Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-26 (of 26 Records) |
Query Trace: Schuster MA [original query] |
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Using ancillary sociodemographic data to identify sexual minority adults among those responding "something else" or "don't know" to sexual orientation questions
Elliott MN , Dahlhamer JM , MacCarthy S , Beckett MK , Orr N , Guerino P , Agniel D , Saunders CL , Schuster MA , Ng JH , Martino SC . Med Care 2019 57 (12) e87-e95 BACKGROUND: General population surveys are increasingly offering broader response options for questions on sexual orientation-for example, not only gay or lesbian, but also "something else" (SE) and "don't know" (DK). However, these additional response options are potentially confusing for those who may not know what the terms mean. Researchers studying sexual orientation-based disparities face difficult methodological trade-offs regarding how best to classify respondents identifying with the SE and DK categories. OBJECTIVES: Develop respondent-level probabilities of sexual minority orientation without excluding or misclassifying the potentially ambiguous SE and DK responses. Compare 3 increasingly inclusive analytic approaches for estimating health disparities using a single item: (a) omitting SE and DK respondents; (b) classifying SE as sexual minority and omitting DK; and (c) a new approach classifying only SE and DK respondents with >50% predicted probabilities of being sexual minorities as sexual minority. MATERIALS AND METHODS: We used the sociodemographic information and follow-up questions for SE and DK respondents in the 2013-2014 National Health Interview Survey to generate predicted probabilities of identifying as a sexual minority adult. RESULTS: About 94% of the 144 SE respondents and 20% of the 310 DK respondents were predicted to identify as a sexual minority adult, with higher probabilities for younger, wealthier, non-Hispanic white, and urban-dwelling respondents. Using a more specific definition of sexual minority orientation improved the precision of health and health care disparity estimates. CONCLUSIONS: Predicted probabilities of sexual minority orientation may be used in this and other surveys to improve representation and categorization of those who identify as a sexual minority adult. |
Racial disparities in fifth-grade sun protection: Evidence from the Healthy Passages study
Correnti CM , Klein DJ , Elliott MN , Veledar E , Saraiya M , Chien AT , Schwebel DC , Mrug S , Tortolero SR , Cuccaro PM , Schuster MA , Chen SC . Pediatr Dermatol 2018 35 (5) 588-596 BACKGROUND/OBJECTIVES: Despite rising skin cancer rates in children, multiple studies reveal inadequate youth sun-protective behavior (eg, sunscreen use). Using Healthy Passages data for fifth-graders, we set out to determine sunscreen adherence in these children and investigated factors related to sunscreen performance. METHODS: Survey data were collected from 5119 fifth-graders and their primary caregivers. Logistic regression was used to assess associations between sunscreen adherence and performance of other preventive health behaviors (eg, flossing, helmet use) and examine predictors of sunscreen adherence. Analyses were repeated in non-Hispanic black, Hispanic, and non-Hispanic white subgroups. RESULTS: Five thousand one hundred nineteen (23.4%) children almost always used sunscreen, 5.9% of non-Hispanic blacks (n = 1748), 23.7% of Hispanics (n = 1802), and 44.8% of non-Hispanic whites (n = 1249). Performing other preventive health behaviors was associated with higher odds of sunscreen adherence (all P < .001), with the greatest association with flossing teeth (odds ratio = 2.41, 95% confidence interval = 1.86-3.13, P < .001). Factors for lower odds of sunscreen adherence included being male and non-Hispanic black or Hispanic and having lower socioeconomic status. School-based sun-safety education and involvement in team sports were not significant factors. CONCLUSION: Our data confirm low use of sun protection among fifth-graders. Future research should explore how public health success in increasing prevalence of other preventive health behaviors may be applied to enhance sun protection messages. Identifying risk factors for poor adherence enables providers to target patients who need more education. Improving educational policies and content in schools may be an effective way to address sun safety. |
Unequal interactions: Examining the role of patient-centered care in the inequitable diffusion of a medical innovation, the human papillomavirus (HPV) vaccine
Fenton AT , Elliott MN , Schwebel DC , Berkowitz Z , Liddon NC , Tortolero SR , Cuccaro PM , Davies SL , Schuster MA . Soc Sci Med 2017 200 238-248 RATIONALE: Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care. OBJECTIVE: We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore the role of patient-centered care. METHODS: Using a longitudinal multi-site survey of US parents and adolescents, we assessed whether patient-centered care ratings might shape racial/ethnic and socioeconomic gaps at two decision points in the HPV vaccination process: (1) Whether a medical provider recommends the vaccine and (2) whether a parent decides to vaccinate. RESULTS: We did not find evidence that the association of patient-centeredness with vaccination varies by parent education. In contrast, parent ratings of providers' patient-centeredness were significantly associated with racial/ethnic disparities in parents' reports of receiving a HPV vaccine recommendation from a provider: Among parents who rate patient-centered care as low, white parents' odds of receiving such a recommendation are 2.6 times higher than black parents' odds, but the racial/ethnic gap nearly disappears when parents report high patient-centeredness. Moderated mediation analyses suggest that patient-centeredness is a major contributor underlying vaccination uptake disparities: Among parents who report low patient-centeredness, white parents' odds of vaccinating their child are 8.1 times higher than black parents' odds, while both groups are equally likely to vaccinate when patient-centeredness is high. CONCLUSION: The results indicate that patient-centered care, which has been a relatively understudied factor in the unequal diffusion of medical innovations, deserves more attention. Efforts to raise HPV vaccination rates should explore why certain patient groups may be less likely to receive recommendations and should support providers to consistently inform all patient groups about vaccination. |
