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BackgroundHomelessness among youth is devastating, with high rates of substance use disorders and mental health comorbidity. Mindfulness-based interventions that include meditation and mindfulness skills training reduce stress and symptoms of anxiety or depression. However, engaging high-risk youth in interventions is challenging. Virtual reality is a more flexible platform for delivering meditation and may be appealing to youth. ObjectiveThe study objectives were to evaluate the feasibility of delivering virtual reality meditation and of collecting outcome measures, including anxiety and physiologic stress. MethodsA sample of 30 youth experiencing homelessness was enrolled in the study. Youth were randomized to receive 10 minutes of one of three interventions: (1) virtual reality meditation, (2) audio meditation (through a web-based platform), or (3) virtual reality imagery of historical pictures and text. Subjects who consented to the study attended two research visits. The first visit collected survey measures of demographics, mental health, and substance use, and oriented subjects to the intervention platforms. The second visit (1-3 days later) delivered the intervention and collected pre and post outcome measures of anxiety and physiologic stress (salivary cortisol). Changes in anxiety and cortisol at the second visit were compared across groups using a linear regression model in which the primary analysis compared virtual reality meditation to audio meditation and secondary analyses compared virtual reality meditation to virtual reality imagery. ResultsAnxiety scores decreased in all groups, with a larger reduction among the virtual reality meditation group (difference=10.8) compared to the web-based meditation or virtual reality images groups (difference=5.8 and 5.0, respectively). After controlling for baseline values, there were no significant group differences in changes in anxiety scores or cortisol levels. In comparing virtual reality meditation and audio meditation, the effect size for anxiety was moderate (Cohen d=0.58) while the effect size for cortisol was small (Cohen d=0.08). ConclusionsPreliminary results suggest that virtual reality meditation has a moderate benefit for anxiety but not physiologic stress. Future research is needed to confirm these results in a larger sample and to investigate whether the effects are sustained or increase with repeated use of virtual reality mediation. Virtual reality meditation appears feasible to deliver among homeless youth and merits further study. Trial RegistrationClinicalTrials.gov NCT04004520; https://clinicaltrials.gov/ct2/show/NCT04004520

The effects of place on human health and development have been extensively studied in recent years in the adult and adolescent populations, but minimal research has addressed neighborhood effects in early childhood. This analysis of the National Survey of Children's Health 2011/2012 cross-sectional survey examined relationships between risk for developmental disability in early childhood and neighborhood characteristics in a nationally-representative sample of children ages 0-5 years. Parents reported on their child's development using a well-validated parent report screening tool for developmental problems (the Parent's Evaluation of Developmental Status tool), and neighborhood and family characteristics. Multinomial logistic regression analyses were conducted for each of three neighborhood variables: physical disorder, safety, and isolation. After controlling for parental and child characteristics, the three neighborhood variables were each significantly associated with moderate (but not severe) risk versus low to no risk for developmental disabilities. When all neighborhood characteristics were included simultaneously in the same model, only physical disorder remained statistically significant [OR 1.44 (95% CI 1.09-1.91)], though modestly attenuated. These results suggest that neighborhoods may have effects on early childhood development, after controlling for individual child, parental, and family characteristics., Author(s): Lisa M. Blair [sup.1] , Jodi L. Ford [sup.2] [sup.3] [sup.4] Author Affiliations: (Aff1) 0000 0000 9136 933X, grid.27755.32, University of Virginia School of Nursing, , 202 Jeanette Lancaster [...]

Topic: Early‐life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long‐term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods. Purpose: The purpose of this brief is to (a) review pediatric health disparities related to depression and the intergenerational transmission of pediatric depression using a Life Course Health Development (LCHD) model and (b) provide recommendations for pediatric mental health research. Sources: Peer‐reviewed papers available for PubMed, CINAL, and Medline. Other sources include published books, papers, and gray materials. Conclusions: The LCHD model is a perspective to guide and foster new scientific inquiry about the development of mental health outcomes over the life course. The model enables synthesis of mental health, nursing, and public health, linking mental health prevention, risk reduction, and treatment in children. [ABSTRACT FROM AUTHOR]

