An Organizational Assessment of 34 Home Delivered Meals Programs that Engaged and Assisted Homebound Individuals With Obtaining the COVID-19 Vaccine During the Pandemic.

Vaccinating homebound individuals during the COVID-19 pandemic presented several challenges, including time and cost of engaging this group. In Los Angeles County, the departments of Public Health and Aging and Disabilities turned to home delivered meals programs (HDMs) for help with this public health priority. A mixed-method organizational assessment of 34 HDMs was conducted during March-April 2022 to describe these efforts. Most HDMs were nonprofit (67.6%) and had <25 staff (58.8%). Overall, they served a large catchment area before and during COVID-19, providing services to an estimated total of 24,995 clients/week and delivering 19,511 meals/day. A majority (82.4%) reported engaging their clients to facilitate COVID-19 vaccinations. As of early 2022, <6% of these HDMs' homebound clients were unvaccinated. These programs' efforts to assist older individuals who were homebound during the pandemic represent a potentially underutilized model of public-nonprofit/not-for-profit partnership for improving vaccine delivery and uptake in this hard-to-reach population.

Physical Activity Counseling and Documentation by Pediatric Residents in Primary Care: Before and After Introduction of the FITT Principle.

Physician training on physical activity (PA) counseling in patient care is highly variable. The objective of this study was to improve PA counseling by pediatric residents through introduction of the four components of PA, called the FITT principle (frequency, intensity, time, type). Pediatric residents (n=30) received lectures, curriculum content, and an electronic smart-phrase addressing PA in obesity, including the FITT principle. Surveys assessed resident attitudes, and chart reviews (n = 423 over 16 months) identified evidence of PA counseling including FITT principle components preintervention and postintervention. Survey results showed positive attitudes and confidence regarding primary care provider roles in counseling on PA, with no differences postintervention. Chart reviews demonstrated increased documentation on PA frequency postintervention (pre 31.9% vs post 50.9%, P=.00006), but no significant changes in intensity, time or type. In conclusion, a focused PA curriculum promoted PA counseling by pediatric residents, with increased documentation of one component of the FITT principle.

Impact of an Elementary School-Based Wellness Initiative on Child Obesity Prevalence: LiveWell Kids.

Despite major public health investments over the past several decades, little progress has been made in reducing the prevalence of obesity among school-aged children in the United States. In 2007, the Redondo Beach Unified School District (RBUSD) and the Beach Cities Health District launched a wellness initiative, LiveWell Kids, that included multi-level interventions to improve nutrition and increase physical activity. The initiative also included annual measurements of height and weight among all kindergartners and first, third, and fifth graders in the eight elementary schools in the RBUSD. To assess trends in obesity prevalence, we analyzed height and weight data collected during the 2008 to 2009 to 2018 to 2019 school years. To more fully assess the impact of the initiative, we conducted a least-squares regression difference-in-differences analysis of data from the California Physical Fitness Testing Program on measured height and weight among fifth graders from the RBUSD, three neighboring school districts, and Los Angeles County overall. Among elementary school students in the RBUSD, obesity prevalence decreased from 13.9% in 2008 to 2009 to 6.4% in 2018 to 2019. Significant declines in prevalence were observed in all eight elementary schools, and across all grade levels and demographic groups. Among fifth graders, a similar decline in obesity prevalence was not observed in the other school districts or the county overall. The findings suggest that interventions that adhere to the socio-ecologic model and engage students, parents, and school personnel at all levels while also addressing school and community environments may reduce obesity prevalence among elementary school-aged children.

Influence of Perceived Adolescent Vaccination Desire on Parent Decision for Adolescent COVID-19 Vaccination.

PURPOSE: The purpose of this study was to assess the influence of adolescents' desire for COVID-19 vaccination on their parents' vaccination decision for their adolescent. METHODS: We surveyed an internet-based panel of 1,051 parents of 1,519 adolescents aged 11-18 years from February to March 2021 about their adolescent's desire for COVID-19 vaccination and whether they consider this desire in their vaccination decision for the adolescent. We used multivariable Poisson regression to assess associations with parent-stated likelihood of adolescent vaccination. RESULTS: A total of 58.3% of parents reported that they and their adolescents had the same vaccination desire; similarly, 58.3% considered their adolescent's desire in their vaccination decision. These latter parents were more likely to vaccinate their adolescent than parents who did not consider their adolescent's desire (adjusted risk ratio = 1.25 [95% confidence interval = 1.05-1.50]). DISCUSSION: Most parents considered their adolescent's desire for COVID-19 vaccination. These parents were more likely to state that they will have their adolescent receive a COVID-19 vaccine.

