West Hartford-Bloomfield Health District Community Needs Assessment: A Mixed Methods Study Identifying COVID-19 Knowledge, Perceptions, and Health Disparities

Background: The West Hartford-Bloomfield Health District (WHBHD) is a regional health department serving the towns of West Hartford and Bloomfield in Connecticut. From February to April of 2020, elderly and Black residents accounted for 59% and 38% of COVID-19 related deaths, respectively. Since the district has not assessed community health needs previously and is interested in becoming accredited, a community needs assessment will serve as the first step in implementing effective and timely interventions to address needs, disparities, and misperceptions about the pandemic. Methods: A comprehensive survey was adapted from existing NIH COVID-19 research instruments. 779 responses were collected on the topics of community health and COVID-19 knowledge, practices and perceptions. Five semi-structured key informant interviews were conducted with faith-based organizations and local government leaders to corroborate findings from the survey. Quantitative analyses were performed via SAS and R, and qualitative data was summarized. Results: Demographic distributions significantly differed between West Hartford and Bloomfield in age, income, race, marital status and household size. While there were differences in community health problems, social/environmental problems, and health care barriers, both towns shared individual health problems and perceived certain populations as most underserved. Both towns have adequate COVID-19 knowledge regarding symptoms and transmissions, low perceived risk of infection, and positive attitude towards preventative actions and measures. There were significant differences in COVID-19 testing accessibility between towns (p = 0.002), with nearly double the proportion of West Hartford residents reporting difficulty accessing testing. COVID-19 vaccination status is also different between towns, with both reporting lack of available vaccines as the primary reason preventing or delaying vaccination. Conclusions: The mixed methods approach to conducting this community needs assessment has provided consequential preliminary findings that will be useful in refining the health district’s current and future responses to COVID-19 and other public health issues.https://elischolar.library.yale.edu/ysph_pbchrr/1055/thumbnail.jp

Adverse Childhood Experiences & Breastfeeding - Pakistan

Rationale: Prior studies have found that a history of adverse childhood experiences (ACEs) is associated with breastfeeding, but the evidence is inconsistent. Despite low and middle income countries (LMICs) carrying a disproportionate amount of poor maternal and infant health outcomes, little research has assessed the relative impact of ACEs on breastfeeding initiation and exclusive breastfeeding in LMICs.Objective: The study investigates whether maternal ACEs are associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months postpartum among a cohort of women from rural Pakistan. Methods: The cross-sectional analysis included 869 women 18-45 years of age from the Bachpan Cohort Study. Multivariable modified log-Poisson regression models were used to assess the relationship between any ACE exposure with breastfeeding initiation (n=755) and exclusive breastfeeding at 3 (n=758) and 6 months (n=809). Models were adjusted for mother’s age at baseline, education level, number of living children, and trial arm. Results: The majority of women with a history of at least one ACE did not report breastfeeding within an hour of childbirth (82.54%) or exclusively breastfeeding within the last 24 hours at 3 (56.22%) and 6 (92.36%) months postpartum. Women with ACEs were more likely to initiate breastfeeding within one hour of childbirth (RR=1.2; 95% CI=0.8, 1.8) but less likely to recall exclusively breastfeeding within the last 24 hours at 3 (RR=0.8; 95 CI=0.7, 0.9) and 6 months (RR=0.8; 95% CI=0.5, 1.2) postpartum compared to women with no self-reported history of ACEs. Conclusion: Our findings indicate that ACEs may contribute to differences in breastfeeding outcomes, but these associations differ by ACE type and across domains. Understanding the long-term effects of ACEs on breastfeeding is important to help inform the design of intervention programs to prevent or mediate the negative repercussions of ACEs

Eating disorders in sexual minority adolescents and young adults: examining clinical characteristics and psychiatric co-morbidities in an inpatient medical setting

BackgroundSexual minority adolescents and young adults are at higher risk of eating disorders compared to heterosexual peers. However, little is known about the clinical and psychiatric presentation of this population requiring inpatient medical stabilization. Given the increased risk for eating disorder behaviors in sexual minority individuals amidst increased rates of medical hospitalizations secondary to eating disorders, it is important to understand presenting characteristics of this population. The objectives of this study were to (1) describe the clinical characteristics of sexual minority adolescents and young adults with eating disorders admitted for medical instability and (2) compare psychiatric co-morbidities and suicidality of sexual minority adolescents and young adults to heterosexual peers.MethodsA retrospective chart review was conducted of 601 patients admitted to a large inpatient eating disorders medical stabilization unit between 2012 and 2020. Data collected included demographics, medical data including vital signs, and psychiatric characteristics. Chi square or t-tests were used to examine potential differences in clinical characteristics and psychiatric co-morbidities between groups. Modified Poisson regression was used to assess associations between sexual orientation and psychiatric co-morbidities.ResultsOver one fifth (21.1%, n = 103) of our inpatient sample identified as a sexual minority individual. The average age of participants was 15.6 years (2.7). Sexual minority adolescents and young adults had higher percent median body mass index compared to heterosexual peers and yet equally severe vital sign instability on admission. Sexual minority adolescents and young adults were almost 1.5 times more likely to have a psychiatric comorbidity with higher rates of depression, anxiety, and post-traumatic stress disorder. Sexual minority adolescents and young adults were approximately two times more likely to have a history of self-injurious behaviors and/or suicidality.ConclusionsSexual minority adolescents and young adults with eating disorders have equally severe vital sign instability despite higher percent median body mass index on admission for medical stabilization. Sexual minority adolescents and young adults hospitalized for medical complications of eating disorders are far more likely to have an additional mental health disorder and a history of self-harm and/or suicidality, which may portend a less favorable long-term prognosis

