Search

The study purpose was to use recursive partitioning analysis (RPA) to identify factors that, when clustered, are associated with a high prevalence of pregnancy involvement among US adolescent males. The National Survey of Family Growth is a nationally representative survey of individuals 15-44 years old. RPA was done for the 2002 and 2006-2010 cycles to identify factors which, when combined, identify adolescent males with the highest prevalence of pregnancy involvement. Pregnancy-involvement prevalence among adolescent males was 6 %. Two clusters of adolescent males have the highest pregnancy-involvement prevalence, at 84-87 %. In RPA, the highest pregnancy-involvement prevalence (87 %) was seen in adolescent males who ever HIV tested, had >4 lifetime sexual partners, reported less than an almost certain chance of feeling less physical pleasure with condom use, had an educational attainment of <11th grade, and had ≤2 sexual partners in the past 12 months. Adolescent males who ever HIV tested, had >4 lifetime sexual partners, reported less than an almost certain chance of feeling less physical pleasure with condom use, had an educational attainment ≥11th grade, were >17 years old, and had their first contraceptive education ≥10th grade, had a pregnancy-involvement prevalence of 84 %. Pregnancy-prevention efforts among adolescent males who have been involved in a pregnancy may need to target risk factors identified in clusters with the highest pregnancy prevalence to prevent subsequent pregnancies in these adolescent males and improve their future outcomes. [ABSTRACT FROM AUTHOR]

Abstract: The post-mortem analysis of few blackouts in US and Europe has revealed that the Zone 3 of step-distance protection is one of the primary causes of blackouts in power systems. In order to provide the Zone 3 relays with situational awareness and prevent its undesirable tripping, we propose a non-intrusive agent based relay supervised distance protection scheme. In the proposed scheme, every relay protecting a transmission line is associated with an agent that has the ability to sense and communicate with the other agents in the network. Based on the responsibilities assigned to them, the agents are hierarchically distinguished as master and slave agents. Whenever a relay senses a fault, its associated slave agent communicates with the master agent to distinguish a fault as a real fault or unreal fault and respectively to trip or not to trip. Distance relay protection scheme is a time critical application. Therefore OPNET simulations are performed to evaluate different communication and networking topologies, physical media of communication, networking protocols to ascertain the topology that meets the timing requirements of the protection scheme. The problem of adapting the proposed scheme to a larger power grid is modeled as an integer programming Multiple Facility Location (MFL) problem. [Copyright &y& Elsevier]

Abstract: Study Objective: To identify markers that, when clustered, are associated with the highest and lowest pregnancy prevalence among US adolescent females. Design: Secondary database analysis of the National Survey of Family Growth. Participants: Adolescent females 15–19 years old. Setting: United States. Methods: Bivariate analyses were performed of the 2002 and 2006-08 cycles to identify markers associated with pregnancy in females 15–19 years old. Recursive partitioning analysis (RPA) was done to identify markers which, when combined, identify adolescent females with the highest and lowest pregnancy prevalence. Results: Pregnancy prevalence in 2,528 adolescent females was 14%. In RPA, females who ever HIV tested had a 48% pregnancy prevalence vs 4% in those never tested. The highest pregnancy prevalence (78%) was associated with the combination of ever HIV tested, never lived away from parents before 18 years old, age >17 years old, and age of sexual debut ≤14 years old. Adolescent females with a combination of ever HIV tested, never lived away from parents before 18 years old, age >17 years old, age of sexual debut at 15–16 years old, and the adolescent''s father not having a high-school diploma had a pregnancy prevalence of 75%. Conclusions: Two clusters of markers yield adolescent females with a very high adolescent pregnancy prevalence, at 75%–78%. Pregnancy prevention efforts might be especially effective when targeting combinations of HIV-testing history, never living away from home before 18 years old, adolescent age, age of sexual debut, and paternal educational attainment. [Copyright &y& Elsevier]

