Tag: nevin manimala

JAMA Netw Open. 2025 Feb 3;8(2):e2462139. doi: 10.1001/jamanetworkopen.2024.62139.

ABSTRACT

IMPORTANCE: Poisonings are a leading cause of preventable mortality and morbidity among children. Pediatric poisonings are commonly managed in pediatric intensive care units (PICUs) and may require complex treatment and specialized evaluation. Physicians specializing in medical toxicology are trained to treat poisoned patients of all ages; however, they are not universally part of the medical staff across hospital systems.

OBJECTIVE: To determine if there is a difference in mortality and length of stay for patients with toxicological exposures who receive a medical toxicology consultation.

DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis of an ongoing, cross-sectional registry of patients admitted to PICUs from January 2019 to June 2023 as part of the Virtual Pediatric System (VPS), a database of PICU admissions across 135 medical sites in the US. Patients with toxicological exposure who were admitted to PICUs that participate in the VPS database were included. Data analysis occurred from May to August 2024.

EXPOSURES: Medical toxicology consultations.

MAIN OUTCOMES AND MEASURES: The primary outcome was mortality in the PICU and in the hospital overall. Secondary outcomes were length of stay in the PICU and in the hospital. Multilevel models were used to assess associations of toxicology consultations with the primary and secondary outcomes.

RESULTS: There were a total of 52 836 patients with toxicological exposures (29 867 aged 12 to <21 years [56.5%]; 29 401 female [55.6%]), including 2857 (5.4%) patients with medical toxicology consultations and 49 979 (94.6%) without a consultation. Patients who received medical toxicology consultations had similar risk of mortality at baseline, as measured by the Pediatric Risk of Mortality, compared with those without consultations. After adjusting for severity of illness, poisoning type, and other covariates, medical toxicology consultations were associated with 64% lower odds of death in the PICU (adjusted odds ratio, 0.36; 95% CI, 0.20 to 0.63) and 61% lower odds of mortality at any time during the hospitalization (aOR, 0.39; 95% CI, 0.24 to 0.64). Additionally, medical toxicology consultations were associated with a 15% reduced PICU length of stay (log estimate, -0.16; 95% CI, -0.21 to -0.11) and 10% reduced hospital length of stay (log estimate, -0.10; 95% CI, -0.14 to -0.06) after adjusting for all covariates and differences across hospital sites.

CONCLUSIONS AND RELEVANCE: In this study of patients with toxicological exposures requiring PICU care, having a medical toxicology consultation was associated with lower mortality and shorter LOS compared with not having a consultation, which suggests that medical toxicology consultations may provide life-saving treatment, particularly for the most severe poisonings in the PICU.

PMID:40019762 | DOI:10.1001/jamanetworkopen.2024.62139

JAMA Netw Open. 2025 Feb 3;8(2):e2462176. doi: 10.1001/jamanetworkopen.2024.62176.

ABSTRACT

IMPORTANCE: Use of the race-neutral Global Lung Initiative (GLI) equation has been shown to generate decreased lung function measures in Black children and adults. The effect on asthma detection and diagnosis in children is unknown.

OBJECTIVE: To compare the use of race-specific vs race-neutral equations on subsequent asthma diagnosis in children.

DESIGN, SETTING, AND PARTICIPANTS: The Childhood Asthma Management Program (CAMP, 1991-2012), the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS, 2001-2010), and the Mechanisms of Progression from Atopic Dermatitis to Asthma (MPAACH, 2016-2024) cohorts were included in this cohort study. Children in the CAMP cohort were aged 5 to 12 years with mild to moderate asthma. The CCAAPS and MPAACH cohorts included infants from atopic parents and children aged 0 to 2 years with atopic dermatitis, respectively. Data were analyzed from November 2023 to May 2024.

EXPOSURES: Race-specific vs race-neutral GLI equations to define lung function.

MAIN OUTCOMES AND MEASURES: Percent predicted values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), asthma or asthma symptoms, and eligibility for reversibility testing were determined.

