatemala (4), China (2), Colombia (2), Haiti (2), Philippines (2), Liberia (1), and Nepal (1). Infection was most frequent among children younger than 2 years (6.7%). No symptoms distinguished children with acute HAV infection from uninfected children. HAV infection caused significant social disruption, including separation of children from their ill adoptive parents during the initial weeks postarrival, a period important for postadoption adjustment and attachment. All international adoptees arriving from countries with high or intermediate HAV endemicity should be screened for HAV infection on arrival to the United States.

Children's Perceptions of Healthcare Survey.

BACKGROUND: Few validated pediatric tools exist to directly gather data about children's perceptions of their own healthcare; parent surveys are typically used as proxies. A psychometrically sound, child-focused survey captures children's unique perceptions for quality improvement. OBJECTIVES: This study developed and evaluated reliability of a survey, assessed score differences by children's age, and compared the responses of children and parents. METHOD: The Children's Perceptions of Healthcare Survey was developed for inpatient and outpatient quality improvement. Following expert review, the tool was administered to 237 parent-child dyads at the time of discharge from an inpatient pediatric unit (n = 121) and after outpatient clinic visits (n = 116). Responses were analyzed and compared. RESULTS: Internal consistency reliability for the tool was high (child/adolescents: alpha = .84; parents: alpha = .86), with no significant differences by child age or child gender. Parent and child scores were significantly correlated (r = 0.29, P < .001). About half of parents' scores were higher than their children's scores. DISCUSSION: This tool worked well to collect data from a wide age range of children across healthcare settings. Children's perceptions were unique; involving children in care assessment is worthwhile and captures insights missed when only parents are surveyed. The Children's Perceptions of Healthcare Survey is a valid, psychometrically sound tool to capture children's unique perspectives regarding their healthcare and may be useful for system quality improvement.

Predictors of Mycobacterium tuberculosis infection in international adoptees.

OBJECTIVE: The objective of this study was to measure the factors that are associated with Mycobacterium tuberculosis infection in international adoptees. METHODS: A retrospective chart review was conducted on 880 international adoptees who presented to the International Adoption Clinic at the University of Minnesota between 1986 and 2001. Five tuberculin units of purified protein derivative were placed intradermally on the left forearm. The largest diameter of induration was measured in millimeters between 48 and 72 hours. Nutritional status was assessed using anthropometric measures at initial screening. Data on age, birth country, and year of adoption were assessed. RESULTS: Adoptees (mean age: 26 months; range: 1-200 months; 62% female) came from 33 birth countries. Twenty-eight percent and 5% had evidence of chronic and acute malnutrition, respectively. Twelve percent had evidence of M. tuberculosis infection. The odds of M. tuberculosis infection increased 7% for each subsequent year during the period studied, increased 142% with each additional year of age for children < or = 24 months of age at baseline screening, and increased 15% with each additional year of age for children > 24 months of age at the time of evaluation. Tuberculin skin test induration response was not associated with nutritional status or birth region. CONCLUSIONS: Our study demonstrated a high prevalence of M. tuberculosis infection and malnutrition in internationally adopted children, placing them at considerable risk for progression to tuberculosis disease. These findings also support current guidelines recommending completion of tuberculin screening immediately after adoption.

Comparison of child and parent satisfaction ratings of ambulatory pediatric subspecialty care.

INTRODUCTION: Opinions about satisfaction with care are rarely solicited from children. This study's purpose was to compare children's ratings of patient satisfaction with outpatient care to ratings given by parents. METHOD: This descriptive and comparative survey study compared responses of a convenience sample of children and adolescents (n = 116) who received care at two metropolitan pediatric subspecialty clinics with their parents' responses (n = 115). Ratings were obtained using the "Satisfaction with Child Healthcare Survey," an instrument adapted with permission from the "Kids Count Survey" developed at McMaster Health Center in Ontario, Canada. Additionally, three open-ended questions were solicited and analyzed for major themes. RESULTS: There was moderate significant correlation between child-teen and parent scores. Parents rated care significantly higher than did the children. Children's responses to open-ended questions varied somewhat from their parents' opinions on various aspects of clinic visits. DISCUSSION: Findings suggested that having parents evaluate children's care may not accurately represent the views of children and teens. Findings supported children and teens' ability to provide valuable perceptions about care that can inform clinic improvement processes.