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INTRODUCTION: We test the effects of positive affect and its arousal subscale components of calm, wellbeing, and vigor on asthma control and symptom severity in adolescents with moderate to severe asthma. Additionally, we test whether positive affect (and its arousal components) moderate how stress impacts asthma control and symptom severity. METHODS: Adolescents with asthma (N = 66, ages 12-17) completed brief surveys 4 times a day for 7 days reporting on their positive affect, stress, and asthma symptom severity and conducted a morning peak expiratory flow assessment each day. Asthma control and psychological asthma triggers were assessed at the end of the 7 days. RESULTS: Positive affect moderated the association between stress and asthma control (b = -0.33, p = 0.009) as well as the association between psychological triggers and asthma control (b = -0.74, p = 0.007). When assessing the positive affect arousal components, calm and wellbeing seemed to be driving these effects. Additionally, calm moderated the association between stress and asthma symptom severity (b = -0.33, p = 0.036) as well as the association between psychological triggers and asthma symptom severity (b = -0.75, p = 0.021). CONCLUSIONS: When considering patient stress (e.g., general stress, psychological asthma triggers), positive affect and its arousal components of calm and wellbeing may be helpful for patients with higher levels of stress and/or for patients experiencing greater numbers of psychological triggers.
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BACKGROUND: To explore the role of children's residential environment on opioid prescribing patterns in a predominantly Latinx sample. METHODS: We connected geocoded data from electronic medical records in a diverse sample of pediatric patients to neighborhood environments constructed using latent profile modeling techniques. We then estimated a series of multilevel models to determine whether opioid prescribing patterns vary by residential context. RESULTS: A stepwise pattern exists between neighborhood disadvantage and pediatric opioid prescription patterns, such that higher levels of disadvantage associate with a greater likelihood of opioid prescription, independent of the patient's individual profile. CONCLUSION: In a largely Latinx sample of children, the neighborhood in which a child lives influences whether or not they will receive opioids. Considering the differences in patient residential environment may reduce variation in opioid dispensing rates among pediatric patients.
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Analgésicos Opioides , Pacientes Internados , Humanos , Criança , Analgésicos Opioides/uso terapêutico , Padrões de Prática Médica , Prescrições , Características da VizinhançaRESUMO
The purpose of the current prospective cohort study was to determine if acculturation, measured by primary language spoken, impacts the pain response of children being treated for cancer during an experimental pain task. Sixty-seven Spanish-speaking and English-speaking children ages 6 to 18 years being treated for cancer provided ratings of pain and upset severity during the completion of the cold pressor task (CPT). One week following the CPT, participants provided their recollection of average pain and upset during the CPT. Repeated measures analysis of variance revealed Spanish-speaking children reported significantly higher pain (F1,64=5.58, P=0.02) and upset (F1,64=7.69, P=0.007) ratings during the CPT compared with English-speaking children. Also, Spanish-speaking children were over 4 times as likely to remove their hands from the water before the CPT 4-minute uninformed ceiling compared with English-speaking children (P=0.002). These findings suggest that cultural and contextual factors, including the level of acculturation, are important considerations in the assessment and management of pain in children with cancer. Future research should continue to examine the mechanisms underlying the association between acculturation and the symptom experience for children receiving treatment for cancer.
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Idioma , Neoplasias , Dor , Adolescente , Criança , Humanos , Hispânico ou Latino , Neoplasias/complicações , Neoplasias/terapia , Dor/etiologia , Dor/psicologia , Estudos Prospectivos , Medição da Dor , Aculturação , Angústia PsicológicaRESUMO
BACKGROUND: This investigation aimed to examine the impact of parental psychosocial variables on the administration of opioids to young children experiencing postoperative pain. METHODS: Participants in this longitudinal analysis were children ages 2-12 undergoing tonsillectomy with or without adenoidectomy and their parents. Parents completed validated instruments assessing trait anxiety, perceived stress, and coping style before surgery, and children and parents completed instruments assessing pain and administration of opioids and acetaminophen on days 1, 2, 3, and 7 at home after surgery. The structure of the data was such that parents and children completed multiple data assessments making the data multilevel (ie, days of data within dyads). To address this issue of data structure, multilevel modeling was used to analyze the dataset. RESULTS: Participants included 173 parent-child dyads (mean child age = 5.99 ± 2.51) recruited between 2012 and 2017. We found that parent-related psychosocial variables, such as trait anxiety, stress, and coping style, moderated the relationship between the child's pain and postoperative medication administration. Specifically, when predicting hydrocodone, the interactions between anxiety and pain and stress and pain were significant; when child pain was high, high-anxiety and high-stressed parents gave their children 19% and 12% more hydrocodone, respectively, compared to low-anxiety and low-stressed parents. When predicting acetaminophen, the interactions between anxiety and pain, a blunting coping style and pain, and a monitoring coping style and pain were significant. CONCLUSIONS: These results suggest the need to identify parents who experience high levels of perceived stress and trait anxiety and use appropriate interventions to manage stress and anxiety. This may ensure children receive optimal amounts of pain medication following surgery.
