Parent Awareness of and Attitudes Toward Gender-Affirming Pediatric Health Care: A Cross-Sectional Survey.

PURPOSE: We aimed to characterize parent attitudes toward gender-affirming healthcare for transgender youth, from a general parent sample in a diverse urban setting. METHODS: We surveyed Chicago parents through the Voices of Child Health in Chicago Parent Panel Survey via web and phone in English and Spanish from May-July 2022. We used both probability-based and nonprobability-based sampling, with calibration weights for the nonprobability sample. Parents responded about their awareness of a debate about and support for autonomy in gender-affirming healthcare for transgender youth and provided demographic information. We used descriptive analyses and logistic regression to examine predictors of awareness and support. Data were weighted to be representative of Chicago's parent population. RESULTS: Surveys were completed by 1,059 parents. The survey completion rate for the probability sample was 43.1% (a completion rate was not available for the nonprobability sample from online, opt-in surveys). Most parents were unaware of the debate about gender-affirming healthcare (56.0%). More than two-thirds of parents (68.9%) support decisions about gender-affirming healthcare being left to children, their parents, and their doctor. Parents who were aware of the debate were more likely to support gender-affirming healthcare (83.7%) than parents who were not aware (57.2%, p < .0001). Parents who were aware of the debate had higher odds of supporting gender-affirming care for youth (adjusted odds ratio = 3.00, 95% confidence interval: 1.93-4.66) in a multivariable logistic regression model. DISCUSSION: Broad parent support for gender-affirming healthcare for transgender youth is an important perspective to consider in policy discussions at state and federal levels.

Access to Home- and Community-Based Services for Children with Disability: Academic Institutions' Role and Areas for Improvement.

OBJECTIVE: This project sought to describe provider- and parent-identified needs and barriers to obtaining home- and community-based services (HCBS) for children with disability (CWD) and to determine ways pediatric health care institutions can improve access to HCBS services. METHODS: In this exploratory sequential mixed methods evaluation, semi-structured interviews and focus groups were conducted with multidisciplinary providers and staff from an independent children's hospital, followed by a survey of English and Spanish-speaking parents of CWD. Data from interviews and surveys were then triangulated for overarching common themes regarding how pediatric health care institutions can better support access to HCBS. RESULTS: Among 382 parent respondents, 74.1% reported that their child needed a HCBS, most commonly physical/occupational/speech therapies, school-based support, and case management services. Two-thirds of parents reported at least one barrier to accessing HCBS and one-third experience >3 barriers. While multiple current institutional strengths were noted, internal weaknesses included lack of provider knowledge, staffing difficulties, and lack of protocols for identifying and tracking patients needing or receiving HCBS. External threats included requirements to entry for HCBS and transfer of care, with opportunities for improvement involving dissemination of information, funding support, and connection between providers/support staff and services. CONCLUSIONS: Parents of CWD identified HCBS as necessary for the health of this population, but multiple barriers to HCBS were identified by both parents and providers. Multiple internal and external opportunities for improvement relative to pediatric health care institutions were identified, suggesting a need for a comprehensive approach to ensure that CWD receive necessary HCBS.

Caregiver Concerns About Child Development During the COVID-19 Pandemic among those with Missed Appointments: Preliminary Results.

Introduction: To examine caregiver's perception of their child falling behind on developmental milestones after canceled or delayed appointments in metropolitan Chicago during stay-at-home orders, from March 21-May 7, 2020. Methods: We fielded a web-based caregiver survey to understand the impact of the early weeks of the COVID-19 pandemic on children's health care experiences characterizing proportions of caregiver perceptions of children falling behind in developmental milestones by canceled or delayed appointment types. Multivariable logistic regression was used to estimate the likelihood of falling behind in milestones . Results: Overall, 229 (7.5%) caregivers reported children with canceled or delayed appointments falling behind in developmental milestones. Approximately 25.4% of caregivers reported children falling behind on milestones in the Missed Therapeutic group, compared with the Other Missed group (2.9%) (p<0.001). Children in the Missed Therapeutic group (adjusted odds ratio (aOR) 10.3, 95% confidence interval (CI) 7.60-14.0)) and caregivers who experienced job loss (aOR 1.59, CI 1.11-2.28) or reduced hours or pay (aOR 1.90, CI 1.28-2.82) had higher odds of falling behind on developmental milestones. Conclusions: Implementation of new strategies to address the social needs of families should be develop when disruptions in developmental or therapeutic services among children occurs, particularly among children living in households with job insecurity.