RESULTS: Among 1533 children, there were 849 CAMP (median [IQR] age, 8.7 [7.1-10.6] years; 138 [16%] Black, 711 [84%] White, and 498 [59%] male participants), 578 CCAAPS (median [IQR] age, 6.9 [6.7-7.0]; 115 [20%] Black, 463 [80%] White, and 315 [55%] male participants) and 106 MPAACH (median [IQR] age, 7.4 [7.1-7.8] years; 62 [58%] Black, 44 [42%] White, and 62 [58%] male participants). The median (IQR) percent predicted FEV1 in Black children decreased by 11.9 percentage points (pp) (10.4-13.1 pp) in CAMP, 13.5% pp (11.8-14.6 pp) in CCAAPS, and 13.2 pp (11.6-14.6 pp) in MPAACH compared with the race-specific equation. The race-specific equation failed to detect reduced percent predicted FEV1 in 12 of 22 Black children in CCAAPS with asthma symptoms (55%) and 5 of 15 Black children in MPAACH with asthma (41%). In CCAAPS, children with less than 90% predicted FEV1 based on race-specific equations were eligible for postreversibility testing to objectively diagnose asthma. When this asthma diagnostic algorithm was applied, 16 of 36 Black children in CCAAPS (44%) and 6 of 16 Black children in MPAACH (38%) who were not eligible for reversibility testing based on the race-specific equation became eligible with a less than 90% predicted FEV1 based on the race-neutral equation.

CONCLUSIONS AND RELEVANCE: In this cohort study of 1533 children, the use of the race-neutral equation improved the detection of asthma in children. These results support the universal use of the race-neutral equation to improve asthma detection in children and help guide medical practice toward alleviating asthma-related health disparities.

PMID:40019761 | DOI:10.1001/jamanetworkopen.2024.62176

JAMA Netw Open. 2025 Feb 3;8(2):e2462271. doi: 10.1001/jamanetworkopen.2024.62271.

ABSTRACT

IMPORTANCE: Stroke is a major cause of morbidity and mortality. Timely administration of intravenous thrombolysis (IVT) is essential for improving outcomes for patients with acute ischemic stroke. Significant disparities exist in IVT administration based on socioeconomic and racial and ethnic backgrounds. Understanding how hospital-level segregation is associated with stroke treatment outcomes is crucial for addressing these disparities.

OBJECTIVE: To investigate the association between hospital segregation, using the Index of Concentration at the Extremes (ICE), and IVT administration rates among patients with stroke.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used US hospital data from the 2016-2020 National Inpatient Sample database. Using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes, patients admitted to hospitals with acute ischemic stroke were included. Statistical analysis was performed from March through July 2024.

EXPOSURE: Hospital segregation measured by the ICE, quantifying socioeconomic and racial and ethnic extremes within hospitals. ICE values range from -1 (predominantly Black and socioeconomically disadvantaged) to 1 (predominantly White and socioeconomically advantaged). Hospitals were categorized into ICE quintiles, with the first quintile representing the most disadvantaged hospitals, the third quintile representing a balanced patient mix, and the fifth quintile representing the most privileged hospitals.

MAIN OUTCOMES AND MEASURES: The primary outcome was IVT administration rates. Secondary outcomes included racial and ethnic disparities in IVT administration across ICE quintiles.

RESULTS: Among 2 494 945 patients with stroke, the mean (SD) age was 70.1 (14.0) years, 50.2% were male, 0.5% were American Indian, 3.1% were Asian or Pacific Islander, 17.4% were Black, 8.2% were Hispanic, 68.2% were White, and 2.6% were other race or ethnicity. Of these patients, 65.4% were treated at hospitals in the third ICE quintile, while 1.2% of patients were treated at hospitals in the first ICE quintile. Patients at hospitals in the fourth and fifth ICE quintiles were significantly more likely to receive IVT (fourth quintile: adjusted odds ratio [AOR], 1.32 [95% CI, 1.26-1.38]; fifth quintile: AOR, 1.27 [95% CI, 1.21-1.34]) compared with those in the first quintile. Racial and ethnic disparities in IVT administration were most pronounced in the first ICE quintile, where Black patients were 32% less likely than White patients to receive IVT (AOR, 0.68 [95% CI, 0.58-0.79]). This disparity decreased but persisted in higher quintiles.

CONCLUSIONS AND RELEVANCE: In this study of hospital segregation and IVT administration rates, segregation was associated with lower likelihood of IVT administration for patients at hospitals serving predominantly Black and socioeconomically disadvantaged communities. Socioeconomic improvements were associated with reduced, but not eliminated, racial and ethnic disparities in stroke treatment. Addressing structural racism and segregation is crucial for equitable access to stroke care.

