Convergent and Discriminant Validity of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) and the Vineland Adaptive Behavior Scales (VABS).

Behavior analysts frequently use the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) to assess the language and social skills of children with autism in everyday practice and in research. Despite the widespread use of the VB-MAPP, its psychometric characteristics have not been extensively investigated. To provide information about its convergent validity, we calculated correlations between scores earned by 235 children with autism on the VB-MAPP and the Vineland Adaptive Behavior Scale (VABS), a commonly used assessment with good reliability and validity. We obtained moderate or strong positive correlations between the VB-MAPP Milestones score and VABS Communication, Socialization, and Daily Living Skills subdomains. There was also a strong positive correlation between the VB-MAPP Milestones score and VABS overall raw score. These findings suggest that the VB-MAPP Milestones Assessment measures aspects of social and communicative behavior comparable to those indexed by these VABS subdomains which, like prior findings, supports the use of the Milestones Assessment. No significant relationship was observed between the VB-MAPP Barriers score and the VABS Internalizing, Externalizing, or overall Maladaptive Behavior scores. These findings, like prior findings, question the value of the VB-MAPP's Barriers Assessment as a measure of maladaptive behavior.

The Prevalence, Predictors, and Health Consequences of Disagreement in Reports of Child Maltreatment Exposure.

The purpose of this study was to examine the prevalence, predictors, and consequences of disagreement between prospective caregiver and retrospective child reports of childhood physical and emotional maltreatment. The design was a secondary analysis of data from the Avon Longitudinal Study of Parents and Children, a three-decade long UK-based birth cohort. Prospective caregiver reports were in poor to fair agreement with retrospective child reports for physical and emotional maltreatment exposure, with caregivers tending to underreport exposure. Disagreement between reporters was associated with increased risk of depressive symptoms and substance use severity, but decreased risk for mental health diagnoses. Screening measures of childhood maltreatment exposure should take caution against using measures from different reporters interchangeably (i.e., from mother versus child). Disagreement in reports may indicate unmet need for mental health evaluation.

Parental Legal System Involvement, Positive Childhood Experiences, and Suicide Risk.

OBJECTIVES: To examine whether adverse parental legal system involvement (incarceration, arrest) was associated with suicide risk, accounting for other adverse childhood experiences, and whether there was a moderating relationship between positive childhood experiences (PCEs) and parental legal system involvement in suicide risk. METHODS: This cross-sectional study used 2-year follow-up data from the Adolescent Brain Cognitive Development Study when children were age 11 to 12 years. Outcomes were lifetime suicidal ideation, attempts, and nonsuicidal self-injury (NSSI). Exposures were parent incarceration or arrest. We used generalized linear models to estimate the relative risk of suicide outcomes from adverse parent legal involvement and whether there was an interaction between parent legal system involvement and PCE count, controlling for adverse childhood experiences and demographic factors. RESULTS: Among our sample (n = 10 532;), 687 children (6.5%) reported parent incarceration and 1265 (12.0%) reported parent arrest. Suicidal ideation was the most frequent risk outcome (n = 490; 4.7%). Children whose parents had been incarcerated had a relative risk of suicidal ideation of 1.74 (95% CI: 1.32-2.31). Children whose parents had been arrested had a relative risk of suicidal ideation of 1.89 (95% CI: 1.53-2.37) and a relative risk of suicide attempt of 2.69 (95% CI: 1.7-4.25). Parental incarceration/arrest were not associated with NSSI. PCEs were associated with reduced relative risk of suicidal ideation and NSSI, though there was no significant interaction between PCEs and adverse parent legal system involvement exposures. CONCLUSIONS: Parental legal system involvement may negatively affect child mental health. Strengthening PCEs in childhood may mitigate suicide-related risks.

Racism-related stress and mental health among black women living in Los Angeles County, California: A comparison of postpartum mood and anxiety disorder screening scales.

