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Material Hardship and Stress from COVID-19 in Immigrant Chinese American Families with Infants

Duh-Leong, Carol; Yin, H Shonna; Yi, Stella S; Chen, Sabrina L; Mui, Angel; Perrin, Eliana M; Zhao, Qiuqu; Gross, Rachel S
Material hardship and stress, associated with poor infant outcomes, increased during the Coronavirus Disease 2019 pandemic. Chinese American families were vulnerable to racism-driven disparities. Little is known about maternal perceptions of pandemic impacts on their infants, family, and community. Purposive sampling of low-income Chinese American mothers (n = 25) with infants (1-15 months). Semi-structured qualitative interviews conducted in Mandarin, Cantonese, or English were audio-recorded, transcribed, and translated. Transcripts coded using applied thematic analysis in an iterative process of textual analysis until thematic saturation. Three themes emerged: (1) Heightened family hardship included financial strain, disruption of transnational childcare, experiences of racism; (2) Altered infant routines/developmental consequences included using protective equipment on infants, concerns about infant socio-emotional development; (3) Coping strategies included stockpiling essentials, adapting family diets. Strategies to mitigate disparities include expanding social needs screening, correcting misinformation, strengthening support networks, and including low-income Chinese Americans in these efforts.
PMID: 34491512
ISSN: 1557-1920
CID: 5007302

Social Capital as a Positive Social Determinant of Health: A Narrative Review

Duh-Leong, Carol; Dreyer, Benard P; Huang, Terry T-K; Katzow, Michelle; Gross, Rachel S; Fierman, Arthur H; Tomopoulos, Suzy; Di Caprio, Cecilia; Yin, H Shonna
Social determinants of health influence child health behavior, development, and outcomes. This paper frames social capital, or the benefits that a child receives from social relationships, as a positive social determinant of health that helps children exposed to adversity achieve healthy outcomes across the life course. Children are uniquely dependent on their relationships with surrounding adults for material and non-material resources. We identify and define three relevant aspects of social capital: 1) social support, which is embedded in a 2) social network, which is a structure through which 3) social cohesion can be observed. Social support is direct assistance available through social relationships and can be received indirectly through a caregiver or directly by a child. A child's social network describes the people in a child's life and the relationships between them. Social cohesion represents the strength of a group to which a child belongs (e.g. family, community). Pediatric primary care practices play an important role in fostering social relationships between families, the health care system, and the community. Further research is needed to develop definitional and measurement rigor for social capital, to evaluate interventions (e.g. peer health educators) that may improve health outcomes through social capital, and to broaden our understanding of how social relationships influence health outcomes.
PMID: 33017683
ISSN: 1876-2867
CID: 4626662

Material Hardships and Infant and Toddler Sleep Duration in Low-Income Hispanic Families

Duh-Leong, Carol; Messito, Mary Jo; Katzow, Michelle W; Tomopoulos, Suzy; Nagpal, Nikita; Fierman, Arthur H; Gross, Rachel S
OBJECTIVE:To assess relationships between material hardships, shortened sleep duration, and suboptimal sleep practices across infancy and toddlerhood in low-income Hispanic families. METHODS:We analyzed longitudinal data of 451 low-income Hispanic mother-child pairs from a child obesity prevention trial. During infancy and toddlerhood, we used adjusted linear regression to assess associations between material hardship (financial difficulty, food insecurity, housing disrepair, multiple hardships), sleep duration (24-hour, night), and the number of suboptimal sleep practices (e.g., later bedtime, co-sleeping). We used adjusted linear regression to assess the longitudinal association between the number of suboptimal sleep practices in infancy and toddlerhood, and tested whether specific or multiple hardships moderated this association. RESULTS:In infants, financial difficulty and multiple hardships were associated with decreased night sleep (B=-0.59 hours, 95% CI: -1.04, -0.14; and B=-0.54 hours, 95% CI: -1.00, -0.08). Housing disrepair was associated with decreased 24-hour sleep (B=-0.64 hours, 95% CI: -1.29, -0.01). In toddlers, each additional suboptimal sleep practice was associated with a decrease in night sleep (B=-0.19 hours, 95% CI: -0.29, -0.09). Each additional suboptimal sleep practice in infancy was associated with a 0.30 increase in the number of suboptimal sleep practices in toddlerhood (p<0.001), with greater increases for those with food insecurity or multiple hardships. CONCLUSION/CONCLUSIONS:Specific and multiple hardships shortened sleep duration during infancy, and moderated the increase of suboptimal sleep behaviors between infancy and toddlerhood. Future studies should consider these early critically sensitive periods for interventions to mitigate material hardships and establish healthy sleep practices.
PMID: 32650047
ISSN: 1876-2867
CID: 4517472

Associations Between Family and Community Protective Factors and Attention-Deficit/Hyperactivity Disorder Outcomes Among US Children