Introduction: The 2010 Census revealed the population of Latino and Asian children grew by 5.5 million, while the population of white children declined by 4.3 million from 2000-2010, and minority children will outnumber white children by 2020. No prior analyses, however, have examined time trends in racial/ethnic disparities in children's health and healthcare. The study objectives were to identify racial/ethnic disparities in medical and oral health, access to care, and use of services in US children, and determine whether these disparities have changed over time. Methods: The 2003 and 2007 National Surveys of Children's Health were nationally representative telephone surveys of parents of 193,995 children 0-17 years old (N = 102,353 in 2003 and N = 91,642 in 2007). Thirty-four disparities indicators were examined for white, African-American, Latino, Asian/Pacific-Islander, American Indian/ Alaskan Native, and multiracial children. Multivariable analyses were performed to adjust for nine relevant covariates, and Z-scores to examine time trends. Results: Eighteen disparities occurred in 2007 for ⩾1 minority group. The number of indicators for which at least one racial/ethnic group experienced disparities did not significantly change between 2003-2007, nor did the total number of specific disparities (46 in 2007). The disparities for one subcategory (use of services), however, did decrease (by 82%). Although 15 disparities decreased over time, two worsened, and 10 new disparities arose. Conclusions: Minority children continue to experience multiple disparities in medical and oral health and healthcare. Most disparities persisted over time. Although disparities in use of services decreased, 10 new disparities arose in 2007. Study findings suggest that urgent policy solutions are needed to eliminate these disparities, including collecting racial/ethnic and language data on all patients, monitoring and publicly disclosing disparities data annually, providing health-insurance coverage and medical and dental homes for all children, making disparities part of the national healthcare quality discussion, ensuring all children receive needed pediatric specialty care, and more research and innovative solutions. [ABSTRACT FROM AUTHOR]

Objectives. We identified factors associated with child bullying in the United States. Methods. We used the 2007 National Survey of Children's Health to examine associations among child, parent, and community factors and bullying perpetration among children aged 10 to 17 years, using bivariate and stepwise multivariable analyses. Results. African American and Latino children and children living in poverty and who had emotional, developmental, or behavioral (EDB) problems had higher odds of bullying, as did children of parents who felt angry with their child or who felt their child bothered them a lot or was hard to care for; suboptimal maternal mental health was associated with higher bullying odds. Children who always or usually completed homework and had parents who talked with them and met all or most of their friends had lower bullying odds. Conclusions. Assessing children's EDB problems, maternal mental health, and parental perceptions may identify children at risk for bullying. Parent-child communication, meeting children's friends, and encouraging children academically were associated with lower bullying odds; these protective factors may be useful in designing preventive interventions. (Am J Public Health. 2012;102: 2280-2286). [ABSTRACT FROM AUTHOR]

Objective To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents. Data Source Secondary data analysis of the 2003 National Survey of Children's Health. The survey focus was children 0-17 years old. Study Design Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/ Pacific Islander, American Indian/ Alaskan Native, and multiracial adolescents 10-17 years old ( n = 48,742) to identify disparities in 40 measures of health and health care. Principal Findings Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/ Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/ Alaska Natives; and not receiving all needed dental care in multiracial youth. Conclusions U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents. [ABSTRACT FROM AUTHOR]