School-Age Children's Wellbeing and School-Related Needs During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic and related school closures may have disrupted school-related supports and services important to children's wellbeing. However, we lack national data about US children's wellbeing and family priorities for school-related services. We sought to determine 1) children's social-emotional wellbeing and 2) needs and priorities for school-based services in the 2021-2022 school year among a US sample of parents of school-aged children. METHODS: In June 2021, we surveyed 1504 parents of children enrolling in grades K-12 in the 2021-2022 school year participating in the Understanding America Study, a nationally representative probability-based Internet panel of families completing regular internet-based surveys (Response rate to this survey was 79.2%). Parents completed the Strengths and Difficulties Questionnaire and reported their needs for school-related services regarding "support getting healthcare", "mental wellness support", "food, housing, legal or transportation support", and "learning supports and enrichment." Weighted regressions examined associations among wellbeing, needs, and sociodemographic characteristics. RESULTS: Approximately one-quarter of children had deficits in hyperactivity (26.1%), one-third in peer problems (32.6%), and 40% in prosocial areas. Most parents (83.5%) reported a school-related need, with 77% reporting learning supports and enrichment needs and 57% reporting mental wellness needs. The highest priority needs were for tutoring, socialization, increased instructional time, coping with stress, and physical activity. CONCLUSIONS: US school children have high social-emotional and school-related needs. Investments in schools are urgently needed, particularly for learning supports and mental wellness, to meet the high demand for services and parents' priorities to support child health and wellbeing.

Parents' Intentions and Perceptions About COVID-19 Vaccination for Their Children: Results From a National Survey.

OBJECTIVES: Assess the degree to which US parents are likely to have their children get coronavirus disease 2019 (COVID-19) vaccines and identify parental concerns about the vaccines. METHODS: In February 2021 to March 2021, we surveyed parent members of a nationally representative probability-based Internet panel of ∼9000 adults regarding their intent to have their children receive a COVID-19 vaccination, perceptions of COVID-19 vaccines for children, and trust in sources of information about COVID-19 vaccines for children. We used descriptive and multivariate analyses to evaluate parent-stated likelihood of having their children get a COVID-19 vaccine and to assess the association between likelihood of child COVID-19 vaccination and child age, parent demographics, and parental perceptions about COVID-19 vaccines. RESULTS: Altogether, 1745 parents responded (87% of eligible parents, 3759 children). Likelihood of child COVID-19 vaccination was as follows: very likely (28%), somewhat likely (18%), somewhat unlikely (9%), very unlikely (33%), and unsure (12%). The stated likelihood of child vaccination was greater among parents of older children (P < .001) as well as among parents who had a bachelor's degree or higher education (P < .001), had already received or were likely to receive a COVID-19 vaccine (P < .001), or had Democratic affiliation (P < .001); variations existed by race and ethnicity (P = .04). Parental concerns centered around vaccine safety and side effects. A key trusted source of information about COVID-19 vaccines for children was the child's doctor. CONCLUSIONS: Less than one-half of US participants report that they are likely to have their child receive a COVID-19 vaccine. Pediatric health care providers have a major role in promoting and giving COVID-19 vaccination for children.

Evaluation of the Abbott BinaxNOW rapid antigen test for SARS-CoV-2 infection in children: Implications for screening in a school setting.