PURPOSE: To assess Black women's exposure to and appraisal of racism-related stress during the postpartum period and to distinguish its impact on three indicators of postpartum mood and anxiety disorders (PMADs) symptoms. METHODS: Data from the Black Mothers' Mental Wellness Study (N = 231) and linear regression models estimated the associations between racism-related stress and the PMAD indicators: 3-item Edinburgh Postnatal Depression Scale (EPDS-3), 8-item Patient Health Questionnaire (PHQ-8), and PHQ-15. RESULTS: The majority of participants (80.5%, N = 186) experienced racism a few times a year or more, of which 37.1% (N = 69) were bothered somewhat and 19.3% (N = 36) a lot. Racism-related stress, income, level of education, and history of mental health diagnosis explained greater variance in PMAD symptoms as measured by the PHQ-8 score (R2 = 0.58, p = < 0.001) compared to the EPDS-3 (R2 = 0.46, p = < 0.001) or the PHQ-15 (R2 = 0.14, p = 0.035). CONCLUSIONS: Racism is a stressor for Black women living in Los Angeles County, California. Racism-related stress and emotional expression of PMAD symptoms were salient to the postpartum mental health of the Black women in this study. Findings from this study suggest that the PHQ-8 should be used to assess how racism impacts Black women's postpartum mental health.

Concordance in Child-Parent Reporting of Social Victimization Experiences in the Adolescent Brain Cognitive Development (ABCD) Study.

OBJECTIVE: To investigate child-parent concordance in reporting social victimization experiences and whether parent concordance with child report of victimization was associated with child behavioral symptoms. METHODS: This was an observational study with data from the Adolescent Brain Cognitive Development Social Development (ABCD-SD) substudy. The analytic sample was 2415 pre-adolescent children from the United States. We assessed parent-child concordance on six domains of child social victimization: conventional crime, peer victimization, witnessing violence, internet victimization, school victimization, and gun violence. Child behavior symptoms were measured using the parent-report Child Behavior Checklist. Interrater agreement and multiple linear and logistic regression analyses were conducted to assess parent concordance with child report of victimization and its relationship to behavioral symptoms. RESULTS: Interrater agreement in parent-child social victimizations reports was low, with Cohen's Kappa values ranging from 0.10 to 0.23. Compared to parent-child dyads in which neither reported victimization, parent concordance with child report of victimization across multiple domains of social victimization was associated with more internalizing/externalizing behaviors, as was parent discordance with child reports that did not indicate victimization. Among children who reported victimization, parents' perceptions of greater neighborhood safety were associated with lower odds of concordant parent report of conventional crime (OR = 0.94, 95% CI = 0.90-0.98) and witnessing violence (OR = 0.94, 95% CI-0.89-0.98). CONCLUSIONS: Parents and children do not necessarily agree in reporting social victimization experiences. Parent reports of child social victimization, whether they were concordant with positive child reports or discordant with negative child reports, were associated with parent reports of behavioral symptoms and thus may be an indicator of the severity of experiences, underscoring the need to consider multiple informants when screening for adversity.

Racial and Ethnic Disparities in Receipt of Pediatric Mental Health Care.

BACKGROUND: Studies suggest increasing mental health care needs among children but limited capacity to meet those needs, potentially leaving some needs unmet. There are no recent national studies examining the receipt of mental health treatment among children. We sought to identify the correlates of treatment receipt in a nationally representative sample of children in the United States. METHODS: We conducted a cross-sectional analysis of the 2019 National Health Interview Survey. Parents reported on their child's sociodemographic characteristics, general health care engagement, mental health using the Strengths and Difficulties Questionnaire, and whether their child received therapy or medication in the prior year. Weighted logistic regressions tested associations among child characteristics and receipt of mental health treatment while controlling for parental report of child mental health symptoms. RESULTS: Among 7168 children surveyed, 1044 (15%) received mental health treatment, equating to over 7 million US children. Hispanic children (adjusted odds ratio [AOR]: 0.46 [95% confidence interval (CI): 0.34-0.62]) and non-Hispanic Black children (AOR: 0.35 [95% CI: 0.23-0.54]) had lower odds of receiving treatment compared to non-Hispanic White children, controlling for mental health symptoms. Children with a well-child visit in the last year (AOR: 2.05 [95% CI: 1.20-3.52]) and whose usual place of care was a doctor's office (AOR 2.10 [95% CI: 1.33-3.34]) had higher odds of treatment receipt. CONCLUSIONS: Racially and ethnically minoritized children and those without primary care access have disproportionately low levels of receipt of mental health treatment. Interventions to meet the needs of these groups should be prioritized to reduce mental health disparities.

