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1.
Child Abuse Negl ; 154: 106952, 2024 Jul 24.
Article in English | MEDLINE | ID: mdl-39053221

ABSTRACT

BACKGROUND: Child maltreatment may alter the way that adolescents engage in and interact within the places they visit in their daily routines, namely youth activity spaces. Thus, it is important to understand how maltreatment experiences are linked to adolescents' exposure to environmental and contextual risks within their activity spaces. OBJECTIVE: The aim of the study was to explore the associations between child maltreatment and patterns of risk exposures within youth activity spaces among adolescents. PARTICIPANTS AND SETTING: Study participants were 1364 adolescents between the ages of 11 and 17, living in a Midwest state in the United States. METHODS: We linked data from the Adolescent Health and Development in Context (AHDC) study and the Statewide Automated Child Welfare Information System (SACWIS). A three-step latent class analysis (LCA) was employed. RESULTS: Three contextual risk exposure classes were identified: 1) The aggression/violence class (7.7 %); 2) The smoking and drinking class (12.3 %); and 3) The non-risk class (80.0 %). Adolescents with more maltreatment reports were more likely to be in the aggression/violence class compared to the non-risk class. CONCLUSIONS: Capitalizing on the novel linkage between administrative child welfare records and ecological momentary assessment (EMA)-based youth spatial/environmental exposure data, we found a positive link between the number of maltreatment reports made to child protective services and membership in the aggression/violence class. Intervention efforts should be directed toward youths with a history of child maltreatment, ensuring that they have access to safe, structured, and non-violent environments during their daily routines.

2.
Ann Appl Stat ; 18(1): 794-818, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38831930

ABSTRACT

Collective efficacy-the capacity of communities to exert social control toward the realization of their shared goals-is a foundational concept in the urban sociology and neighborhood effects literature. Traditionally, empirical studies of collective efficacy use large sample surveys to estimate collective efficacy of different neighborhoods within an urban setting. Such studies have demonstrated an association between collective efficacy and local variation in community violence, educational achievement, and health. Unlike traditional collective efficacy measurement strategies, the Adolescent Health and Development in Context (AHDC) Study implemented a new approach, obtaining spatially-referenced, place-based ratings of collective efficacy from a representative sample of individuals residing in Columbus, OH. In this paper we introduce a novel nonstationary spatial model for interpolation of the AHDC collective efficacy ratings across the study area, which leverages administrative data on land use. Our constructive model specification strategy involves dimension expansion of a latent spatial process and the use of a filter defined by the land-use partition of the study region to connect the latent multivariate spatial process to the observed ordinal ratings of collective efficacy. Careful consideration is given to the issues of parameter identifiability, computational efficiency of an MCMC algorithm for model fitting, and fine-scale spatial prediction of collective efficacy.

3.
J Adolesc Health ; 74(6): 1156-1163, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38483377

ABSTRACT

PURPOSE: The everyday experience of safety promotes health and successful development during adolescence. To date, few studies have examined racial variation in the spatial determinants of in-the-moment perceived safety. METHODS: Drawing on data from the Columbus, Ohio-based Adolescent Health and Development in Context study (N = 1,405), we consider the influence of intraindividual variability in Global Positioning System-based exposure to both high-proportion White urban neighborhoods and neighborhood violence for the everyday location-based safety perceptions of Black and White youth (ages 11-17) as captured by ecological momentary assessment. RESULTS: Exposure to higher area-level violence reduces youths' safety perceptions. Momentary exposure to residentially White-dominated neighborhoods also reduces perceived safety, but only for Black youth who spend more time, on average, in White areas. In contrast, we observe some limited evidence that White youth perceive greater safety when in White neighborhoods if they spend more time in white neighborhoods on average. DISCUSSION: These findings point to the need for greater attention to in situ experiences in understanding the origins of racial disparities in health and wellbeing. For Black youth, a restricted focus on the consequences of residing in Black segregated neighborhoods may obscure potentially health consequential exposures beyond these areas.


