Relationship Between Food Insecurity and Neighborhood Child Opportunity Index.

OBJECTIVES: To evaluate the association between the Child Opportunity Index (COI) and food insecurity. STUDY DESIGN: This was a secondary analysis of a comprehensive screening instrument for social determinants of health and behavioral health risks. It was administered in 2 urban pediatric emergency departments to adolescents aged 13-21 years and caregivers of children aged 0-17 years. Food insecurity was assessed using the 2-item Hunger Vital Sign. Residential addresses were geocoded and linked with COI data. Bivariable and multivariable logistic regression models were developed to measure the relationship between COI and food insecurity. RESULTS: Of the 954 participants (384 adolescents, 570 caregivers) who underwent screening, 15.7% identified food insecurity (14.3% of adolescent and 16.7% of caregiver participants). The majority of participants were non-Hispanic Black (overall, 62.3%; food secure, 60.9%; food insecure, 72.0%), were publicly insured (overall, 56.6%; food secure, 53.1%; food insecure, 73.3%), and lived in neighborhoods of low/very low opportunity (overall, 76.9%; food secure, 74.7%; food insecure, 88.3%). In adjusted analyses, participants living in neighborhoods of low/very low child opportunity had 3-fold greater odds of being food insecure compared with children living in neighborhoods of high child opportunity (aOR, 3.0; 95% CI, 1.4-6.3). CONCLUSION: We demonstrate that food insecurity is associated with lower neighborhood opportunity. Our results could inform future screening initiatives and support the development of novel, place-based interventions to tackle the complex issue of food insecurity.

Racial and Ethnic Disparities in Pediatric Mental Health-Related Emergency Department Visits.

OBJECTIVES: To test the hypotheses that (1) rates of mental health-related concerns presenting to pediatric emergency departments (ED) have increased (2) rates are increasing more in minority than nonminority youth. METHODS: We performed a 5-year retrospective cohort study of youth with mental health-related ED visits using the Pediatric Health Information System. We calculated rates of mental health-related visits, in aggregate and by race/ethnicity. The Poisson model was used to generate incidence rate ratios of unique mental health-related visits each year using census data as the population denominator. RESULTS: There were 242,036 mental health-related visits that met the inclusion criteria, representing 160,656 unique patients. Approximately 7% of unique patients had 3 or more mental health-related visits, differing by race/ethnicity (8.75% non-Hispanic [NH]-Black vs 7.01% NH-White; adjusted odds ratio 1.14 [1.03, 1.26]). Overall, there were 42.8 mental health-related ED visits per 100,000 US children. The NH-Black children had higher rates of visits per 100,000 children compared with NH-Whites (66.1 vs 41.5; adjusted relative risk, 1.54 [1.50-1.59]). Mental health-related visits increased from 2012 to 2016 (33.31 [32.92-33.70] to 49.94 [49.46-50.41]). Every racial/ethnic group experienced an increase in rate of presentation over the study period; Hispanics experienced a significantly larger increase compared with NH-White children (P < 0.05). CONCLUSIONS: Mental health-related ED visits among children are increasing overall, disproportionally affecting minority children. The NH-Black children have the highest visit rates, and rates among Hispanics are increasing at a significantly higher rate when compared with NH-Whites. These results indicate need for increased capacity of EDs to manage mental health-related complaints, especially among minority populations.

Experiencing Bullying Is Associated With Firearm Access, Weapon Carriage, Depression, Marijuana Use, and Justice Involvement in Adolescents.

