Lessons Learned From Adolescent COVID-19 Vaccine Administration in Medically Underserved Communities.

OBJECTIVES: In May 2021, the Health Resources and Services Administration Health Center COVID-19 Vaccine Program (HCCVP) began supporting the national adolescent vaccination rollout for a safe return to in-person learning for children and adolescents from medically underserved communities. To understand the initial implementation of adolescent vaccinations, we estimated the number of vaccines administered through the HCCVP at the national and state level to adolescents aged 12-17 years, and we examined challenges and solutions in vaccine deployment. METHODS: We analyzed data on vaccine administration, challenges, and solutions from the Health Center COVID-19 Survey during May 14-August 27, 2021, and we analyzed data on patients served from the 2019 Uniform Data System. National adolescent COVID-19 vaccination and population data came from CDC's COVID Data Tracker and the US Census Bureau's 2019 Current Population Survey. RESULTS: HCCVP health centers administered >485 000 COVID-19 vaccine doses to adolescents during the study period, with variations across states. Health centers in 13 states and territories (Arizona, California, Colorado, Connecticut, Delaware, Maine, Massachusetts, Missouri, Nebraska, Nevada, Oregon, Virginia, and Puerto Rico) vaccinated more adolescents than their share of prepandemic adolescent patients. The most frequently reported challenges in vaccine administration were vaccine confidence and staffing availability. CONCLUSIONS: This assessment of the initial months of COVID-19 vaccine administration among adolescent health center patients suggests rapid response by health centers in several states, reaching beyond their adolescent patient population to support state-level pandemic response. Future research could examine processes to optimize strategic activation of health centers in public health emergency responses.

Household food insufficiency and flourishing in a nationally representative sample of young children in the U.S.

PURPOSE: This study examined the association between household food insufficiency and flourishing among young children (6 months-5 years) in the U.S. and assessed whether sleep adequacy modifies this association. METHODS: We used data from the 2018-2020 National Surveys of Children's Health. Adjusted prevalence differences and 95% confidence intervals (CI) for the association between household food insufficiency and flourishing were modeled using average marginal predictions from logistic regression models. Sleep adequacy was assessed as an effect measure modifier on the additive scale. RESULTS: Evidence supports additive scale effect measure modification of the food insufficiency-flourishing association by sleep adequacy (Likelihood Ratio Test statistic = 12.4, degrees of freedom = 2, P < .05). Adjusted for potential confounders, the prevalence of flourishing was 13.2 percentage points lower (95% CI: -22.6, -3.7) for children in households with insufficient food and inadequate sleep compared to those with sufficient food and adequate sleep. CONCLUSIONS: Our findings suggest that having enough food and enough sleep are associated with greater wellbeing. These modifiable factors should be targeted by public health interventions to facilitate flourishing among young children in the U.S.

Family-Centered Care and Flourishing in Early Childhood.

INTRODUCTION: Flourishing reflects a child's ability to cope with stress and have positive relationships, which are critical to health and well-being. Pediatricians may increase flourishing in children through family-centered care, which is perceived as sensitive and responsive to specific child needs and family circumstances. The purpose of this study was to examine the relationship between family-centered care and flourishing in young children. METHODS: Data from the 2019-2020 National Survey of Children's Health were used to examine the relationship among children aged 1-5 years (n=17,826). The relationship was explored using chi-square tests and sequential logistic regression modeling, controlling for family socioeconomics and adversity, race/ethnicity, child health, and other measures of healthcare quality. Analyses were conducted in January 2022. RESULTS: Approximately 82% of young children were flourishing. After adjusting for all variables, receipt of family-centered care was the only measure of quality health care associated with an increased likelihood of flourishing in young children (adjusted prevalence rate ratio=1.14; 95% CI=1.01, 1.29; p=0.02). Disparities in flourishing by child sex, race/ethnicity, parental education, income, and insurance type were mitigated after adjustment. However, a decreased likelihood of flourishing continued to be associated with having a special healthcare need (adjusted prevalence rate ratio=0.74; 95% CI=0.68, 0.82) and experiencing multiple adverse childhood experiences (adjusted prevalence rate ratio=0.78; 95% CI=0.66, 0.92). CONCLUSIONS: Expanding receipt of family-centered care may support flourishing and help to reduce disparities in flourishing during early childhood. Future research should evaluate the strategies to overcome barriers to delivering and receiving family-centered care, especially among children with special healthcare needs and children who experienced multiple adverse childhood experiences.