PMID:40019760 | DOI:10.1001/jamanetworkopen.2024.62271

JAMA Netw Open. 2025 Feb 3;8(2):e2462277. doi: 10.1001/jamanetworkopen.2024.62277.

ABSTRACT

IMPORTANCE: Racial and ethnic minority groups disproportionately experience food insecurity. During the COVID-19 pandemic, the US enacted temporary food assistance policies, including emergency allotments for Supplemental Nutrition Assistance Program (SNAP) benefits. The effects of the pandemic and these policies on food insecurity by race and ethnicity are unclear.

OBJECTIVE: To examine prevalence trends in food insecurity by racial and ethnic groups and SNAP use before and during the pandemic.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study analyzed National Health Interview Survey data before (January 2019 to March 2020) and during the COVID-19 pandemic (April 2020 to December 2022). Participants were noninstitutionalized US adults (≥18 years) with low income (<200% federal poverty level). Statistical analysis was performed from September 25, 2023, to February 27, 2024.

EXPOSURE: COVID-19 pandemic time period.

MAIN OUTCOMES AND MEASURES: Food insecurity was measured using the 10-item US Department of Agriculture Adult Food Security Survey module, categorizing participants as food secure (high or marginal food security) or insecure (low or very low food security). Survey-weighted Poisson regressions were modeled to examine changes in food insecurity prevalence over time by race and ethnicity (Asian, Black, Hispanic, and White) and by race and ethnicity and SNAP use (yes or no) including a 3-way interaction term (time × race and ethnicity × SNAP).

RESULTS: Among 30 396 adults with low income, approximately one-half were female (56.0% [95% CI, 54.7%-57.2%] during the pre-COVID-19 time period; 57.4% [95% CI, 56.4%-58.4%] during the COVID-19 time period). Food insecurity prevalence decreased from 20.9% (95% CI, 19.9%-22.0%) before the COVID-19 pandemic to 18.8% (95% CI, 17.9%-19.7%) during the pandemic (P < .001). SNAP use prevalence increased overall (from 31.5% [95% CI, 30.1%-32.9%] to 36.0% [95% CI, 34.8%-37.3%]; P < .001) and for each racial and ethnic group. There were no significant differences in food insecurity changes over time by racial and ethnic group (Wald test F = 1.29; P = .28 for 2-way interaction). Among SNAP participants, food insecurity decreased for Asian, Hispanic, and White adults but did not change for Black adults; among non-SNAP participants, food insecurity did not change for Black, Hispanic, and White adults but increased for Asian adults (Wald test F = 4.43; P = .02 for 3-way interaction).

CONCLUSIONS AND RELEVANCE: During the COVID-19 pandemic, food insecurity decreased among SNAP participants in most racial and ethnic groups but did not decrease among non-SNAP participants in any group. These results suggest that during the pandemic, increased SNAP benefit amounts were associated with ameliorating food insecurity for many US adults who were able to access SNAP but did not reduce racial and ethnic disparities in food insecurity.

PMID:40019759 | DOI:10.1001/jamanetworkopen.2024.62277

JAMA Netw Open. 2025 Feb 3;8(2):e2462360. doi: 10.1001/jamanetworkopen.2024.62360.

ABSTRACT

IMPORTANCE: Given the disparities in access to primary care and the growing nurse practitioner (NP) workforce, it is important to understand the distribution of primary care practices with NPs across communities of varying socioeconomic characteristics.

OBJECTIVE: To compare the socioeconomic characteristics of communities that have primary care practices with or without NPs.

DESIGN, SETTING, AND PARTICIPANTS: This secondary, cross-sectional analysis of 79 743 primary care practices used 4 merged data sources: the IQVIA 2023 OneKey database, the 2020 US biennial Census, the 2017-2022 American Community Survey, and the 2021 Area Deprivation Index (ADI). US Census Tracts and Divisions from 2023 were used to examine differences in socioeconomic characteristics across communities.

EXPOSURE: Primary care practices with NPs vs without NPs.

MAIN OUTCOMES AND MEASURES: Socioeconomic characteristics of Census Tracts and Block Groups, including racial and ethnic composition, median household income, percentage below the federal poverty level, educational attainment, and the ADI (an ordinal percentile ranking of Census Block Groups from 1 to 100, with 1 being least disadvantaged and 100 being most disadvantaged).

