The impact of COVID-19 on adolescent wellness in Chicago.

PURPOSE: This study aimed to understand the impact of the initial COVID-19 pandemic remote schooling period on self-reported wellness among adolescents in Chicago. METHODS: Students (n = 55) completed a 22-item wellness questionnaire before (February 2020) and shortly after the onset of the COVID-19 outbreak (April 2020). Precomparisons/postcomparisons (overall and by survey item) were evaluated using two-sided paired t-tests with an alpha level of 0.05. Descriptive statistics were used to evaluate mean scores overall by demographic variables. RESULTS: Significant differences were found in the following areas: Balance (Pre: 7.3, During: 6.4, p = 0.02), Education (Pre: 8.4, During 7.7, p = 0.03) and Friends (Pre:8.0, During: 6.3, p = 0.001). Overall wellness scores varied by demographic variables, though not significantly. CONCLUSIONS: Results suggest the onset of the pandemic impacted students' ability to effectively learn, as well as to maintain balance in their lives and social relationships. Comprehensive support is needed in these areas to promote adolescent wellness.

Caregiver Perceptions of Children's Psychological Well-being During the COVID-19 Pandemic.

Importance: Understanding youth well-being during the COVID-19 pandemic can help appropriately allocate resources and inform policies to support youth. Objective: To examine caregiver-reported changes in the psychological well-being of their children 3 to 4 months after the start of COVID-19 stay-at-home orders, and to examine the association of caregiver-reported COVID-19 exposure and family stressors with caregiver perceptions of child psychological well-being. Design, Setting, and Participants: This survey study used an anonymous survey distributed via email from June 24 to July 15, 2020, to 350 000 families of students attending public schools in Chicago, Illinois. The a priori hypotheses were that caregivers would report worsening in child psychological well-being during the closure period compared with preclosure and that exposure to COVID-19-related stressors would be associated with a higher probability of worsening child psychological well-being. Data were analyzed from September 10, 2020, to March 15, 2021. Main Outcomes and Measures: Outcomes were 7 mental health concerns and 5 positive adjustment characteristics reported by caregivers using a retrospective pre-post design. COVID-19 exposure and family stressors were also reported by caregivers. Results: Among 350 000 families invited to participate, 32 217 caregivers (10 827 [39.3%] White, 8320 [30.2%] Latinx, 6168 [22.4%] Black; 2223 [8.1%] with multiple or other races/ethnicities) completed the survey on behalf of 49 397 children in prekindergarten through 12th grade. Child-specific outcomes were reported for 40 723 to 40 852 children depending on the specific question. The frequency of caregiver endorsement of youth mental health concerns ranged from 0.1 percentage point (suicidal ideation or self-harm, reported by 191 caregivers [0.5%] preclosure vs 246 caregivers [0.6%] during closure; P < .001) to 28.3 percentage points (loneliness, reported by 1452 caregivers [3.6%] preclosure vs 13 019 caregivers [31.9%] during closure; P < .001) higher after the end of in-person instruction compared with preclosure. Frequency of caregiver endorsement of youth positive adjustment characteristics ranged from -13.4 percentage points (plans for the future, reported by 18 114 caregivers [44.3%] preclosure vs 12 601 caregivers [30.9%] during closure; P < .001) to -30.9 percentage points (positive peer relationships, reported by 24 666 caregivers [60.4%] preclosure vs 19 130 caregivers [46.8%] during closure; P < .001) lower after the end of in-person instruction. Significant differences in COVID-19 exposure were observed across racial/ethnic (F3,27 534 = 614.8; P < .001) and household income strata (F5,27 506 = 842.0; P < .001). After accounting for covariates, all mental health concerns increased in probability (eg, angry: odds ratio, 1.55 [95% CI, 1.48-1.62]; P < .001) and all the positive adjustment characteristics decreased in probability (eg, hopeful or positive: odds ratio, 0.88 [95% CI, 0.84-0.92]; P < .001) as COVID-19 exposure and family stressors increased. Conclusions and Relevance: In this survey study of caregivers during the COVID-19 pandemic, COVID-19 and resulting exposure to stress were associated with worse youth psychological well-being, demonstrating the need for a comprehensive public health approach that prioritizes children's well-being and draws broad public attention to the mental health needs of youth.

Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial.

BACKGROUND: Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting ß-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear. METHODS: Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (≥19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline. RESULTS: Dyads were assigned to the control (n = 127) or intervention (n = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (Δintervention-control = 2.2; SE = 0.6; P < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratioemergency department = 2.2; SE = 0.5; P < .01; incidence rate ratiohospital = 3.4; SE = 1.4; P < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (Δintervention-control = 0.3; SE = 0.2; P = .1) than the control. CONCLUSIONS: Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted.