Background: Investigations of chronic physiological stress measured by hair cortisol are rapidly expanding among community samples of adolescents and adults. However, research examining physiological stress among youth experiencing homelessness is nascent despite the youth's increased risk for adverse exposures and subsequent impaired mental health. Objective: This article aimed to examine the feasibility of collecting hair formeasuring cortisol among diverse youth experiencing homelessness and gain an understanding of variation in participation. Methods: Analysis of survey and hair participation data from three pilot studies among youth experiencing homelessness was conducted. Survey measures included sociodemographic characteristics (age, race and ethnicity, sex assigned at birth, and sexual orientation) and reasons for nonparticipation. Descriptive analysis examined participation rates in hair collection for cortisol measurement, including sociodemographic differences in participation. Results: Participation in the hair sampling for cortisol was high for the combined sample (88.4%), with some variation across the three pilot studies. Insufficient hair for cutting was the most common reason for not participating; Black andmultiracial youth, as well as male youth, had a higher prevalence of nonparticipation. Discussion: The collection of hair for cortisol research among youth experiencing homelessness is feasible, and integration of physiological measures of stress into research with this vulnerable population should be considered, given their high risk for adversity and death by suicide and drug overdose. Methodological considerations and avenues for potential research are discussed. [ABSTRACT FROM AUTHOR]

Background: In the United States, Black women experience preterm birth (PTB; <37 weeks gestation) at more than 1.5 times the rate of non-Hispanic White women. Social determinants of health including the neighborhood environment have been recognized as contributing to the risk of PTB. Due to historical segregation, Black women are more likely to live in neighborhoods with higher levels of neighborhood disorder compared with White women. Perceived neighborhood disorder appears to be a risk factor for maternal psychological distress in Black women and psychological distress has mediated the association between neighborhood disorder and the risk for PTB. However, the biological pathways underpinning these associations are not clear. Objective: We examined the associations among neighborhood disorder; psychological distress; DNA methylation of six stress-related, glucocorticoid candidate genes (AVP, CRH, CRHBP, FKBP5, HSD11B2, NR3C1); and gestational age at birth among 44 Black pregnant women. Methods: Women who were 18–45 years old and 8–18 weeks gestation had blood drawn and completed questionnaires measuring perceived neighborhood disorder, neighborhood crime, and psychological distress. Results: Three CpG sites were associated with neighborhood disorder (cg03405789 [ CRH ], cg14939152 and cg15910486 [ NR3C1 ]). One CpG site, cg03098337 (FKBP5) was associated with psychological distress. Three of the identified CpG sites were located within gene CpG islands or shores—areas at which DNA methylation is known to affect gene transcription. Conclusion: These findings warrant further research to clarify intermediate biological pathways and potential biomarkers to identify women at risk for PTB. Identification of PTB risk early in pregnancy would allow for interventions to prevent PTB. [ABSTRACT FROM AUTHOR]

Youth experiencing homelessness (YEH) often face increased levels of adversity and higher rates of trauma, suicide, and mortality compared to their housed peers. A multi‐level life course lens is proposed by applying the ecobiodevelopmental model to examine social support mechanisms as a buffer to psychopathologies following adversity within YEH. Further discussion contributes to the theoretical basis for future public health research and intervention work addressing youth homelessness and related adversities. [ABSTRACT FROM AUTHOR]

This observational, longitudinal study's purpose was to investigate whether social network integration has a moderating effect on smoking initiation among those with attention deficit hyperactivity disorder (ADHD). Data were drawn from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative longitudinal dataset. Social network and smoking data were collected in schools, with a 6-year follow-up that included ADHD symptoms and reported smoking. Social integration was measured as peer friendship nominations (degree) and the influence of an individual on the entire social network (centrality). Multilevel logistic regression found a main effect for ADHD symptoms and low numbers of friendship nominations on smoking initiation, but social network measures were not significant moderators of the relationship between ADHD symptoms and smoking initiation among adolescents. Further investigation of the drivers of smoking initiation among those with ADHD is warranted. [ABSTRACT FROM AUTHOR]