More than 600,000 U.S. children are reported for physical abuse annually. Risk factors are proposed in the literature, but a comprehensive, national assessment of risk factors and support services has not been conducted. An analysis of national data from the National Child Abuse and Neglect Dataset revealed that domestic violence, parental alcohol and drug use, prior child abuse and neglect, public assistance receipt, and child behavior problems are associated with higher odds of substantiated physical abuse reports, compared to unsubstantiated reports. Most families, however, failed to receive relevant support services for any of these risk factors. Screening by physicians, child protection workers, and others for these risk factors could help identify children at increased risk for physical abuse and inform prevention efforts and support-service provision. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify factors associated with initiation of the human papillomavirus vaccine series and parental report of a healthcare provider recommendation of the human papillomavirus vaccine in adolescent females. Design: Cross-sectional analysis of 2007 National Survey of Children''s Health. Participants: Parents of 12–17 year-old US adolescent females. Main outcome measures: Associations of sociodemographic and healthcare factors with initiation of the human papillomavirus vaccine series and parental report of a healthcare provider recommendation of the human papillomavirus vaccine. Results: Data were analyzed for 16,139 adolescent females. Almost 20% of adolescent females initiated the HPV vaccine series. Significantly higher proportions of adolescent females who initiated the human papillomavirus vaccine series vs. those who did not initiate the human papillomavirus vaccine series had a parental report of their healthcare provider recommending the human papillomavirus vaccine (84% vs. 20%). In multivariable analyses, adolescent females who were American Indian/Alaska Native, were multiracial, received the meningococcal vaccine, received the tetanus/tetanus–diphtheria/tetanus–diphtheria–acellular pertussis vaccine, or were poor had higher adjusted odds of initiating the human papillomavirus vaccine series; parental report of a healthcare provider recommendation of the human papillomavirus vaccine was associated with about 18 times the adjusted odds of initiating the human papillomavirus vaccine series. In separate multivariable analyses, adolescent females who were African-American and uninsured had lower adjusted odds of a parental report of a healthcare provider recommendation of the human papillomavirus vaccine. Conclusion: Parental report of a healthcare provider recommendation is significantly associated with human papillomavirus vaccine-series initiation. African-American race/ethnicity and uninsurance were associated with lower odds of a parental report of a healthcare provider recommendation of the human papillomavirus vaccine. Routine healthcare provider recommendation of human papillomavirus vaccination might improve adolescent females’ human papillomavirus vaccination rates. [Copyright &y& Elsevier]

Background. Asthma disproportionately affects minorities, but not enough is known about morbidity and specialist access in asthmatic minority children. Objective. To examine asthma morbidity and access to specialty care in urban minority children. Methods. A consecutive series was recruited in 2004-2007 of urban minority children 2 to 18 years old seen for asthma in four emergency departments (EDs) or admitted to a children's hospital. Outcomes assessed included asthma symptom and attack frequency; missed school and parental work; asthma ED visits and hospitalizations; severity of illness; and asthma specialty care. Results. Of 648 children assessed, 220 were eligible. The mean age was 7 years; 68% were poor, 83% had Medicaid, 84% were African-American, and 16% were Latino. Sixty-eight percent of children were not in excellent/very good health, 73% had persistent asthma (moderate/severe = 52%), and only 44% had asthma care plans. The mean number of asthma attacks in the past year was 12, and of monthly daytime and nighttime asthma symptoms, is 12 and 12, respectively. The mean annual number of asthma doctor visits was 6; of ED asthma visits, 3; hospitalizations, 1; missed school days, 7; and missed parent work days, 6. Eighty-three percent of children have no asthma specialist, and 62% use EDs as the usual asthma care source. Poor children were less likely than the non-poor to have asthma specialists (13 vs. 26%; p < 0.03). African-Americans were more likely than Latinos to use EDs for usual asthma care (68% vs. 44%; p < 0.01). In multivariable analyses, poverty was associated with greater odds and having an asthma care plan with lower odds of an asthma attack in the past year; poverty also was associated with half the odds of having an asthma specialist. African-American children were significantly more likely to report the ED as the usual source of asthma care, and having an asthma specialist and male gender were associated with greater odds of having an asthma care plan. Conclusions. Urban minority children with asthma average 1 asthma symptom daily, 1 exacerbation monthly, and 7 missed school days, 6 missed parental work days, 3 ED visits, and 1 hospitalization yearly; most receive their usual asthma care in EDs and have no asthma care plan or asthma specialist. Urban minority asthmatic children need interventions to reduce morbidity and improve access to specialists and asthma care plans, especially among the poor and African-Americans. [ABSTRACT FROM AUTHOR]