Subject(s)
Black or African American , Residence Characteristics , Safety , Urban Population , White , Adolescent , Child , Female , Humans , Male , Black or African American/psychology , Geographic Information Systems , Ohio , Perception , Violence/ethnology
4.
Soc Forces ; 101(4): 1888-1917, 2023 Apr.
Article in English | MEDLINE | ID: mdl-37082330

ABSTRACT

The formative work of Jane Jacobs underscores the combination of "eyes on the street" and trust between residents in deterring crime. Nevertheless, little research has assessed the effects of residential street monitoring on crime due partly to a lack of data measuring this process. We argue that neighborhood-level rates of households with dogs captures part of the residential street monitoring process core to Jacobs' hypotheses and test whether this measure is inversely associated with property and violent crime rates. Data from a large-scale marketing survey of Columbus, OH, USA residents (2013; n = 43,078) are used to measure census block group-level (n = 595) rates of households with dogs. Data from the Adolescent Health and Development in Context study are used to measure neighborhood-level rates of trust. Consistent with Jacobs' hypotheses, results indicate that neighborhood concentration of households with dogs is inversely associated with robbery, homicide, and, to a less consistent degree, aggravated assault rates within neighborhoods high in trust. In contrast, results for property crime suggest that the inverse association of dog concentration is independent of levels of neighborhood trust. These associations are observed net of controls for neighborhood sociodemographic characteristics, temporally lagged crime, and spatial lags of trust and dog concentration. This study offers suggestive evidence of crime deterrent benefits of local street monitoring and dog presence and calls attention to the contribution of pets to other facets of neighborhood social organization.

5.
Article in English | MEDLINE | ID: mdl-36540354

ABSTRACT

Human mobility analysis plays a crucial role in urban analysis, city planning, epidemic modeling, and even understanding neighborhood effects on individuals' health. Often, these studies model human mobility in the form of co-location networks. We have recently seen the tremendous success of network representation learning models on several machine learning tasks on graphs. To the best of our knowledge, limited attention has been paid to identifying communities using network representation learning methods specifically for co-location networks. We attempt to address this problem and study user mobility behavior through the communities identified with latent node representations. Specifically, we select several diverse network representation learning models to identify communities from a real-world co-location network. We include both general-purpose representation models that make no assumptions on network modality as well as approaches designed specifically for human mobility analysis. We evaluate these different methods on data collected in the Adolescent Health and Development in Context (AHDC) study. Our experimental analysis reveals that a recently proposed method (LocationTrails) offers a competitive advantage over other methods with respect to its ability to represent and reflect community assignment that is consistent with extant findings regarding neighborhood racial and socio-economic differences in mobility patterns. We also compare the learned activity profiles of individuals by factoring in their residential neighborhoods. Our analysis reveals a significant contrast in the activity profiles of individuals residing in white-dominated vs. black-dominated neighborhoods and advantaged vs. disadvantaged neighborhoods in a major metropolitan city of United States. We provide a clear rationale for this contrastive pattern through insights from the sociological literature.

6.
Demography ; 59(5): 1763-1789, 2022 10 01.
Article in English | MEDLINE | ID: mdl-36095161

ABSTRACT

In the United States, Black youth tend to grow up in remarkably less resourced neighborhoods than White youth. This study investigates whether and to what extent Black youth are moreover exposed to less resourced activity spaces beyond the home. We draw on GPS data from a large sample of urban youth in the Columbus, Ohio-based Adolescent Health and Development in Context study (2014-2016) to examine to what extent Black youth experience nontrivial, disproportionate levels of exposure to more disadvantaged and segregated contexts in their daily routines compared with similarly residentially situated White youth. Specifically, we estimate Black-White differences in nonhome exposure to concentrated disadvantage, racial segregation, collective efficacy, and violent crime. We find that Black youths' activity spaces have substantially higher rates of racial segregation and violent crime than those of White youth, and substantially lower levels of collective efficacy-even after accounting for a host of individual- and home neighborhood-level characteristics. We find more modest evidence of differences in exposure to socioeconomic disadvantage. These findings have important implications for neighborhood-centered interventions focused on youth well-being and the contextual effects and segregation literatures more generally.


