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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 19 of 19 Research Studies DisplayedRichmond J, Adams LB, Annis IE
Rapid and deferred help seeking among African American parents of children with emotional and behavioral difficulties.
The purpose of this cross-sectional survey study was to assess factors related with African American parents seeking care for their child within 30 days after identifying the child’s behavioral or emotional need and with postponing care for 1 year or more. The researchers surveyed 289 African American parents who were raising a child with emotional or developmental challenges to explore relationships between parent activation, medical mistrust, and care-seeking barriers with two outcomes: rapidly seeking care (within 30 days after identifying a child’s need) and deferring care seeking. The study found that approximately 22% of parents rapidly sought care, and 49% deferred care for 1 year or more. Parents were more likely to rapidly seek care if they had higher parent activation scores; lived with other adults with mental health challenges; or, contrary to the authors' hypothesis, mistrusted doctors. Parents were less likely to rapidly seek care if the challenge did not initially bother them much or if their health insurance would not cover the service. Parents were more likely to defer care if they feared involuntary hospitalization for their child or if their health insurance would not cover the service. Parents were less likely to defer care if they had at least some college education or lived with other adults with mental health challenges. The researchers concluded that when developing programs that support African American families, professionals should be advised about facilitators and barriers to mental health care seeking.
AHRQ-funded; HS026122.
Citation: Richmond J, Adams LB, Annis IE .
Rapid and deferred help seeking among African American parents of children with emotional and behavioral difficulties.
Psychiatr Serv 2022 Dec;73(12):1359-66. doi: 10.1176/appi.ps.202100553..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Behavioral Health, Healthcare Utilization
Jindal M, Thornton RLJ, McRae A
Effects of a curriculum addressing racism on pediatric residents' racial biases and empathy.
The authors sought to evaluate the impact of participation in a curriculum addressing racism on pediatric residents' racial biases and empathy. They conducted a pre-post survey study in two urban, university-based, midsized pediatric residency programs. They found that, among participants with baseline pro-White bias, there was a statistically significant shift toward no preference, while among participants with a baseline pro-Black bias, there was a statistically significant shift toward no preference. Among all residents, there was a modest but statistically significant decrease in mean empathy.
AHRQ-authored.
Citation: Jindal M, Thornton RLJ, McRae A .
Effects of a curriculum addressing racism on pediatric residents' racial biases and empathy.
J Grad Med Educ 2022 Aug;14(4):407-13. doi: 10.4300/jgme-d-21-01048.1..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Education: Curriculum
Kleinman LC, Howell EA
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
The researchers report that in the context of quality improvement research, risk adjustment (RA) methods can obscure disparities in health care. In this study the researchers address the impact of considering equity when conducting risk adjustments in pediatric health, and describe the danger of veiled justice, a type of overadjustment that takes place when risk adjustments obscure real disparities because more than one covariate, such as race and socioeconomic status, are on related causal paths. Underadjustment can occur when these same structural characteristics are not addressed when calculating models of payment. The purpose of this study was to describe the literature and present a conceptual framework that identifies these two problems for validity related to the interactions between risk adjustment and health equity in pediatric health care. The researchers conclude that the science of quality improvement must address issues of health equity as an essential construct, with the development of a specific conceptual model. Statistical analysis should be interpreted using the conceptual model, and the dynamics of child development and life course should also be addressed, as well as additional contextual and process factors such as the role of caregivers and public insurance, the epidemiology of the disease, family financial status, and others. The goal of RA is to make valid conclusions such that observed differences can be attributed to the relevant causes. When higher risk is attributed to social determinants and not disease differences, RA can obscure disparities (veiled injustice) and differences at the population level and experienced by individuals are falsely hidden. Not addressing these same structural characteristics when calculating models of payment can lead to patterns of underadjustment. The authors advise that these 2 sides of a similar coin reveal the critical importance of both the underlying model and the capacity to reliably evaluate disparities and quality.
AHRQ-funded; HS020518; 233201550088A.