Background: Of the 4.8 million uninsured children in America, 62-72% are eligible for but not enrolled in Medicaid or CHIP. Not enough is known, however, about the impact of health insurance on outcomes and costs for previously uninsured children, which has never been examined prospectively.Methods: This prospective observational study of uninsured Medicaid/CHIP-eligible minority children compared children obtaining coverage vs. those remaining uninsured. Subjects were recruited at 97 community sites, and 11 outcomes monitored monthly for 1 year.Results: In this sample of 237 children, those obtaining coverage were significantly (P < .05) less likely than the uninsured to have suboptimal health (27% vs. 46%); no PCP (7% vs. 40%); experienced never/sometimes getting immediate care from the PCP (7% vs. 40%); no usual source of preventive (1% vs. 20%) or sick (3% vs. 12%) care; and unmet medical (13% vs. 48%), preventive (6% vs. 50%), and dental (18% vs. 62%) care needs. The uninsured had higher out-of-pocket doctor-visit costs (mean = $70 vs. $29), and proportions of parents not recommending the child's healthcare provider to friends (24% vs. 8%) and reporting the child's health caused family financial problems (29% vs. 5%), and lower well-child-care-visit quality ratings. In bivariate analyses, older age, birth outside of the US, and lacking health insurance for >6 months at baseline were associated with remaining uninsured for the entire year. In multivariable analysis, children who had been uninsured for >6 months at baseline (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4-10.3) and African-American children (OR, 2.8; 95% CI, 1.1-7.3) had significantly higher odds of remaining uninsured for the entire year. Insurance saved $2886/insured child/year, with mean healthcare costs = $5155/uninsured vs. $2269/insured child (P = .04).Conclusions: Providing health insurance to Medicaid/CHIP-eligible uninsured children improves health, healthcare access and quality, and parental satisfaction; reduces unmet needs and out-of-pocket costs; and saves $2886/insured child/year. African-American children and those who have been uninsured for >6 months are at greatest risk for remaining uninsured. Extrapolation of the savings realized by insuring uninsured, Medicaid/CHIP-eligible children suggests that America potentially could save $8.7-$10.1 billion annually by providing health insurance to all Medicaid/CHIP-eligible uninsured children. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is now considered among the top three contributors to mortality globally. There is limited understanding surrounding the contribution of magnesium to the progression of COPD. This survey aims to evaluate the connection between dietary magnesium intake and both lung function and COPD prevalence among the US population. The research comprised 4865 participants in the National Health and Nutrition Examination Survey (NHANES) program conducted from 2007 to 2012. To evaluate the association between dietary magnesium intake and lung function as well as COPD, the study conducted multiple regression analyses, stratified analyses, and smoothed curves. In this study, we explored the relationship between higher magnesium intake and higher FEV 1 [β = 0.21 (95% CI 0.12, 0.30)] and FVC [β = 0.25 (95% CI 0.14, 0.36)] after accounting for all potential confounding factors. We demonstrated a relationship between increased magnesium intake and reduced odds of developing COPD [OR = 0.9993 (95% CI 0.9987, 1.0000)]. The results of stratified analyses further indicated that the relationship between magnesium intake and the risk of COPD is more pronounced in the 40-60 age group and males. The study demonstrated positive associations between the intake of dietary magnesium and both FEV 1 and FVC. Additionally, an adverse relationship between magnesium intake and the prevalence of COPD was also observed, suggesting that supplementation with magnesium may be a practical approach to preventing and managing COPD., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Latinos have the highest US childhood uninsurance rate of any race/ethnicity, but little is known about effective ways to eliminate this disparity. We evaluated the effects of parent mentors-Latino parents with children covered by Medicaid or the Children's Health Insurance Program-on insuring Latino children in a randomized, controlled, community-based trial of 155 uninsured children conducted in the period 2011-15. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health. We found that parent mentors were more effective than traditional methods in insuring children (95 percent versus 69 percent), achieving faster coverage and greater parental satisfaction, reducing unmet health care needs, providing children with primary care providers, and improving the quality of well-child and subspecialty care. Children in the parent-mentor group had higher quality of overall and specialty care, lower out-of-pocket spending, and higher rates of coverage two years after the end of the intervention (100 percent versus 70 percent). Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities.