Subject(s)
Social Segregation , Adolescent , Humans , Racial Groups , Residence Characteristics , Socioeconomic Factors , United States , Violence
7.
AJS ; 128(3): 914-961, 2022 Nov.
Article in English | MEDLINE | ID: mdl-38213504

ABSTRACT

Foundational urban social theories view heterogeneity of exposure to spatial and social contexts as essential aspects of the urban experience. In contrast, contemporary neighborhood research emphasizes the isolation of city dwellers - particularly residents of racially segregated neighborhoods. Using geospatial data on a sample of youth from the 2014-16 Columbus, OH-based Adolescent Health and Development in Context study, we explore the extent to which the neighborhood locations of everyday activities vary with respect to residential racial composition. In the context of segregated US metro areas, the geographic isolation approach expects home census tract racial composition to powerfully shape the racial composition of activity location neighborhoods. In this view, Black youth residing in high proportion Black neighborhoods are expected to spend the vast majority of their time exposed to similarly Black-concentrated neighborhoods. Consistent with an alternative compelled mobility approach, we find that Black youth residing in high proportion Black neighborhoods exhibit among the highest levels of heterogeneity in the racial composition of neighborhoods encountered. Moreover, Black youth residing in high proportion Black neighborhoods are expected to spend 39% of their non-home time (roughly 2.5 hours a day) in low proportion Black neighborhoods compared to 23% (1.5 hours) in high proportion Black neighborhoods. Exposures to low proportion Black neighborhoods among these youth are largely driven by organizationally-based resource seeking. These findings call into question the assumption that residence in Black segregated neighborhoods leads to homogeneously Black segregated neighborhood exposures and encourage theoretical development and data collection strategies that acknowledge the potential for significant heterogeneity in the everyday neighborhood experiences of urban youth.

8.
Urban Stud ; 58(13): 2758-2781, 2021 Oct 01.
Article in English | MEDLINE | ID: mdl-34840355

ABSTRACT

The inadequacies of residential census geography in capturing urban residents' routine exposures have motivated efforts to more directly measure residents' activity spaces. In turn, insights regarding urban activity patterns have been used to motivate alternative residential neighborhood measurement strategies incorporating dimensions of activity space in the form of egocentric neighborhoods-measurement approaches that place individuals at the center of their own residential neighborhood units. Unexamined, however, is the extent to which the boundaries of residents' own self-defined residential neighborhoods compare with census-based and egocentric neighborhood measurement approaches in aligning with residents' routine activity locations. We first assess this question, examining whether the boundaries of residents' self-defined residential neighborhoods are in closer proximity to the coordinates of a range of activity location types than are the boundaries of their census and egocentric residential neighborhood measurement approaches. We find little evidence that egocentric or, crucially, self-defined residential neighborhoods better align with activity locations, suggesting a division in residents' activity locations and conceptions of their residential neighborhoods. We then examine opposing hypotheses about how self-defined residential neighborhoods and census tracts compare in socioeconomic and racial composition. Overall, our findings suggest that residents bound less segregated neighborhoods than those produced by census geography, but self-defined residential neighborhoods still reflect a preference toward homophily when considering areas beyond the immediate environment of their residence. These findings underscore the significance of individuals' conceptions of residential neighborhoods to understanding and measuring urban social processes such as residential segregation and social disorganization.