Targeted Vaccine Messaging to Promote COVID-19 Vaccines for Children and Youth.

OBJECTIVES: To assess the effectiveness of distinct message types in promoting coronavirus disease 2019 (COVID-19) vaccination intentions for parents of children and adolescents. METHODS: We collected data through the Voices of Child Health in Chicago Parent Panel Survey from October to November 2021. Parents were randomly assigned to read 1 of 4 vaccine message types and then report their intentions to vaccinate each COVID-19-unvaccinated child (0-17 years) in their household (n = 1453). RESULTS: The sample included 898 parents. Compared with a control group (37.5%), the proportion of parents who were very likely to vaccinate their children was higher when messages highlighted that other trusted parents have vaccinated their children (53.3%) or that the vaccine is safe and thoroughly tested (48.9%) but not when messages highlighted that the vaccine is well-tolerated (41.5%). After adjusting for parent and child characteristics, the odds of being very likely to vaccinate remained higher in the trusted parents group but not in the safe/thoroughly tested group. Unlike the control and well-tolerated groups, there were no racial/ethnic disparities in the unadjusted proportion of parents who were very likely to vaccinate in the trusted parents and safe/thoroughly tested groups. Message types affected the unadjusted proportion of COVID-19-unvaccinated parents who were very likely to vaccinate their children. CONCLUSIONS: Messages that focus on trusted parents choosing to vaccinate their children were more effective at promoting parents' COVID-19 vaccination intentions for their children than alternative messages. These findings have implications for public health messaging and pediatric providers' communications with parents.

Parental Concerns About Climate Change in a Major United States City.

OBJECTIVE: To examine climate change concerns among parents in Chicago, a large and diverse urban setting that experiences climate change-related weather events and rising water levels which have the potential to affect more than 1 million children living in the city. METHODS: We collected data through the Voices of Child Health in Chicago Parent Panel Survey from May to July 2021. Parents indicated their personal level of worry about climate change, concern about the impact of climate change on themselves and their families, and how well they understood the issue of climate change. Parents also provided demographic information. RESULTS: Parents reported high levels of concern about climate change in general and specifically about the impact on their families. Logistic regression indicated that parents who were Latine/Hispanic (vs White) and those who felt they understood climate change well (vs less well) had higher odds of reporting high levels of concern. Parents with some college (vs high school education or below) had lower odds of high concern. CONCLUSIONS: Parents indicated high levels of concern about climate change and its potential impact on their families. These results can help inform pediatricians' discussions with families about child health in the context of a changing climate.

Pediatric Telehealth Access and Utilization in Chicago During the First Year of the COVID-19 Pandemic.