Importance: The outcome of older patients with acute myeloid leukemia (AML) remains unsatisfactory. Recent studies have shown that HLA-mismatched microtransplant could improve outcomes in such patients., Objective: To evaluate outcomes in different age groups among older patients with newly diagnosed AML who receive HLA-mismatched microtransplant., Design, Setting, and Participants: This multicenter clinical study included 185 patients with de novo AML at 12 centers in China, the United States, and Spain in the Microtransplantation Interest Group. Patients were divided into the following 4 age groups: 60 to 64 years, 65 to 69 years, 70 to 74 years, and 75 to 85 years. The study period was May 1, 2006, to July 31, 2015., Exposures: Induction chemotherapy and postremission therapy with cytarabine hydrochloride with or without anthracycline, followed by highly HLA-mismatched related or fully mismatched unrelated donor cell infusion. No graft-vs-host disease prophylaxis was used., Main Outcomes and Measures: The primary end point of the study was to evaluate the complete remission rates, leukemia-free survival, and overall survival in different age groups. Additional end points of the study included hematopoietic recovery, graft-vs-host disease, relapse rate, nonrelapse mortality, and other treatment-related toxicities., Results: Among 185 patients, the median age was 67 years (range, 60-85 years), and 75 (40.5%) were female. The denominators in adjusted percentages in overall survival, leukemia-free survival, relapse, and nonrelapse mortality are not the sample proportions of observations. The overall complete remission rate was not significantly different among the 4 age groups (75.4% [52 of 69], 70.2% [33 of 47], 79.1% [34 of 43], and 73.1% [19 of 26). The 1-year overall survival rates were 87.7%, 85.8%, and 77.8% in the first 3 age groups, which were much higher than the rate in the fourth age group (51.7%) (P = .004, P = .008, and P = .04, respectively). The 2-year overall survival rates were 63.7% and 66.8% in the first 2 age groups, which were higher than the rates in the last 2 age groups (34.2% and 14.8%) (P = .02, P = .03, P < .001, and P < .001, respectively). The 1-year cumulative incidences of nonrelapse mortality were 10.2%, 0%, 3.4%, and 26.0% in the 4 age groups and 8.1% in all patients. The median times to neutrophil and platelet recovery were 12 days and 14 days after induction chemotherapy, respectively. Five patients had full or mixed donor engraftment, and 30.8% (8 of 26) of patients demonstrated donor microchimerism. Two patients (1.1%) developed severe acute graft-vs-host disease., Conclusions and Relevance: Microtransplant achieved a high complete remission rate in AML patients aged 60 to 85 years and higher 1-year overall survival in those aged 60 to 74 years.