RESULTS: Of 79 743 primary care practices, 42 601 (53.4%) employed NPs in 2023. Practices with NPs, compared with those without, were significantly more likely to be in communities classified as low income (23.3% vs 17.0%; P < .001) and rural (11.9% vs 5.5%; P < .001). On average, these communities had a higher proportion of the population living below the federal poverty level (14.4% [95% CI, 14.3%-14.5%] vs 12.8% [95% CI, 12.7%-12.9%]; P < .001) and without a high school diploma (19.8% [95% CI, 19.7%-19.9%] vs 18.5% [95% CI, 18.4%-18.6%]; P < .001). Communities with practices with NPs also had significantly higher mean ADI percentiles than communities with practices without NPs (53.3% [95% CI, 53.1%-53.6%] vs 42.5% [95% CI, 42.2%-42.7%]; P < .001). As the number of primary care practices decreased in disadvantaged areas, the proportion of practices with NPs increased. In most US Census Divisions, there were more primary care practices with NPs than without, a difference that was marked in low-income communities.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of primary care practices in the US found that primary care practices with NPs, compared with those without NPs, were more likely to be located in communities with lower income and educational attainment and greater levels of overall socioeconomic disadvantage. This finding suggests that NPs are key to ensuring access to primary care in communities with socioeconomic disadvantage.

PMID:40019758 | DOI:10.1001/jamanetworkopen.2024.62360

JAMA Netw Open. 2025 Feb 3;8(2):e2462365. doi: 10.1001/jamanetworkopen.2024.62365.

ABSTRACT

IMPORTANCE: Women with a history of breast cancer (BC) experience greater physical health decline compared with age-matched women without cancer. However, whether this decline differs in patients who received chemotherapy and endocrine therapy is not well understood.

OBJECTIVE: To investigate physical health decline in BC survivors who received chemotherapy or endocrine therapy compared with age-matched women without cancer.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted as part of the Cancer Prevention Study-3, a prospective US cohort study that enrolled participants in 35 states, the District of Columbia, and Puerto Rico between 2006 and 2013. Follow-up for this analysis was through April 1, 2020. Statistical analyses were conducted between May 2023 and December 2024. Female participants diagnosed with nonmetastatic BC who returned a survey at least 90 days after their diagnosis were matched on age and year of survey return with up to 5 women without cancer.

EXPOSURE: Cancer status and treatment information.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were measures of physical health, assessed using the Patient-Reported Outcomes Measurement Information System Global Health Scale instrument. Linear regression was used to estimate associations (β) and 95% CIs of treatment with physical health.

RESULTS: This analysis included 2566 individuals diagnosed with BC and 12 826 age-matched women without cancer. Median (IQR) age at diagnosis was 56.3 (49.9-61.9) years. Of women with BC, 1223 (47.7%) received endocrine therapy, 276 (10.8%) received chemotherapy, and 634 (24.7%) received both. Compared with women without cancer, there was a greater physical health decline within 2 years of diagnosis for BC survivors receiving endocrine therapy (β = -1.12; 95% CI, -1.64 to -0.60), chemotherapy (β = -3.13; 95% CI, -4.19 to -2.07), or both (β = -3.26; 95% CI, -3.97 to -2.55). The decline among endocrine therapy users was restricted to women receiving aromatase inhibitors. More than 2 years after diagnosis, the decline was only observed in women who received chemotherapy.

CONCLUSIONS AND RELEVANCE: In this cohort study of 15 392 BC survivors and age-matched women without cancer, BC survivors who received chemotherapy had a long-lasting physical health decline, unlike survivors who received endocrine therapy without chemotherapy. Further studies are needed to confirm these results and to better understand the health consequences of these treatments.

PMID:40019757 | DOI:10.1001/jamanetworkopen.2024.62365

JAMA Netw Open. 2025 Feb 3;8(2):e250056. doi: 10.1001/jamanetworkopen.2025.0056.

ABSTRACT

IMPORTANCE: Social determinants of health (SDOH) are associated with health outcomes. Thus, providing referrals for unmet social needs within clinical settings may improve the health of children.

OBJECTIVE: To examine the prevalence and demographic characteristics of pediatric families with unmet social needs and their association with families accepting help from a pediatric clinical practice.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined data from a comprehensive SDOH screening and referral program at a large academic pediatric practice in the US. Participants were caregivers of patients younger than 17 years and indicated at least 1 social need. Data were collected from April 16, 2018, through September 29, 2019, and analyzed from November 18, 2019, through December 17, 2019. The data review was finalized December 20, 2023.