Sex differences in refeeding among hospitalized adolescents and young adults with eating disorders

ObjectiveTo determine sex differences in refeeding (i.e., short-term nutritional rehabilitation) outcomes among hospitalized adolescents and young adults with eating disorders.MethodsWe retrospectively reviewed electronic medical records of 601 patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program for medical and nutritional management between May 2012 and August 2020. Descriptive statistics, crude, and adjusted linear regression models were used to assess the association between sex and nutritional outcomes and predictors of length of stay.ResultsA total of 588 adolescents and young adults met eligibility criteria (16% male, mean [SD] age 15.96  [2.75], 71.6% anorexia nervosa, admission percent median body mass index [%mBMI] 87.1 ± 14.1). In unadjusted comparisons, there were no significant sex differences in prescribed kilocalories (kcal) per day at admission (2013 vs. 1980, p = .188); however, males had higher estimated energy requirements (EER, kcal) (3,694 vs. 2,925, p < .001). In linear regression models adjusting for potential confounders, male sex was associated with higher prescribed kcals at discharge (B = 835 kcal, p < .001), greater weight change (B = 0.47 kg, p = .021), and longer length of stay (B = 1.94 days, p = .001) than females. Older age, lower admission weight, lower prescribed kcal at admission, higher EER, and lower heart rate at admission were factors associated with longer length of stay in a linear regression model.DiscussionThese findings support the development of individualized approaches for males with eating disorders to improve quality of care and health care efficiency among an underserved population

Sex differences and associations between zinc deficiency and anemia among hospitalized adolescents and young adults with eating disorders.

PurposeTo determine sex differences in and associations between zinc deficiency and anemia among adolescents and young adults hospitalized for medical complications of eating disorders.MethodsWe retrospectively reviewed electronic medical records of 601 patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program for medical instability, between May 2012 and August 2020. Descriptive statistics, crude, and adjusted logistic regression models were used to assess the association between zinc deficiency (< 55 mcg/dL) and anemia (< 13.6 g/dL in males [M] and < 11.8 g/dL in females [F]).ResultsA total of 87 males and 450 females met eligibility criteria (age 15.98 ± 2.81, 59.4% anorexia nervosa; admission body mass index 17.49 ± 2.82). In unadjusted comparisons, plasma zinc in males and females were not statistically different (M 64.88 ± 14.89 mcg/dL vs F 63.81 ± 13.96 mcg/dL, p = 0.517); moreover, there were no differences in the percentage of males and females with zinc deficiency (M 24.14% vs F 24.89%). However, a greater percentage of males than females were anemic (M 50.00% vs F 17.61%, p < 0.001), with similar findings in the subgroup with anorexia nervosa. In logistic regression models stratified by sex and eating disorder diagnosis, zinc deficiency was significantly associated with anemia in males (AOR 3.43, 95% CI 1.16, 10.13), but not females (AOR 1.47, 95% CI 0.86, 2.54).ConclusionsFor the first time, we demonstrate that zinc deficiency is equally severe in males compared to females hospitalized with medical complications from eating disorders, with nearly a quarter of inpatients experiencing zinc deficiency. Anemia is more common in males than females hospitalized with eating disorders.Level of evidenceLevel V: descriptive cross-sectional study

Assessment of vitamin D among male adolescents and young adults hospitalized with eating disorders.

PurposeMedical complications of eating disorders in males are understudied compared to females, as is the case of vitamin D deficiency. The aim of this study was to assess vitamin D levels among male and female adolescents and young adults hospitalized for medical complications of eating disorders.MethodsWe retrospectively reviewed electronic medical records of patients aged 9-25 years (N = 565) admitted to the University of California, San Francisco Eating Disorders Program for medical instability, between May 2012 and August 2020. Serum vitamin D (25-hydroxy) level was assessed at admission as was history of prior calcium, vitamin D, or multivitamin supplementation. Linear regression was used to assess factors associated with vitamin D levels.ResultsA total of 93 males and 472 females met eligibility criteria (age 15.5 ± 2.8, 58.8% anorexia nervosa; admission body mass index 17.6 ± 2.91). Among male participants, 44.1% had 25-hydroxyvitamin D levels < 30 ng/mL, 18.3% had 25-hydroxyvitamin D levels < 20 ng/mL, and 8.6% had 25-hydroxyvitamin D levels < 12 ng/mL. There were no significant differences in 25-hydroxyvitamin D levels in males compared to females, except that a lower proportion (1.9%) of female participants had 25-hydroxyvitamin D levels < 12 ng/mL (p = 0.001). Only 3.2% of males reported calcium or vitamin D-specific supplementation prior to hospital admission, while 8.6% reported taking multivitamins. White race, prior calcium/vitamin D supplementation, and higher calcium levels were associated with higher vitamin D levels on admission.ConclusionsNearly half of patients admitted to the hospital for malnutrition secondary to eating disorders presented with low 25-hydroxyvitamin D levels; males were more likely than females to have severe vitamin D deficiency. These findings support vitamin D assessment as part of the routine medical/nutritional evaluation for hospitalized eating disorder patients, with particular attention on male populations