Racial and ethnic disparities in ADHD diagnosis and treatment
Coker TR , Elliott MN , Toomey SL , Schwebel DC , Cuccaro P , Tortolero Emery S , Davies SL , Visser SN , Schuster MA . Pediatrics 2016 138 (3) OBJECTIVES: We examined racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis and medication use and determined whether medication disparities were more likely due to underdiagnosis or undertreatment of African-American and Latino children, or overdiagnosis or overtreatment of white children. METHODS: We used a population-based, multisite sample of 4297 children and parents surveyed over 3 waves (fifth, seventh, and 10th grades). Multivariate logistic regression examined disparities in parent-reported ADHD diagnosis and medication use in the following analyses: (1) using the total sample; (2) limited to children with an ADHD diagnosis or symptoms; and (3) limited to children without a diagnosis or symptoms. RESULTS: Across all waves, African-American and Latino children, compared with white children, had lower odds of having an ADHD diagnosis and of taking ADHD medication, controlling for sociodemographics, ADHD symptoms, and other potential comorbid mental health symptoms. Among children with an ADHD diagnosis or symptoms, African-American children had lower odds of medication use at fifth, seventh, and 10th grades, and Latino children had lower odds at fifth and 10th grades. Among children who had neither ADHD symptoms nor ADHD diagnosis by fifth grade (and thus would not likely meet ADHD diagnostic criteria at any age), medication use did not vary by race/ethnicity in adjusted analysis. CONCLUSIONS: Racial/ethnic disparities in parent-reported medication use for ADHD are robust, persisting from fifth grade to 10th grade. These findings suggest that disparities may be more likely related to underdiagnosis and undertreatment of African-American and Latino children as opposed to overdiagnosis or overtreatment of white children. |
Relationship of age for grade and pubertal stage to early initiation of substance use
Dudovitz RN , Chung PJ , Elliott MN , Davies SL , Tortolero S , Baumler E , Banspach SW , Schuster MA . Prev Chronic Dis 2015 12 E203 INTRODUCTION: Studies suggest students who are substantially older than the average age for their grade engage in risky health behaviors, including substance use. However, most studies do not account for the distinct reasons why students are old for their grade (ie, grade retention vs delayed school entry) or for their pubertal stage. Thus, whether the association between age for grade and substance use is confounded by these factors is unknown. We sought to determine whether age, grade, or pubertal stage were associated with early substance use. METHODS: Cross-sectional Healthy Passages Wave I survey data from 5,147 fifth graders and their caregivers in Alabama, California, and Texas from 2004 through 2006 were analyzed in 2014. Logistic regressions examined whether older age for grade, grade retention, delayed school entry, or pubertal stage were associated with use of any substance, cigarettes, alcohol, or other drugs. RESULTS: Seventeen percent of fifth graders reported trying at least 1 substance. Among boys, advanced pubertal stage was associated with increased odds of cigarette, alcohol, or other drug use, whereas delayed school entry was associated with lower odds of any substance, alcohol, or other drug use. Among girls, advanced pubertal stage was associated only with higher odds of alcohol use, and delayed school entry was not associated with substance use. Neither older age for grade or grade retention was independently associated with substance use after controlling for potential confounders. CONCLUSION: Advanced pubertal stage may be a more important risk factor for substance use than age for grade. Pediatricians should consider initiating substance use screening earlier for patients with advanced pubertal stage. |
The association between youth violence exposure and attention-deficit/hyperactivity disorder (ADHD) symptoms in a sample of fifth-graders
Lewis T , Schwebel DC , Elliott MN , Visser SN , Toomey SL , McLaughlin KA , Cuccaro P , Tortolero Emery S , Banspach SW , Schuster MA . Am J Orthopsychiatry 2015 85 (5) 504-13 The purpose of the current study was to examine the association between violence exposures (no exposure, witness or victim only, and both witness and victim) and attention-deficit/hyperactivity disorder (ADHD) symptoms, as well as the potential moderating role of gender. Data from 4,745 5th graders and their primary caregivers were drawn from the Healthy Passages study of adolescent health. Parent respondents completed the DISC Predictive Scales for ADHD, and youth provided information about exposure to violence. Results indicated that youth who reported both witnessing and victimization had more parent-reported ADHD symptoms and were more likely to meet predictive criteria for ADHD. Among those with both exposures, girls exhibited a steeper increase in ADHD symptoms and higher probability of meeting predictive criteria than did boys. Findings indicate that being both victim-of and witness-to violence is significantly associated with ADHD symptoms particularly among girls. (PsycINFO Database Record |
TV viewing, perceived similarity, coviewing, and mental well-being among African American, Latino, and White children