Telomere length (TL) is proposed to play a mechanistic role in how the exposome affects health outcomes. Little is known about TL during adolescence, a developmental period during which precursors of adult‐onset health problems often emerge. We examined health and demographic sources of variation in TL in 899 youth aged 11–17. Demographic and health information included age, sex, race, household income, caregiver age and marital status, youth tobacco exposure, body mass index, pubertal status, health problems, medication use, and season of data collection. Genomic DNA was extracted from saliva, and T/S ratios were computed following qPCR. Age, race, season of data collection, and household income were associated with the telomere to single copy (T/S) ratio. We found that T/S ratios were larger at younger ages, among Black youth, for saliva collected during autumn and winter, and among households with higher income. Analyses stratified by race revealed that the association between age and T/S ratio was present for Black youth, that season of collection was present across races, but that family demographic associations with T/S ratio varied by race. The results provide information for future telomere research and highlight adolescence as a potentially important developmental phase for racial disparities in telomere shortening and health. [ABSTRACT FROM AUTHOR]

Preterm birth (PTB; <37 weeks gestation) rates have increased for 5 of the last 6 consecutive years in the United States. These rates are particularly alarming for U.S. non-Hispanic Black women who give birth prematurely at 1.5 times the rate of non-Hispanic White women. Previous research suggests that psychological stress is associated with PTB in Black women. However, the biological pathways by which stress alters birth timing are not clear. We examined DNA methylation (DNAm) in peripheral blood leukocytes in 6 glucocorticoid, stress-related genes in 44 (22 PTB; 22 term birth) pregnant Black women. Four cytosine-phosphate-guanine (CpG) sites were identified as differentially methylated (p < 0.05) between women with PTB and women with term births. The ability to identify stress-related biological markers that are associated with PTB among Black women would provide a critical step toward decreasing the PTB disparity among these women. Future studies should include larger sample sizes and gene expression analyses of the stress-related biological pathways to PTB. [ABSTRACT FROM AUTHOR]

The Developmental Psychobiological Model of Experiential Canalization (DPMEC) proposes that conditions of poverty-related adversity influence child self-regulation through parental caregiving, stress hormones, and the child's genetics. However, empirical findings investigating these relationships with prolonged stress hormones are mixed. Further, the relationships among conditions of adversity with prolonged stress hormones have seldom been investigated in toddlers living in poverty. Guided by the DPMEC, we examined the relationships among maternal caregiving, prolonged stress, and self-regulation in toddlers living in poverty in the United States, to include examining whether toddler prolonged stress mediated relations between maternal caregiving and child self-regulation. Participants were mothers and toddlers (20 to 24 months of age) living in poverty, who provided hair samples to measure four months of average cortisol concentration to estimate prolonged stress. We used observational measures to examine maternal caregiving and indirect report to measure children's self-regulation. Findings did not support the role of toddler prolonged stress in mediating the relationship between maternal caregiving and toddler self-regulation. However, multiple linear regression models showed that higher levels of maternal emotionally supportive caregiving significantly predicted better toddler soothability (b = 0.90; p =.03; 95% CI [0.10, 1.69]; partial correlation = 0.26). This study adds partial support for the DPMEC to represent associations between maternal caregiving and toddler self-regulation for mothers and toddlers experiencing poverty. While these data come from an observational study, pediatric nurses may consider assessing maternal supportive caregiving upon reports of poor toddler soothability. • We tested toddlers' stress hormones and self-regulation responses to adversity. • The sample comprised 94 mothers and toddlers living in poverty in the United States. • Toddler stress did not mediate parental caregiving and child self-regulation. • Toddlers had better soothability if mothers were more emotionally supportive. [ABSTRACT FROM AUTHOR]