EXPOSURE: Screening for SDOH in primary care.

MAIN OUTCOME AND MEASURES: The main outcome was interest in assistance among patient families with at least 1 social need. Factor analyses categorized social needs as basic needs, stress, challenges to economic mobility, and marginalization. χ2 Tests and multivariable Poisson regression were used to examine the associations between patient characteristics and caregiver interest in assistance.

RESULTS: There were 758 caregivers (median [IQR] age, 34 [29-40] years; 614 mothers [81.0%]) reporting at least 1 unmet social need, such as food or utility insecurity or unemployment. The median age of children was 23 months (IQR, 4-70 months), and 163 (21.5%)were of Asian, Pacific Islander, or Native Hawaiian ; 213 (28.1%) of Black; 156 (20.6%) of Latino or Hispanic; 37 (4.9%) of White ; and 122 (16.1%) of other race and ethnicity. A total of 315 caregivers (41.6%) were not interested in assistance. Families with basic needs (adjusted prevalence ratio [PR], 5.56; 95% CI, 3.33-10.00), stress (adjusted PR, 1.75; 95% CI, 1.43-2.17), challenges to economic mobility (adjusted PR, 2.17; 95% CI, 1.67-2.86), or marginalization (adjusted PR, 1.41; 95% CI, 1.15-1.72) were more likely to be interested in assistance. Additionally, Black race (adjusted PR, 1.23; 95% CI, 1.01-1.49), other race and ethnicity (adjusted PR, 1.22; 95% CI, 1.01-1.47), and inadequate social support (adjusted PR, 1.85; 95% CI, 1.32-2.63) were associated with acceptance of referral services.

CONCLUSIONS AND RELEVANCE: These findings suggest that the implementation of referral programs may help to achieve health equity, especially among marginalized populations, and improve the referral process for families who have social needs but are not interested in assistance.

PMID:40019756 | DOI:10.1001/jamanetworkopen.2025.0056

JAMA Health Forum. 2025 Feb 7;6(2):e245523. doi: 10.1001/jamahealthforum.2024.5523.

ABSTRACT

IMPORTANCE: Nonprofit hospitals receive substantial tax exemptions to provide a community benefit. However, little is known about the distribution of community benefit spending (CBS) across US communities with varying degrees of social vulnerability beyond the hospital’s immediate geographic area.

OBJECTIVE: To assess associations of CBS per capita with community-level characteristics and social determinants of health.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Internal Revenue Service Series 990 Tax Forms from 2018 to 2023, to create a dataset of CBS for nonprofit hospitals in the US. Facility-level CBS allocation to counties was based on inpatient utilization to more accurately reflect a hospital’s community. Data were analyzed from January to December 2024.

EXPOSURES: County-level race and ethnicity characteristics and socioeconomic factors, including educational attainment, proportion living below 138% of the federal poverty level (FPL), and the Social Vulnerability Index (SVI) score.

MAIN OUTCOMES AND MEASURES: The primary outcome was total CBS per capita. Generalized linear regression models with a γ log-link function were used to assess the association of CBS per capita with community-level social determinants of health characteristics.

RESULTS: A total of 2465 nonprofit hospitals across 3140 US counties were included. Allocation of CBS varied significantly across communities, with the counties in the highest quintile receiving a mean (SD) of $540 ($250) per capita compared with counties in the lowest quintile with $22 ($16) per capita. Communities in the highest quintile of CBS had a higher proportion of White residents, while communities in the lowest quintile had a higher proportion of residents who were non-Hispanic Black or Hispanic, had lower educational attainment, and were living with incomes below 138% of the FPL. For every 1% proportional increase in non-Hispanic Black or Hispanic residents in a community, there was 1.61% (95% CI, 1.38%-1.84%) and 0.88% (95% CI, 0.63%-1.14%) less CBS per capita, respectively. In addition, there was less allocation of CBS per capita among counties with a greater proportion of people with low educational attainment, greater levels of poverty, or higher SVI scores. These results were consistent before and during the COVID-19 pandemic.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that nonprofit hospitals’ CBS was regressively allocated across US communities, with more socially vulnerable or racially and ethnically minoritized communities receiving less benefit than more affluent, non-Hispanic White communities, suggesting that the nonprofit tax system may be structurally discriminatory and contributing to health disparities.