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Analgésicos Opioides/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/psicologia , Pais/psicologia , Fatores Sociais , Tonsilectomia/efeitos adversos , Adaptação Psicológica/efeitos dos fármacos , Adaptação Psicológica/fisiologia , Analgésicos Opioides/efeitos adversos , Ansiedade/diagnóstico , Ansiedade/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Tonsilectomia/tendênciasRESUMO
BACKGROUND: Mindset, or one's beliefs about the ability to change one's outcomes, has been studied in the educational domain but not in surgical settings. The purpose of this study was to examine the role of parental health mindset on children's recovery. METHODS: Participants were part of a larger National Institutes of Health-funded trial that included 1470 children undergoing outpatient tonsillectomy and adenoidectomy. We used measures of parental coping style (Monitor Blunter Style Scale; MBSS) and medication attitudes (Medication Attitudes Questionnaire; MAQ) to validate the Health Beliefs Scale (HBS; Criterion validity, Cohen's kappa). HBS categorizes parents as having a growth mindset, or the belief that health can be changed, or a fixed mindset, which reflects the belief that individuals cannot change their health. Next, we identified demographic and personality variables (eg, temperament, anxiety) as predictors for the HBS. Finally, we examined the relationship between the HBS with postoperative outcomes. RESULTS: Findings supported criterion validity of the HBS. Parents with a growth mindset reported seeking out more medical information (MBSS, 7.15 ± 3.32 vs 6.22 ± 3.38, P < .001, CI = -1.387 to -0.471) and reported fewer misconceptions regarding analgesic use (MAQ, 22.11 ± 4.09 vs 21.41 ± 4.25, P = .035, CI = 0.046 to 1.229). In assessing outcomes, we found that fixed-mindset parents rated their children's postoperative pain as more severe on days 1 (9.22 ± 3.82 vs 8.37 ± 3.71, P = .007, CI = 0.234 to 1.459) and 3 (8.13 ± 4.28 vs 7.27 ± 4.28, P = .007, CI = 0.094 to 1.638) and reported that their children received more doses of ibuprofen on postoperative day 1 (2.91 ± 1.24 vs 2.44 ± 1.44, P = .041, CI = 0.089 to 0.848). There was no difference in children's self-reported pain scores between groups (P = .585). CONCLUSIONS: These findings, coupled with recent mindset intervention studies in the educational space, suggest that parent mindset is an important target for clinical intervention in the context of children's surgical recovery.
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Analgésicos , Pais , Adaptação Psicológica , Analgésicos/uso terapêutico , Criança , Humanos , Dor Pós-Operatória/tratamento farmacológico , Relações Pais-FilhoRESUMO
This research examined whether pediatric inpatients without an anxiety/mood disorder are more likely to receive opioids in response to pain compared to patients diagnosed with a mental health condition. Research questions were tested using cross-sectional inpatient electronic medical record data. Propensity score matching was used to match patients with a disorder with patients without the disorder (anxiety analyses: N = 2892; mood analyses: N = 1042). Although patients with anxiety and mood disorders experienced greater pain, physicians were less likely to order opioids for these patients. Analyses also disclosed an interaction of anxiety with pain-the pain-opioid relation was stronger for patients without an anxiety disorder than for patients with an anxiety diagnosis. Instead, physicians were more likely to place non-opioid analgesic orders to manage the pain of patients with anxiety disorders. Findings imply that pain management decisions might be influenced by patient's mental health.
