First name
Aditi
Last name
Vasan

Title

Food Insufficiency Following Discontinuation of Monthly Child Tax Credit Payments Among Lower-Income US Households.

Year of Publication

2022

Number of Pages

e224039

Date Published

11/2022

ISSN Number

2689-0186

Abstract

Importance: The 2021 expanded Child Tax Credit provided advance monthly payments to many US families with children from July through December 2021 and was associated with a reduction in food insufficiency. Less is known about the effect of the discontinuation of monthly payments.

Objective: To assess whether the discontinuation of monthly Child Tax Credit payments was associated with subsequent changes in food insufficiency among lower-income US households with children.

Design, Setting, and Participants: This population-based cross-sectional study used data from the Household Pulse Survey, a recurring online survey of US households conducted by the US Census Bureau, from January 2021 to March 2022. This study estimated difference-in-differences regression models for households making less than $50 000, less than $35 000, and less than $25 000 annually, adjusting for demographic characteristics and state of residence. The estimation sample of households making less than $50 000/y included 114 705 responses, representing a weighted population size of 27 342 296 households.

Exposures: Receipt of monthly Child Tax Credit payments, as measured by living in a household with children during the period of monthly payments from July through December 2021.

Main Outcomes and Measures: Household food insufficiency, as measured by a respondent indicating that there was sometimes or often not enough food to eat in the household in the previous 7 days.

Results: Among 114 705 households making less than $50 000/y, respondents were predominantly female (57%); White (71%); not of Hispanic, Latino, or Spanish origin (79%); had high school or equivalent education (38%); and were unmarried (70%). Following the discontinuation of monthly Child Tax Credit payments, food insufficiency in US households with children increased by 3.5 percentage points (95% CI, 1.4-5.7 percentage points) among households making less than $50 000/y, 4.9 percentage points (95% CI, 2.6-7.3 percentage points) among households making less than $35 000/y, and 6.2 percentage points (95% CI, 3.3-9.3 percentage points) among households making less than $25 000/y. These estimates represent a relative increase in food insufficiency of approximately 16.7% among households making less than $50 000/y, 20.8% among households making less than $35 000/y, and 23.2% among households making less than $25 000/y.

Conclusions and Relevance: In this population-based cross-sectional study, discontinuation of monthly Child Tax Credit payments in December 2021 was associated with a statistically significant increase in household food insufficiency among lower-income households, with the greatest increase occurring in the lowest-income households.

DOI

10.1001/jamahealthforum.2022.4039

Alternate Title

JAMA Health Forum

PMID

36367738

Title

Food Insufficiency Following Discontinuation of Monthly Child Tax Credit Payments Among Lower-Income US Households.

Year of Publication

2022

Number of Pages

e224039

Date Published

11/2022

ISSN Number

2689-0186

Abstract

Importance: The 2021 expanded Child Tax Credit provided advance monthly payments to many US families with children from July through December 2021 and was associated with a reduction in food insufficiency. Less is known about the effect of the discontinuation of monthly payments.

Objective: To assess whether the discontinuation of monthly Child Tax Credit payments was associated with subsequent changes in food insufficiency among lower-income US households with children.

Design, Setting, and Participants: This population-based cross-sectional study used data from the Household Pulse Survey, a recurring online survey of US households conducted by the US Census Bureau, from January 2021 to March 2022. This study estimated difference-in-differences regression models for households making less than $50 000, less than $35 000, and less than $25 000 annually, adjusting for demographic characteristics and state of residence. The estimation sample of households making less than $50 000/y included 114 705 responses, representing a weighted population size of 27 342 296 households.

Exposures: Receipt of monthly Child Tax Credit payments, as measured by living in a household with children during the period of monthly payments from July through December 2021.

Main Outcomes and Measures: Household food insufficiency, as measured by a respondent indicating that there was sometimes or often not enough food to eat in the household in the previous 7 days.

Results: Among 114 705 households making less than $50 000/y, respondents were predominantly female (57%); White (71%); not of Hispanic, Latino, or Spanish origin (79%); had high school or equivalent education (38%); and were unmarried (70%). Following the discontinuation of monthly Child Tax Credit payments, food insufficiency in US households with children increased by 3.5 percentage points (95% CI, 1.4-5.7 percentage points) among households making less than $50 000/y, 4.9 percentage points (95% CI, 2.6-7.3 percentage points) among households making less than $35 000/y, and 6.2 percentage points (95% CI, 3.3-9.3 percentage points) among households making less than $25 000/y. These estimates represent a relative increase in food insufficiency of approximately 16.7% among households making less than $50 000/y, 20.8% among households making less than $35 000/y, and 23.2% among households making less than $25 000/y.

Conclusions and Relevance: In this population-based cross-sectional study, discontinuation of monthly Child Tax Credit payments in December 2021 was associated with a statistically significant increase in household food insufficiency among lower-income households, with the greatest increase occurring in the lowest-income households.

