The objectives of this paper are to investigate: 1) how the COVID-19 pandemic influenced both physical activity practices and mental health status, and 2) to assess the relationship between the two. Our mixed-methods study draws on 4,026 online survey responses collected between April – September 2020 across five states (Louisiana, Montana, North Carolina, Oregon and West Virginia). Logistic regression models were run for two outcome variables (physical activity and mental health status (measured using the Kessler Psychological Distress scale)). Researchers controlled for race/ethnicity, household income/size, gender, urbanicity, education, employment, use of government assistance and presence of chronic health conditions. Qualitative analysis was applied to open-ended survey responses to contextualize quantitative findings. Household income was significant in predicting difficulty maintaining pre-pandemic physical activity levels; pre-pandemic physical activity levels were associated with increased psychological distress levels during COVID-19; and race/ethnicity, income status and urbanicity were significantly associated with deteriorating mental health status and physical activity levels during COVID-19. Data suggests that a bi-directional, cyclical relationship between physical activity and mental health exists. Policy implications should include physical activity promotion as a protective factor against declining mental health.
Purpose and Objectives Academic literature indicates a need for more integration of Indigenous and colonial research systems in the design, implementation, and evaluation of randomized controlled trials (RCTs) with American Indian communities. In this article, we describe ways to implement RCTs with Tribal Nations using community-based participatory research (CBPR) principles and practices. Intervention Approach We used a multiple case study research design to examine how Tribal Nations and researchers collaborated to develop, implement, and evaluate CBPR RCTs. Evaluation Methods Discussion questions within existing tribal–academic partnerships were developed to identify the epistemologic, methodologic, and analytic strengths and challenges of 3 case studies. Results We identified commonalities that were foundational to the success of CBPR RCTs with Tribal Nations. Long-standing community–researcher relationships were critical to development, implementation, and evaluation of RCTs, although what constituted success in the 3 CBPR RCTs was diverse and dependent on the context of each trial. Respect for the importance of diverse knowledge systems that account for both Indigenous knowledge and colonial science also contributed to the success of the RCTs. Implications for Public Health Tribal–academic partnerships using CBPR RCTs must include 1) establishing trusted CBPR partnerships and receiving tribal approval before embarking on RCTs with Tribal Nations; 2) balancing tribal community interests and desires with the colonial scientific rigor of RCTs; and 3) using outcomes that include tribal community concepts of success as well as outcomes found in standard colonial scientific research practices to measure the success of the CBPR RCTs.
Objective Regionalization directs patients to high‐volume hospitals for specialized care. We investigated regionalization trends and outcomes in pediatric cardiac surgery. Data Sources/Study Setting Statewide inpatient data from eleven states between 2000 and 2012. Study Design Mortality, length of stay (LOS), and cost were assessed using multivariable hierarchical regression with state and year fixed effects. Primary predictor was hospital case‐volume, categorized into low‐, medium‐, and high‐volume tertiles. Data Collection/Extraction Methods We used Risk Adjustment for Congenital Heart Surgery‐1 (RACHS‐1) to select pediatric cardiac surgery discharges. Principal Findings In total, 2841 (8.5 percent), 8348 (25.1 percent), and 22 099 (66.4 percent) patients underwent heart surgeries in low‐, medium‐, and high‐volume hospitals. Mortality decreased over time, but remained higher in low‐ and medium‐volume hospitals. High‐volume hospitals had lower odds of mortality and cost than low‐volume hospitals (odds ratio [OR] 0.59, P < 0.01, and relative risk [RR] 0.91, P < 0.01, respectively). LOS was longer for high‐ and medium‐volume hospitals, compared to low‐volume hospitals (high‐volume: RR 1.18, P < 0.01; medium‐volume: RR 1.05, P < 0.01). Conclusions Regionalization reduced mortality and cost, indicating fewer complications, but paradoxically increased LOS. Further research is needed to explore the full impact on health care utilization.
BACKGROUND AND OBJECTIVES: Asthma is widely prevalent among US children, particularly in homeless children, who often lack proper medication storage or the ability to avoid environmental triggers. In this study, we assess asthma-attributed health care use among homeless youth. We hypothesize that asthma hospitalization rates, symptom severity, and admission through the emergency department (ED) will be higher among homeless youth compared with nonhomeless youth. METHODS: This secondary data analysis identified homeless and nonhomeless pediatric patients (,18 years old) with a primary diagnosis of asthma from New York statewide inpatient databases between 2009 and 2014. Hospitalization rate, readmission rate, admission through the ED, ventilation use, ICU admittance, hospitalization cost, and length of stay were measured. RESULTS: We identified 71 837 asthma hospitalizations, yielding 73.8 and 2.3 hospitalizations per 1000 homeless and nonhomeless children, respectively. Hospitalization rates varied by nonhomeless income quartile, with low-income children experiencing higher rates (5.4) of hospitalization. Readmissions accounted for 16.0% of homeless and 12.5% of nonhomeless hospitalizations. Compared with nonhomeless patients, homeless patients were more likely to be admitted from the ED (odds ratio 1.96; 95% confidence interval: 1.82-2.12; P , .01), and among patients .5 years old, homeless patients were more likely to receive ventilation (odds ratio 1.45; 95% confidence interval: 1.01-2.09; P 5 .04). No significant differences were observed in ICU admittance, cost, or length of stay. CONCLUSIONS: Homeless youth experience an asthma hospitalization rate 31 times higher than nonhomeless youth, with higher rates of readmission. Homeless youth live under uniquely challenging circumstances. Tailored asthma control strategies and educational intervention could greatly reduce hospitalizations. WHAT'S KNOWN ON THIS SUBJECT: Asthma is widely prevalent among US children, particularly in homeless children, who often lack proper medication storage or ability to avoid environmental triggers. Poor treatment adherence and follow-up have been reported, making homeless children susceptible to attacks. WHAT THIS STUDY ADDS: Because of high prevalence and attack susceptibility, use of health care by homeless patients with asthma could be high. However, no prior studies have quantified these levels. This study offers new insight on asthma-attributed health care use among homeless and nonhomeless youth.
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