Background: The COVID-19 pandemic demanded rapid development of telemedicine services for pediatric care and highlighted disparities for marginalized communities. Objective: To understand the demographic characteristics of patients with completed and incomplete telemedicine visits at Ann and Robert H. Lurie Children's Hospital of Chicago. Methods: This was a cross-sectional retrospective analysis of telemedicine visits for patients <25 years old scheduled between March 21, 2020, and March 17, 2021. We examined visit outcomes and compared outcomes by race/ethnicity, language, and payer using logistic regression. Geographic information system mapping and linear regression were used to examine the relationship between incomplete visits and broadband access within Cook County. Results: A total of 13,655 eligible video visits were scheduled for children within 147 ZIP codes during the study time frame. Patient characteristics included median age 9 years, 53% female, 42% non-Latinx White, 31% Latinx, 13% non-Latinx Black, 11% non-Latinx other, and 3% declined/unknown. Preferred language was 89% English, 10% Spanish, and 1% other. Payer was 56% private, 43% public, and <1% other/self-pay. Overall, 86% video visits were completed, 7% cancelled, and 7% no-show with significant variation by patient demographic. Odds of incomplete visits were higher for Latinx patients (odds ratio [OR] 1.93) and non-Latinx Black patients (OR 2.33) than for non-Latinx White patients, patients with preferred language other than English (OR 1.53), and patients not privately insured (OR 1.89). Incomplete visit rates and broadband access were inversely related. Conclusion: System and policy solutions are needed to ensure equitable access and address disparities in incomplete telemedicine visits for marginalized populations in urban areas with lower broadband.

Development and Validation of an Integrated Suite of Prediction Models for All-Cause 30-Day Readmissions of Children and Adolescents Aged 0 to 18 Years.

Importance: Readmission is often considered a hospital quality measure, yet no validated risk prediction models exist for children. Objective: To develop and validate a tool identifying patients before hospital discharge who are at risk for subsequent readmission, applicable to all ages. Design, Setting, and Participants: This population-based prognostic analysis used electronic health record-derived data from a freestanding children's hospital from January 1, 2016, to December 31, 2019. All-cause 30-day readmission was modeled using 3 years of discharge data. Data were analyzed from June 1 to November 30, 2021. Main Outcomes and Measures: Three models were derived as a complementary suite to include (1) children 6 months or older with 1 or more prior hospitalizations within the last 6 months (recent admission model [RAM]), (2) children 6 months or older with no prior hospitalizations in the last 6 months (new admission model [NAM]), and (3) children younger than 6 months (young infant model [YIM]). Generalized mixed linear models were used for all analyses. Models were validated using an additional year of discharges. Results: The derivation set contained 29 988 patients with 48 019 hospitalizations; 50.1% of these admissions were for children younger than 5 years and 54.7% were boys. In the derivation set, 4878 of 13 490 admissions (36.2%) in the RAM cohort, 2044 of 27 531 (7.4%) in the NAM cohort, and 855 of 6998 (12.2%) in the YIM cohort were followed within 30 days by a readmission. In the RAM cohort, prior utilization, current or prior procedures indicative of severity of illness (transfusion, ventilation, or central venous catheter), commercial insurance, and prolonged length of stay (LOS) were associated with readmission. In the NAM cohort, procedures, prolonged LOS, and emergency department visit in the past 6 months were associated with readmission. In the YIM cohort, LOS, prior visits, and critical procedures were associated with readmission. The area under the receiver operating characteristics curve was 83.1 (95% CI, 82.4-83.8) for the RAM cohort, 76.1 (95% CI, 75.0-77.2) for the NAM cohort, and 80.3 (95% CI, 78.8-81.9) for the YIM cohort. Conclusions and Relevance: In this prognostic study, the suite of 3 prediction models had acceptable to excellent discrimination for children. These models may allow future improvements in tailored discharge preparedness to prevent high-risk readmissions.

Epidemic Adolescent Binge Drinking at Lollapalooza, A Music Festival in Chicago.