McDade-Montez E , Wallander J , Elliott M , Grunbaum JA , Tortolero S , Cuccaro P , Schuster MA . J Early Adolesc 2015 35 (3) 329-352 Research among adults has demonstrated concurrent and prospective negative associations between TV viewing and mental health, yet little research has examined these associations among African American and Latino youth or examined the role of children's involvement with TV and parental mediation of TV viewing via coviewing. The purpose of the present study is to examine associations between TV viewing, perceived similarity, and coviewing and mental well-being in African American, Latino, and White children. Results from Healthy Passages a study of 4,824 African American (30%), Latino (47%), and White (23%) fifth graders, indicated that TV viewing and perceived similarity were negatively associated with mental well-being among most groups of children, and coviewing was positively associated with mental well-being among Latinos. This study extends findings from adult research on media exposure and mental well-being into a diverse sample of fifth graders and illuminates the role of perceived similarity and coviewing. |
Gender role orientation is associated with health-related quality of life differently among African-American, Hispanic, and White youth
Scott SM , Wallander JL , Depaoli S , Elliott MN , Grunbaum JA , Tortolero SR , Cuccaro PM , Schuster MA . Qual Life Res 2015 24 (9) 2139-49 PURPOSE: This study examined the association between gender role orientation (GRO) and health-related quality of life (HRQOL) in youth, and how this relationship may differ between males and females as well as among African-American, White, and Hispanic individuals. GRO has been reported to influence serious health outcomes including cancer, heart disease, mental illness, and mortality rates. However, few studies have examined the link between GRO and health outcomes for children, even though gender identity is formed in childhood. METHODS: Data were examined from 4824 participants in the Healthy Passages project, a population-based survey of fifth-grade children in three US metropolitan areas. Children reported their own HRQOL using the PedsQL and degree of female, male, and androgynous GRO using the Children's Sex Role Inventory. RESULTS: Based on structural equations analysis, male GRO was positively associated with HRQOL for all racial/ethnic groups, regardless of sex, whereas female GRO was associated with better HRQOL for Hispanic and White females and poorer HRQOL for Hispanic males. Androgynous GRO was associated with better HRQOL among Hispanic and White females, but not males nor African-Americans of either sex. CONCLUSIONS: Racial/ethnic differences emerged for female and androgynous, but not male, GROs. Hispanic males are the only group for which GRO (female) was associated with poorer HRQOL. Future research should find ways to help youth overcome negative effects on health from gender beliefs and behavior patterns with sensitivity to racial/ethnic membership. |
Media violence exposure and physical aggression in fifth-grade children
Coker TR , Elliott MN , Schwebel DC , Windle M , Toomey SL , Tortolero SR , Hertz MF , Peskin MF , Schuster MA . Acad Pediatr 2014 15 (1) 82-8 OBJECTIVE: To examine the association of media violence exposure and physical aggression in fifth graders across 3 media types. METHODS: We analyzed data from a population-based, cross-sectional survey of 5,147 fifth graders and their parents in 3 US metropolitan areas. We used multivariable linear regression and report partial correlation coefficients to examine associations between children's exposure to violence in television/film, video games, and music (reported time spent consuming media and reported frequency of violent content: physical fighting, hurting, shooting, or killing) and the Problem Behavior Frequency Scale. RESULTS: Child-reported media violence exposure was associated with physical aggression after multivariable adjustment for sociodemographics, family and community violence, and child mental health symptoms (partial correlation coefficients: TV, 0.17; video games, 0.15; music, 0.14). This association was significant and independent for television, video games, and music violence exposure in a model including all 3 media types (partial correlation coefficients: TV, 0.11; video games, 0.09; music, 0.09). There was a significant positive interaction between media time and media violence for video games and music but not for television. Effect sizes for the association of media violence exposure and physical aggression were greater in magnitude than for most of the other examined variables. CONCLUSIONS: The association between physical aggression and media violence exposure is robust and persistent; the strength of this association of media violence may be at least as important as that of other factors with physical aggression in children, such as neighborhood violence, home violence, child mental health, and male gender. |
Cultural orientations, parental beliefs and practices, and latino adolescents' autonomy and independence