OBJECTIVES: The aims of this study were to assess whether bullying experience among youths is associated with firearm access and to evaluate assault perpetration risk factors between bullied and nonbullied adolescents. METHODS: This was a secondary analysis of a cross-sectional survey designed to measure self-reported social determinants of health and behavioral health risks among adolescents (13-21 years) in a pediatric emergency department between July 2017 and August 2019. Participants were included in this subanalysis if they responded to a survey item that assessed bullying. Multivariable logistic regression was used to measure the association of firearm access, weapon carriage, and assault perpetration factors (violence, mental health, substance abuse, and justice involvement) with bullying after adjustment for sex, race/ethnicity, and insurance status. RESULTS: Of the 369 participants meeting inclusion criteria, 147 adolescents (40.5%) reported experiencing bullying. Bullied teenagers had higher odds of a gun in the home (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.2-7.8]), weapon carriage (aOR, 5.6; 95% CI, 1.6-18.8), witnessing an assault (aOR, 3.0; 95% CI, 1.6-5.6), negative experience with law enforcement (aOR, 4.5; 95% CI, 2.2-9.2), mental health diagnosis (aOR, 3.9; 95% CI, 2.3-6.7), and marijuana use (aOR, 2.7; 95% CI, 1.1-7.0]). CONCLUSIONS: More than 1 in 3 adolescents presenting to the emergency department report having ever experienced bullying. Bullied teenagers have a higher likelihood of firearm access, weapon carriage, and violent injury perpetration risk factors compared with nonbullied youths. Further studies are needed to understand the relationship between bullying and assault perpetration.

The Adolescent Experience of Filling Prescriptions for the Treatment of Sexually Transmitted Infections.

PURPOSE: To describe adolescents' experience with treatment adherence when prescribed antibiotics for sexually transmitted infections (STIs) in emergency departments (ED). METHODS: Adolescents diagnosed with STIs in two EDs and prescribed outpatient treatment were interviewed to identify barriers and facilitators to treatment adherence. RESULTS: Of 26 participants, 46.2% filled their prescriptions, 38.5% returned to the ED for treatment, 7.7% received treatment elsewhere, and 7.7% received no treatment. All adolescents who filled their prescriptions notified caregivers of their diagnosis, compared with 50.0% who returned to the ED (P = 0.01). Adolescents identified cost, transportation, lack of insurance card, and lack of knowledge as perceived barriers to treatment adherence. Less than half of the participants were interested in school-based health clinics due to anonymity concerns. Most expressed interest in using mobile health (mHealth) to overcome adherence challenges. CONCLUSIONS: Adolescents identified multiple barriers to treatment adherence. Future work should explore the role of caregiver communication and incorporation of mHealth.

Occupational Exposures to Phthalates among Black and Latina U.S. Hairdressers Serving an Ethnically Diverse Clientele: A Pilot Study.

Hairdressers may be differentially exposed to phthalates through hair salon services provided and products used, yet no U.S. studies have investigated these exposures in this population. We characterized concentrations and exposure determinants to nine phthalate metabolites in postshift urine samples among 23 hairdressers from three Black and three Dominican salons, as well as a comparison group of 17 female office workers from the Maryland/Washington D.C. metropolitan area. Overall, hairdressers had higher metabolite concentrations than office workers. The geometric mean (GM) for monoethyl phthalate (MEP) was 10 times higher in hairdressers (161.4 ng/mL) than office workers (15.3 ng/mL). Hairdressers providing select services and using certain products had higher GM MEP concentrations than those who did not: permanent waves/texturizing (200.2 vs 115.4 ng/mL), chemical straightening/relaxing (181.6 vs 92.1 ng/mL), bleaching (182.3 vs 71.6 ng/mL), permanent hair color (171.9 vs 83.2 ng/mL), and Brazilian blowout/keratin treatments (181.4 vs 134.6 ng/mL). Interestingly, hairdressers providing natural services had lower GM MEP concentrations than those who did not: twists (129.1 vs 215.8 ng/mL), sister locs/locs (86.0 vs 241.9 ng/mL), and afros (94.7 vs 203.9 ng/mL). Larger studies are warranted to confirm our findings and identify disparities in occupational phthalate exposures.

Firearms Injuries Involving Young Children in the United States During the COVID-19 Pandemic.

