Implications of Exposure to Intimate Partner Violence in Childhood.

The most recent available data show that children were present at 38% of domestic incidents reported throughout Delaware, and analysis of barriers to reporting predict this number to be much higher. Intimate partner violence (IPV) can take numerous forms, such as patterns of physical, sexual, psychological, economic, and reproductive abuse, meaning each situation manifests differently and requires individualized intervention. Children face unique short- and long-term challenges as a result of their witness status within such scenarios. Programming throughout Delaware works to support victims and mitigate the negative ramifications that IPV has on children and their families.

Factors Associated with Antihypertensive Therapy Prescription in Youth Delaware Medicaid Recipients with Primary Hypertension Diagnosis.

BACKGROUND: Higher neighborhood deprivation is associated with hypertension diagnosis in youth. In this study, we assess if there is an association between neighborhood deprivation and antihypertensive therapy prescription among insured youth with a primary hypertension diagnosis. METHODS: Using a retrospective cross-sectional design, we assessed the proportion of youth with a diagnosis of primary hypertension prescribed antihypertensive therapy. We evaluated the proportion of youth prescribed antihypertensive therapy and compared prescribing patterns by area deprivation index (ADI), age, sex, obesity diagnosis, race, ethnicity, and duration of Medicaid coverage. RESULTS: Of the 65,452 non-pregnant Delaware Medicaid recipients, 8-18 years of age, 1,145 (1.7%) had an International classification of diseases (ICD)-9/ICD-10 diagnosis of primary hypertension; 165 of the 1,145 (14%) were prescribed antihypertensive therapy. Factors associated with a greater odds of prescription by multivariable logistic regression were age, obesity diagnosis, and duration of Medicaid full benefit coverage. Odds of antihypertensive therapy prescription did not vary by race, ethnicity, or ADI. CONCLUSIONS: Antihypertensive therapy prescription rates are poor despite national guideline recommendations. Among youth receiving Delaware Medicaid between 2014 and 2019, prescription proportions were highest among youth of older age, with an obesity diagnosis, and among youth with longer duration of Medicaid benefit coverage. Although high area deprivation has been shown to be associated with the diagnosis of hypertension, high vs. low area deprivation was not associated with greater antihypertensive therapy prescription among youth with primary hypertension. Our finding of a mismatch between hypertension diagnosis and antihypertensive therapy prescription highlights a potential disparity in antihypertensive therapy prescription in youth.

Health & Housing in Delaware:: Matching Medicaid Claims and Encounters and the Community Management Information System Databases.

This study draws upon data from two databases: claims and encounters that were reimbursed by the state's Division of Medicaid and Medical Assistance (DMMA) and the Homeless Management Information System (HMIS) database that collects homeless services data on individuals experiencing homelessness. Records from both sets are matched to identify 838 adults who both experienced homelessness and were Medicaid eligible in 2019, and to select, through propensity score matching, an equal set of control observations who were similarly Medicaid-eligible but had no record of homelessness. Outcomes are compared based upon scores on the Charlson Elixhauser Comorbidity index, incidence of substance use disorder, inpatient, emergency department, and outpatient visits, and inpatient, emergency department, and outpatient costs. Using ordinary least squares regression models, we estimate homelessness (as indicated by use of homeless services) to be associated with excess costs of $4,611 (non-chronic homelessness) to $5,218 (chronic homelessness) per person over the course of 2019, compared to similar Medicaid enrollees who were housed.

LGBTQ+ Youth Homelessness in Delaware:: Building a Case for Targeted Surveillance and Assessment of LGBTQ+ Youth Needs and Experiences.