PMID:40019742 | DOI:10.1001/jamahealthforum.2024.5523

JAMA Health Forum. 2025 Feb 7;6(2):e245565. doi: 10.1001/jamahealthforum.2024.5565.

ABSTRACT

IMPORTANCE: Rising out-of-pocket costs of maternal health care for people with commercial insurance may affect use of health care and outcomes. There are stark racial and ethnic disparities in outcomes, but little is known about differences in spending.

OBJECTIVE: To measure differences in out-of-pocket spending for maternity care by race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used administrative data from Blue Cross Blue Shield of Massachusetts from January 1, 2018, through December 31, 2022, for pregnancies, deliveries, and 42-day postpartum care. Participants were continuously enrolled during pregnancy, delivery, and 42 days post partum (collectively termed maternity episode).

EXPOSURES: The primary characteristic of interest was the birthing person’s race and ethnicity.

MAIN OUTCOMES AND MEASURES: The primary outcome was total out-of-pocket spending during the maternity episode. Out-of-pocket spending was measured separately for the pregnancy period, prenatal services, and delivery, by type of cost sharing, and as a percentage of the median household income in the patient’s census tract (using American Community Survey data). Race and ethnicity were measured via self-report and imputation.

RESULTS: The analytic sample included 87 253 maternity episodes among 76 826 unique birthing persons (mean [SD] age, 32.4 [4.7] years; 99.8% female) between 2018 and 2022; among maternity episodes, 8572 birthing persons (9.8%) were Asian, 3331 (3.8%) were Black, 6872 (7.9%) were Hispanic, and 68 478 (78.5%) were White. Mean out-of-pocket spending for the maternity episode was highest among Black birthing people ($2398 [$426]), followed by Hispanic ($2300 [$572]), Asian ($2202 [$603]), and White ($2036 [$1547]) birthing people (P < .001). These differences remained statistically significant after adjusting for health and demographic characteristics. The differences were largest in the prenatal period and for coinsurance payments. Black (1003 [30.1%]) and Hispanic (2302 [33.5%]) birthing people were more likely than Asian (1569 [18.3%]) and White (12 600 [18.4%]) birthing people to be enrolled in plans with high coinsurance, but not plans with high deductibles (3317 [38.7%] for Asian, 1232 [37.0%] for Black, 2350 [34.2%] for Hispanic, and 24 515 [35.8%] for White birthing people).

CONCLUSIONS AND RELEVANCE: In this study, differences in out-of-pocket maternity spending among the commercially insured were associated with differences in coinsurance rates. These costs could lead people to forgo needed health care or other basic needs that support health (eg, food or housing). Changes to health plan benefit design could improve equity in out-of-pocket maternity spending and its consequences.

PMID:40019741 | DOI:10.1001/jamahealthforum.2024.5565

Can J Public Health. 2025 Feb 28. doi: 10.17269/s41997-024-00992-5. Online ahead of print.

ABSTRACT

OBJECTIVES: Although past studies have identified sex differences in child maltreatment experiences and poor mental and physical health‒related outcomes, more research is needed to understand child maltreatment among sexual minorities (i.e., those who identify as other than heterosexual) and how child maltreatment and sexual identity are related to depression, anxiety, and at-risk alcohol and cannabis use among emerging adults.

METHODS: Data were drawn from the longitudinal Well-Being and Experiences (WE) Study collected from 2017 (14 to 17 years) to 2022 (18 to 23 years) from Manitoba, Canada (n = 584). Descriptive statistics and logistic regression models were computed.

RESULTS: Compared to heterosexual or straight sexual identity: homosexual, gay or lesbian; bisexual; and different or other identity were associated with an increased likelihood of experiencing child maltreatment, with the most robust relationships for bisexual identity and all child maltreatment outcomes. Indicating “I don’t know” for sexual identity compared to heterosexual identity was associated with 7.45 increased odds of exposure to intimate partner violence in adjusted models. Bisexual identity compared to heterosexual identity had the most robust association, with increased odds of depression, anxiety, at-risk alcohol use, and at-risk cannabis use. Findings provide some evidence to suggest that trends may be worse for some mental health and substance use outcomes among sexual minorities who also experience child maltreatment.

CONCLUSION: Preventing child maltreatment among all children, including youth identifying as other than heterosexual, is a public health priority. Such efforts will work towards optimizing mental health and reducing substance use in early adulthood.

PMID:40019705 | DOI:10.17269/s41997-024-00992-5