BACKGROUND: Rapid antigen tests hold much promise for use in the school environment. However, the performance of these tests in non-clinical settings and among one of the main target populations in schools-asymptomatic children-is unclear. To address this gap, we examined the positive and negative concordance between the BinaxNOW™ rapid SARS-CoV-2 antigen assay and an RT-PCR test among children at a community-based Covid-19 testing site. METHODS: We conducted rapid antigen (BinaxNOW™) and oral fluid RT-PCR (Curative Labs) tests on children presenting at a walk-up testing site in Los Angeles County from November 25, 2020 to December 9, 2020. Positive concordance was determined as the fraction of RT-PCR positive participants that were also antigen positive. Negative concordance was determined as the fraction of RT-PCR negative participants that were also antigen negative. Multivariate logistic regression models were used to examine the association between positive or negative concordance and participant age, race-ethnicity, sex at birth, symptoms and Ct values. RESULTS: 226 children tested positive on RT-PCR; 127 children or 56.2% (95% CI: 49.5% to 62.8%) of these also tested positive on the rapid antigen test. Positive concordance was higher among symptomatic children (64.4%; 95% CI: 53.4% to 74.4%) compared to asymptomatic children (51.1%; 95% CI: 42.5% to 59.7%). Positive concordance was negatively associated with Ct values and was 93.8% (95% CI: 69.8% to 99.8%) for children with Ct values less than or equal to 25. 548 children tested negative on RT-PCR; 539 or 98.4% (95% CI: 96.9% to 99.2%) of these also tested negative on the rapid antigen test. Negative concordance was higher among asymptomatic children. CONCLUSIONS: Rapid antigen testing can successfully identify most COVID infections in children with viral load levels likely to be infectious. Serial rapid testing may help compensate for limited sensitivity in early infection.

Associations of Parental Monitoring and Violent Peers with Latino Youth Violence.

This study aimed to examine the associations of parental monitoring and violent peers with violence among Latino youth, and whether these associations varied by acculturation. 133 adolescents were surveyed. Associations between parental monitoring, peer violence, and physical and non-physical violence were examined using bivariate and multivariable negative binomial regression. Multivariable analysis was stratified by age and acculturation. A path model examined whether peer violence mediated the relationship between parental monitoring and youth violence. Stratified analysis demonstrated that peer violence increased the risk of physical (RR = 1.24; 95% CI 1.02-1.20) and non-physical violence (RR = 1.32; 95% CI 1.08-1.62) for high-acculturated youth, whereas parental monitoring was protective for low-acculturated youth (physical RR = 0.88; 95% CI 0.78-0.99; non-physical RR = 0.80; 95% CI 0.68-0.93). In path analysis, low parental monitoring increased risk of involvement with violent peers, which was associated with increased risk of youth violence. Interventions may benefit from focusing on parental monitoring, peer violence, and tailoring by acculturation.

Infant Temperament and Behavioral Problems: Analysis of High-Risk Infants in Child Welfare.

Researchers have demonstrated the association between difficult temperament in infancy and early childhood behavioral problems, but to date this has not been demonstrated in the child welfare population. This study utilized the National Survey of Child and Adolescent Well-Being (NSCAW), a nationally representative, longitudinal survey of children in the child-welfare system. The sample consisted of 1,084 infants 0-12 months old at baseline who were investigated for suspected child abuse. The researchers used longitudinal, multivariable logistic regression to examine the association between difficult temperament score in infants 0-12 months who had child welfare involvement and clinical-range Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000) score at 36-months-follow-up. Findings from this study suggest that among children with substantiated maltreatment, difficult temperament in infancy predicts early childhood behavioral problems. This relationship persists after adjusting for other risk factors, such as placement, caregiver depression, and family income. The study also discusses implications for child welfare practices.

African-American and Latino Parents' Attitudes and Beliefs Regarding Adolescent Fighting and Its Prevention.

Adolescent fighting affects 25% of youth, with the highest rates among African-Americans and Latinos but little is known about parental views on youth fighting. The purpose of this study was to examine African-American and Latino parents' perspectives on adolescent fighting and methods to prevent fighting. We conducted four focus groups with parents of African-American and Latino urban adolescents. Focus groups were stratified by race/ethnicity and fighting status. Groups were audiotaped, transcribed, and analyzed by three independent coders using thematic content analysis. Seventy-six percent of the 17 participants were female. Latino parents condoned fighting only as a last resort, and taught children about consequences of fighting, emotional regulation, and non-violent conflict-resolution strategies. African-American parents endorsed teaching non-violent strategies, but expressed some doubts about their effectiveness. African-American parents also suggested corporal punishment, but acknowledged that this may not be an optimal long-term strategy. Positive role modeling and involvement by teachers and other adults were cited as having important roles in fighting prevention. Suggested interventions included teaching adolescents non-violent conflict-resolution skills, anger management, and alternatives to fighting. Parents recommended that violence prevention programs incorporate the experiences of former fighters and be tailored to community needs. Study findings suggest that youth violence-prevention programs may benefit from addressing parental attitudes towards fighting and parent-child communication about fighting, teaching adolescents non-violent conflict-resolution skills, and tailoring programs by race/ethnicity. Promoting positive modeling and involvement by teachers and other adults also may be beneficial.