9.
Psychoneuroendocrinology ; 125: 104884, 2021 03.
Article in English | MEDLINE | ID: mdl-33453595

ABSTRACT

BACKGROUND: Emerging evidence indicates that exposure to police-related deaths is associated with negative health and wellbeing outcomes among black people. Yet, no study to date has directly examined the biological consequences of exposure to police-related deaths for urban black youth. METHODS AND FINDINGS: We employ unique data from the 2014-16 Adolescent Health and Development in Context (AHDC) study - a representative sample of youth ages 11 to 17 residing in the Columbus, OH area. A subsample of participants contributed nightly saliva samples for cortisol for up to six days, providing an opportunity to link recent exposures to police-related deaths within the residential county to physiological stress outcomes during the study period (N = 585). We examine the effect of exposure to a recent police-related death in the same county on the physiological stress (nightly cortisol) levels of black youth. We find evidence of elevated average levels of nightly cortisol (by 46%) for black boys exposed to a police-related death of a black victim in the 30 days prior to the subject's cortisol collection. We find no evidence of police-related death effects on the physiological stress levels of black girls or white youth. CONCLUSIONS: These analyses indicate that police-related deaths influence the biological functioning of black boys, with potential negative consequences for health. We consider the implications of exposure to lethal police violence among black boys for understanding racial disparities in health more broadly.


Subject(s)
Police , Stress, Physiological , Adolescent , Black People , Child , Female , Humans , Hydrocortisone , Male , Violence
10.
Am Sociol Rev ; 86(2): 201-233, 2021 Mar 18.
Article in English | MEDLINE | ID: mdl-34992302

ABSTRACT

Since the inception of urban sociology, the "neighborhood" has served as the dominant context thought to capture developmentally significant youth experiences beyond the home. Yet no large-scale study has examined patterns of exposure to the most commonly used operationalization of neighborhood - the census tract - among urban youth. Using smartphone GPS data from the Adolescent Health and Development in Context study (N=1405), we estimate the amount of time youth spend in residential neighborhoods and consider explanations for variation in neighborhood exposure. On average, youth (ages 11 to 17) spend 5.7% of their waking time in their neighborhood but not at home, 60% at home, and 34.3% outside their neighborhood. Multilevel negative binomial regression models indicate that residence in economically disadvantaged neighborhoods is associated with less time in neighborhood. Higher levels of local violence and the absence of a neighborhood school the youth is eligible to attend are negatively associated with time in neighborhood and mediate the concentrated disadvantage effect. Fractional multinomial logit models indicate that higher violence is linked with increased time at home while school absence is associated with increased outside-neighborhood time. Theoretical development and empirical research on neighborhood effects should incorporate findings on the extent and nature of neighborhood and broader activity space exposures among urban youth.

11.
Complex Netw XI (2020) ; 2020: 197-211, 2020.
Article in English | MEDLINE | ID: mdl-35662896

ABSTRACT

Sociologists associate the spatial variation of crime within an urban setting, with the concept of collective efficacy. The collective efficacy of a neighborhood is defined as social cohesion among neighbors combined with their willingness to intervene on behalf of the common good. Sociologists measure collective efficacy by conducting survey studies designed to measure individuals' perception of their community. In this work, we employ the curated data from a survey study (ground truth) and examine the effectiveness of substituting costly survey questionnaires with proxies derived from social media. We enrich a corpus of tweets mentioning a local venue with several linguistic and topological features. We then propose a pairwise learning to rank model with the goal of identifying a ranking of neighborhoods that is similar to the ranking obtained from the ground truth collective efficacy values. In our experiments, we find that our generated ranking of neighborhoods achieves 0.77 Kendall tau-x ranking agreement with the ground truth ranking. Overall, our results are up to 37% better than traditional baselines.

12.
J Res Adolesc ; 29(3): 627-645, 2019 09.
Article in English | MEDLINE | ID: mdl-31573764

ABSTRACT

We employ data from the Adolescent Health and Development in Context Study-a representative sample of urban youth ages 11-17 in and around the Columbus, OH area-to investigate the feasibility and validity of smartphone-based geographically explicit ecological momentary assessment (GEMA). Age, race, household income, familiarity with smartphones, and self-control were associated with missing global positioning systems (GPS) coverage, whereas school day was associated with discordance between percent of time at home based on GPS-only versus recall-aided space-time budget data. Fatigue from protocol compliance increases missing GPS across the week, which results in more discordance. Although some systematic differences were observed, these findings offer evidence that smartphone-based GEMA is a viable method for the collection of activity space data on urban youth.