Roche KM , Caughy MO , Schuster MA , Bogart LM , Dittus PJ , Franzini L . J Youth Adolesc 2014 43 (8) 1389-403 Despite the salience of behavioral autonomy and independence to parent-child interactions during middle adolescence, little is known about parenting processes pertinent to youth autonomy development for Latino families. Among a diverse sample of 684 Latino-origin parent-adolescent dyads in Houston, Texas, this study examines how parents' cultural orientations are associated directly and indirectly, through parental beliefs, with parenting practices giving youth behavioral autonomy and independence. Informed by social domain theory, the study's parenting constructs pertain to youth behaviors in an "ambiguously personal" domain-activities that adolescents believe are up to youth to decide, but which parents might argue require parents' supervision, knowledge, and/or decision-making. Results for latent profile analyses of parents' cultural identity across various facets of acculturation indicate considerable cultural heterogeneity among Latino parents. Although 43 % of parents have a Latino cultural orientation, others represent Spanish-speaking/bicultural (21 %), bilingual/bicultural (15 %), English-speaking/bicultural (15 %), or US (6 %) cultural orientations. Structural equation modeling results indicate that bilingual/bicultural, English-speaking/bicultural, and US-oriented parents report less emphasis on the legitimacy of parental authority and younger age expectations for youth to engage in independent behaviors than do Latino-oriented parents. Parental beliefs endorsing youth's behavioral independence and autonomy, in turn, are associated with less stringent parental rules (parental report), less parental supervision (parental and youth report), and more youth autonomy in decision-making (parental and youth report). Evidence thus supports the idea that the diverse cultural orientations of Latino parents in the US may result in considerable variations in parenting processes pertinent to Latino adolescents' development. |
School programs and characteristics and their influence on student BMI: findings from Healthy Passages
Richmond TK , Elliott MN , Franzini L , Kawachi I , Caughy MO , Gilliland MJ , Walls CE , Franklin FA , Lowry R , Banspach SW , Schuster MA . PLoS One 2014 9 (1) e83254 BACKGROUND: Little is known about the contribution of school contextual factors to individual student body mass index (BMI). We set out to determine if school characteristics/resources: (1) are associated with student BMI; (2) explain racial/ethnic disparities in student BMI; and (3) explain school-level differences in student BMI. METHODS: Using gender-stratified multi-level modeling strategies we examined the association of school characteristics/resources and individual BMI in 4,387 5(th) graders in the Healthy Passages Longitudinal Study of Adolescent Health. Additionally, we examined the association of race/ethnicity and individual BMI as well as the between-school variance in BMI before and after adding individual and school characteristics to test for attenuation. RESULTS: The school-level median household income, but not physical activity or nutrition resources, was inversely associated with female BMI (beta = -0.12, CI: -0.21,-0.02). Neither school demographics nor physical activity/nutrition resources were predictive of individual BMI in males. In Black females, school characteristics attenuated the association of race/ethnicity and BMI. Individual student characteristics-not school characteristics/resources-reduced the between-school variation in BMI in males by nearly one-third and eliminated it in females. CONCLUSIONS: In this cohort of 5(th) graders, school SES was inversely associated with female BMI while school characteristics and resources largely explained Black/White disparities in female weight status. Between-school differences in average student weight status were largely explained by the composition of the student body not by school characteristics or programming. |
Is obesity associated with reduced health-related quality of life in Latino, black and white children in the community?
Wallander JL , Kerbawy S , Toomey S , Lowry R , Elliott MN , Escobar-Chaves SL , Franzini L , Schuster MA . Int J Obes (Lond) 2013 37 (7) 920-5 OBJECTIVE: Few studies have examined the impact of obesity on health-related quality of life (HRQOL) in non-clinical community samples of children, and methodological limitations have hindered drawing firm conclusions, especially whether the impact is similar across racial/ethnic groups. The present aims were to examine at what levels of non-normal weight, school-aged children experience lower HRQOL and whether this differs among racial/ethnic groups, when controlling for socioeconomic status (SES) differences. DESIGN: Cross-sectional community cohort survey.Subjects and methods:Data are from the Healthy Passages, reporting on 4824 Latino, black and white 5th graders in a population-based survey conducted in three United States metropolitan areas. Children's weight status was classified from measured weight and height into underweight (1%), normal weight (52%), overweight (19%), obese (13%) and extremely obese (14%). Children reported their own HRQOL using the Pediatric Quality of Life Inventory and additional scales addressing global self-worth, physical appearance and body satisfaction. Parents reported children's overall health status. RESULTS: Each increment in higher non-healthy weight class-overweight to obese to extremely obese-was associated with significantly lower scores in more domains of psychosocial HRQOL compared with that in normal weight. However, only extremely obese children reported significantly lower physical HRQOL. Differences among weight classes remained when adjusting for SES and were independent of race/ethnicity. Underweight children generally reported HRQOL that was not significantly different from normal weight children. CONCLUSIONS: Overweight, obese and extremely obese 5th graders on average experience worse HRQOL than normal weight children, especially in psychosocial domains including self-worth and peer relationships, regardless of race/ethnicity. If messages can be conveyed in a sensitive and supportive manner, the desire to improve HRQOL could provide additional motivation for children and their parents in addressing unhealthy weight. |
Parental and home environmental facilitators of sugar-sweetened beverage consumption among overweight and obese Latino youth