Citation: Kleinman LC, Howell EA .
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948G.
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Risk
Johnson TJ, Goyal MK, Lorch SA
Racial/ethnic differences in pediatric emergency department wait times.
The authors sought to determine whether racial/ethnic differences exist in wait times for children presenting to pediatric emergency departments (PEDs) and to examine between-site and within-site differences. They found that median wait time was 35 minutes. Further, in unadjusted analyses, non-White children experienced longer PED wait times than non-Hispanic White (NHW) children. After adjusting for illness severity, patient demographics, and overcrowding measures, wait times for non-Hispanic Black and other race children were largely determined by site of care. Hispanic children experienced longer within-site and between-site wait times compared with NHW children.
AHRQ-funded; HS020270.
Citation: Johnson TJ, Goyal MK, Lorch SA .
Racial/ethnic differences in pediatric emergency department wait times.
Pediatr Emerg Care 2022 Feb;38(2):e929-e35. doi: 10.1097/pec.0000000000002483..
Keywords: Children/Adolescents, Emergency Department, Racial and Ethnic Minorities
Carroll AR, Hall M, Brown CM
Association of race/ethnicity and social determinants with rehospitalization for mental health conditions at acute care children's hospitals.
This retrospective cohort study evaluated the associations of race/ethnicity and social determinants with 90-day rehospitalization of children with mental health conditions to acute non-psychiatric children’s hospitals. Children included were aged 5 to 18 years at 32 freestanding U.S. children’s hospitals from 2016-2018 using the Children’s Hospital Association’s Pediatric Health Information System (PHIS) database to assess the association of race/ethnicity and social determinants (insurance payer, neighborhood median household income, and rurality of patient home location) with 90-day rehospitalization. Among 23,556 index hospitalizations, 5.9% (n = 1382) were rehospitalized for mental health within 90 days. Non-Hispanic Black children were 26% more likely to be rehospitalized than non-Hispanic White children. Those with government insurance were 18% more likely to rehospitalized than those with private insurance. Those living in a suburban location were 22% less likely to be rehospitalized than those living in an urban location.
AHRQ-funded; HS026122.
Citation: Carroll AR, Hall M, Brown CM .
Association of race/ethnicity and social determinants with rehospitalization for mental health conditions at acute care children's hospitals.
J Pediatr 2022 Jan;240:228-34.e1. doi: 10.1016/j.jpeds.2021.08.078..
Keywords: Children/Adolescents, Hospital Readmissions, Behavioral Health, Social Determinants of Health, Racial and Ethnic Minorities
Bastani R, Glenn BA, Singhal R
Increasing HPV vaccination among low-income, ethnic minority adolescents: effects of a multicomponent system intervention through a county health department hotline.
The human papillomavirus (HPV) vaccine has cancer prevention benefits, yet low uptake. The purpose of the study was to evaluate an intervention intended to improve vaccine uptake in low-income, ethnic minority adolescents using a telephone hotline to seek county health department services. The researchers recruited participants through randomization of health department hotline callers who were caregivers of never-vaccinated adolescents aged 11-17. The intervention included multi-lingual print and telephone education and personalized referral to a low cost or free provider of vaccines. Participants completed baseline, 3-month, and 9-month telephone surveys. The study found that by the end of the 9-month follow up period, the HPV vaccination rates had increased, however there were no differences between the intervention (45%) and control (42%) groups. The researchers also observed significant improvements in perceived HPV knowledge, perceived HPV risk, and barriers to vaccination. The study concluded that the county hotline intervention did not produce a greater increase in HPV vaccine rates in the intervention group than the group without the intervention. The study authors recommend that future studies should evaluate interventions which are more intensive and address accessing and using services in complex, safety net settings. The authors also noted that because 44% of unvaccinated adolescents in both the intervention and control groups received at least one dose of the vaccine during the study period, investigators of future studies should be aware of the potential priming effects of participation in the study, which may impact the results of interventions.
AHRQ-funded; HS000046.