Prevalence and Correlates of Food Allergy Among Medicaid-Enrolled United States Children.

OBJECTIVE: The objective of this study is to provide a comprehensive epidemiological profile detailing food allergy (FA) prevalence and related correlates among Medicaid-enrolled children. METHODS: The 2012 Medicaid Analytic eXtract person-level 100% files for 50 states and the District of Columbia were analyzed. The analytic sample of 23,825,160 included all children ages 0 to 19 years as of January 1, 2012 who were continuously enrolled in Medicaid in 2012. The prevalence of FA was measured using International Classification of Diseases, Ninth Revision, Clinical Modification codes and compared with other atopic conditions (atopic dermatitis, allergic rhinitis, and asthma). Logistic regression was used to evaluate child characteristics associated with FA. RESULTS: The prevalence of FA among Medicaid-enrolled children was less than 1% (0.6%). State-level prevalence ranged from a high of 1.4% in Alaska to a low of 0.2% in Nevada. Race and ethnicity were associated with FA such that Asian, Black, and Pacific Islander/Native Hawaiian children had a higher odds of FA, while Hispanic and Native American children had 15% and 24% lower odds of FA, respectively, compared with White children. CONCLUSIONS: Compared with estimates of parent-reported, physician-diagnosed FA in the general population, the claims-based prevalence of FA among Medicaid-enrolled children is substantially lower. Racial and ethnic differences are consistent with the general population. The findings signal a need to better understand reasons for these differences including awareness, access to care, and service utilization patterns in this population.

Guideline-informed care among Medicaid-enrolled children with food allergy.

OBJECTIVES: To describe food allergy (FA)-related service utilization and identify factors associated with guideline-informed care among Medicaid-enrolled US children with FA. STUDY DESIGN: Retrospective cohort study. METHODS: We used the 2012 Medicaid Analytic eXtract files to identify children with an FA diagnosis. FA-related services including outpatient allergist visits, emergency department (ED) visits, epinephrine autoinjector prescription fills, and diagnostic testing were identified. Factors associated with services were assessed using logistic regression. Kaplan-Meier survival curves evaluated the time to guideline-informed care, and proportional hazard models determined associated socioeconomic characteristics. RESULTS: There were 64,276 Medicaid-enrolled children younger than 20 years who had at least 1 claim with an FA diagnosis in 2012. Minority children and those living in a high-poverty county were less likely to have visited an allergist for FA or received diagnostic testing but more likely to have an FA-related ED visit compared with White children and those not living in a high-poverty county. Survival analyses found that of children seen for FA-related primary care or an ED visit, rates of allergist follow-up visits were 21% and 17%, respectively, and rates of epinephrine autoinjector prescription fills were 39% and 41%. Significant associations with guideline-informed care were found by race/ethnicity, dense population, and high-poverty counties. CONCLUSIONS: Although guideline-informed FA care includes follow-up with an allergist and epinephrine autoinjector prescription, this study finds low probabilities of timely service utilization after medical visits, as well as socioeconomic disparities in care.

Leaving the nest: Improving food allergy management on college campuses.

BACKGROUND: The transition from adolescence to young adulthood marks a developmental period in which responsibility for management of chronic conditions such as food allergy shifts from the caregiver to the young adult. Fatal food-induced anaphylaxis is most common among adolescents and young adults. However, colleges are currently not well positioned to provide integrated support for students with food allergies. OBJECTIVE: The study objective was to explore the systems, structures, and policies that currently support students with food allergies at college, assess unmet needs, and develop pilot interventions through the use of patient-centered design processes. METHODS: Key informant interviews were conducted with stakeholders in the campus management of food allergies (n = 26) between April and May 2016. Data were coded and assessed for relative frequencies of each code to determine challenges and potential solutions. RESULTS: The convergence of stakeholder-identified themes indicated that the transition to college for students with food allergy would be improved by providing support for: (1) Notification of others in the student's campus network about food allergy; (2) Establishing clearly defined roles/responsibilities; and (3) Increasing campus awareness of food allergy signs, symptoms, and lethality. To better provide comprehensive support for students, 5 interventions-collectively called Spotlight-were developed. CONCLUSION: The use of qualitative research methods, patient-centered design processes, and collaborations with diverse stakeholders-including pediatricians that care for adolescents-can provide a framework for designing coordinated systems and policies to provide comprehensive support to college students with food allergy. Next steps include rigorously testing implementation of the Spotlight intervention prototypes.