Bogart LM , Cowgill BO , Sharma AJ , Uyeda K , Sticklor LA , Alijewicz KE , Schuster MA . Acad Pediatr 2013 13 (4) 348-55 OBJECTIVE: To explore parental and home environmental facilitators of sugar-sweetened beverage (SSB) and water consumption among obese/overweight Latino youth. METHODS: Semistructured interviews were conducted with 55 overweight/obese Latino youth aged 10 to 18 and 55 parents, recruited from school-based clinics and a school in one West Coast district. All youth consumed SSBs regularly and lived in a home where SSBs were available. We used qualitative methods to examine key themes around beliefs about SSBs and water, facilitators of SSB and water consumption, and barriers to reducing SSB consumption. RESULTS: A few parents and youth believed that sports drinks are healthy. Although nearly all thought that water is healthy, most parents and about half of youth thought that tap water is unsafe. About half of parent-child dyads had discordant beliefs regarding their perceptions of tap water. About half of parents believed that homemade culturally relevant drinks (eg, aguas frescas), which typically contain sugar, fruit, and water, were healthy because of their "natural" ingredients. Participants cited home availability as a key factor in SSB consumption. About half of parents set no rules about SSB consumption at home. Among those with rules, most parent-child pairs differed on their beliefs about the content of the rules, and youth reported few consequences for breaking rules. CONCLUSIONS: Obesity programs for Latino youth should address misconceptions around water and should discuss culturally relevant drinks and sports drinks as potential sources of weight gain. Health care providers can help parents set appropriate rules by educating about the risks of keeping SSBs at home. |
Association between perceived discrimination and racial/ethnic disparities in problem behaviors among preadolescent youths
Bogart LM , Elliott MN , Kanouse DE , Klein DJ , Davies SL , Cuccaro PM , Banspach SW , Peskin MF , Schuster MA . Am J Public Health 2013 103 (6) 1074-81 OBJECTIVES: We examined the contribution of perceived racial/ethnic discrimination to disparities in problem behaviors among preadolescent Black, Latino, and White youths. METHODS: We used cross-sectional data from Healthy Passages, a 3-community study of 5119 fifth graders and their parents from August 2004 through September 2006 in Birmingham, Alabama; Los Angeles County, California; and Houston, Texas. We used multivariate regressions to examine the relationships of perceived racial/ethnic discrimination and race/ethnicity to problem behaviors. We used values from these regressions to calculate the percentage of disparities in problem behaviors associated with the discrimination effect. RESULTS: In multivariate models, perceived discrimination was associated with greater problem behaviors among Black and Latino youths. Compared with Whites, Blacks were significantly more likely to report problem behaviors, whereas Latinos were significantly less likely (a "reverse disparity"). When we set Blacks' and Latinos' discrimination experiences to zero, the adjusted disparity between Blacks and Whites was reduced by an estimated one third to two thirds; the reverse adjusted disparity favoring Latinos widened by about one fifth to one half. CONCLUSIONS: Eliminating discrimination could considerably reduce mental health issues, including problem behaviors, among Black and Latino youths. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e8. doi:10.2105/AJPH.2012.301073). |
Parental and peer factors associated with body image discrepancy among fifth-grade boys and girls
Michael SL , Wentzel K , Elliott MN , Dittus PJ , Kanouse DE , Wallander JL , Pasch KE , Franzini L , Taylor WC , Qureshi T , Franklin FA , Schuster MA . J Youth Adolesc 2013 43 (1) 15-29 Many young adolescents are dissatisfied with their body due to a discrepancy between their ideal and actual body size, which can lead to weight cycling, eating disorders, depression, and obesity. The current study examined the associations of parental and peer factors with fifth-graders' body image discrepancy, physical self-worth as a mediator between parental and peer factors and body image discrepancy, and how these associations vary by child's sex. Body image discrepancy was defined as the difference between young adolescents' self-perceived body size and the size they believe a person their age should be. Data for this study came from Healthy Passages, which surveyed 5,147 fifth graders (51 % females; 34 % African American, 35 % Latino, 24 % White, and 6 % other) and their primary caregivers from the United States. Path analyses were conducted separately for boys and girls. The findings for boys suggest father nurturance and getting along with peers are related negatively to body image discrepancy; however, for girls, fear of negative evaluation by peers is related positively to body image discrepancy. For both boys and girls, getting along with peers and fear of negative evaluation by peers are related directly to physical self-worth. In addition, mother nurturance is related positively to physical self-worth for girls, and father nurturance is related positively to physical self-worth for boys. In turn, physical self-worth, for both boys and girls, is related negatively to body image discrepancy. The findings highlight the potential of parental and peer factors to reduce fifth graders' body image discrepancy. |
Racial/ethnic disparities in health-related quality of life and health in children are largely mediated by family contextual differences