Citation: Bastani R, Glenn BA, Singhal R .
Increasing HPV vaccination among low-income, ethnic minority adolescents: effects of a multicomponent system intervention through a county health department hotline.
Cancer Epidemiol Biomarkers Prev 2022 Jan;31(1):175-82. doi: 10.1158/1055-9965.Epi-20-1578..
Keywords: Children/Adolescents, Vaccination, Low-Income, Racial and Ethnic Minorities, Sexual Health, Prevention
Jindal M, Mistry KB, Trent M
AHRQ Author: Mistry KB
Police exposures and the health and well-being of Black youth in the us: a systematic review.
This systematic review examined the literature describing the impact of policing on the well-being of Black youth 26 years and younger. A total of 16 quantitative studies including 19,493 participants were included in the review. An association between police exposure and adverse mental health, sexual risk behaviors and substance use was found. A total of 13 qualitative studies including 461 participants were also included in the review, which corroborated and contextualized the quantitative evidence and provided additional health outcomes, such as fear for life and hopelessness.
AHRQ-authored.
Citation: Jindal M, Mistry KB, Trent M .
Police exposures and the health and well-being of Black youth in the us: a systematic review.
JAMA Pediatr 2022 Jan;176(1):78-88. doi: 10.1001/jamapediatrics.2021.2929..
Keywords: Children/Adolescents, Young Adults, Racial and Ethnic Minorities
McDonald ML, Huang A, Proudfoot JA
Association of obesity, BMI, and Hispanic ethnicity on ambulatory status in children with spinal dysraphism followed near the California-Mexico border.
This study evaluated the relationship between body mass index (BMI), overweight status (OW), or obesity (OB) and ambulatory status in a predominantly Hispanic population of children with spinal dysraphism (SD). It found that,despite no difference in ambulatory status, increasing BMI and OW / OB are associated with Hispanic ethnicity and increasing age.
AHRQ-funded; HS022404.
Citation: McDonald ML, Huang A, Proudfoot JA .
Association of obesity, BMI, and Hispanic ethnicity on ambulatory status in children with spinal dysraphism followed near the California-Mexico border.
J Health Care Poor Underserved 2016;27(4):1956-69. doi: 10.1353/hpu.2016.0173.
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Keywords: Obesity, Racial and Ethnic Minorities, Racial and Ethnic Minorities, Children/Adolescents, Health Status
Lipton BJ, Wherry LR, Miller S
AHRQ Author: Lipton BJ, Decker S
Previous Medicaid expansion may have had lasting positive effects on oral health of non-Hispanic black children.
The researchers estimated the relationship between adult oral health and the extent of state public health insurance eligibility for pregnant women, infants, and children throughout childhood separately for non-Hispanic whites, non-Hispanic blacks, and Hispanics. They found that expanded Medicaid coverage geared toward pregnant women and children during their first year of life was linked to better oral health in adulthood among non-Hispanic blacks.
AHRQ-authored.
Citation: Lipton BJ, Wherry LR, Miller S .
Previous Medicaid expansion may have had lasting positive effects on oral health of non-Hispanic black children.
Health Aff 2016 Dec;35(12):2249-58. doi: 10.1377/hlthaff.2016.0865.
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Keywords: Medicaid, Dental and Oral Health, Children/Adolescents, Disparities, Racial and Ethnic Minorities
Heerman WJ, Mitchell SJ, Thompson J
Parental perception of built environment characteristics and built environment use among Latino families: a cross-sectional study.
The researchers examined the association of perceived availability, condition, and safety of the built environment with its self-reported use for physical activity among underserved families with children at risk for obesity. In their sample of underserved families, perceived availability and condition of built environment structures were associated with use rather than perceived safety.
AHRQ-funded; HS022990.
Citation: Heerman WJ, Mitchell SJ, Thompson J .
Parental perception of built environment characteristics and built environment use among Latino families: a cross-sectional study.
BMC Public Health 2016 Nov 22;16(1):1180. doi: 10.1186/s12889-016-3854-7.