Preliminary Investigation: Pilot Study of Program Directors' Perceptions of Wellness and Suicide Prevention for Student Registered Nurse Anesthetists.

The purpose of this pilot study was to investigate wellness and student suicidality in nurse anesthesia programs. Graduate students such as student registered nurse anesthetists (SRNAs) are at increased risk of suicide from environmental and educational stressors. Wellness interventions may help. An observational, anonymous online survey of all program directors (PDs) was conducted. Identical responses on a simultaneous pilot SRNA study were compared. Quantitative data were analyzed using Wilcoxon rank sum and Fisher's exact tests. Three PDs reported student suicides. Anxiety, depression, and emotional lability were warning signs. Student and PD responses to wellness program assessments were varied, with PD responses more positive and students more negative. PDs were as stressed as students and struggled to meet their own wellness needs. Most PDs reported no or insufficient training in suicide risk and prevention. Suggestions for improving wellness initiatives included to improve and standardize activities and make initiatives more accessible and seek innovative solutions to fit more content into an overcrowded curriculum. PDs and SRNAs need suicide prevention training and improved wellness efforts at local and national levels. Approaches are needed to counter stigma and reluctance to discuss mental health challenges. Suicide is multidimensional, but with proactive awareness, it may be preventable.

Neurocognition in adults with congenital heart disease post-cardiac surgery: A systematic review.

BACKGROUND: Congenital heart disease (CHD) is the most common birth defect worldwide. Neurocognitive deficits and psychiatric disorders, which can impact daily life, have been reported in over 50% of adolescents and young adults with moderate to complex CHD. OBJECTIVE: Conduct a systematic review of sex, clinical, psychological and social determinants of health (SDoH) factors affecting neurocognition in adults with CHD post-cardiac surgery. METHODS: PubMed, Cumulated Index to Nursing and Allied Health Literature, and Embase were searched for relevant studies over the past 5 years. Thirteen articles met inclusion criteria of: 1) CHD post-cardiac surgery, 2) age ≥ 18 years, and 3) used a validated measure of neurocognition. RESULTS: A total of 507 articles were identified. After screening, 30 articles underwent full text review yielding 13 eligible articles. Twelve articles reported deficits in multiple domains including executive function, intellectual functioning, visuospatial ability, and verbal fluency in more complex CHD. Only three studies examined cognition based on sex, with female and lower parental SES associated with worse cognitive outcomes. Most studies were from Europe, predominantly sampled Caucasian participants, had heterogeneous samples of CHD complexity, and lacked standardized cognitive measures which limited generalizability of findings. CONCLUSIONS: Adults with CHD present with a wide variety of cognitive deficits, with some associations with sex, clinical history, and SDoH factors. It remains unclear to what degree these factors affect cognition in adults with moderate to complex CHD. Future longitudinal studies should focus on age-related effects on cognition and potential health care disparities in diverse CHD samples.

Preliminary Investigation: Pilot Study of Wellness and Suicide Prevention for Student Registered Nurse Anesthetists.

This pilot study investigated wellness and causes and prevention of suicide in student registered nurse anesthetists (SRNAs). A cross-sectional anonymous survey study was conducted of a sample of randomly chosen SRNAs. Data were analyzed with descriptive and inferential statistics. Responses to open-ended questions were summarized and presented. Results demonstrated elevated SRNA stress levels. There was an association between suicidal ideation in SRNAs and depression, lack of perceived agency, and elevated anxiety in the classroom. SRNAs reported mental health challenges, depression, and anxiety. Sixteen percent of SRNAs felt that classmates were at risk of suicide, and two SRNAs had lost a classmate to suicide. Twenty-nine percent of SRNAs reported suicidal thoughts prior to matriculation, and 35% reported suicidal thoughts during training. Students with suicidal ideation asked for help from friends and family, but not faculty, and some did not ask for help. Students gave existing wellness initiatives low ratings, and many felt faculty did not promote wellness. Involving student group leaders and appointing a student lead wellness point person may encourage students to ask for help. Faculty should continually prioritize, check-in on, and monitor student wellness. Wellness is a never-ending, essential, and continually evolving effort. Suicide is preventable with compassionate intervention.

