Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources.

We found it is feasible and acceptable for clinicians to screen for FI in suburban practices, but the referral method used in this study was ineffective in assisting families in obtaining benefits. Better approaches to connect families to local resources may be needed to maximize the effectiveness of screening in suburban settings.

Aims-We sought to investigate the hypothesis that smoking is accompanied by systemic inflammation.Methods and Results-We examined the relation of smoking to 11 systemic inflammatory markers in Framingham Study participants (n=2944, mean age 60 years, 55% women, 12% ethnic minorities) examined from 1998-2001. The cohort was divided into never (n=1149), former (n=1424), and current smokers with last cigarette >6 hours (n=134) or ≤6 hours (n=237) prior to phlebotomy. In multivariable-adjusted models there were significant overall between-smoking group differences (defined as p<0.0045 to account for multiple testing) for every inflammatory marker tested, except for serum CD40 ligand (CD40L), myeloperoxidase (MPO) and tumor necrosis factor receptor-2 (TNFR2). With multivariable-adjustment, pair-wise comparisons with never smokers revealed that former smokers had significantly lower concentrations of plasma CD40L (p<0.0001) and higher concentrations of C-reactive protein (p=0.002).Conclusions-As opposed to never smokers, those with acute cigarette smoke exposure (≤6 hours) had significantly higher concentrations of all markers (p<0.0001) except serum CD40L, MPO, and TNFR2; plasma CD40L were significantly lower. Compared with never smokers, cigarette smokers have significantly elevated concentrations of most circulating inflammatory markers, consistent with the hypothesis that smoking is associated with a systemic inflammatory state.

IMPORTANCE 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.OBJECTIVE To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization. DESIGN, SETTING, AND PARTICIPANTSThis 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.EXPOSURE Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence. MAIN OUTCOMES AND MEASURES ED encounters for a mental health-related chief complaint or primary diagnosis.RESULTS 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]).CONCLUSIONS AND RELEVANCE 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.

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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.OBJECTIVE To estimate the state-level association between transition from paper vouchers to EBT and subsequent WIC participation. DESIGN, SETTING, AND PARTICIPANTSThis 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.EXPOSURES Statewide transition from WIC paper vouchers to WIC EBT cards, specified by month and year. MAIN OUTCOMES AND MEASURES Monthly number of state residents enrolled in WIC.RESULTS 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.CONCLUSIONS AND RELEVANCE 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.

On-site service use was associated with improved caregiver satisfaction but decreased well-child visit adherence. Caregivers using support services may face barriers to accessing preventive care.

Between April and June 2020 at the start of the COVID-19 pandemic, 29.5% of children in the US, predominantly from lowincome families and racial and ethnic minority groups, experienced household food insecurity. 1 The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a key source of nutritional support for women and children living in poverty. WIC benefits are currently issued on electronic benefits transfer (EBT) debit cards, which can be used to purchase WIC-approved food and beverage products.