Subject(s)
Budgets/statistics & numerical data , Ecological Momentary Assessment/statistics & numerical data , Geographic Information Systems/statistics & numerical data , Smartphone/instrumentation , Adolescent , Adolescent Development/physiology , Adolescent Health/economics , Child , Compliance , Feasibility Studies , Female , Geographic Information Systems/trends , Humans , Longitudinal Studies , Male , Ohio/epidemiology , Ohio/ethnology
13.
SSM Popul Health ; 7: 004-4, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30581955

ABSTRACT

Sleep deprivation among adolescents has received much attention from health researchers and policymakers. Recent research indicates that variation in sleep duration from night to night is associated with multiple health outcomes. While there is evidence that sleep deprivation is socially patterned, we know little about how social contexts are associated with nightly sleep variation during adolescence (a life course stage when nightly sleep variation is particularly high). Given the importance of family environments for influencing adolescents' sleep patterns, we hypothesized that disadvantaged family contexts would be associated with higher intra-individual variation (IIV) in nightly sleep duration, in addition to lower average nightly sleep duration. We tested these hypotheses in a diverse, population-based sample of 11-17 year-olds (N = 1095) from the Adolescent Health and Development in Context Study. Using survey and ecological momentary assessment data and a novel form of multi-level regression modeling (location-scale mixed modeling), we found that adolescents living in unmarried-parent, low SES, economically insecure, and high caregiver stress families had higher IIV in sleep than adolescents in families with more resources and less caregiver stress. There were fewer family effects on average sleep duration. This suggests family social and economic contexts are associated with an under-researched aspect of adolescent sleep, nightly variation, and may contribute to adolescent sleep problems with implications for their health and health disparities.

14.
SSM Popul Health ; 6: 125-135, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30258971

ABSTRACT

Although racial inequalities in health are well documented, much less is known about the underlying mechanisms that create and sustain these population patterns, especially among nonpoor subgroups. Using 20 waves of data from the Panel Study of Income Dynamics (PSID), we estimate the magnitude of the Black/White gap in self-rated health among middle-income, working-age (18-65) adults and explore potential sources of this disparity. Findings from multilevel regression models suggest that intragenerational gains in family income result in significantly smaller improvements in self-rated health for middle-class African-Americans than similarly situated Whites. We also note that childhood disadvantage predicts subsequent health trajectories in adulthood, but does little to explain the Black/White gap in the association between family income and self-rated health. We conclude that middle-class status provides restricted health returns to upward mobility for African-Americans and this differential relationship cannot be accounted for by greater exposure to early life disadvantage.

15.
RSF ; 3(2): 210-231, 2017 Feb.
Article in English | MEDLINE | ID: mdl-29034322

ABSTRACT

Residential segregation by income and education is increasing alongside slowly declining black-white segregation. Segregation in urban neighborhood residents' non-home activity spaces has not been explored. How integrated are the daily routines of people who live in the same neighborhood? Are people with different socioeconomic backgrounds that live near one another less likely to share routine activity locations than those of similar education or income? Do these patterns vary across the socioeconomic continuum or by neighborhood structure? The analyses draw on unique data from the Los Angeles Family and Neighborhood Survey that identify the location where residents engage in routine activities. Using multilevel p2 (network) models, we analyze pairs of households located in the same neighborhood and examine whether the dyad combinations across three levels of SES conduct routine activities in the same location, and whether neighbor socioeconomic similarity in the co-location of routine activities is dependent on the level of neighborhood socioeconomic inequality and trust. Results indicate that, on average, increasing SES diminishes the likelihood of sharing activity locations with any SES group. This pattern is most pronounced in neighborhoods characterized by high levels of socioeconomic inequality. Neighborhood trust explains a nontrivial proportion of the inequality effect on the extent of routine activity sorting by SES. Thus stark, visible neighborhood-level inequality by SES may lead to enhanced effects of distrust on the willingness to share routines across class.