Updates to the Autism Intervention Research Network on Physical Health (AIR-P) Research Agenda.

INTRODUCTION: Autistic individuals, now representing one in 36 individuals in the U.S., experience disproportionate physical health challenges relative to non-autistic individuals. The Health Resources and Services Administration's (HRSA) Autism Intervention Research Network on Physical Health (AIR-P) is an interdisciplinary, multi-center Research Network that aims to increase the health, well-being, and quality of life of autistic individuals. The current paper builds on the initial AIR-P Research Agenda (proposed in Year 1) and provides an updated vision for the Network. METHODS: Updates to the Research Agenda were made via the administration of a Qualtrics survey, and disseminated widely to all AIR-P entities, including the Research Node Leaders, Steering Committee, Autistic Researcher Review Board, and collaborating academic and non-academic entities. Network members were tasked with evaluating the Year 1 Research Agenda and proposing additional priorities. RESULTS: Within each Research Node, all Year 1 priorities were endorsed as continued priorities for research on autism and physical health. Specific topics, including co-occurring conditions and self-determination, advocacy, and decision-making, were particularly endorsed. Opportunities for exploratory studies and intervention research were identified across Research Nodes. Qualitative responses providing feedback on additional research priorities were collected. CONCLUSION: The updated AIR-P Research Agenda represents an important step toward enacting large-scale health promotion efforts for autistic individuals across the lifespan. This updated agenda builds on efforts to catalyze autism research in historically underrepresented topic areas while adopting a neurodiversity-oriented approach to health promotion.

Implementing the NCTSN Trauma-Informed Organizational Assessment (TIOA) for Improving Trauma-Informed Care in Inpatient Child Psychiatry.

BACKGROUND: Children and adolescents receiving inpatient psychiatric services have disproportionately high levels of exposure to trauma and adversity. The National Child Traumatic Stress Network Trauma-Informed Organizational Assessment (TIOA) is a comprehensive tool intended to guide implementation of trauma-informed care, but it has not yet been applied in inpatient settings. AIMS: The purpose of this quality improvement project was to describe trauma-informed care in inpatient child/adolescent psychiatry with the TIOA, examine relatedness among trauma-informed care domains, and explore barriers or facilitators to applying trauma-informed care. METHODS: This quality improvement project used mixed methods. We conducted a web-based survey in Summer 2022 with staff members (clinical and administrative) at two inpatient child/adolescent psychiatric units in California to assess trauma-informed care practices with the TIOA (87 items). Qualitative follow-up interviews were offered to interested participants. A correlation matrix and cluster analyses were used to examine relationships among TIOA domains; qualitative data were analyzed thematically. RESULTS: There were 69 survey respondents and seven qualitative interviews. TIOA domain scores ranged from a low of 2.3 to a high of 3.2, indicating that practices were occurring only "rarely" to "sometimes." There were two major themes identified from qualitive interviews: (a) barriers to trauma-informed care in an inpatient context that can be resource-constrained or coercive; and (b) discovering strategies to provide trauma-informed care despite structural barriers. CONCLUSION: Organizational interventions targeting any domains of trauma-informed care are needed in inpatient settings given limited uptake of trauma-informed care.

Association of neighborhood gentrification and residential moves with hypertension and diabetes control in Los Angeles County, 2014-2019: A retrospective cohort study.