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Analgésicos Opioides , Médicos , Analgésicos Opioides/uso terapêutico , Ansiedade , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/tratamento farmacológico , Criança , Estudos Transversais , Hospitais Pediátricos , Humanos , Transtornos do Humor/tratamento farmacológico , Padrões de Prática MédicaRESUMO
The opioid crisis in the United States has grown at an alarming rate. Children with cancer are at high risk for pain, and opioids are a first-line treatment in this population. Accordingly, there is an urgent need to optimize pain management in children with cancer without contributing to the opioid crisis. This report details opportunities for this optimization, including clinical practice guidelines, comprehensive approaches to pain management, mobile health, and telemedicine. It is vital to balance appropriate use of analgesics with efforts to prevent misuse in order to reduce unnecessary suffering and minimize unintended harms.
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Dor do Câncer/tratamento farmacológico , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor , Adolescente , Criança , Pré-Escolar , Humanos , Manejo da Dor/métodos , Manejo da Dor/normas , Guias de Prática Clínica como AssuntoRESUMO
OBJECTIVES: Cancer-related pain in children is prevalent and undermanaged. Mobile health (mHealth) applications provide a promising avenue to address the gap in pain management in children with cancer. Pain Buddy is a multicomponent mHealth application developed to manage cancer-related pain in children. The goal of this paper is to present preliminary efficacy data of the impact of Pain Buddy on children's pain severity and frequency. METHODS: In a randomized controlled trial over 60 days, children (N = 48) reported daily pain on a tablet while receiving usual care. Those in the intervention group (N = 20) received remote symptom monitoring and skills training for pain management. Children in the attention control group (N = 28) only reported on their pain. RESULTS: Both groups experienced significant reductions in average daily pain over the study period (B = -0.10, z = -3.40, P = 0.001), with no group differences evident (z = -0.83, P = 0.40). However, the intervention group reported significantly fewer instances of moderate to severe pain compared with the control group, t(4125) = 2.67, P = 0.007. In addition, the intervention group reported no instances of moderate to severe pain toward the end of the study period. CONCLUSION: Pain Buddy is an innovative and interactive mHealth application that aims to improve pain and symptom management among children with cancer. The findings from this pilot study suggest that Pain Buddy may aid in the reduction of pain severity in children during cancer treatment.
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Dor do Câncer/terapia , Aplicativos Móveis/estatística & dados numéricos , Neoplasias/complicações , Manejo da Dor/métodos , Qualidade de Vida , Telemedicina/métodos , Adolescente , Dor do Câncer/psicologia , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Prognóstico , Estudos ProspectivosRESUMO
Positive affect (PA) is associated with better health across a wide range of physical health outcomes. This review reflects on why the study of PA is an essential component of our understanding of physical health and expands on pathways that connect these two variables. To encourage forward movement in this burgeoning research area, measurement and design issues in the study of PA and health are discussed, as are the connections between PA and a range of different health outcomes. Plausible biological, social, and behavioral pathways that allow for positive feelings to get under the skin and influence physical wellness are detailed and framed in the context of several theoretical models. Finally, new directions for the field and important methodological and interpretative considerations that are essential to moving this important research area forward are explored.
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Doença Crônica , Emoções , Nível de Saúde , Psicoterapia , Estresse Psicológico , Doença Crônica/epidemiologia , Emoções/fisiologia , Humanos , Psicoterapia/métodos , Estresse Psicológico/fisiopatologiaRESUMO
BACKGROUND: Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain. METHODS: In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically-based intervention which was then evaluated by experienced nurses (N = 8) and parents (N = 9) during focus groups. After revising the intervention based on focus group feedback, it was tested in Phase 2 using a pre-post study design. Nurses (N = 23) who worked in the recovery room were recruited to be part of both pre- and post-intervention data collection periods. Parents were recruited to be part of either the pre- (N = 52) or post-intervention (N = 60) data collection periods. Nurses and parent-child dyads were recorded in the post anesthesia care unit and videos were coded for the desired (ie, behaviors that may decrease child pain) and non-desired (ie, behaviors that may increase child pain) behaviors. Pain data was collected from the children's medical records to assess pain after surgery. The intervention was given to the nurses and parents in the post-intervention data collection period. RESULTS: Nurses significantly increased their rate of desired behaviors by 231% (P = 0.001; Somer's D = 1) and significantly decreased their rate of non-desired behaviors by 62% (P = 0.004, Somer's D = -0.88, 95% CI [-1.74, -0.03]). Parents significantly increased their rate of desired behaviors by 124% (P = 0.033). Moreover, the intervention significantly decreased child pain in the post anesthesia care unit (b = -2.19, SE = 0.63, z = -3.46, P = 0.001, 95%CI [-3.43, -0.95]). CONCLUSION: The intervention was effective in changing nurse and parent behaviors as well as child pain after surgery.