OBJECTIVES: Increased rates of firearm ownership, school closures, and a suspected decrease in supervision during the coronavirus disease 2019 (COVID-19) pandemic place young children at increased risk of firearm injuries. We measured trends in firearm injuries in children and inflicted by children discharging a firearm during the pandemic and correlated these changes with a rise in firearm acquisition. METHODS: In this cross-sectional study with an interrupted time series analysis, we used multiyear data from the Gun Violence Archive. We compared trends in (1) firearm injuries in children younger than 12 years old and (2) firearm injuries inflicted by children younger than 12 years old during the pre-COVID-19 period (March to August in the years 2016-2019) and during the first 6 months of the COVID-19 pandemic (March 2020 to August 2020). Linear regression models were developed to evaluate the relationship between firearm injuries and new firearm acquisitions. RESULTS: There was an increased risk of (1) firearm injuries in young children (relative risk = 1.90; 95% confidence interval 1.58 to 2.29) and (2) firearm injuries inflicted by young children (relative risk = 1.43; 95% confidence interval 1.14 to 1.80) during the first 6 months of the COVID-19 pandemic as compared to the pre-COVID-19 study period. These increased incidents correlate with an increase in new firearm ownership (P < .03). CONCLUSIONS: There has been a surge in firearm injuries in young children and inflicted by young children during the first 6 months of the COVID-19 pandemic. There is an urgent and critical need for enactment of interventions aimed at preventing firearm injuries and deaths involving children.

Results of Testing Children for Severe Acute Respiratory Syndrome Coronavirus-2 Through a Community-based Testing Site.

OBJECTIVE: To describe the demographics, clinical features, and test results of children referred from their primary provider for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the community setting. STUDY DESIGN: Retrospective cross-sectional study of children ≤22 years of age who were tested for SARS-CoV-2 at a community-based specimen collection site in Washington, DC, affiliated with a large children's hospital between March 21 and May 16, 2020. RESULTS: Of the 1445 patients tested at the specimen collection site for SARS-CoV-2 virus, 408 (28.2%) had a positive polymerase chain reaction test. The daily positivity rate increased over the study period, from 5.4% during the first week to a peak of 47.4% (Ptrend < .001). Patients with fever (aOR, 1.7; 95% CI, 1.3-2.3) or cough (aOR, 1.4; 95% CI, 1.1-1.9) and those with known contact with someone with confirmed SARS-CoV-2 infection (aOR, 1.6; 95% CI, 1.0-2.4.) were more likely have a positive test, but these features were not highly discriminating. CONCLUSIONS: In this cohort of mildly symptomatic or well children and adolescents referred to a community drive-through/walk-up SARS-CoV-2 testing site because of risk of exposure or clinical illness, 1 in 4 patients had a positive test. Children and young adults represent a considerable burden of SARS-CoV-2 infection. Assessment of their role in transmission is essential to implementing appropriate control measures.

Racial and/or Ethnic and Socioeconomic Disparities of SARS-CoV-2 Infection Among Children.

OBJECTIVES: To evaluate racial and/or ethnic and socioeconomic differences in rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children. METHODS: We performed a cross-sectional study of children tested for SARS-CoV-2 at an exclusively pediatric drive-through and walk-up SARS-CoV-2 testing site from March 21, 2020, to April 28, 2020. We performed bivariable and multivariable logistic regression to measure the association of patient race and/or ethnicity and estimated median family income (based on census block group estimates) with (1) SARS-CoV-2 infection and (2) reported exposure to SARS-CoV-2. RESULTS: Of 1000 children tested for SARS-CoV-2 infection, 20.7% tested positive for SARS-CoV-2. In comparison with non-Hispanic white children (7.3%), minority children had higher rates of infection (non-Hispanic Black: 30.0%, adjusted odds ratio [aOR] 2.3 [95% confidence interval (CI) 1.2-4.4]; Hispanic: 46.4%, aOR 6.3 [95% CI 3.3-11.9]). In comparison with children in the highest median family income quartile (8.7%), infection rates were higher among children in quartile 3 (23.7%; aOR 2.6 [95% CI 1.4-4.9]), quartile 2 (27.1%; aOR 2.3 [95% CI 1.2-4.3]), and quartile 1 (37.7%; aOR 2.4 [95% CI 1.3-4.6]). Rates of reported exposure to SARS-CoV-2 also differed by race and/or ethnicity and socioeconomic status. CONCLUSIONS: In this large cohort of children tested for SARS-CoV-2 through a community-based testing site, racial and/or ethnic minorities and socioeconomically disadvantaged children carry the highest burden of infection. Understanding and addressing the causes of these differences are needed to mitigate disparities and limit the spread of infection.

A pilot study to assess residential noise exposure near natural gas compressor stations.