Predictors of Weapon-Related Behaviors among African American, Latino, and White Youth.

OBJECTIVE: To identify risk and protective factors for weapon involvement among African American, Latino, and white adolescents. STUDY DESIGN: The National Longitudinal Study of Adolescent to Adult Health is a nationally representative survey of 7th-12th grade students. Predictors at wave 1 and outcome at wave 2 were analyzed. Data were collected in the mid-1990s, when rates of violent crime had been declining. The outcome was a dichotomous measure of weapon-involvement in the past year, created using 3 items (weapon-carrying, pulled gun/knife, shot/stabbed someone). Bivariate and multilevel logistic regression analyses examined associations of individual, peer, family, and community characteristics with weapon involvement; stratified analyses were conducted with African American, Latino, and white subsamples. RESULTS: Emotional distress and substance use were risk factors for all groups. Violence exposure and peer delinquency were risk factors for whites and African Americans. Gun availability in the home was associated with weapon involvement for African Americans only. High educational aspirations were protective for African Americans and Latinos, but higher family connectedness was protective for Latinos only. CONCLUSIONS: Interventions to prevent weapon-related behaviors among African American, Latino, and white adolescents may benefit from addressing emotional distress and substance use. Risk and protective factors vary by race/ethnicity after adjusting for individual, peer, family, and community characteristics. Addressing violence exposure, minimizing the influence of delinquent peers, promoting educational aspirations, and enhancing family connectedness could guide tailoring of violence prevention interventions.

Raising Bilingual Children: A Qualitative Study of Parental Attitudes, Beliefs, and Intended Behaviors.

We examined parental preferences in raising Spanish/English bilingual children. We identified factors influencing their decisions, and the strategies used to promote bilingualism. Focus groups were conducted with Spanish-primary-language parents of children 3 to 7 years old. These groups were audiotaped and transcribed. Three reviewers independently analyzed transcripts for themes using margin-coding and grounded theory; disagreements were resolved by consensus. Thirteen Spanish-primary-language parents participated in two focus groups. The results show that parents wanted their children to be bilingual. Parents also stated that the benefits of bilingualism included better career opportunities, and preservation of culture and native language. Family members, schools, and prior parental experiences influenced the parents' decisions to raise bilingual children. Parents preferred English-only school classes and to teach Spanish at home. Strategies identified for raising bilingual children included reading bilingual books and having children speak only Spanish at home. Schools and pediatricians are used as resources.

Why adolescents fight: a qualitative study of youth perspectives on fighting and its prevention.

OBJECTIVE: To identify risk factors for fighting, factors that protect against fighting, and strategies to prevent fighting, among adolescents who fight and those uninvolved in fighting. METHODS: Focus groups were conducted with middle and high school students, stratified by fighting (fighter/nonfighter) status, race/ethnicity, and gender. Groups were audiotaped, transcribed, and analyzed using margin coding and thematic content analysis. Themes were independently identified by 3 coders; disagreements were resolved by consensus. RESULTS: The 65 participants in the 12 focus groups were 13 to 17 years old. Reasons for fighting include self-defense, to gain/maintain respect, or anger; having goals for the future is protective. Nonfighters state that their parents condone fighting only when physically attacked and that they teach adolescents strategies to avoid fighting. Fighters describe mixed messages from parents, and pro-fighting attitudes and modeling of aggressive behavior among some family members. Nonfighters avoid fighting by ignoring insults or walking away. Fighters feel unable to use nonviolent conflict-resolution methods effectively. Peers may instigate or encourage fights. Suggested prevention strategies include anger-management and conflict-resolution programs, relationships with caring adults, and physicians counseling youth about the consequences of fighting. CONCLUSIONS: Nonfighters use various strategies to avoid fighting, whereas fighters are aware of few alternatives to fighting. Conflicting parental messages about fighting may enhance the likelihood of fighting. Physicians can counsel youth about the negative consequences of fighting. Interventions that teach anger management and conflict resolution, promote adolescent self-efficacy for using nonviolent strategies, and address parental attitudes about fighting may be effective in preventing fighting.

Incarcerated Youths' Perspectives on Protective Factors and Risk Factors for Juvenile Offending: A Qualitative Analysis.