OBJECTIVE: To examine whether gentrification exposure is associated with future hypertension and diabetes control. METHODS: Linking records from an integrated health care system to census-tract characteristics, we identified adults with hypertension and/or diabetes residing in stably low-SES census tracts in 2014 (n = 69,524). We tested associations of census tract gentrification occurring between 2015 and 2019 with participants' disease control in 2019. Secondary analyses considered the role of residential moves (possible displacement), race and ethnicity, and age. RESULTS: Gentrification exposure was associated with improved odds of hypertension control (aOR: 1.08; 95% CI: 1.00, 1.17), especially among non-Hispanic Whites and adults >65 years. Gentrification was not associated with diabetes control overall, but control improved in the Hispanic subgroup. Disease control was similar regardless of residential moves in the overall sample, but disparate associations emerged in models stratified by race and ethnicity. CONCLUSIONS: Residents of newly gentrifying neighborhoods may experience modestly improved odds of hypertension and/or diabetes control, but associations may differ across population subgroups. POLICY IMPLICATIONS: Gentrification may support-or at least not harm-cardiometabolic health for some residents. City leaders and health systems could partner with impacted communities to ensure that neighborhood development meets the goals and health needs of all residents and does not exacerbate health disparities.

"The Wild West:" Nurse Experiences of Responding to the 2017 Las Vegas Mass Shooting.

OBJECTIVE: The purpose of this study was to explore the experiences of nurses who responded to a public mass shooting in 2017. METHODS: This qualitative study was conducted with a sample of nurses who responded to a mass shooting, recruited purposively from a hospital in Las Vegas, Nevada. Intensive interviews were conducted with a total of 7 nurses, audio-recorded and transcribed for thematic analysis. RESULTS: Six themes were developed from interview data: (1) "The worst night of my life": Overrun and overwhelmed; (2) Unexpected altruism and benevolence of patients and staff; (3) "The Wild West": Giving victim care by improvising beyond rules; (4) Experiencing a range of reactions in the immediate aftermath and in the long term; (5) Shifts in nursing practice and evolving team dynamics; and (6) Defining realistic approaches to support staff mental health and mass casualty preparation. CONCLUSION: Nurses who were involved in responding to the public mass shooting described the event as life-altering. Given the critical role of nurses in responding to mass shootings, it is essential to consider how nurses can be supported in the aftermath of these events and how mass disaster preparation can include attention to the needs of nurses.

Structural Factors in Health Care Associated With the Mental Health Needs of Black Women in California During the Perinatal Period.

OBJECTIVE: To identify structural factors associated with the receipt of mental health care treatment among Black women in California during pregnancy and after childbirth. DESIGN: Secondary analysis of data from the population-based Listening to Mothers in California survey. PARTICIPANTS: The sample included 194 non-Latina Black women in the postpartum period. METHODS: We used descriptive statistics, including differences between means and logistic regression, to conduct a series of bivariate analyses. RESULTS: Most respondents (84.4%, n = 163) reported symptoms of perinatal mood and anxiety disorders prenatally, and half (50% n = 97) reported symptoms of perinatal mood and anxiety disorders in the postpartum period. Only 12.3% to 14.6% of those who reported symptoms received mental health care treatment. Furthermore, 21.2% (n = 38) of respondents were not screened for postpartum depression. Respondents with private insurance coverage were more likely to report receipt of mental health care after childbirth (OR = 4.6; 95% confidence interval [1.5, 13.5]) compared to respondents with public insurance coverage. CONCLUSION: Our results suggest a high prevalence of unmet mental health needs among non-Latina Black women who lived in California during the perinatal period. Practitioners in clinical settings may be more likely to make referrals to mental health care for women with private insurance coverage in the postpartum period.

Discrimination during childbirth and postpartum care utilization among Black birthing people in California, United States.

BACKGROUND: The purpose of this study was to investigate the relationship between discrimination during childbirth hospitalization and postpartum care utilization among Black birthing people in California, United States. METHODS: This was a secondary analysis of data from the Listening to Mothers in California survey, a population-based survey of individuals with a singleton hospital-based birth in California in 2016. The primary outcome was number of postpartum care visits. The primary exposures were racial, language, and insurance discrimination. A multiple linear regression model was used to estimate associations between discrimination and postpartum care use, adjusting for sociodemographic covariates. RESULTS: Black birthing people in the sample had an average of two postpartum visits. Almost 15% of the sample reported one or more forms of discrimination during hospital-based childbirth. In adjusted models, racial discrimination (ß = 0.09, 95% CI = 0.04-0.14, p < 0.01) and language discrimination (ß = 1.03, 95% CI = 0.98-1.07, p < 0.01) were associated with increased postpartum visits, while insurance discrimination was linked to decreased postpartum visits (ß = -0.96, 95% CI = -1.04 to -0.89, p < 0.01). CONCLUSION: Among Black birthing people in California, the drivers of postpartum care utilization after childbirth are complex. There are multiple negative drivers (e.g., experiencing racial and language discrimination and unmet needs), barriers (e.g., insurance discrimination), and positive drivers (e.g., clinician type and education) that affect postpartum care utilization among Black birthing people.