DOI

10.1001/jamahealthforum.2022.4039

Alternate Title

JAMA Health Forum

PMID

36367738

Title

Promoting Health Equity Through Family-Centered Social Needs Screening and Intervention in the Inpatient Setting.

Year of Publication

2022

Number of Pages

e275-e277

Date Published

08/2022

ISSN Number

2154-1671

DOI

10.1542/hpeds.2022-006725

Alternate Title

Hosp Pediatr

PMID

35843956

Title

Community Resource Connection for Pediatric Caregivers with Unmet Social Needs: A Qualitative Study.

Year of Publication

2021

Date Published

2021 Sep 24

ISSN Number

1876-2867

Abstract

<p><strong>OBJECTIVE: </strong>Pediatric health systems are increasingly screening caregivers for unmet social needs. However, it remains unclear how best to connect families with unmet needs to available and appropriate community resources. We aimed to explore caregivers' perceived barriers to and facilitators of community resource connection.</p>

<p><strong>METHODS: </strong>We conducted semi-structured interviews with caregivers of pediatric patients admitted to one inpatient unit of an academic quaternary care children's hospital. All caregivers who screened positive for one or more unmet social needs on a tablet-based screener were invited to participate in an interview. Interviews were recorded, transcribed, and coded by two independent coders using content analysis, resolving discrepancies by consensus. Interviews continued until thematic saturation was achieved.</p>

<p><strong>RESULTS: </strong>We interviewed 28 of 31 eligible caregivers. Four primary themes emerged. First, caregivers of children with complex chronic conditions felt that competing priorities related to their children's medical care often made it more challenging to establish connection with resources. Second, caregivers cited burdensome application and enrollment processes as a barrier to resource connection. Third, caregivers expressed a preference for geographically tailored, web-based resources, rather than paper resources. Lastly, caregivers expressed a desire for ongoing longitudinal support in establishing and maintaining connections with community resources after their child's hospital discharge.</p>

<p><strong>CONCLUSION: </strong>Pediatric caregivers with unmet social needs reported competing priorities and burdensome application processes as barriers to resource connection. Electronic resources can help caregivers identify locally available services, but longitudinal supports may also be needed to ensure caregivers can establish and maintain linkages with these services.</p>

DOI

10.1016/j.acap.2021.09.010

Alternate Title

Acad Pediatr

PMID

34571255

Title

Association of Neighborhood Gun Violence With Mental Health-Related Pediatric Emergency Department Utilization.

Year of Publication

2021

Date Published

2021 Sep 20

ISSN Number

2168-6211

Abstract

<p><strong>Importance: </strong>Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood.</p>

<p><strong>Objective: </strong>To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization.</p>

<p><strong>Design, Setting, and Participants: </strong>This location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021.</p>

<p><strong>Exposure: </strong>Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence.</p>

<p><strong>Main Outcomes and Measures: </strong>ED encounters for a mental health-related chief complaint or primary diagnosis.</p>

<p><strong>Results: </strong>A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health-related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]).</p>

<p><strong>Conclusions and Relevance: </strong>Exposure to neighborhood gun violence is associated with an increase in children's acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children's exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.</p>

DOI

10.1001/jamapediatrics.2021.3512

Alternate Title

JAMA Pediatr

PMID

34542562

Title

Using Quality Improvement and Technology to Improve Social Supports for Hospitalized Children.

Year of Publication

2021

Date Published

2021 Sep 02

ISSN Number

2154-1671

Abstract

<p><strong>OBJECTIVES: </strong>To develop and test the feasibility of a caregiver self-administered social needs screener, a Web-based searchable community resource map, and a process map for implementation of these tools as part of social needs screening and referral on a pediatric inpatient unit.</p>

<p><strong>METHODS: </strong>A multidisciplinary team used quality improvement methodology to develop an electronic social needs screener, resource map Web site, and electronic health record enhancements. A process map for implementation of these tools was refined through plan-do-study-act cycles before full implementation. Weekly measures included the number of eligible caregivers screened, prevalence of reported social needs, and use of social work resources.</p>

<p><strong>RESULTS: </strong>During the 22-week study period, 147 caregivers were screened and 2 declined to participate. Thirty-four percent of caregivers endorsed ≥1 social need. The most common needs identified were depressive symptoms (23%), food insecurity (19%), and need for assistance with utilities (10%). All participants received information about the resource map, and 99% of caregivers with an identified need met with a social worker during their admission.</p>

<p><strong>CONCLUSIONS: </strong>Using quality improvement methodology and technology, the team implemented a new standardized process for addressing social needs on an inpatient unit. This led to identification of social needs in more than one-third of caregivers screened and provision of resource map information to all caregivers. These findings reinforce the importance of standardized assessment of social needs in the pediatric inpatient setting. The role of technology, including resource maps and electronic health record enhancements, was highlighted.</p>

DOI

10.1542/hpeds.2020-005800

Alternate Title

Hosp Pediatr

PMID

34475224

Title

Association of WIC Participation and Electronic Benefits Transfer Implementation.