Wallander JL , Fradkin C , Chien AT , Mrug S , Banspach SW , Davies S , Elliott MN , Franzini L , Schuster MA . Acad Pediatr 2012 12 (6) 532-8 OBJECTIVE: To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL), and overall health status among African-American, Hispanic, and white 5th graders in the general population and (2) the extent to which socioeconomic status (SES) and other family contextual variables mediate any disparities. METHODS: A total of 4824 African-American, Hispanic, and white fifth-graders participating in a population-based, cross-sectional survey conducted in 3 U.S. metropolitan areas reported their own HRQOL by using the Pediatric Quality of Life Inventory Version 4.0 and supplemental personal and social well-being scales. Parents reported these children's overall health status. SES was indexed by parent education and household income. Other family contextual variables included family structure and degree to which English is spoken at home. RESULTS: Marked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring white children and especially disfavoring Hispanic children. Most of these disparities were no longer significant after adjusting for SES and other family contextual differences that were observed among these racial/ethnic groups. Only disparities in parent-reported overall health status and self-reported global self-worth remained. CONCLUSIONS: Racial/ethnic disparities in children's health status are substantial but may be mediated by corresponding disparities in SES and other family contextual variables. Race/ethnicity and family context are related to one another and should be considered jointly in efforts to reduce health disparities in children. |
Racial and ethnic health disparities among fifth-graders in three cities
Schuster MA , Elliott MN , Kanouse DE , Wallander JL , Tortolero SR , Ratner JA , Klein DJ , Cuccaro PM , Davies SL , Banspach SW . N Engl J Med 2012 367 (8) 735-45 BACKGROUND: For many health-related behaviors and outcomes, racial and ethnic disparities among adolescents are well documented, but less is known about health-related disparities during preadolescence. METHODS: We studied 5119 randomly selected public-school fifth-graders and their parents in three metropolitan areas in the United States. We examined differences among black, Latino, and white children on 16 measures, including witnessing of violence, peer victimization, perpetration of aggression, seat-belt use, bike-helmet use, substance use, discrimination, terrorism worries, vigorous exercise, obesity, and self-rated health status and psychological and physical quality of life. We tested potential mediators of racial and ethnic disparities (i.e., sociodemographic characteristics and the child's school) using partially adjusted models. RESULTS: There were significant differences between black children and white children for all 16 measures and between Latino children and white children for 12 of 16 measures, although adjusted analyses reduced many of these disparities. For example, in unadjusted analysis, the rate of witnessing a threat or injury with a gun was higher among blacks (20%) and Latinos (11%) than among whites (5%), and the number of days per week on which the student performed vigorous exercise was lower among blacks (3.56 days) and Latinos (3.77 days) than among whites (4.33 days) (P<0.001 for all comparisons). After statistical adjustment, these differences were reduced by about half between blacks and whites and were eliminated between Latinos and whites. Household income, household highest education level, and the child's school were the most substantial mediators of racial and ethnic disparities. CONCLUSIONS: We found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children. Adjustment for socioeconomic status and the child's school substantially reduced most of these differences. Interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health. (Funded by the Centers for Disease Control and Prevention.). |
Unmet eye care needs among U.S. 5th-grade students
Zhang X , Elliott MN , Saaddine JB , Berry JG , Cuccaro P , Tortolero S , Franklin F , Barker LE , Schuster MA . Am J Prev Med 2012 43 (1) 55-8 BACKGROUND: There is substantial evidence of a disparity in access to eye care services among adults in the U.S.; however, little is known about health disparities for children's eye care. PURPOSE: The goal of the study was to assess the prevalence of and risk factors for 5th-grade students' unmet eye care needs. METHODS: Data were collected from 5147 5th-grade students (aged 10-11 years) and their parents and primary caregivers (hereafter "parents") participating in the Healthy Passages study between fall 2004 and summer 2006 (analyzed in 2011). Logistic regression estimated the probability of inability to afford needed eyeglasses and absence of vision insurance coverage. RESULTS: 1794 5th-grade students wore eyeglasses or were told that they need eyeglasses; 13.7% of their parents were unable to afford needed eyeglasses (new prescription or replacement) for their children; 27.4% of their parents reported no vision insurance coverage for eye examinations and eyeglasses. After controlling for confounders, parents without general children's health insurance were more likely to report being unable to afford eyeglasses than those with health insurance (Medicaid, SCHIP, private/other insurance; adjusted percentages: 22.5% vs 10.9%, 9.6%, 12.5%; all p<0.05). Parents with lower income were more likely to report being unable to afford children's eyeglasses even after controlling for all other factors (17.6% with income <$15,000 vs 2.7% with income ≥$70,000; p<0.001). CONCLUSIONS: SES and health insurance status are strongly associated with 5th-grade students' unmet eye care needs. Policies targeting socioeconomically disadvantaged groups and those without insurance may be needed to reduce disparities in access to appropriate eye care. |
Marital conflict and fifth-graders' risk for injury