Objective: In this article, we examine the issue of LGBTQ+ youth homelessness in Delaware, summarize current services available and prior research work that has been done, examining the number, needs, and experiences of unaccompanied unhoused LGBTQ+ youth. Methods: We provide a literature review detailing risks associated with LGBTQ+ youth homelessness, resources available, and prior studies and surveys examining this population. Results: LGBTQ+ youth experiencing homelessness are particularly vulnerable to physical and mental health challenges, abuse, and violence. The unique needs of this population necessitate specialized resources, yet there are a limited number of such resources available in Delaware and a dearth of information on youth homelessness in general, including LGBTQ+ youth. For example, administrative barriers exist for unaccompanied queer youth seeking shelter services, such as need for legal identification or being grouped in shelter populations based on sex assigned at birth rather than gender identity. Exposure to unsafe environments is a general problem for queer youth. This can make public spaces feel unsafe and increase risk of physical or mental harm, mistreatment, or abuse when seeking shelter outside of agency services and resources. In order to accurately identify and appropriately serve this population, additional research is necessary. Conclusions: Evidence building is a critical first step in creating an effective study to examine the issue of LGBTQ+ youth homelessness in Delaware. With the evidence acquired in our literature review our next step to establish an informed methodology is to hold service provider and LGBTQ+ lived experience focus groups. Through a qualitative approach we aim to learn how to appropriately utilize the quantitative tools identified in our analysis and to assess what questions are missing to advance the needs of this population.

Evaluating Approaches to Linking Evictions Records:: Assessing the Feasibility of Research with Integrated Data.

Objectives: This study investigates different approaches to integrating evictions data with Medicaid and homeless shelter utilization records at the individual level for the state of Delaware. We especially focus on evaluating the feasibility of creating an integrated dataset focused on children and adolescents through different approaches to matching. Methods: We attempt to link existing statewide records on evictions, Medicaid, and shelter from 2017-2019. We first compare direct match and probabilistic match approaches to linking evictions and Medicaid records, and then incorporate shelter records. Finally, we consider a limited set of characteristics relevant to potential future public health research among children who experienced eviction, had a shelter stay, and were enrolled in Medicaid. Results: Direct matching resulted in a lower match (14%) rate than probabilistic matching (22%) of eviction records to Medicaid data. Homeless shelter records had a high match rate to Medicaid records, even when using a direct match (75%). A sizeable subset of children (n=216) were linked across the three data sources, though this was from a small percentage of cases in the evictions data. Among this subset of children, most (71%) were enrolled in Medicaid in all three years considered by this study and Black children were greatly overrepresented (75%). Conclusions: Integrating evictions records with other health and human service data involves a number of challenges. Probabilistic matching yielded a considerably higher number of matches after manual review, resulting in a possible study sample of children who have experienced eviction, a homeless shelter stay, and were enrolled in Medicaid. Strategies to increase the match rate for eviction records through using records from other, more universal services may be necessary for investigations that require more comprehensive coverage of the population.

An Overview of Poverty in Delaware.

Delaware's 2017-2021 five-year average poverty rate was 11.4%, which is lower than the rate of 12.6% throughout the United States as a whole. Poverty rates by race and ethnic background show disparities. Black Delaware residents were more than twice as likely to live in poverty as white Delawareans, with poverty rates of 17.8% and 8.4%, respectively, while Asian individuals had a poverty rate of 10.5%. Hispanic or Latino/x individuals of any race were the most likely to experience poverty and had a five-year average poverty rate of 18.2%. Tracking the overall poverty rate (most commonly through the American Community Survey 5-Year Averages) is valuable when studying trends over time but lacks the power to display the true economic status of individuals and families. Access: work, income supports, shelter, food, and healthcare all complete each whole person. Level of access within each of these sectors of life determines well-being, and varies based on race and ethnic background, geography, and age. A new challenge is now faced as the Public Health Emergency (PHE) has ended, repealing a multitude of supports with the risk of putting individuals and families into a new phase of crisis.

Impact of Health Literacy on Medication Adherence Among Black Medicaid Beneficiaries with Hypertension in Delaware: A Cross-Sectional Study.