OBJECTIVES: Lollapalooza (LP) is an annual 3-day outdoor music festival in Chicago. Underage drinking and drug use are believed to be common, but the burden on emergency departments (EDs) has not been documented. We assessed the burden on health care resources associated with this music festival. METHODS: We performed a retrospective chart review of adolescent (aged 11-20 years) ED visits during LP weekend and 4 summer comparison weekends at Lurie Children's Hospital in Chicago, Ill, in 2014 (n = 356). We then analyzed adolescent alcohol- and drug-related hospital visits to all Chicago hospitals for each weekend in 2014 0 using Illinois hospital discharge data. RESULTS: Adolescents accounted for a greater proportion of our ED visits during LP weekend than comparison weekends (25% vs 19%, P < 0.02). Lollapalooza weekend patients were more likely female (P = 0.025), older (P = 0.0067), more often unsupervised (P < 0.0001), and less likely to live in the city (P < 0.001) than adolescents seen during comparison weekends. Thirty-one underage adolescents who attended LP were treated in our ED; 84% were intoxicated (blood alcohol content, 88-328 mg/dL). Citywide there was an 11-fold increase in adolescent alcohol-related hospital visits during LP weekend compared with an average weekend. Drug intoxication was much less common. CONCLUSIONS: Adolescents seen in our ED the weekend of LP were older, more often female, frequently unsupervised, and less likely to be city residents than those seen during comparison weekends. Those who attended LP had high rates of alcohol intoxication. This surge of intoxicated adolescent patients affected numerous EDs in the city.

Staged imaging pathway for the evaluation of pediatric appendicitis.

PURPOSE: Despite significant radiation exposure involved with computed tomography (CT) in evaluation of pediatric appendicitis, its use is still widespread. The goal of this study was to assess the effect of a staged imaging pathway for appendicitis to significantly decrease CT use while maintaining diagnostic accuracy. METHODS: Chart review was performed for patients evaluated for appendicitis over a 12-month period prior to and after pathway implementation. RESULTS: There was a significant decrease in CT use as initial imaging after implementation of the pathway; 87.1-13.4 % for evaluations positive for appendicitis (decrease 84.6 %, p < 0.0001) and 82.6-9.2 % for evaluations negative for appendicitis (decrease 88.9 %, p < 0.0001). Use of CT during any point in the evaluation decreased from 91.7 to 25.1 % (decrease 72.6 %, p < 0.0001). The negative appendectomy rate was similar; 5.4 % prior, 4.9 % post (p = 0.955). The missed appendicitis rate did not statistically change; 1.1 % prior, 3.7 % post (p = 0.523). The perforation rate was not statistically altered; 6.5 % prior; 9.8 % post (p = 0.421). 350 less patients underwent CT during the year following the pathway. CONCLUSIONS: The staged imaging pathway resulted in a marked decrease in children exposed to CT without compromising diagnostic accuracy.

Pediatric emergency department visits and hospitalizations due to food-induced anaphylaxis in Illinois.

BACKGROUND: Rates of food-induced anaphylaxis among children remain uncertain. In addition, little is known about the demographics of children who have experienced food-induced anaphylaxis resulting in emergency department (ED) visits and/or subsequent hospitalizations. OBJECTIVES: To evaluate trends in ED visits and hospital admissions due to food-induced anaphylaxis among Illinois children and to identify socioeconomic variation in trend distribution. METHODS: Illinois hospital discharge data compiled by the Illinois Hospital Association were used to identify ED visits or hospitalizations for food-induced anaphylaxis in Illinois hospitals from 2008-2012. Data for children aged 0 to 19 years who were Illinois residents and received a diagnosis of food-induced anaphylaxis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes (995.60 through 995.69) were included for analysis. RESULTS: There was a significant increase in the rate of ED visits and hospital admissions due to food-induced anaphylaxis among children in Illinois during the 5-year period, with an annual percent increase of 29.1% from 6.3 ED visits and hospital admissions per 100,000 children in 2008 to 17.2 in 2012 (P < .001). Increases in visit frequency were observed for all study variables, including age, sex, race/ethnicity, insurance type, metropolitan status, hospital type, and allergenic food. Visits were most frequent each year for Asian children and children with private insurance. However, the annual percent increase in visits was most pronounced among Hispanic children (44.3%, P < .001) and children with public insurance (30.2%, P < .001). CONCLUSION: ED visits and hospital admissions for food-induced anaphylaxis have increased during a 5-year period among children in Illinois, regardless of race/ethnicity and socioeconomic status.