Suicide is a public health crisis disproportionately affecting transgender adolescents and young adults. There are gaps in research evaluating this phenomenon using a multilevel, life‐course approach. The following paper will provide an overview of the current models of suicide, critique their applicability to understanding suicide among transgender youth, and discuss how using a bioecological systems approach will help to advance our understanding of suicide among transgender youth. Transgender adolescents and young adults often face unique combinations of interpersonal and intrapersonal challenges that require managing a stark misalignment of social characters, expectations, and roles. These factors are imposed by the complex interactions and influences of the bioecological systems in which transgender adolescents and young adults are situated. Future research is needed to elucidate the characteristics of bioecological adversity faced by this vulnerable population. Identification of these relationships are likely to highlight effective targets for multilevel interventions aimed at preventing suicide. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effects of a social determinants of health (SDH) screening tool and service referral on emergency department (ED) use among patients at a Federally Qualified Health Center primary care clinic. Study design: Quasi‐experimental. Sample: Three‐hundred and eleven English‐speaking patients 18 years and older. Measures: The Core 5 SDH screening tool consists of five yes/no items assessing food, housing, utilities, transportation, and safety needs. The number of ED visits 3 months before and after the intervention were collected from electronic health records. Intervention: The research team administered the Core 5 SDH screening tool and if desired, referred patients with an identified need for SDH services. Results: Approximately 43% of patients reported a SDH need with food insecurity most prevalent (62.2%). The number of ED visits was significantly lower 3 months post‐intervention compared to 3 months before for the 125 participants who wanted and received the SDH service referral (IRR = 0.64, 95% CI = 0.41, 0.99) and for the 35 participants who reported receiving some/all of the needed services at the 2‐week follow‐up (IRR = 0.36, 95% CI = 0.17, 0.76). Conclusions: Addressing patients' SDH needs may reduce ED visits, lower healthcare costs, and ultimately, improve health. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean rates are particularly high among Hispanic women in some regions of the United States, placing a disproportionate health burden on women and their newborns. This integrative review synthesized the literature on mode of birth (vaginal vs cesarean) and related childbirth complications (hemorrhage, surgical site infection, perineal trauma) among Mexican American women living in the United States. Methods: Four electronic databases, PubMed, Embase, CINAHL, and SCOPUS, were searched to identify studies meeting the inclusion criteria, research studies that included Mexican American women who were pregnant or postpartum. Results were limited to English language and publications that were peer‐reviewed and published before May 2020. Covidence was used in article identification, screening, and assessment. Critical appraisal of the research was performed using the Quality Assessment Tool for Studies with Diverse Designs. Results: Ten articles met inclusion criteria. In some studies, Mexican American women born in the United States were more likely to have cesareans than women born in Mexico; in other studies, these findings were reversed. Mexican American women often had lower unadjusted cesarean rates compared with non‐Hispanic white women, but adjusting for birth facility (some facilities perform more cesareans than others), sociodemographic, and risk factors often revealed Mexican American women have a higher adjusted risk for cesarean birth. Women with higher socioeconomic status had higher cesarean rates compared with women with lower socioeconomic status. In studies of birth outcome by level of acculturation, women who were US‐oriented had higher rates of cesarean and more frequent perinatal complications. By ethnic subgroup, rates of cesarean and complications varied among Hispanic women. Discussion: Birth facility was associated with perinatal outcomes for Mexican American women; those who gave birth at higher‐performing facilities had better outcomes when compared with women who gave birth at lower‐performing facilities. After adjusting for pregnancy complications, Mexican American women had a greater risk for cesarean birth compared with non‐Hispanic white women, a finding that may have clinical practice implications. Level of acculturation affected birth outcomes, but more research using precise instruments is needed. [ABSTRACT FROM AUTHOR]

Epigenetic modifications are chemical changes that can modify gene expression without changing the sequence of the gene. These modifications are potentially identifiable and reversible, making the epigenome an important area of research for discovering biomarkers to identify those who may be at risk and providing therapeutic interventions to prevent adverse health outcomes. African Americans bear a disproportionate risk of adverse health outcomes (e.g., hypertension, cancer). Indeed, African American women experience preterm birth (PTB; <37 completed weeks gestation) at more than twice the rate of non-Hispanic White women. Research suggests that environmental influences may play a significant role in PTB outcomes for this population. However, the biological pathways by which these influences contribute to PTB are poorly understood. This paper describes research methods and ethical considerations for the collection and analysis of biological samples based on our study examining the epigenetic regulation of stress pathways in PTB in pregnant African American women. [ABSTRACT FROM AUTHOR]