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Educação Continuada em Enfermagem , Dor Pós-Operatória/terapia , Dor/prevenção & controle , Pais/educação , Estresse Psicológico/terapia , Adolescente , Adulto , Criança , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Children with cancer routinely undergo painful medical procedures invoking strong physiological stress responses. Resilience to this pain may be conferred through resources such as emotion regulation strategies and positive affect. PROCEDURE: This study measured dispositional positive affect in children with cancer (N = 73) and randomly assigned participants to one of three emotion regulation strategy conditions (distraction, reappraisal, or reassurance). Children applied their assigned strategy during an experimental pain procedure (the cold pressor task [CPT]) and provided saliva samples before, immediately after, and 15 min after the CPT. Saliva samples were later assayed for salivary alpha amylase (sAA)-a surrogate marker for autonomic/sympathetic nervous system activity and regulation. RESULTS: Children in the reassurance group had sAA levels that continued to rise after completion of the CPT compared to children in the distraction (b = -1.68, P = 0.021) and reappraisal conditions (b = -1.24, P = 0.084). Furthermore, dispositional positive affect moderated the effect of condition such that children in the reassurance group with lower levels of positive affect had sAA levels that continued to rise after completion of the CPT (dy/dx = 1.56, P = 0.027), whereas children in the reassurance condition with higher levels of positive affect did not exhibit this rise (P > 0.05). CONCLUSIONS: Specific emotion regulation strategies, such as distraction and reappraisal, may attenuate the stress response to pain in pediatric patients with cancer, and positive affect may confer resilience in response to pain even with use of less effective coping strategies such as reassurance.
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Adaptação Psicológica , Biomarcadores/metabolismo , Emoções/fisiologia , Neoplasias/complicações , Dor/enzimologia , alfa-Amilases Salivares/metabolismo , Estresse Psicológico/enzimologia , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Dor/etiologia , Dor/fisiopatologia , PrognósticoRESUMO
OBJECTIVE: The goal of this study was to examine pain responses in pediatric patients with cancer. METHOD: Children (ages 6 to 18) undergoing treatment for cancer (N=68) completed the cold pressor task. RESULTS: Average pain tolerance was 118.22 seconds (SD=101.18) and 40% of the children kept their hand in the water the entire 4-minute ceiling. On a 0 to 10 numeric rating scale, children reported a pain severity of 5.07 (SD=3.47) at their first report of pain, a pain severity of 5.94 (SD=3.54) at their maximum report of pain, and a pain severity of 5.33 (SD=3.72) at the time they reached pain tolerance. Children receiving chemotherapy agents (N=56) with possible neuropathic effects exhibited higher pain tolerance compared with children not receiving such treatments (N=10), ß=0.84, SE=0.38, Wald χ1=4.88, P=0.027, hazard ratio=2.33, 95% confidence interval (1.10-4.92). CONCLUSIONS: This study provides data on experimental pain responses in a sample of children undergoing cancer treatment and suggests that pain experience may be moderated by cancer treatment type.
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Antineoplásicos , Neoplasias , Neuralgia , Percepção da Dor , Adolescente , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Criança , Feminino , Humanos , Masculino , Neoplasias/tratamento farmacológico , Neoplasias/fisiopatologia , Neuralgia/induzido quimicamente , Neuralgia/fisiopatologia , Medição da DorRESUMO
BACKGROUND: Satisfaction in the hospital setting is an important component of both hospital funding and patient experience. When it comes to a child's hospital experience, parent satisfaction of their child's perioperative care is also necessary to understand. However, little research has been conducted on the predictors of this outcome. Therefore, the purpose of this current study was to validate a priori selected predictors for parental satisfaction in their child's perioperative process. METHODS: Eight hundred and ten pediatric patients who underwent tonsillectomy and adenoidectomy surgery and their parents were included in this study. The primary outcome was assessed using a 21-item parent satisfaction questionnaire resulting in three satisfaction scores: overall care satisfaction, OR/induction satisfaction, and total satisfaction. RESULTS: Descriptive statistics and correlational analysis found that sedative-premedication, parental presence at anesthesia induction, child social functioning, parental anxiety, and language were all significant predictors of various components of the satisfaction score. Regression models, however, revealed that only parent anxiety and child social functioning remained significant predictors such that parents who reported lower state anxiety (OR/induction satisfaction: OR = 0.975, 95% CI [0.957, 0.994]; total satisfaction: OR = 0.968, 95% CI [0.943, 0.993]) and who had higher socially functioning children (overall care satisfaction: OR = 1.019, 95% CI [1.005, 1.033]; OR/induction satisfaction: OR = 1.011, 95% CI [1.000, 1.022]) were significantly more satisfied with the perioperative care they received. CONCLUSION: Lower parent anxiety and higher child social functioning were predictive of higher parental satisfaction scores.