16.
Ann Am Acad Pol Soc Sci ; 669(1): 41-62, 2017 Jan.
Article in English | MEDLINE | ID: mdl-28845047

ABSTRACT

Emerging evidence indicates that exposure to violent areas may influence youth wellbeing. We employ smartphone GPS data on youth activity spaces to examine the extent of, and potential explanations for, racial disparities in these exposures. Multilevel models of data from the Adolescent Health and Development in Context study indicate that exposures to violent areas vary significantly across days of the week and between youth who reside in the same neighborhood. African American youth are exposed to areas with substantially higher levels of violence. Residing in a disadvantaged neighborhood is significantly associated with exposure to violent areas and explains a non-trivial proportion of the racial difference in this outcome. However, neighborhood factors are incomplete explanations of the racial disparity. Characteristics of the activity locations at which youth spend time explain the residual racial disparity in exposure to violent areas. These findings highlight the importance of youth activity spaces, above and beyond their neighborhood environments.

17.
Criminology ; 55(4): 754-778, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29459884

ABSTRACT

Drawing on Jacobs (1961), we hypothesize that public contact among neighborhood residents while engaged in day-to-day routines, captured by the aggregate network structure of shared local exposure, is consequential for crime. Neighborhoods in which residents come into contact more extensively in the course of conventional routines will exhibit higher levels of public familiarity, trust, and collective efficacy with implications for the informal social control of crime. We employ the concept of ecological ("eco-") networks - networks linking households within neighborhoods through shared activity locations - to formalize the notion of overlapping routines. Using micro-simulations of household travel patterns to construct census tract-level eco-networks for Columbus, OH, we examine the hypothesis that eco-network intensity (the probability that households tied through one location in a neighborhood eco-network will also be tied through another visited location) is negatively associated with tract-level crime rates (N=192). Fitted spatial autoregressive models offer evidence that neighborhoods with higher intensity eco-networks exhibit lower levels of violent and property crime. In contrast, a higher prevalence of non-resident visitors to a given tract is positively associated with property crime. These analyses hold the potential to enrich insight into the ecological processes that shape variation in neighborhood crime.

18.
Soc Forces ; 95(2): 779-807, 2016 Dec 07.
Article in English | MEDLINE | ID: mdl-29430065

ABSTRACT

Latino immigrant presence in urban neighborhoods has been linked with reduced neighborhood cohesion in social disorganization-based ethnic heterogeneity hypotheses and enhanced cohesion in immigration revitalization approaches. Using the 2000-2002 Los Angeles Family and Neighborhood Survey and the 1994-1995 Project on Human Development in Chicago Neighborhoods Community Survey, we explore the association between Latino immigrant concentration and both levels of, and agreement about, neighborhood collective efficacy. Findings from multilevel models with heteroskedastic variance indicate that Latino immigrant concentration exhibits a nonlinear association with collective efficacy. At low levels, increases in Latino immigrant concentration diminish collective efficacy, consistent with a heterogeneity hypothesis. The negative association between Latino immigrant concentration and collective efficacy declines in magnitude as immigrant concentration increases and, particularly in LA, becomes positive beyond a threshold, consistent with an immigration revitalization effect. We also find an inverse nonlinear pattern of association with the variance of collective efficacy. At low levels, increasing Latino immigrant concentration increases the variance of collective efficacy (reflecting more disagreement), but beyond a threshold, this association becomes negative (reflecting increasing agreement). This pattern is observed in both LA and Chicago. The prevalence of social interaction and reciprocated exchange within neighborhoods explains a modest proportion of the Latino immigrant concentration effect on mean levels of collective efficacy in Chicago, but does little to explain effects on the mean in LA or effects on the variance in either LA or Chicago. These findings offer insight into the complex role Latino immigrant presence plays in shaping neighborhood social climate.