Year of Publication

2021

Date Published

2021 Mar 29

ISSN Number

2168-6211

Abstract

<p><strong>Importance: </strong>The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important source of nutritional support and education for women and children living in poverty; although WIC participation confers clear health benefits, only 50% of eligible women and children currently receive WIC. In 2010, Congress mandated that states transition WIC benefits by 2020 from paper vouchers to electronic benefits transfer (EBT) cards, which are more convenient to use, are potentially less stigmatizing, and may improve WIC participation.</p>

<p><strong>Objective: </strong>To estimate the state-level association between transition from paper vouchers to EBT and subsequent WIC participation.</p>

<p><strong>Design, Setting, and Participants: </strong>This economic evaluation of state-level WIC monthly benefit summary administrative data regarding participation between October 1, 2014, and November 30, 2019, compared states that did and did not implement WIC EBT during this time period. Difference-in-differences regression modeling allowed associations to vary by time since policy implementation and included stratified analyses for key subgroups (pregnant and postpartum women, infants younger than 1 year, and children aged 1-4 years). All models included dummy variables denoting state, year, and month as covariates. Data analyses were performed between March 1 and June 15, 2020.</p>

<p><strong>Exposures: </strong>Statewide transition from WIC paper vouchers to WIC EBT cards, specified by month and year.</p>

<p><strong>Main Outcomes and Measures: </strong>Monthly number of state residents enrolled in WIC.</p>

<p><strong>Results: </strong>A total of 36 states implemented WIC EBT before or during the study period. EBT and non-EBT states had similar baseline rates of poverty and food insecurity. Three years after statewide WIC EBT implementation, WIC participation increased by 7.78% (95% CI, 3.58%-12.15%) in exposed states compared with unexposed states. In stratified analyses, WIC participation increased by 7.22% among pregnant and postpartum women (95% CI, 2.54%-12.12%), 4.96% among infants younger than 1 year (95% CI, 0.95%-9.12%), and 9.12% among children aged 1 to 4 years (95% CI, 3.19%-15.39%; P for interaction = .20). Results were robust to adjustment for state unemployment and poverty rates, population, and Medicaid expansion status.</p>

<p><strong>Conclusions and Relevance: </strong>In this study, the transition from paper vouchers to WIC EBT was associated with a significant and sustained increase in enrollment. Interventions that simplify the process of redeeming benefits may be critical for addressing low rates of enrollment in WIC and other government benefit programs.</p>

DOI

10.1001/jamapediatrics.2020.6973

Alternate Title

JAMA Pediatr

PMID

33779712

Title

Building Political Capital: Engaging Families in Child Health Policy.

Year of Publication

2020

Date Published

2020 Sep 29

ISSN Number

1098-4275

DOI

10.1542/peds.2020-0766

PMID

32994180

Title

Pediatric provider perspectives and practices regarding health policy discussions with families: a mixed methods study.

Year of Publication

2020

Number of Pages

343

Date Published

2020 Jul 13

ISSN Number

1471-2431

Abstract

<p><strong>BACKGROUND: </strong>Advocacy regarding child health policy is a core tenet of pediatrics. Previous research has demonstrated that most pediatric providers believe collective advocacy and political involvement are essential aspects of their profession, but less is known about how pediatric providers engage with families about policy issues that impact child health. The objectives of this study were to examine providers' perceptions and practices with regards to discussing health policy issues with families and to identify provider characteristics associated with having these discussions.</p>

<p><strong>METHODS: </strong>In this cross-sectional mixed methods study, pediatric resident physicians, attending physcians, and nurse practitioners at primary care clinics within a large academic health system were surveyed to assess (1) perceived importance of, (2) frequency of, and (3) barriers to and facilitators of health policy discussions with families. Multivariable ordinal regression was used to determine provider characteristics (including demographics, practice location, and extent of civic engagement) associated with frequency of these discussions. A subset of providers participated in subsequent focus groups designed to help interpret quantitative findings.</p>

<p><strong>RESULTS: </strong>The overall survey response rate was 155/394 (39%). The majority of respondents (76%) felt pediatricians should talk to families about health policy issues affecting children, but most providers (69%) reported never or rarely having these discussions. Factors associated with discussing policy issues included being an attending physician/nurse practitioner (OR 8.22, 95% CI 2.04-33.1) and urban practice setting (OR 3.85, 95% CI 1.03-14.3). Barriers included feeling uninformed about relevant issues and time constraints. In provider focus groups, four key themes emerged: (1) providers felt discussing policy issues would help inform and empower families; (2) providers frequently discussed social service programs, but rarely discussed policies governing these programs; (3) time constraints and concerns about partisan bias were a barrier to conversations; and (4) use of support staff and handouts with information about policy changes could help facilitate more frequent conversations.</p>

<p><strong>CONCLUSIONS: </strong>Pediatric providers felt it was important to talk to families about child health policy issues, but few providers reported having such conversations in practice. Primary care practices should consider incorporating workflow changes that promote family engagement in relevant health policy discussions.</p>

DOI

10.1186/s12887-020-02238-y

Alternate Title

BMC Pediatr

PMID

32660527

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