OBJECTIVES: We sought to understand incarcerated youths' perspectives on the role of protective factors and risk factors for juvenile offending. METHODS: We performed an in-depth qualitative analysis of interviews (conducted October-December 2013) with 20 incarcerated youths detained in the largest juvenile hall in Los Angeles. RESULTS: The adolescent participants described their homes, schools, and neighborhoods as chaotic and unsafe. They expressed a need for love and attention, discipline and control, and role models and perspective. Youths perceived that when home or school failed to meet these needs, they spent more time on the streets, leading to incarceration. They contrasted the path through school with the path to jail, reporting that the path to jail felt easier. All of them expressed the insight that they had made bad decisions and that the more difficult path was not only better but also still potentially achievable. CONCLUSIONS: Breaking cycles of juvenile incarceration will require that the public health community partner with legislators, educators, community leaders, and youths to determine how to make success, rather than incarceration, the easier path for disadvantaged adolescents.

Suboptimal maternal and paternal mental health are associated with child bullying perpetration.

This study examines associations between maternal and paternal mental health and child bullying perpetration among school-age children, and whether having one or both parents with suboptimal mental health is associated with bullying. The 2007 National Survey of Children's Health, a nationally-representative, random-digit-dial survey, was analyzed, using a parent-reported bullying measure. Suboptimal mental health was defined as fair/poor (vs. good/very good/excellent) parental self-reported mental and emotional health. Of the 61,613 parents surveyed, more than half were parents of boys and were white, 20% were Latino, 15% African American, and 7% other race/ethnicity. Suboptimal maternal (OR 1.4; 95% CI 1.1-1.8) and paternal (OR 1.5; 95% CI 1.1-2.2) mental health are associated with bullying. Compared with children with no parents with suboptimal mental health, children with only one or both parents with suboptimal mental health have higher bullying odds. Addressing the mental health of both parents may prove beneficial in preventing bullying.

Healthcare Access for Iraqi Refugee Children in Texas: Persistent Barriers, Potential Solutions, and Policy Implications.

To identify access barriers to healthcare and potential interventions to improve access for Iraqi refugee children. Four focus groups were conducted using consecutive sampling of Iraqi refugee parents residing in the US for 8 months to 5 years. Eight key-informant interviews also were conducted with employees of organizations serving Iraqi refugee families, recruited using snowball sampling. Focus groups and interviews were audiotaped, transcribed, and analyzed using margin coding and grounded theory. Iraqi refugees identified provider availability, Medicaid maintenance and renewal, language issues, and inadequate recognition of post-traumatic stress disorder as barriers to care for their children. Interviewees cited loss of case-management services and difficulties in understanding the Medicaid renewal process as barriers. Potential interventions to improve access include community-oriented efforts to educate parents on Medicaid renewal, obtaining services, and accessing specialists. Given the enduring nature of language and Medicaid renewal barriers, policies addressing eligibility alone are insufficient.

Mental health beliefs and barriers to accessing mental health services in youth aging out of foster care.

OBJECTIVE: To examine the perspectives of youth on factors that influence mental health service use after aging out of foster care. METHODS: Focus groups were conducted with youth with a history of mental health needs and previous service use who had aged out of foster care. Questions were informed by the Health Belief Model and addressed 4 domains: youth perceptions of the "threat of mental health problems," treatment benefits versus barriers to accessing mental health services, self-efficacy, and "cues to action." Data were analyzed using a modified grounded-theory approach. RESULTS: Youth (N = 28) reported ongoing mental health problems affecting their functioning; however, they articulated variable levels of reliance on formal mental health treatment versus their own ability to resolve these problems without treatment. Past mental health service experiences influenced whether youth viewed treatment options as beneficial. Youth identified limited self-efficacy and insufficient psychosocial supports "cueing action" during their transition out of foster care. Barriers to accessing mental health services included difficulties obtaining health insurance, finding a mental health provider, scheduling appointments, and transportation. CONCLUSIONS: Youths' perceptions of their mental health needs, self-efficacy, psychosocial supports during transition, and access barriers influence mental health service use after aging out of foster care. Results suggest that strategies are needed to 1) help youth and clinicians negotiate shared understanding of mental health treatment needs and options, 2) incorporate mental health into transition planning, and 3) address insurance and other systemic barriers to accessing mental health services after aging out of foster care.