Objective: To identify risk and protective factors for weapon involvement among African American, Latino, and white adolescents., Study Design: The National Longitudinal Study of Adolescent to Adult Health is a nationally representative survey of 7th-12th grade students. Predictors at wave 1 and outcome at wave 2 were analyzed. Data were collected in the mid-1990s, when rates of violent crime had been declining. The outcome was a dichotomous measure of weapon-involvement in the past year, created using 3 items (weapon-carrying, pulled gun/knife, shot/stabbed someone). Bivariate and multilevel logistic regression analyses examined associations of individual, peer, family, and community characteristics with weapon involvement; stratified analyses were conducted with African American, Latino, and white subsamples., Results: Emotional distress and substance use were risk factors for all groups. Violence exposure and peer delinquency were risk factors for whites and African Americans. Gun availability in the home was associated with weapon involvement for African Americans only. High educational aspirations were protective for African Americans and Latinos, but higher family connectedness was protective for Latinos only., Conclusions: Interventions to prevent weapon-related behaviors among African American, Latino, and white adolescents may benefit from addressing emotional distress and substance use. Risk and protective factors vary by race/ethnicity after adjusting for individual, peer, family, and community characteristics. Addressing violence exposure, minimizing the influence of delinquent peers, promoting educational aspirations, and enhancing family connectedness could guide tailoring of violence prevention interventions., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Seven million US children lack health insurance. Community health workers are effective in insuring uninsured children, and parent mentors (PMs) in improving asthmatic children's outcomes. It is unknown, however, whether a training program can result in PMs acquiring knowledge/skills to insure uninsured children. The study aim was to determine whether a PM training program results in improved knowledge/skills regarding insuring uninsured minority children., Methods: Minority parents in a primary-care clinic who already had Medicaid/Children's Health Insurance Program (CHIP)-covered children were selected as PMs, attending a 2-day training session addressing 9 topics. A 33-item pretraining test assessed knowledge/skills regarding Medicaid/CHIP, the application process, and medical homes. A 46-item posttest contained the same 33 pretest items (ordered differently) and 13 Likert-scale questions on training satisfaction., Results: All 15 PMs were female and nonwhite, 60% were unemployed, and the mean annual income was $20,913. After training, overall test scores (0-100 scale) significantly increased, from a mean of 62 (range 39-82) to 88 (range 67-100) (P < .01), and the number of wrong answers decreased (mean reduction 8; P < .01). Significant improvements occurred in 6 of 9 topics, and 100% of PMs reported being very satisfied (86%) or satisfied (14%) with the training. Preliminary data indicate PMs are significantly more effective than traditional Medicaid/CHIP outreach/enrollment in insuring uninsured minority children., Conclusions: A PM training program resulted in significant improvements in knowledge and skills regarding outreach to and enrollment of uninsured, Medicaid/CHIP-eligible children, with high levels of satisfaction with the training. This PM training program might be a useful model for training Patient Protection and Affordable Care Act navigators., (Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background & Objectives: Six million US children have no health insurance, and substantial racial/ethnic disparities exist. The design, methods, and baseline characteristics are described for Kids' Health Insurance by Educating Lots of Parents (Kids' HELP), the first randomized, clinical trial of the effectiveness of Parent Mentors (PMs) in insuring uninsured minority children., Methods & Research Design: Latino and African-American children eligible for but not enrolled in Medicaid/CHIP were randomized to PMs, or a control group receiving traditional Medicaid/CHIP outreach. PMs are experienced parents with ≥1 Medicaid/CHIP-covered children. PMs received two days of training, and provide intervention families with information on Medicaid/CHIP eligibility, assistance with application submission, and help maintaining coverage. Primary outcomes include obtaining health insurance, time interval to obtain coverage, and parental satisfaction. A blinded assessor contacts subjects monthly for one year to monitor outcomes., Results: Of 49,361 candidates screened, 329 fulfilled eligibility criteria and were randomized. The mean age is seven years for children and 32 years for caregivers; 2/3 are Latino, 1/3 are African-American, and the mean annual family income is $21,857. Half of caregivers were unaware that their uninsured child is Medicaid/CHIP eligible, and 95% of uninsured children had prior insurance. Fifteen PMs completed two-day training sessions. All PMs are female and minority, 60% are unemployed, and the mean annual family income is $20,913. Post-PM-training, overall knowledge/skills test scores significantly increased, and 100% reported being very satisfied/satisfied with the training., Conclusions: Kids' HELP successfully reached target populations, met participant enrollment goals, and recruited and trained PMs., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Study Objective: To identify factors associated with a positive pregnancy attitude among sexually active US teen females., Design: Secondary database analysis of the National Survey of Family Growth., Participants: Adolescent females 15-19 years old., Setting: Nationally representative sample., Methods: Bivariate and multivariable analyses were performed of the 2002 and 2006-08 cycles to examine whether sociodemographic factors, contraceptive history, sexual education and behavior history, medical services history, and family and sexual attitudes were associated with a positive pregnancy attitude among sexually active teen females., Results: Among the 975 sexually active US adolescent females surveyed, 15% reported a positive pregnancy attitude. Compared with adolescent females with a negative pregnancy attitude, those females with a positive pregnancy attitude were significantly (P < .05) more likely to have public insurance (43% vs 20%), to be poor (33% vs 10%), to have reached menarche at an earlier age (12 years old vs 13 years old), ever have HIV tested (35% vs 23%), but less likely to have ever been forced to have sex (1% vs 10%). In multivariable analyses, Latino race/ethnicity was associated with triple the odds, and African-American double the odds, of a positive pregnancy attitude. Older age of menarche and higher family income were associated with reduced odds of a positive pregnancy attitude., Conclusions: One in 7 sexually active US adolescent females had a positive pregnancy attitude. Minority race/ethnicity was associated with greater odds of a positive pregnancy attitude, whereas older age of menarche and a higher family income were associated with lower odds of a positive pregnancy attitude. Assessing pregnancy attitudes for these groups of adolescent females might prove useful to decrease adolescent pregnancy rates., (Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