Examining the Association Between Adverse Childhood Experiences and Lifetime History of Head or Neck Injury and Concussion in Children From the United States.

OBJECTIVE: Our objective was to determine whether there is an association between adverse childhood experiences (ACEs) and lifetime history of early childhood mild head or neck injury and concussion in a nationally representative US cohort. SETTING AND DESIGN: This is a cross-sectional study using data from the Adolescent Brain Cognitive Development (ABCD) Study (data release 3.0), a prospective investigation of child brain development and health. PARTICIPANTS: There were 11 878 children aged 9 or 10 years at baseline, recruited from 21 school-based sites in the United States. After excluding children with missing questionnaires for the primary exposure variable and children with severe brain injuries involving more than 30-minute loss of consciousness, the final sample size was 11 230 children. MEASURES: The primary exposure variable was ACEs. We measured eight ACEs: sexual abuse, physical abuse, emotional neglect, parent domestic violence, parent substance use disorder, parental mental illness, parent criminal involvement, and parent divorce. The primary outcomes were head or neck injury and concussion, measured using the Ohio State University Traumatic Brain Injury Screen-Identification Method Short Form. RESULTS: The sample (N = 11 230) was 52% boys with a mean age of 9.9 years (SD = 0.62 years). The racial and ethnic makeup was reflective of national demographics. Having a higher overall ACE count was associated with higher odds of head or neck injury, with greater odds with more ACEs reported. Children with 2 ACEs had 24% greater odds of head or neck injury (AOR = 1.24, 95% confidence interval [CI] = 1.06-1.45) and 64% greater odds of concussion (AOR = 1.64, 95% CI = 1.18-2.22), and children with 4 or more ACEs had 70% greater odds of head or neck injury (AOR = 1.7, 95% CI = 1.14, 2.49) and 140% greater odds of concussion (AOR = 2.4, 95% CI = 1.15-4.47). The individual ACE categories of sexual abuse, parent domestic violence, parental mental illness, and parent criminal involvement were significantly associated with increased risk of head or neck injury and parental mental illness with increased risk of concussion. CONCLUSIONS AND RELEVANCE: ACEs are associated with early childhood mild head or neck injury and concussion and should be integrated in head injury prevention and intervention efforts.

Preparing nurse scientists for health services and policy research: Five-year outcomes of interprofessional postdoctoral training in the National Clinician Scholars Program.

BACKGROUND: The National Clinician Scholars Program (NCSP) is an interprofessional postdoctoral fellowship for physicians and nurses with a PhD. or DNP focused on health services research, policy, and leadership. PURPOSE: To evaluate 5-year outcomes of nurse postdoctoral scholars in the NCSP. METHODS: We describe the 5-year outcomes of nurse fellows and graduates from six NCSP sites (positions, number of peer-reviewed publications, citations, and h-index). CONCLUSION: There were 53 nurses in the sample (34 alumni, 19 fellows). Approximately half (47%, n = 16) of alumni had tenure-track faculty positions and had bibliometric performance indicators (such as h-indices) 2 to 4 times greater than those previously reported for assistant professors in nursing schools nationally. NCSP nurse scholars and alumni also had an impact on community partnerships, health equity, and health policy DISCUSSION: This study highlights the potential of interprofessional postdoctoral fellowships such as the NCSP to prepare nurse scientists for health care leadership roles.

Availability of LGBTQ Mental Health Services for US Youth, 2014 to 2020.

This survey study reports the variability of lesbian, gay, bisexual, transgender, queer (LGBTQ) youth­specific mental health care in the US from 2014 to 2020.