Schwebel DC , Roth DL , Elliott MN , Chien AT , Mrug S , Shipp E , Dittus P , Zlomke K , Schuster MA . Accid Anal Prev 2012 47 30-5 BACKGROUND: Injuries are the leading cause of morbidity and mortality for American children. Marital conflict has been associated with a range of negative health outcomes, but little is known about how marital conflict may influence risk of injury among children. We hypothesized marital conflict would be related to increased youth injury risk after controlling for relevant demographic and parenting covariates. METHODS: A community sample of 3218 fifth-graders recruited from three US locales was utilized. Ordinal logistic regression models were used to predict the frequency of unintentional injuries from marital conflict while adjusting for demographics, parenting factors (nurturance, communication, involvement with youth), and family cohesion. RESULTS: Higher levels of marital conflict were associated with higher rates of injury that required professional medical attention (OR=1.20, 95% CI 1.06, 1.35 per standard deviation). The same association held after inclusion of all covariates in a multivariate ordinal logistic regression model. CONCLUSIONS: Parental marital conflict is associated with higher rates of injuries requiring professional medical attention in preadolescent children. |
Association of externalizing behavior disorder symptoms and injury among fifth graders
Schwebel DC , Roth DL , Elliott MN , Visser SN , Toomey SL , Shipp EM , Grunbaum JA , Schuster MA . Acad Pediatr 2011 11 (5) 427-31 OBJECTIVE: Injury is the leading cause of death among American youth, killing more 11-year-olds than all other causes combined. Children with symptoms of externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) may have increased risk. Our aims were to determine: (1) whether increasing symptoms of ADHD and CD associate positively with injuries among a community sample of fifth graders; and (2) whether symptoms of ADHD and CD have a multiplicative rather than additive association with injuries among the sample. METHODS: Data were collected from 4745 fifth graders and their primary caregivers participating in Healthy Passages, a multisite, community-based study of pediatric health risk behaviors and health outcomes. The primary outcome was injury frequency. Primary independent variables were ADHD and CD symptoms. Additional covariates included gender, race/ethnicity, and household income. Ordinal logistic regression examined correlates of injury frequency. The interaction between ADHD and CD symptoms also was examined. RESULTS: In bivariate analyses, the odds of injury increased as ADHD symptoms (odds ratio [OR] 1.29; 95% confidence interval [95% CI] 1.18-1.41) and CD symptoms (OR 1.18; 95% CI 1.07-1.31) increased. However, in multivariate analysis, only ADHD symptoms were significantly associated with injury (OR 1.22; 95% CI 1.10-1.35). There was no statistically significant interaction between ADHD and CD symptoms. CONCLUSIONS: ADHD symptoms are associated with increased odds of injury in fifth graders. Findings have implications for potential injury prevention strategies for mental health practitioners (for example, cognitive training with at-risk youth), pediatricians (ADHD screening), and parents (improved supervision). |
Association of family stressful life-change events and health-related quality of life in fifth-grade children
Coker TR , Elliott MN , Wallander JL , Cuccaro P , Grunbaum JA , Corona R , Saunders AE , Schuster MA . Arch Pediatr Adolesc Med 2011 165 (4) 354-9 OBJECTIVE: To examine the association of recent family-related stressful life-change events (SLEs) with health-related quality of life (HRQOL) in fifth graders. DESIGN: Population-based, cross-sectional survey. SETTING: Three US metropolitan areas; 2004-2006. PARTICIPANTS: A total of 5147 fifth graders and their parents. MAIN EXPOSURES: Nine recent family-related SLEs: a parent's death, another family member's death, a family member's injury/illness, a family member's alcohol/drug problems, loss of a pet, recent change of residence, addition of a new baby or child to the household, parental separation, and parental divorce. MAIN OUTCOME MEASURE: The HRQOL measured using the 23-item Pediatric Quality of Life Inventory. RESULTS: Twenty-four percent of children had no reported recent SLEs; 33% had 1, 25% had 2, 12% had 3, and 6% had 4 or more. Mean HRQOL scores (total, physical, and psychosocial scales) were lower for children with more SLEs. The mean total HRQOL score was 80.4 (95% confidence interval, 79.4-81.3) for children with no recent SLEs and 71.8 (70.2-73.5) for children with 4 or more SLEs (P < .001). In adjusted logistic regression analyses, children with more SLEs had greater odds of impaired HRQOL compared with children without any SLEs. Psychosocial HRQOL fully mediated the relationship between SLEs and physical HRQOL. CONCLUSIONS: The occurrence of multiple family-related SLEs in children is associated with less positive HRQOL. By incorporating the needs of families as part of comprehensive, high-quality care, health care professionals can identify these types of family-level needs and assist families in accessing community resources for support. |
The association of activity level, parent mental distress, and parental involvement and monitoring with unintentional injury risk in fifth graders
Schwebel DC , Roth DL , Elliott MN , Windle M , Grunbaum JA , Low B , Cooper SP , Schuster MA . Accid Anal Prev 2011 43 (3) 848-52 OBJECTIVE: Extend findings with young children by examining the strength of association of activity level, parent mental distress, and parental involvement and monitoring with fifth graders' unintentional injuries. METHODS: Ordinal logistic regression models were used to predict unintentional injury frequency among 4745 fifth-graders. Examined predictors included demographics, parent reports of mental distress, temperamental activity level (tendency to be fidgety, restless, and constantly in motion), and parental involvement and monitoring in adolescents' lives. RESULTS: Higher levels of both activity level and parent mental distress predicted more frequent injuries. CONCLUSIONS: As has been found with younger children, unintentional injuries in fifth graders are associated with both parent and child characteristics. The result is discussed in the context of adolescent development. Implications include those for injury prevention (multi-dimensional prevention strategies that incorporate environmental modifications as well as training of youth and parents) and future research (study of potential mechanisms behind injury risk behavior via longitudinal and experimental research; study of injury risk during this phase of child development). |
