Family and Neighborhood Resilience Are Associated with Children's Healthcare Utilization.

OBJECTIVE: To evaluate the association of external factors of resilience, neighborhood, and family resilience with healthcare use. STUDY DESIGN: A cross-sectional, observational study was conducted using data from the 2016-2017 National Survey of Children's Health. Children aged 4-17 years were included. Multiple logistic regression was used to determine aOR and 95% CIs for association between levels of family resilience, neighborhood resilience and outcome measures: presence of medical home, and ≥2 emergency department (ED) visits per year while adjusting for adverse childhood experiences (ACEs), chronic conditions, and sociodemographic factors. RESULTS: We included 58 336 children aged 4-17 years, representing a population of 57 688 434. Overall, 8.0%, 13.1%, and 78.9% lived in families with low, moderate, and high resilience, respectively; 56.1% identified their neighborhood as resilient. Of these children, 47.5% had a medical home and 4.2% reported ≥2 ED visits in the past year. A child with high family resilience had 60% increased odds of having a medical home (OR, 1.60; 95% CI, 1.37-1.87), and a child with moderate family resilience or resilient neighborhood had a 30% increase (OR, 1.32 [95% CI, 1.10-1.59] and OR, 1.31 [95% CI, 1.20-1.43], respectively). There was no association between resilience factors and ED use, although children with increased ACEs had increased ED use. CONCLUSIONS: Children from resilient families and neighborhoods have an increased odds of receiving care in a medical home after adjusting for the effects of ACEs, chronic conditions, and sociodemographic factors, but no association was seen with ED use.

Obesity in Adolescents: Understanding the Combined Role of Food Security and Emotional and Behavioral Disorders.

PURPOSE: To examine the associations and interactions between levels of food security and emotional and behavioral disorders with obesity in adolescents. METHODS: Multiple logistic regression modeling was used to analyze the association of adolescent obesity with levels of food security and emotional and behavior disorders in children aged 12-17 years using data from National Health Interview Survey 2016-2018 combined years. Presence of emotional and behavioral disorders within food security categories was added to logistic regression modeling to examine interactions. RESULTS: When added individually to multiple logistic regression models, marginal and low food security, Attention Deficit Hyperactivity Disorder (ADHD) and anxiety were associated with increased odds of obesity, but very low food security and depression were not. Within the group of adolescents with very low food security, those with anxiety, depression, or ADHD had a nearly two to three-fold increase in odds of obesity compared to adolescents with very low food security and no emotional and behavioral disorders. A similar increase in the odds of obesity with the presence of anxiety, depression, or ADHD was not seen in the adolescents with high food security. DISCUSSION: This study finds a significant interaction between food security level and emotional and behavioral disorders. The distinction that very low food security in adolescents is only associated with obesity when either anxiety, depression or ADHD are present, but not independently, is an important contribution to understanding complex interactions contributing to obesity.

Relationship of Children's Emotional and Behavioral Disorders With Health Care Utilization and Missed School.

OBJECTIVE: To assess the association between emotional and behavioral disorders (EBD), missed school days and health care visits while controlling for sociodemographic factors, and comorbid medical conditions in a nationally representative sample. METHODS: Data from the 2016 National Health Interview Survey were used to assess the associations between EBD, in children aged 4 to 11 and 12 to 17 years, on missed days of school, health care office visits, and emergency department visits. EBD was assessed utilizing a validated screener. Multiple logistic regression was used to control for comorbid medical conditions and sociodemographic factors. RESULTS: Adolescents who screened positive for anxiety, depression, peer problems, and severe impairment had 4 to 8 times the odds of missing more school than their peers that screened negative. Young children with anxiety had 4 times increased odds of missing more school whereas positive emotional and behavioral health was protective against missing school. Young children and adolescents who screened positive for anxiety, depression, and severe impairment had 3 to 6 and 2 to 4 times the odds of more office visits respectively. Emergency department utilization was significantly increased in adolescents with anxiety and younger children with severe impairment. CONCLUSIONS: This study shows that children with EBD are more likely to have increased office visits and missed days of school, even after adjusting for sociodemographic factors and comorbid medical conditions. Recognition of early associations of EBD can create an opportunity for early identification of children with EBD in the pediatric practice.