Decision-Making about COVID-19 Vaccines among Health Care Workers and Their Adolescent Children.

Health care workers promote COVID-19 vaccination for adolescent patients, and as parents, may influence their own children to get vaccinated. We conducted virtual, semi-structured qualitative interviews with vaccinated health care workers and their adolescent children to explore their decision-making process for COVID-19 vaccination. In total, 21 health care workers (physicians, nurses, and medical staff) and their adolescent children (N = 17) participated in interviews. The following three themes described parent-adolescent decision-making for COVID-19 vaccination: (1) family anticipation and hesitation about COVID-19 vaccine approval; (2) parents' or adolescents' choice: the decision maker for adolescent COVID-19 vaccination; and (3) leveraging one's vaccination status to encourage others to get vaccinated. Nurses encouraged adolescent autonomy in decisions for COVID-19 vaccination while physicians viewed vaccination as the parent's decision. Health care workers and their adolescent children used role-modeling to motivate unvaccinated peers and may model their decision-making process for adolescent COVID-19 vaccination with their own children to support their patients' and parents' vaccine decisions.

Association of Cost-Driven Residential Moves With Health-Related Outcomes Among California Renters.

Importance: Unaffordable housing is associated with adverse health-related outcomes, but little is known about the associations between moving due to unaffordable housing and health-related outcomes. Objective: To characterize the association of recent cost-driven residential moves with health-related outcomes. Design, Setting, and Participants: This cross-sectional study involved a weighted multivariable regression analysis of California Health Interview Survey data from January 1, 2011, to December 31, 2017. A population-based sample of 52 646 adult renters and other nonhomeowners in California were included. Data were analyzed from March 2, 2021, to January 6, 2023. Exposure: Cost-driven moves in the past 3 years relative to no move and to non-cost-driven moves. Main Outcomes and Measures: Five outcomes were assessed: psychological distress (low, moderate, or severe, as categorized by the 6-item Kessler Psychological Distress Scale), emergency department [ED] visits in the past year (any vs none), preventive care visits in the past year (any vs none), general health (poor or fair vs good, very good, or excellent), and walking for leisure in the past 7 days (in minutes). Results: Among 52 646 adult renters and other nonhomeowners, 50.3% were female, 85.2% were younger than 60 years, 45.3% were Hispanic, and 55.1% had income lower than 200% of the federal poverty level. Overall, 8.9% of renters reported making a recent cost-driven move, with higher prevalence among Hispanic (9.9%) and non-Hispanic Black (11.3%) renters compared with non-Hispanic White renters (7.2%). In multivariable models, compared with not moving, cost-driven moving was associated with a 4.2 (95% CI, 2.6-5.7) percentage point higher probability of experiencing moderate psychological distress; a 3.2 (95% CI, 1.9-4.5) percentage point higher probability of experiencing severe psychological distress; a 2.5 (95% CI, 0-4.9) percentage point higher probability of ED visits; a 5.1 (95% CI, 1.6-8.6) percentage point lower probability of having preventive care visits; a 3.7 (95% CI, 1.2-6.2) percentage point lower probability of having good, very good, or excellent general health; and 16.8 (95% CI, 6.9-26.6) fewer minutes of walking for leisure. General health, psychological distress, and walking for leisure were also worse with cost-driven moves relative to non-cost-driven moves, with a 3.2 (95% CI, 1.7-4.7) percentage point higher probability of experiencing moderate psychological distress; a 2.5 (95% CI, 1.2-3.9) percentage point higher probability of experiencing severe psychological distress; a 4.6 (95% CI, 2.1-7.2) percentage point lower probability of having good, very good, or excellent general health; and 13.0 (95% CI, 4.0-21.9) fewer minutes of walking for leisure. However, the incidence of preventive care and ED visits did not differ between those who made cost-driven vs non-cost-driven moves. Conclusions and Relevance: In this study, cost-driven moves were associated with adverse health-related outcomes relative to not moving and to non-cost-driven moves. These findings suggest that policies to improve housing affordability, prevent displacement, and increase access to health care for groups vulnerable to cost-driven moves may have the potential to improve population health equity, especially during the current national housing affordability crisis.