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Pais/psicologia , Satisfação do Paciente , Assistência Perioperatória/psicologia , Ansiedade/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Hipnose Anestésica/psicologia , MasculinoRESUMO
BACKGROUND: It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations. METHODS: This study included 105 families of children aged 2 to 15 years of Hispanic origin and low income undergoing outpatient tonsillectomy and adenoidectomy surgery. Participating parents completed baseline and demographic packets. Recorded postoperative pain ratings and administration of analgesics at home for 1 week were collected during home visits. RESULTS: Despite the high (70%; 99% confidence interval [CI], 57%-82%) incidence of significant pain in the first 24 hours home, 32% (95% CI, 20%-45%) of the children received 0 to 1 dose of analgesia. Overall, 21% children (99% CI, 11%-35%) received 4 or less total doses of pain medication over the entire week after surgery. Of the total analgesic doses administered to children in the week after surgery, only 44% (99% CI, 40%-47%) were in accepted ranges. CONCLUSIONS: Despite experiencing significant postoperative pain, Hispanic children assessed in this study received suboptimal analgesic therapy at home.
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Hispânico ou Latino , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Aculturação , Adenoidectomia , Adolescente , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Cuidadores , Criança , Pré-Escolar , Estudos de Coortes , Uso de Medicamentos , Expressão Facial , Feminino , Disparidades em Assistência à Saúde , Humanos , Lactente , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , TonsilectomiaRESUMO
BACKGROUND: The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children's posthospitalization and postoperative new-onset behavioral changes. However, the psychometric properties of the scale have not been re-evaluated in the past five decades despite substantial changes in the practice of surgery and anesthesia. In this investigation, we examined the psychometric properties of the PHBQ to potentially increase the efficacy and relevance of the instrument in current perioperative settings. METHOD: This study used principal components analysis, a panel of experts, Cronbach's alpha, and correlations to examine the current subscale structure of the PHBQ and eliminate items to create the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS). Data from previous investigations (N = 1064, Mage = 5.88) which utilized the PHBQ were combined for the purposes of this paper. RESULTS: A principal components analysis revealed that the original subscale structure of the PHBQ could not be replicated. Subsequently, a battery reduction, which utilized principal components analysis and a panel of experts, was used to eliminate the subscale structure of the scale and reduce the number of items from 27 to 11, creating the PHBQ-AS. The PHBQ-AS demonstrated good internal consistency reliability and concurrent validity with another measure of children's psychosocial and physical functioning. CONCLUSION: Revising the former subscale structure and reducing the number of items in the PHBQ to create the PHBQ-AS may provide a means for reducing the burden of postoperative behavioral assessment through decreasing time of administration and eliminating redundancy of items and allow for more accurate measurement of child postoperative behavioral changes.
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Procedimentos Cirúrgicos Ambulatórios/psicologia , Comportamento Infantil/psicologia , Inquéritos e Questionários/normas , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Anestesia/psicologia , Anestesia/estatística & dados numéricos , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Período Pós-Operatório , Análise de Componente Principal , Psicometria , Reprodutibilidade dos TestesRESUMO
BACKGROUND: The modified Yale Preoperative Anxiety Scale (mYPAS) is the current "criterion standard" for assessing child anxiety during induction of anesthesia and has been used in >100 studies. This observational instrument covers 5 items and is typically administered at 4 perioperative time points. Application of this complex instrument in busy operating room (OR) settings, however, presents a challenge. In this investigation, we examined whether the instrument could be modified and made easier to use in OR settings. METHODS: This study used qualitative methods, principal component analyses, Cronbach αs, and effect sizes to create the mYPAS-Short Form (mYPAS-SF) and reduce time points of assessment. Data were obtained from multiple patients (N = 3798; Mage = 5.63) who were recruited in previous investigations using the mYPAS over the past 15 years. RESULTS: After qualitative analysis, the "use of parent" item was eliminated due to content overlap with other items. The reduced item set accounted for 82% or more of the variance in child anxiety and produced the Cronbach α of at least 0.92. To reduce the number of time points of assessment, a minimum Cohen d effect size criterion of 0.48 change in mYPAS score across time points was used. This led to eliminating the walk to the OR and entrance to the OR time points. CONCLUSIONS: Reducing the mYPAS to 4 items, creating the mYPAS-SF that can be administered at 2 time points, retained the accuracy of the measure while allowing the instrument to be more easily used in clinical research settings.
