Community features' varying insight into emergency department use for different childhood injuries.

BACKGROUND: Community-level factors, including poverty level, minority population, and rurality are predictive of child injury rates. Community-based interventions targeting high-risk communities have been suggested for prevention and are reliant on understanding details of the community and prevalent types of injuries. The present study assessed injury rates based on characteristics of the community and for different types of injuries. METHOD: A retrospective review of emergency department visits identified zip-code and injury type data for children 0-19. Injuries related to bicycles, falls, motor-vehicle traffic (MTV), and violence were examined. Poverty level, minority population, rural classification, and insured population were obtained at the zip-code level. Regression models examined the association between community features and injury rates for the four categories of injuries. RESULTS: The results showed that the relationship between community features and injury rates was dependent on injury type. Rurality was associated with a lower rate for bicycle and falls, but a higher rate of MVT; higher insured population was associated with higher MVT and violence rates; higher minority population was associated with lower rates for falls and MTV; and higher population in poverty was associated with lower rate for MTV. CONCLUSIONS: The findings indicate that injury rates not only cluster among community-level characteristics, but also the type of injury. Variation in community features and injury types offer insight into a holistic approach to child health. PRACTICAL APPLICATIONS: In addition to other factors related to risk for injuries, health providers' knowledge of features of the local community and prevalent injuries in the environment may be helpful additions to programming geared toward lessening the burden of injuries on children and healthcare systems.

School-Based Mental Health Service Utilization Through the COVID-19 Pandemic and Beyond.

BACKGROUND: We examined trends in mental health service utilization before, during, and in the immediate return to in-person learning throughout the COVID-19 pandemic. METHODS: Retrospective chart review was assessed for changes in odds of any visit being a mental health encounter from five school-based health centers from the 2018-2019 to the 2021-2022 school years. Data are limited to the in-person school year from mid-August to early June. RESULTS: Data were assessed from 1239 students seen through 2256 visits over the 4 school years (Mage = 12.93). The odds of any visit being related to a mental health encounter increased each school year, with the 2020 to 2021 and 2021 to 2022 school years having significant increases in odds (both compared to the first and to the antecedent school year). In addition, during the 2019 to 2020 and 2020 to 2021 school years, the odds of a repeated mental health encounter significantly increased from year to year. CONCLUSIONS: Findings indicate a steadily increasing number of mental health service utilization needs among adolescent students that was significantly exponentiated throughout the COVID-19 pandemic.

Parent/Guardian Experiences With the Healthcare System and Community Supports for Pediatric Asthma Management.

Determinants of pediatric asthma management include child, family, healthcare, and community factors. The purpose of this study is to investigate how parents/guardians are impacted by and act on these factors to aid in their child's asthma self-management. Interviews were conducted in Fall 2020 with 12 female parents/guardians of Black/African American children who participated in a community paramedic pilot study with their child in South Carolina. Children in the initial study had an asthma diagnosis of moderate persistent asthma, had Medicaid insurance, and were determined high-risk for emergency room presentation. Inductive and deductive qualitative analysis identified that child management self-efficacy and independence, parent/guardian health literacy, parent and child negative experiences related to asthma diagnosis and management, asthma management tools, and social support from multiple sources impact child self-management. Findings from this study highlight the importance of clear asthma education and management tool recommendations from healthcare and community providers, particularly for parents/guardians with low health literacy. Health literacy impacted parental responses and likely how families comprehend Medicaid and clinical asthma guidance.

Factors related to youth self-efficacy for injury prevention bicycle skills.

INTRODUCTION: Bicycle riding is a common activity for children, but they are prone to bicycle-related injuries. It is well-established that injury prevention measures such as wearing a helmet and correctly riding a bicycle can reduce the severity of an injury and the likelihood of having an accident. However, how to increase bicycle injury prevention behaviors among children, who collectively fail to engage in injury prevention behaviors, is less well understood. Self-efficacy is consistently predictive of injury prevention behavior, making it an important approach to understanding injury prevention skills among this key population. The objective of this study was to explore and identify factors internal to the child as well as factors about his or her environment that predict a child's self-efficacy for injury prevention skills. METHOD: Two generalized linear mixed effects models were created from survey data collected from elementary school students (n = 2,255) as part of a school-based bicycle education program. Models focused on self-efficacy for riding a bicycle and self-efficacy for wearing a helmet correctly. RESULTS: In both models, road safety knowledge, opportunity for skill building through owning appropriate equipment (a bicycle or helmet), and situation through perception of neighborhood safety were predictive. The analyses reveal these variables as key factors for greater confidence, with feeling safe riding in the neighborhood, in particular, emerging as highly predictive of self-efficacy for injury prevention skills. CONCLUSIONS: These findings highlight the interplay of individual and environmental factors within confidence for injury prevention behavior. Given self-efficacy's strong relationship to prevention behavior, these findings indicate actionable strategies. Practical Applications: The key factors highlighted in this study can be used by policymakers to target specific areas (e.g., neighborhood safety) to promote self-efficacy and thus improve injury prevention. These factors can also inform strategies for establishing safety skills in bicycle-safety education programs.

Feedback Following a Family-Focused Pediatric Weight Management Intervention: Experiences From the New Impact Program.

Weight management interventions have the potential to reduce body mass index and help families adopt healthier behaviors. This study examined feedback from families to identify central aspects of various intervention strategies based on self-determination theory constructs that have the strongest influence on patient success, with the aim of understanding how best to approach weight management in a clinical pediatric setting. Telephone interviews were conducted with 22 individuals (20 parents/guardians and 2 teenagers) who participated in a multidisciplinary weight management program and data was analyzed using inductive and deductive thematic analysis processes. Participants identified motivational interviewing strategies that were most influential to their success. Parents and patient's identified barriers and facilitators to success included patient readiness to change, personal logistics, family engagement, and establishing long- and short-term goals. Successful pediatric obesity management requires consideration to both the patient and family's readiness, structured implementation adaptations to address barriers, intentional efforts to move from external reward to internal motivation, and strategies to ensure families develop self-efficacy toward achievable healthy behaviors.

Disparity between the presence and absence of food allergy action plans in one school district.

The Joint Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology; the American Academy of Pediatrics; and the National Association of School Nurses all recommend emergency action plans (EAPs) that direct therapy of allergic reactions in children. This study investigated the school nurse's perception of food allergies and their use of EAPs in food-allergic students in a large, socioeconomically diverse school district. An electronic and paper survey was developed and administered to all elementary and middle school nurses in Greenville County, SC. Forty-three of the eligible school nurses participated for a response rate of 64% (43/67). All of the participants worked at schools that had at least one student with food allergies (mean, nine students with food allergies per school; SD, seven students). Forty-four percent (19/43) of schools had a written action plan for all their food-allergic students, whereas in 42% (18/43) of schools, one-half or less of the food-allergic students, had an action plan. Seventy percent (30/43) of schools made at least one accommodation for students with food allergies and 23% (10/43) of schools made multiple accommodations. At least three additional school personnel were trained in administering rescue medications besides the school nurse in 86% (37/43) of schools, but in 5% (2/43) of schools no additional adults were trained to give rescue medications. Although multiple organizations recommend EAPs for food-allergic students, our study highlights their inconsistent use in this school district.