Racial and ethnic minorities are disproportionately affected by limited health literacy. Therefore, this study assessed census block health literacy level and medication adherence in Delaware among Black individuals with hypertension (HTN) receiving health care through Medicaid. This was a cross-sectional study of Black Delaware Medicaid beneficiaries (18-64 years old) from the 3 counties in Delaware (Kent, New Castle, and Sussex) from 2016 to 2019. The primary outcome was medication adherence (full adherence = 80%-100%, partial adherence = 50%-79%, and nonadherence = 0-49%) as a function of health literacy. Health literacy scores were categorized as below basic (0-184), basic (184-225), intermediate (226-309), and proficient (310-500). The results of the study showed that 18,958 participants (29%) had ≥1 HTN diagnosis during the study period. Mean area health literacy score for participants without HTN was significantly higher than participants with HTN (234.9 vs. 233.7, P < 0.0001). Men had lower odds of adherence compared with women (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.75-0.92, P < 0.001). Increased time enrolled in Medicaid decreased full adherence. Participants 21-30 and 31-50 years of age are significantly less likely to have full adherence in comparison with participants 51-64 years of age (P < 0.0001). Participants living in an area with basic level of health literacy reported lower medication adherence than those living in an area with an intermediate level of health literacy (OR: 0.72, 95% CI: 0.64-0.81, P < 0.001). In conclusion, men, younger adults, increased time enrolled in Medicaid for the study period, and basic health literacy were significantly associated with low adherence to medication among 3 census blocks in Delaware.

Association of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware.

Importance: The association between degree of neighborhood deprivation and primary hypertension diagnosis in youth remains understudied. Objective: To assess the association between neighborhood measures of deprivation and primary hypertension diagnosis in youth. Design, Setting, and Participants: This cross-sectional study included 65 452 Delaware Medicaid-insured youths aged 8 to 18 years between January 1, 2014, and December 31, 2019. Residence was geocoded by national area deprivation index (ADI). Exposures: Higher area deprivation. Main Outcomes and Measures: The main outcome was primary hypertension diagnosis based on International Classification of Diseases, Ninth Revision and Tenth Revision codes. Data were analyzed between September 1, 2021, and December 31, 2022. Results: A total of 65 452 youths were included in the analysis, including 64 307 (98.3%) without a hypertension diagnosis (30 491 [47%] female and 33 813 [53%] male; mean [SD] age, 12.5 (3.1) years; 12 500 [19%] Hispanic, 25 473 [40%] non-Hispanic Black, 24 565 [38%] non-Hispanic White, and 1769 [3%] other race or ethnicity; 13 029 [20%] with obesity; and 31 548 [49%] with an ADI ≥50) and 1145 (1.7%) with a diagnosis of primary hypertension (mean [SD] age, 13.3 [2.8] years; 464 [41%] female and 681 [59%] male; 271 [24%] Hispanic, 460 [40%] non-Hispanic Black, 396 [35%] non-Hispanic White, and 18 [2%] of other race or ethnicity; 705 [62%] with obesity; and 614 [54%] with an ADI ≥50). The mean (SD) duration of full Medicaid benefit coverage was 61 (16) months for those with a diagnosis of primary hypertension and 46.0 (24.3) months for those without. By multivariable logistic regression, residence within communities with ADI greater than or equal to 50 was associated with 60% greater odds of a hypertension diagnosis (odds ratio [OR], 1.61; 95% CI 1.04-2.51). Older age (OR per year, 1.16; 95%, CI, 1.14-1.18), an obesity diagnosis (OR, 5.16; 95% CI, 4.54-5.85), and longer duration of full Medicaid benefit coverage (OR, 1.03; 95% CI, 1.03-1.04) were associated with greater odds of primary hypertension diagnosis, whereas female sex was associated with lower odds (OR, 0.68; 95%, 0.61-0.77). Model fit including a Medicaid-by-ADI interaction term was significant for the interaction and revealed slightly greater odds of hypertension diagnosis for youths with ADI less than 50 (OR, 1.03; 95% CI, 1.03-1.04) vs ADI ≥50 (OR, 1.02; 95% CI, 1.02-1.03). Race and ethnicity were not associated with primary hypertension diagnosis. Conclusions and Relevance: In this cross-sectional study, higher childhood neighborhood ADI, obesity, age, sex, and duration of Medicaid benefit coverage were associated with a primary hypertension diagnosis in youth. Screening algorithms and national guidelines may consider the importance of ADI when assessing for the presence and prevalence of primary hypertension in youth.