Duh-Leong, Carol; Fuller, Anne; Brown, Nicole M
BACKGROUND:Evidence has established the association between risk factors and attention-deficit/hyperactivity disorder (ADHD) severity, but less is known about factors that may have protective effects on clinical, academic, and social outcomes among children with ADHD. OBJECTIVE:To examine associations between family cohesion, caregiver social support, community support, and (1) ADHD severity, (2) school engagement, and (3) difficulty making or keeping friends. METHODS:Cross-sectional study of school-aged and adolescent children with ADHD using data from the 2016 National Survey of Children's Health. Our outcomes were (1) parent-rated ADHD severity, (2) school engagement, and (3) difficulty making or keeping friends. Our independent variables were (1) family cohesion, (2) caregiver social support, and (3) community support. We used logistic regression models to examine associations between our independent variables and each of our outcome variables, adjusting for child and parent sociodemographic characteristics. RESULTS:In our sample (N = 4,122, weighted N = 4,734,322), children exposed to family cohesion and community support had lower odds of moderate to severe ADHD [adjusted OR (aOR): 0.73 (0.55-0.97); aOR: 0.73 (0.56-0.95), respectively], higher odds of school engagement [aOR: 1.72, (1.25-2.37); aOR: 1.38, (1.04-1.84), respectively], and lower odds of difficulty making or keeping friends [aOR: 0.64, (0.48-0.85); aOR: 0.52, (0.40-0.67), respectively]. CONCLUSION/CONCLUSIONS:Among children with ADHD, family cohesion and community support show protective effects in clinical, academic, and social outcomes. Systematically identifying family- and community-level strengths may be important components of multimodal treatment strategies in children with ADHD.
PMID: 31464826
ISSN: 1536-7312
CID: 4054582

Implementation of Febrile Infant Management Guidelines Reduces Hospitalization

Foster, Lauren Z; Beiner, Joshua; Duh-Leong, Carol; Mascho, Kira; Giordani, Victoria; Rinke, Michael L; Trasande, Leonardo; Wiener, Ethan; Rosenberg, Rebecca E
The clinical management of well-appearing febrile infants 7-60 days of age remains variable due in part to multiple criteria differentiating the risk of a serious bacterial infection. The purpose of this quality improvement study was to standardize risk stratification in the emergency department and length of stay in the inpatient unit by implementing an evidence-based clinical practice guideline (CPG).
PMID: 32190797
ISSN: 2472-0054
CID: 4352872

Social Networks and Sugar-Sweetened Beverage Consumption in a Pediatric Urban Academic Practice

Duh-Leong, Carol; Braganza, Sandra
Increased sugar-sweetened beverage (SSB) consumption is linked to childhood obesity. The risk of increased SSB consumption is multifactorial. Limited studies have examined children's SSB consumption and social networks. In order to examine the association between SSB consumption and SSB preferences of a child's social network, a cross-sectional survey was administered to patients aged 8-17 years from June to September 2016. In a questionnaire, subjects completed a beverage consumption recall, identified people important to them along with each person's favorite beverage, and answered questions about habits, environment, and attitudes. Subjects with higher SSB consumption (>16 fl oz) were compared to subjects with lower SSB consumption (≤16 fl oz). 202 surveyed: 55% female, 53% Hispanic, 45% Black, 28% overweight or obese. Children drank an average of 3 cups/day of SSBs, range of 0-15 cups/day. Social networks included caregiver, relative, and friend. Subjects with higher SSB consumption (n = 96) were compared to those with lower SSB consumption (n = 106). We found children with higher SSB consumption had higher odds of reporting a higher number of people in their immediate social networks who prefer SSB, adjusted for habits, environment, and attitudes (aOR 1.41; 95% CI: 1.02-1.99; p < 0.05). Children are more likely to have higher SSB consumption if they list people in their immediate social network who prefer SSB as their favorite drink. Further research is required to explore the influence of social networks on health behaviors of children.
PMID: 30481137
ISSN: 0896-4289
CID: 3677662

Ordering Interruptions in a Tertiary Care Center: A Prospective Observational Study

Dadlez, Nina M; Azzarone, Gabriella; Sinnett, Mark J; Resnick, Micah; Ushay, H Michael; Adelman, Jason S; Broder, Molly; Duh-Leong, Carol; Huang, Joyce; Kiely, Victoria; Nadler, Ariella; Nelson, Vayola; Simcik, Jared; Rinke, Michael L
OBJECTIVES:By self-report, interruptions may contribute to up to 80% of ordering errors. A greater understanding of the frequency and context of interruptions during ordering is needed to identify targets for intervention. We sought to characterize the epidemiology of interruptions during order placement in the pediatric inpatient setting. METHODS:, and run charts were used. RESULTS:= .002). CONCLUSIONS:Residents and physician assistants are interrupted at a rate of 57 interruptions per 100 orders placed. This may contribute to ordering errors and worsen patient safety. Efforts should be made to decrease interruptions during the ordering process and track their effects on medication errors.
PMID: 28148543
ISSN: 2154-1663
CID: 3142002