This study examines trends in prevalence and factors associated with bullying perpetration among children 10-17 years old, using the 2003 and 2007 National Survey of Children's Health. A parent-reported bullying measure and NSCH-designed questions were used to measure factors associated with bullying. The 2003 (n = 48,639) and 2007 (n = 44,152) samples were 51 % male, with mean age of 13.5 (standard deviation 2.3). 23 % of children bullied at least sometimes in 2003 and 15 % bullied in 2007. Parental anger with their child, a child emotional/developmental/behavioral problem, and suboptimal maternal mental health were associated with higher bullying odds in 2003 and 2007, whereas parents talking with their child very/somewhat well, and meeting their child's friends were associated with lower odds. Between 2003 and 2007, parental anger with their child was associated with increasing bullying odds and parents' meeting their child's friends was associated with decreasing odds. Targeting these persistent factors may result in effective bullying-prevention interventions.

Objective: To identify risk factors associated with the greatest and lowest prevalence of bullying perpetration among U.S. children., Methods: Using the 2001-2002 Health Behavior in School-Aged Children, a nationally representative survey of U.S. children in 6th-10th grades, bivariate analyses were conducted to identify factors associated with any (once or twice or more), moderate (two to three times/month or more), and frequent (weekly or more) bullying. Stepwise multivariable analyses identified risk factors associated with bullying. Recursive partitioning analysis (RPA) identified risk factors which, in combination, identify students with the highest and lowest bullying prevalence., Results: The prevalence of any bullying in the 13,710 students was 37.3%, moderate bullying was 12.6%, and frequent bullying was 6.6%. Characteristics associated with bullying were similar in the multivariable analyses and RPA clusters. In RPA, the highest prevalence of any bullying (67%) accrued in children with a combination of fighting and weapon-carrying. Students who carry weapons, smoke, and drink alcohol more than 5 to 6 days/week were at greatest risk for moderate bullying (61%). Those who carry weapons, smoke, have more than one alcoholic drink per day, have above-average academic performance, moderate/high family affluence, and feel irritable or bad-tempered daily were at greatest risk for frequent bullying (68%)., Conclusions: Risk clusters for any, moderate, and frequent bullying differ. Children who fight and carry weapons are at greatest risk of any bullying. Weapon-carrying, smoking, and alcohol use are included in the greatest risk clusters for moderate and frequent bullying. Risk-group categories may be useful to providers in identifying children at the greatest risk for bullying and in targeting interventions., (Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To identify risk clusters that are associated with higher or lower risk of new abuse reports (rereports) and substantiated rereports (reabuse) in children who remain in the home after an abuse report., Design: A 5-year prospective cohort study., Setting: National Survey of Child and Adolescent Well-Being., Participants: Children reported to the child protection system for child abuse., Main Exposure: Remaining in the home after an abuse report., Main Outcome Measure: Incidence of rereports and reabuse., Results: A total of 2578 children remained in the home following an abuse report, and 44% were rereported within the follow-up period. In bivariate analyses, children with behavior problems (49% vs 38%), caregivers with an abuse history (33% vs 16%) or a child welfare history (38% vs 25%), and families with an annual income lower than $20 000 (70% vs 60%) were more likely to be rereported. Forty-five percent of rereports were substantiated reabuse, but 2 risk clusters had a higher incidence: (1) the cluster with a substantiated index report, having a caregiver without parenting class, non-African American race/ethnicity, and caregiver younger than 41.5 years (54%); and (2) the cluster with a substantiated index report, a caregiver with parenting class, and child age younger than 8.5 years (60%). The lowest risk group for reabuse had a substantiated index report, a caregiver without parenting class, non-African American race/ethnicity, and a caregiver 41.5 years or older (26%)., Conclusions: Among children remaining in the home following an abuse report, specific risk groups have higher and lower incidence of rereports and reabuse. These risk-group categories may be useful to child protection services and others in identifying at-risk children and making decisions about placement and services.