Early and later onset type 2 diabetes in uninsured patients: clinical and behavioral differences.

OBJECTIVE: The national burden of type 2 diabetes mellitus (T2DM) is increasing rapidly. This study investigated a) clinical differences between early onset and later onset T2DM; and b) if specific risk factors were associated with age at diagnosis or clinical outcomes among uninsured adults in a large urban setting. METHODS: We compared 417 adults diagnosed under age 30 with 968 adults diagnosed ages 50-58 on clinical and social measures using standard parametric tests. RESULTS: Early onset patients had higher hemoglobin A1c, were more likely to smoke and to be depressed, and had more emergency department visits. Insulin monotherapy was more common in early onset patients (32% vs. 11%). Complications were already present in 11% of early onset patients and 29% of later onset patients within one year of diagnosis. CONCLUSION: Early onset patients had more acute beta-cell failure and coped less well with their diabetes. It is crucial to expand specialized diabetes resources for young, medically indigent patients.

Incidence of childhood type I and non-type 1 diabetes mellitus in a diverse population: the Chicago Childhood Diabetes Registry, 1994 to 2003.

BACKGROUND: Reports of increasing risk for type 1 (T1) and type 2 diabetes mellitus in youth are emerging, but information on socioeconomically diverse populations is limited. METHOD: The Chicago Childhood Diabetes Registry is a city-wide study of patients 0-17 years old at onset. Incidence data came from medical records and interviews; census data provided denominators; analyses used Poisson regression. Non-type 1 (nT1) patients had a type 2-like clinical course or related indicators. RESULTS: There were 1,366 incident cases: 719 in non-Hispanic Black (NHB), 379 in Hispanic, 229 in non-Hispanic White (NHW), and 39 in children of other ethnicities. Average annual incidence was 16.0 (95% CI: 14.6, 17.6)/10(5) for boys, 20.1 (18.3, 22.1)/10(5) for girls, and 18.1 (16.9, 19.3)/10(5) overall. Risk was 21.6 (19.6, 23.8)/10(5) for NHB, 14.6 (13.0, 16.4)/10(5) for Hispanic, and 18.1 (15.9, 20.6)/10(5) for NHW. Children aged 10-14 years experienced the highest incidence, irrespective of ethnicity. T1 was predominant in all ethnic groups, except NHB, where the rates of T1 and nT1 were similar. Over ten years there was a marked increase in all childhood diabetes in Chicago, averaging 2.73% (95% CI: 0.49, 5.02) per annum, adjusted for age. This increase was confined to nT1, with an average annual percent change of +6.23% (2.28, 10.34), while T1 incidence remained stable. CONCLUSIONS: Incidence of childhood diabetes increased between 1994-2003, driven primarily by nT1, suggesting a role for behavioral and/or environmental determinants of insulin resistance. These estimates are likely to be conservative, if nT1 cases were more apt to be missed.

The clinical, psychosocial, and socioeconomic concerns of urban youth living with diabetes.

OBJECTIVE: Young people with chronic diseases face the challenge of moving from the pediatric to the adult health care environment, in addition to the normal hurdles of young adulthood. To most effectively help them through this process, we must first understand their perspective. DESIGN: Qualitative study of the social and emotional impact of having diabetes. SAMPLE: Young adults (n=23), aged 19-26, who had been living with diabetes for a median of 12 years (range 4-19) were contacted; all but one were from underserved ethnic minorities. MEASUREMENTS: Semistructured telephone interviews were conducted, transcribed, and coded. RESULTS: Having diabetes profoundly affected the life choices and expectations of these young people; their feelings and attitudes evolved over time. Financial and insurance concerns were key, because managing diabetes care on one's own as an adult was a major challenge. Most young people reported that family, friends, and coworkers were sources of support, but that disclosure of their diabetes was problematic. CONCLUSIONS: Offering emotional and practical support to young adults coping with diabetes is key to ensuring adequate medical management as they move into the adult system and assume full responsibility for their health.