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Ansiedade/diagnóstico , Ansiedade/psicologia , Testes Neuropsicológicos/normas , Período Pré-Operatório , Criança , Feminino , Humanos , Masculino , Pais , Análise de Componente Principal , Psicometria , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
Neighborhood socioeconomic context where Latinx children live may influence body weight status. Los Angeles County and Orange County of Southern California both are on the list of the top ten counties with the largest Latinx population in the USA. This heterogeneity allowed us to estimate differential impacts of neighborhood environment on children's body mass index z-scores by race/ethnicity using novel methods and a rich data source. We geocoded pediatric electronic medical record data from a predominantly Latinx sample and characterized neighborhoods into unique residential contexts using latent profile modeling techniques. We estimated multilevel linear regression models that adjust for comorbid conditions and found that a child's place of residence independently associates with higher body mass index z-scores. Interactions further reveal that Latinx children living in Middle-Class neighborhoods have higher BMI z-scores than Asian and Other Race children residing in the most disadvantaged communities. Our findings underscore the complex relationship between community racial/ethnic composition and neighborhood socioeconomic context on body weight status during childhood.
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Etnicidade , Obesidade , Criança , Humanos , Índice de Massa Corporal , Peso Corporal , Hispânico ou Latino , Características de Residência , Asiático , Grupos RaciaisRESUMO
Increasing evidence suggests that within-person variation in affect is a dimension distinct from mean levels along which individuals can be characterized. This study investigated affect variability's association with concurrent and longitudinal mental health and how mean affect levels moderate these associations. The mental health outcomes of depression, panic disorder, self-rated mental health, and mental health professional visits from the second and third waves of the Midlife in the United States Study were used for cross-sectional (n = 1,676) and longitudinal outcomes (n = 1,271), respectively. These participants took part in the National Study of Daily Experiences (NSDE II), where they self-reported their affect once a day for 8 days, and this was used to compute affect mean and variability. Greater positive affect variability cross-sectionally predicted a higher likelihood of depression, panic disorder, mental health professional use, and poorer self-rated mental health. Greater negative affect variability predicted higher panic disorder probability. Longitudinally, elevated positive and negative affect variability predicted higher depression likelihood and worse self-rated mental health over time, while greater positive affect variability also predicted increased panic disorder probability. Additionally, mean affect moderated associations between variability and health such that variability-mental health associations primarily took place when mean positive affect was high (for concurrent mental health professional use and longitudinal depression) and when mean negative affect was low (for concurrent depression, panic disorder, self-rated mental health, and longitudinal self-rated mental health). Taken together, affect variability may have implications for both short- and long-term health and mean levels should be considered. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-024-00238-0.
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Causes of asthma exacerbation in children have been studied extensively at the individual level, but contributions of neighborhood-level factors are less explored. We test which distinctive residential characteristics produce variation in uncontrolled asthma among pediatric patients. We extracted electronic medical record data from pediatric patients living in Southern California and used multilevel modeling techniques to isolate which neighborhood characteristics drive inequitable asthma control. Above and beyond the individual-level factors known to predict inadequate disease control, neighborhoods with greater concentration of non-Hispanic black residents (odds ratios [OR] = 1.02; 95% confidence interval [CI]: 0.99-1.03; P < .05), higher proportions of female-headed households (OR = 1.01; 95% CI: 0.99-1.01; P < .05), and higher levels of ambient air pollution (OR = 1.05; 95% CI: 1.01-1.10; P < .001) associate with greater odds of asthma exacerbation. The interplay between community characteristics and asthma management during childhood is complex, and place-based initiatives are needed to narrow the gap in asthma exacerbation.