BACKGROUND: U.S. natural gas production increased 40% from 2000 to 2015. This growth is largely related to technological advances in horizontal drilling and high-volume hydraulic fracturing. Environmental exposures upon impacted communities are a significant public health concern. Noise associated with natural gas compressor stations has been identified as a major concern for nearby residents, though limited studies exist. OBJECTIVES: We conducted a pilot study to characterize noise levels in 11 homes located in Doddridge County, West Virginia, and determined whether these levels differed based on time of day, indoors vs. outdoors, and proximity of homes to natural gas compressor stations. We also compared noise levels at increasing distances from compressor stations to available noise guidelines, and evaluated low frequency noise presence. METHODS: We collected indoor and outdoor 24-hour measurements (Leq, 24hr) in eight homes located within 750 meters (m) of the nearest compressor station and three control homes located >1000m. We then evaluated how A-weighted decibel (dBA) exposure levels differed based on factors outlined above. RESULTS: The geometric mean (GM) for 24-hour outdoor noise levels at homes located <300m (Leq,24hr: 60.3 dBA; geometric standard deviation (GSD): 1.0) from the nearest compressor station was nearly 9 dBA higher than control homes (Leq,24hr: 51.6 dBA; GSD: 1.1). GM for 24 hour indoor noise for homes <300m (Leq,24hr: 53.4 dBA; GSD: 1.2) from the nearest compressor station was 11.2 dBA higher than control homes (Leq,24hr: 42.2 dBA; GSD: 1.1). Indoor average daytime noise for homes <300m of the nearest compressor stations were 13.1 dBA higher than control homes, while indoor nighttime readings were 9.4 dBA higher. CONCLUSIONS: Findings indicate that living near a natural gas compressor station could potentially result in high environmental noise exposures. Larger studies are needed to confirm these findings and evaluate potential health impacts and protection measures.

Place-based perceptions of the impacts of fracking along the Marcellus Shale.

We examined community perspectives and experiences with fracking in Doddridge County, West Virginia, USA as part of a larger assessment to investigate the potential health impacts associated with fracking in neighboring Maryland, USA. In November 2013, we held two focus groups with community residents who had been impacted by fracking operations and conducted field observations in the impacted areas. Employing grounded theory, we conducted qualitative analysis to explore emergent themes related to direct and indirect health impacts of fracking. Three components of experience were identified, including (a) meanings of place and identity, (b) transforming relationships, and (c) perceptions of environmental and health impacts. Our findings indicate that fracking contributes to a disruption in residents' sense of place and social identity, generating widespread social stress. Although community residents acknowledged the potential for economic growth brought about by fracking, rapid transformations in meanings of place and social identity influenced residents' perceptions of environmental and health impacts. Our findings suggest that in order to have a more complete understanding of the health impacts of fracking, future work must consider the complex linkages between social disruption, environmental impacts, and health outcomes through critical engagements with communities undergoing energy development.

Hazard Ranking Methodology for Assessing Health Impacts of Unconventional Natural Gas Development and Production: The Maryland Case Study.

The recent growth of unconventional natural gas development and production (UNGDP) has outpaced research on the potential health impacts associated with the process. The Maryland Marcellus Shale Public Health Study was conducted to inform the Maryland Marcellus Shale Safe Drilling Initiative Advisory Commission, State legislators and the Governor about potential public health impacts associated with UNGDP so they could make an informed decision that considers the health and well-being of Marylanders. In this paper, we describe an impact assessment and hazard ranking methodology we used to assess the potential public health impacts for eight hazards associated with the UNGDP process. The hazard ranking included seven metrics: 1) presence of vulnerable populations (e.g. children under the age of 5, individuals over the age of 65, surface owners), 2) duration of exposure, 3) frequency of exposure, 4) likelihood of health effects, 5) magnitude/severity of health effects, 6) geographic extent, and 7) effectiveness of setbacks. Overall public health concern was determined by a color-coded ranking system (low, moderately high, and high) that was generated based on the overall sum of the scores for each hazard. We provide three illustrative examples of applying our methodology for air quality and health care infrastructure which were ranked as high concern and for water quality which was ranked moderately high concern. The hazard ranking was a valuable tool that allowed us to systematically evaluate each of the hazards and provide recommendations to minimize the hazards.