A pilot study: the impact of clinic-provided transportation on missed clinic visits and system costs among teenage mother-child dyads.

Transportation insecurity has profound impacts on the health and wellbeing of teenage parents and their children, who are at particularly high risk for missed clinic visits. In other settings, clinic-offered rideshare interventions have reduced the rates of missed visits. We conducted a one-arm pre-post time series analysis of missed visits before and after a pilot study rideshare intervention within a clinic specializing in the care of teenage parents and their children. We compared the number of missed visits during the study with the number during the preceding year (July 2019-March 2020), as well as the cost difference of missed visits, adjusting for inflation and clinic census. Of 153 rides scheduled, 106 (69.3%) were completed. Twenty-nine (29.9%) of 97 clinic visits were missed during the study period, compared to 145 (32.7%) of 443 comparison period visits (p-value = 0.59). The estimated cost difference of missed visits including intervention costs was a net savings of $90,830.32. However, the standardized cost difference was a net excess of $6.90 per clinic visit. We found no difference in rates of missed visits or costs, though likely impacted by the low census during the SARS-CoV-2 pandemic. Given the potential to improve health disparities exacerbated by the pandemic, further research is warranted into the impact and utility of clinic-offered rideshare interventions.

Unpacking the Influence of Abuse and Depression on Grades among Urban Ethnic Minority Adolescents and Young Adults.

BACKGROUND: Both depression and a history of abuse have known negative consequences on the overall health of adolescents and young adults (AYAs). Research is not clear, however, on the interactive influence of abuse and depression on academic achievement, especially among AYAs of color. OBJECTIVE(S): This study aims to assess the interactive influence of abuse and depression on academic grades among African American and Latino AYAs. METHODS: The study sample was made up of 476 predominantly urban African American and Latino youth ages 14 to 24. Study participants completed a demographic questionnaire (which included self-reported grades) and the Beck Depression Inventory for Primary Care-Fast Screen. Screenings for abuse were done through three structured methods using the Childhood Maltreatment Interview Schedule-Short Form, a short-structured questionnaire, and a face-to-face unstructured interview with a clinical provider. FINDINGS: Depression had a significant main effect on grades, while abuse did not. Abuse and depression had a significant interactive effect on grades in that non-depressed adolescents who reported abuse had an almost four point higher average grade score than their non-depressed counterparts who did not report abuse. CONCLUSIONS: Our findings highlight an unexpected effect in AYAs of color with a history of abuse but no history of depression, suggesting that perhaps there is something intrinsic to this group's resilience or their support systems that protects both against depression and supports their academic achievement. In conclusion, abuse alone does not serve as a predictor of grade achievement. Further work should be done to determine influential factors behind this relationship, with recommendations for school-based counselors and medical providers to screen for depression along with abuse in AYAs in order to determine how best to support this population.

Use of active ingredient information for low socioeconomic status parents' decision-making regarding cough and cold medications: role of health literacy.

OBJECTIVE: Parent administration of multiple medications with overlapping active ingredients places children at risk for overdose. We sought to examine how parents use active ingredient information as part of the process of selecting a cough/cold medication for their child and how health literacy plays a role. METHODS: Experimental study of parents of children presenting for care in an urban public hospital pediatric clinic. Parents were asked to determine which of 3 cough/cold medications could be given to relieve a child's cold symptoms, as part of a scenario in which they had already given a dose of acetaminophen; only 1 did not contain acetaminophen. Primary dependent variable: correct selection of cough/cold medication by using active ingredient as the rationale for choice. Primary independent variable: parent health literacy (Newest Vital Sign test). RESULTS: Of 297 parents, 79.2% had low health literacy (Newest Vital Sign score 0-3); 35.4% correctly chose the cough/cold medication that did not contain acetaminophen. The proportion of those who made the correct choice was no different than expected from chance alone (Goodness of fit test; χ(2) = 2.1, P = .3). Only 7.7% chose the correct medication and used active ingredient as the rationale. Those with adequate literacy skills were more likely to have selected the correct medication and rationale (25.8% vs 3.0% (P = .001); adjusted odds ratio 11.1 (95% confidence interval 3.6-33.7), after we adjusted for sociodemographics, including English proficiency and education. CONCLUSIONS: Many parents, especially those with low health literacy, do not use active ingredient information as part of decision-making related to administering multiple medications.