Factor structure and psychometric properties of the Brief Symptom Inventory-18 in women: a MACS approach to testing for invariance across racial/ethnic groups
Wiesner M , Chen V , Windle M , Elliott MN , Grunbaum JA , Kanouse DE , Schuster MA . Psychol Assess 2010 22 (4) 912-922 This study used data from 3 sites to examine the invariance and psychometric characteristics of the Brief Symptom Inventory-18 across Black, Hispanic, and White mothers of 5th graders (N = 4,711; M = 38.07 years of age, SD = 7.16). Internal consistencies were satisfactory for all subscale scores of the instrument regardless of ethnic group membership. Mean and covariance structures analysis indicated that the hypothesized 3-factor structure of the instrument was not robust across ethnic groups. It provided a reasonable approximation to the data for Black and White women but not for Hispanic women. Tests for differential item functioning (DIF) were therefore conducted for only Black and White women. Analyses revealed no more than trivial instances of nonuniform DIF but more substantial evidence of uniform DIF for 3 of the 18 items. After having established partial strong factorial invariance of the instrument, latent factor means were found to be significantly higher for Black than for White women on all 3 subscales (somatization, depression, anxiety). In conclusion, the instrument may be used for mean comparisons between Black and White women. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract). |
Parenting predictors of early-adolescents' health behaviors: simultaneous group comparisons across sex and ethnic groups
Windle M , Brener N , Cuccaro P , Dittus P , Kanouse DE , Murray N , Wallander J , Schuster MA . J Youth Adolesc 2010 39 (6) 594-606 The purpose of this study was to evaluate the invariance of predictive relations across early-adolescent sex and ethnic groups regarding parenting factors and externalizing and internalizing problems and victimization. Data (n = 598; 54% female) from a triethnic (Hispanic, non-Hispanic white, and non-Hispanic black) probability sample of fifth graders collected from three sites (Birmingham, AL, Houston, TX, and Los Angeles, CA) were used in the analyses. Simultaneous group structural equation modeling supported the invariance of parenting-early adolescent outcomes across sex and ethnic groups. Parental monitoring and parental norms were relatively robust predictors of early-adolescent externalizing problems and victimization, and to a lesser extent, of internalizing problems. A maternal nurturance by parental monitoring interaction was statistically significant for all outcome behaviors, indicating that higher monitoring in conjunction with higher maternal nurturance was associated with lower levels of early-adolescent problem behaviors. The findings suggest that core parenting factors such as nurturance, monitoring, and normative expectations for early adolescent problem behaviors may serve as a foundation for parenting components of multi-component intervention studies. |
Neighborhood characteristics favorable to outdoor physical activity: disparities by socioeconomic and racial/ethnic composition
Franzini L , Taylor W , Elliott MN , Cuccaro P , Tortolero SR , Gilliland MJ , Grunbaum J , Schuster MA . Health Place 2010 16 (2) 267-74 This paper uses a socioecological framework to investigate socioeconomic and racial/ethnic disparities in neighborhood characteristics that are associated with outdoor physical activity. We surveyed 632 parents of 5th graders about perceptions of their neighborhood social processes and collected systematic observations of the physical environment on their block-face of residence. Higher poverty neighborhoods and non-White neighborhoods have better accessibility; however, they are less safe, less comfortable, and less pleasurable for outdoor physical activity, and have less favorable social processes. Interventions to reduce disparities in physical activity should address not only the physical environment, but also social processes favorable to physical activity. |
Prevalence, characteristics, and associated health and health care of family homelessness among fifth-grade students
Coker TR , Elliott MN , Kanouse DE , Grunbaum JA , Gilliland MJ , Tortolero SR , Cuccaro P , Schuster MA . Am J Public Health 2009 99 (8) 1446-52 OBJECTIVES: We describe the lifetime prevalence and associated health-related concerns of family homelessness among fifth-grade students. METHODS: We used a population-based, cross-sectional survey of 5147 fifth-grade students in 3 US cities to analyze parent-reported measures of family homelessness, child health status, health care access and use, and emotional, developmental, and behavioral health and child-reported measures of health-related quality of life and exposure to violence. RESULTS: Seven percent of parents reported that they and their child had experienced homelessness (i.e., staying in shelters, cars, or on the street). Black children and children in the poorest families had the highest prevalence of homelessness (11%). In adjusted analyses, most general health measures were similar for children who had and had not been homeless. Children who had ever experienced homelessness were more likely to have an emotional, behavioral, or developmental problem (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.1, 2.6; P = .01), to have received mental health care (OR = 2.2; 95% CI = 1.6, 3.2; P < .001), and to have witnessed serious violence with a knife (OR = 1.6; 95% CI = 1.1, 2.3; P = .007) than were children who were never homeless. CONCLUSIONS: Family homelessness affects a substantial minority of fifth-grade children and may have an impact on their emotional, developmental, and behavioral health. |
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