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Keywords: Obesity, Social Determinants of Health, Children/Adolescents, Racial and Ethnic Minorities, Vulnerable Populations
Sharifi M, Sequist TD, Rifas-Shiman SL
The role of neighborhood characteristics and the built environment in understanding racial/ethnic disparities in childhood obesity.
The authors sought to examine the extent to which racial/ethnic disparities in elevated child body mass index (BMI) are explained by neighborhood socioeconomic status (SES) and the built environment. They concluded that SES and the built environment may be important drivers of childhood obesity disparities and that interventions must be tailored to the neighborhood contexts in which families live.
AHRQ-funded; HS022986.
Citation: Sharifi M, Sequist TD, Rifas-Shiman SL .
The role of neighborhood characteristics and the built environment in understanding racial/ethnic disparities in childhood obesity.
Prev Med 2016 Oct;91:103-09. doi: 10.1016/j.ypmed.2016.07.009.
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Keywords: Children/Adolescents, Disparities, Obesity, Racial and Ethnic Minorities, Social Determinants of Health
Nieman CL, Tunkel DE, Boss EF
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
The study’s objective was to analyze the association of patient- and neighborhood-level demographics and SES with clinical indications for tympanostomy tube (TT). It found that among children receiving tubes, those from high poverty areas were more likely than those from low poverty neighborhoods to receive tubes for the indication of chronic otitis media with effusion (OME) as opposed to recurrent acute otitis media (RAOM).
AHRQ-funded; HS022932.
Citation: Nieman CL, Tunkel DE, Boss EF .
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
Int J Pediatr Otorhinolaryngol 2016 Sep;88:98-103. doi: 10.1016/j.ijporl.2016.06.029.
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Keywords: Children/Adolescents, Ear Infections, Racial and Ethnic Minorities, Social Determinants of Health, Surgery, Low-Income
Wiese AD, Grijalva CG, Zhu Y
Changes in childhood pneumonia hospitalizations by race and sex associated with pneumococcal conjugate vaccines.
Introduction of pneumococcal conjugate vaccines in the childhood immunization schedule was associated with decreases in all-cause pneumonia hospitalizations among black and white children in Tennessee, USA. Although racial disparities that existed before introduction of these vaccines have been substantially reduced, rates remain higher in boys than in girls among young children.
AHRQ-funded; HS022342.
Citation: Wiese AD, Grijalva CG, Zhu Y .
Changes in childhood pneumonia hospitalizations by race and sex associated with pneumococcal conjugate vaccines.
Emerg Infect Dis 2016 Jun;22(6). doi: 10.3201/eid2206.152023.
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Keywords: Hospitalization, Vaccination, Children/Adolescents, Racial and Ethnic Minorities
Morales-Aleman MM, Scarinci IC
Correlates and predictors of sexual health among adolescent Latinas in the United States: a systematic review of the literature, 2004-2015.
The authors conducted a systematic literature review to better understand the correlates and predictors of sexual health among adolescent Latinas in the US. They found that results varied widely between studies, suggesting that the relationship between individual and proximal contextual variables and sexual health may be more complex than previously thought. They concluded that their review integrates the findings on correlates and predictors of sexual health among adolescent Latinas, and supports the need for strengths-based theoretically guided research on the mechanisms driving these associations.
AHRQ-funded; HS013852.
Citation: Morales-Aleman MM, Scarinci IC .
Correlates and predictors of sexual health among adolescent Latinas in the United States: a systematic review of the literature, 2004-2015.
Prev Med 2016 Jun;87:183-93. doi: 10.1016/j.ypmed.2016.03.005.
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Keywords: Children/Adolescents, Racial and Ethnic Minorities, Pregnancy, Racial and Ethnic Minorities, Sexual Health
Farmer C, Yehia BR, Fleishman JA
AHRQ Author: Fleishman JA
Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network.