19.
Nicotine Tob Res ; 14(9): 1105-9, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22193574

ABSTRACT

INTRODUCTION: A significant proportion of children in the United States remain exposed to secondhand smoke (SHS). We are reporting on relationships observed between parental report of their child's SHS exposure in two groups of children (ages 2-5 years and 9-14 years) with a biological marker of long-term SHS exposure, hair nicotine. METHODS: Participants were healthy children recruited via convenience sampling for two age groups: 2-5 years and 9-14 years. The presence and amount of SHS exposure were assessed by both questionnaire and hair sampling for nicotine determination. RESULTS: A total of 115 participants were recruited (54 toddlers and 61 youth). The groups were similar in terms of demographics and reported SHS exposure. Hair nicotine levels were significantly different by age group, with toddlers having higher levels than youth. The most important independent determinants of hair nicotine were toddler age group, receiving Medicaid for health insurance, and number of smokers the subject was exposed to in 24 hr. CONCLUSIONS: Our findings suggest that young children who are insured by Medicaid have higher levels of hair nicotine, a biomarker of SHS exposure, when compared with an older age group. Further efforts to protect this vulnerable population and mitigate their lifetime risks of SHS exposure-related morbidities are warranted.


Subject(s)
Environmental Monitoring/methods , Hair/chemistry , Nicotine/analysis , Tobacco Smoke Pollution/analysis , Adolescent , Child , Child Welfare , Child, Preschool , Female , Humans , Male , Poverty , Risk Factors , Socioeconomic Factors , United States
20.
Congenit Heart Dis ; 6(4): 347-58, 2011.
Article in English | MEDLINE | ID: mdl-21696547

ABSTRACT

OBJECTIVE: Multiple surgical approaches to the initial palliation of patients with hypoplastic left heart syndrome (HLHS) have been advocated throughout the years. We sought to examine what procedure, if any, is recommended for HLHS management in regard to physician preference, anatomical variations, and concomitant medical issues. PATIENTS AND METHODS: A Web-based survey of pediatric cardiologist subscribed to PediHeart was conducted. OUTCOME MEASURES: The types of palliation recommended (Norwood palliation, Sano modification, hybrid palliation, primary cardiac transplantation, or hospice care) for patients with HLHS with anatomic or comorbid variants were queried. Counseling provided by the physicians to families was also documented as regards survival and outcomes. RESULTS: Two hundred physicians (21% female) who averaged 12.3 years removed from training responded to the survey. US East Coast and Midwest respondents were more likely to recommend Norwood palliation (54% and 60%, respectively) and the US South and West respondents preferred Sano modification (73% and 82%, respectively). Norwood or Sano palliation was recommended over hospice care, hybrid palliation, or cardiac transplant for patients with an intact atrial septum (P < 0.05), moderate to severe tricuspid regurgitation (P < 0.05), or low birth weight defined as less than 2 kg (P < 0.05). Hospice was preferred in low-birth-weight infants over hybrid palliation or cardiac transplantation (P < 0.05). Hospice was recommended over any other palliation for premature infants (less than 30 weeks gestation), chromosomal abnormalities, or end-organ dysfunction (P < 0.05). CONCLUSIONS: This survey demonstrates that different palliative options are primarily recommended by caretakers based upon institutional location and patient characteristics. Prospective comparative trials may force a rethinking of this approach over time.


Subject(s)
Cardiac Surgical Procedures , Counseling , Hospice Care , Hypoplastic Left Heart Syndrome/surgery , Palliative Care , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Female , Health Care Surveys , Healthcare Disparities , Humans , Hypoplastic Left Heart Syndrome/complications , Hypoplastic Left Heart Syndrome/mortality , Internet , Male , Patient Selection , Practice Patterns, Physicians' , Preoperative Care , Residence Characteristics , Risk Assessment , Risk Factors , United States
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