Background: Minorities are more prevalent than the general population in the child protection system; however, racial/ ethnic disparities in physical abuse and child protective services interventions are not understood., Methods: Bivariate and multivariate analyses evaluated racial/ethnic differences in reported and substantiated physical abuse, physical abuse deaths, and interventions provided in all reported maltreatment from the 2006 National Child Abuse and Neglect Data System., Results: In bivariate analyses, African American (25%), Asian/ Pacific Islander (21%), and multiracial children (21%) have a higher prevalence of substantiated physical abuse than whites (20%). Native Americans (0.21%), African Americans (0.15%), Asians/Pacific Islanders (0.12%), and Latinos (0.11%) are more likely to die from physical abuse than whites (0.09%). African Americans have higher odds than whites of reported (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.11-1.14) and substantiated (OR, 1.27; 95% CI, 1.23-1.31) physical abuse. Latinos have higher odds of reported physical abuse (OR, 1.18; 95% CI, 1.16-1.20) and lower odds of substantiated physical abuse (OR, 0.93; 95% CI, 0.90-0.96). Native Americans have lower odds (OR, 0.53; 95% CI, 0.49-0.56) and Asian/Pacific Islanders higher odds (OR, 1.34; 95% CI, 1.26-1.44) of reported physical abuse vs whites. Latinos have significantly lower odds than whites of receiving support services., Conclusions: Compared with whites, African Americans are at increased risk. Latino, Asian/Pacific Islander, and multiracial children have greater odds of reports, and Native Americans have lower odds of reports for physical abuse. Significant disparities exist in interventions provided to minority families. Understanding these disparities has the potential to improve reporting, prevention, and interventions.

Objectives: To comprehensively assess family services, health, and health care outcomes for US children in kinship care vs foster care., Design: A 3-year prospective cohort study., Setting: National Survey of Child and Adolescent Well-Being., Participants: The sample consisted of 1308 US children entering out-of-home care following reported maltreatment., Main Exposure: Kinship care vs foster care., Main Outcome Measures: Baseline caregivers' support services and the children's behavioral, mental health, and health service use outcomes 3 years after placement., Results: Kinship caregivers were more likely than foster caregivers to have a low socioeconomic status but reported significantly fewer support services (caregiver subsidies, parent training, peer support, and respite care). Kinship care was associated with a lower risk ratio (RR) of continuing behavioral problems (RR = 0.59; 95% confidence interval [CI], 0.41-0.80), low social skills (RR = 0.61; 95% CI, 0.40-0.87), mental health therapy use (RR = 0.45; 95% CI, 0.27-0.73), and psychotropic medication use (RR = 0.46; 95% CI, 0.24-0.82) but higher risk of substance use (RR = 1.88; 95% CI, 0.92-3.20) and pregnancy (RR = 4.78; 95% CI, 1.07-17.11)., Conclusions: Kinship caregivers received fewer support services than foster caregivers. Children in kinship care fared better with behavioral and social skills problems, mental health therapy use, and psychotropic medication use. Adolescents in kinship care may be at higher risk for substance use and pregnancy.

Objective: The goal was to examine pediatric hospitalist rounding practices and characteristics associated with programs conducting family-centered rounds (FCRs)., Methods: The Pediatric Hospitalist Triennial Survey, sent to a subset of pediatric hospitalists on the Pediatric Research in Inpatient Settings listserv from the United States and Canada, consisted of 63 questions on sociodemographic characteristics, training, practice characteristics, and rounding practices., Results: Among 265 respondents (response rate: 70%), 78% practiced in academic hospitals and 22% in nonacademic hospitals. The prevalences of specific rounding categories were as follows: FCRs, 44%; sit-down, 24%; hallway, 21%; others, 11%. FCRs occurred significantly more often in academic (48%) than nonacademic (31%) hospitals (P = .04). FCRs can include pediatric residents, bedside nurses, charge nurses, case managers, pharmacists, and social workers. Academic settings and higher average daily patient censuses, but not FCRs, were significantly associated with prolonged rounding duration. The most commonly perceived FCR benefits included increased family involvement and understanding, trainee role modeling, and effective team communication. Physical constraints, trainees' apprehensions, and time were the main perceived FCR barriers. Greater perceived benefit/barrier ratios, FCR benefits, and family involvement in care were associated with a greater likelihood of conducting FCRs, whereas a greater number of perceived FCR barriers was associated with not conducting FCRs., Conclusions: FCRs were the most-common rounding category among respondents. FCRs were not associated with a self-reported increase in rounding duration. Successful FCR implementation may require educating staff members and trainees about FCR benefits and addressing FCR barriers.