The researchers evaluated the clinical and demographic characteristics of non-perinatally HIV (nPHIV)-infected youth associated with retention in care 1 year after initiating care and in the 2 years thereafter. They concluded that patients who were Hispanic, were men who have sex with men, or were seen at pediatric clinics were more likely to be retained in care.
AHRQ-authored.
Citation: Farmer C, Yehia BR, Fleishman JA .
Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network.
J Pediatric Infect Dis Soc 2016 Mar;5(1):39-46. doi: 10.1093/jpids/piu102.
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Keywords: Healthcare Delivery, Children/Adolescents, Human Immunodeficiency Virus (HIV), Risk, Racial and Ethnic Minorities
Rivera-Soto WT, Rodriguez-Figueroa L
Is waist-to-height ratio a better obesity risk-factor indicator for Puerto Rican children than is BMI or waist circumference?
This study aimed to explore the association of a single blood pressure reading with 3 different obesity indicators (WC, BMI, and WHtR). Its findings suggest the possibility of higher prevalence of high blood pressure in obese Puerto Rican children. The waist-to height ratio could be the best indicator to measure obesity and potential hypertension in Puerto Rican children.
AHRQ-funded; HS014060.
Citation: Rivera-Soto WT, Rodriguez-Figueroa L .
Is waist-to-height ratio a better obesity risk-factor indicator for Puerto Rican children than is BMI or waist circumference?
P R Health Sci J 2016 Mar;35(1):20-5.
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Keywords: Racial and Ethnic Minorities, Obesity, Children/Adolescents, Risk, Blood Pressure
Aalsma MC, Lau KS, Perkins AJ
Mortality of youth offenders along a continuum of justice system involvement.
This study of youth offenders in Marion County, Indiana, found a greater risk for early mortality than for community youth. The risk increased as justice system involvement became more severe. Black male youth had the highest risk.
AHRQ-funded; HS022681.
Citation: Aalsma MC, Lau KS, Perkins AJ .
Mortality of youth offenders along a continuum of justice system involvement.
Am J Prev Med 2016 Mar;50(3):303-10. doi: 10.1016/j.amepre.2015.08.030.
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Keywords: Children/Adolescents, Mortality, Racial and Ethnic Minorities
Zamora-Kapoor A, Nelson L, Buchwald D
Maternal correlates of body mass index in American Indian/Alaska Native and white adolescents: differences between mother/son and mother/daughter pairs.
This study sough to determine the influence of maternal correlates on adolescent body mass index (BMI), and the extent to which the size and significance of these correlates vary by adolescent sex and race. Its findings suggest that maternal factors are critical in the transmission of obesogenic behaviors from one generation to the next, and their effects vary between mother/son and mother/daughter pairs, and are similar for AI/ANs and Whites.
AHRQ-funded; HS021686.
Citation: Zamora-Kapoor A, Nelson L, Buchwald D .
Maternal correlates of body mass index in American Indian/Alaska Native and white adolescents: differences between mother/son and mother/daughter pairs.
Eat Behav 2016 Jan;20:43-7. doi: 10.1016/j.eatbeh.2015.11.002..
Keywords: Children/Adolescents, Obesity, Racial and Ethnic Minorities, Risk, Social Determinants of Health
Thienprayoon R, Marks E, Funes M
Perceptions of the pediatric hospice experience among English- and Spanish-speaking families.
The objective of this study was to explore parental perspectives of the hospice experience in children with cancer, and to explore how race/ethnicity impacts this experience. Both English and Spanish speakers described the importance of honest, direct communication by medical providers, and anxieties surrounding the expectation of the moment of death. English-speaking families were more likely to return to the hospital because of unsatisfactory symptom management.
AHRQ-funded; HS022418.
Citation: Thienprayoon R, Marks E, Funes M .
Perceptions of the pediatric hospice experience among English- and Spanish-speaking families.
J Palliat Med 2016 Jan;19(1):30-41. doi: 10.1089/jpm.2015.0137.
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Keywords: Children/Adolescents, Palliative Care, Long-Term Care, Racial and Ethnic Minorities, Cancer