Browsing by Author "So, Marvin"
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Item Adolescent Sleep and Mental Health Across Race/Ethnicity: Does Parent-Child Connectedness Matter?(Journal of Developmental & Behavioral Pediatrics, 2021-04-22) So, Marvin; Perry, Nicole B.; Langenfeld, Adam D.; Barnes, Andrew J.Objective: Sleep is vital for healthy development, yet most adolescents do not meet recommended nightly hours. Although racial/ethnic minorities often experience relatively worse sleep outcomes compared with White peers, little is known about how the sleep-mental health relationship holds across diverse groups or how family relationships affect this association. Method: Using data on 8th, 9th, and 11th grade public school respondents to the 2016 Minnesota Student Survey (N = 113,834), we conducted univariate, bivariate, and multivariate analyses to examine whether sleep duration was associated with depressive symptoms, suicide ideation, and suicide attempt, adjusting for sociodemographic covariates. Furthermore, we examined the effect of the parent-child connectedness by sleep interaction on these relationships. Analyses were conducted for 9 racial/ethnic groups collectively and separately. Results: Overall, youth sleep duration and parent-child connectedness were independently associated with reduced rates of depressive symptoms, suicide ideation, and suicide attempt. There was significant interaction between parent-child connectedness and sleep, demonstrating that connectedness magnifies the benefits of the sleep-mental health relationship. Main effects of sleep and parent-child connectedness for mental health were similar for most individual racial/ethnic groups, although magnitudes varied. The connectedness-sleep interaction only remained significant for White and Asian youth on select suicide-related outcomes. Conclusion: Despite racial/ethnic differences, adolescent sleep and parent-child connectedness both seem to buffer youth from poor mental health in a large, multiethnic sample. On the whole, these factors demonstrate a synergistic protective effect and reflect promising intervention targets. The extent to which their interactive benefit translates across diverse populations requires additional study.Item Are the Kids All Right? A Look at Flourishing among School-age Children and Youth in Minnesota(Minnesota Medical Association, 2021-01-01) So, Marvin; Lynn, AnnaFlourishing is a state characterized by positive social and behavioral functioning in children, which can be influenced by family, health care, and community factors. The National Survey of Children’s Health (NSCH) provides an opportunity to describe characteristics of the children who are—and are not yet—flourishing at the state level. Using the 2016-2017 NSCH to calculate prevalence estimates and odds ratios (ORs), this study examined parents’ perspectives on Minnesota children aged 6–17 in households, and explored select child, family, and health care correlates. The findings indicate that 41.4% of children in the state met flourishing criteria. Unadjusted ORs demonstrated differences in flourishing by child, family, and health care characteristics; after accounting for relevant covariates, parent-child connectedness, family resilience during difficult times, medical home status, and encountering adverse childhood experiences remained significantly associated with flourishing. Through highlighting factors predictive of parent-perceived flourishing, this study outlines potential insights for intervention that could accelerate child and adolescent well-being in Minnesota.Item Centering Community Voices: Establishment of a Community Advisory Board at a Student-Run Free Clinic(Journal of Health Care for the Poor and Underserved, 2022-11) So, Marvin; Nur, Amran; Keaveny, Sarah Jane; Loftus, John; Martin, Christie; Mohamed, Gandhi; Sick, BrianStudent-run free clinics (SRFCs) are common throughout the U.S. and have potential to meet the needs of both health professions trainees and patients in underserved communities. Here, we describe our SRFC's initial process for recruiting, implementing, and evaluating a Community Advisory Board to better align clinic offerings with community needs.Item Effect of Virtual Versus In Person Interpreting on Diabetes Outcomes in Non-English Language Preference Patients: A Pilot Study(Journal of Primary Care & Community Health, 2024-05-02) So, Marvin; Jadoo, Hailie; Stong, Jennifer; Klemenhagen, Kristen; Philbrick, Ann; Freeman, KathrynObjective: The objective of this pilot study was to explore the impact of interpreter format (virtual vs in person) on clinical outcomes in patients with non-English language preference (NELP) and type 2 diabetes mellitus (T2DM) in a primary care setting. We hypothesized that NELP patients utilizing in person interpreters would have improved HbA1c values, better follow-up rate, and more complex care plans compared to patients utilizing virtual interpreters. Methods: We completed a retrospective chart review of 137 NELP patients with T2DM who required a medical interpreter (February to June 2021). We calculated univariate and bivariate statistics to characterize the sample and assess the extent to which measures of continuity (follow-up visit rate and time to follow-up visit), quality (change in HbA1c), and complexity (medication intervention complexity) were associated with interpreter type. Results: There was no statistically significant difference in follow-up rate or average days to follow-up visit for NELP patients with in person as opposed to virtual interpreters. Patients with virtual interpreters demonstrated a non-statistically significant decrease in HbA1c compared to those with in person interpreters. Finally, there was no statistically significant association between interpreter format and intervention complexity. Conclusions: Quality medical interpretation contributes to optimal health outcomes in NELP patients with diabetes. Our study suggests that both in person and virtual interpreters can be effective in providing care for NELP patients, especially for chronic disease management in the context of a primary care relationship. It also highlights the importance of pursuing additional qualitative and mixed method studies to better understand the benefits of various interpreter formats across different visit types.Item An Evaluation of the Literacy Demands of Online Natural Disaster Preparedness Materials for Families(Disaster Medicine and Public Health Preparedness, 2020) So, Marvin; Franks, Jessica L.; Cree, Robyn A.; Leeb, Rebecca T.Objective: Natural disasters are becoming increasingly common, but it is unclear whether families can comprehend and use available resources to prepare for such emergencies. The objective of this study was to evaluate the literacy demands of risk communication materials on natural disasters for US families with children. Methods: In January 2018, we assessed 386 online self-directed learning resources related to emergency preparedness for natural disasters using 5 literacy assessment tools. Assessment scores were compared by information source, audience type, and disaster type. Results: One-in-three websites represented government institutions, and 3/4 were written for a general audience. Nearly 1-in-5 websites did not specify a disaster type. Assessment scores suggest a mismatch between the general population’s literacy levels and literacy demands of materials in the areas of readability, complexity, suitability, web usability, and overall audience appropriateness. Materials required more years of education beyond the grade level recommended by prominent health organizations. Resources for caregivers of children generally and children with special health care needs possessed lower literacy demands than materials overall, for most assessment tools. Conclusions: Risk communication and public health agencies could better align the literacy demands of emergency preparedness materials with the literacy capabilities of the general public.Item Exclusionary Discipline: A Pressing Concern for Minnesota’s Children and Youth(Minnesota Pediatrician, 2021-06) So, Marvin; Richardson, Ruth; Scheurer, Johannah M.Item Health and Care Utilization among Youth with a History of Parental Incarceration and Homelessness(Families, Systems, & Health, 2023-07-28) So, Marvin; Davis, Laurel; Barnes, Andrew; Freese, Rebecca; Atella, Julie; Shlafer, RebeccaIntroduction. Despite widespread recognition of the health and social risks posed by parental incarceration and homelessness, these challenges are rarely considered in unison. We sought to (1) assess the experiences of homelessness among youth with and without a history of parental incarceration (PI), and (2) compare the health and health care utilization among youth with a combined history of PI and homelessness. Methods. Examining data from eighth, ninth, and eleventh grade public school participants in the 2019 Minnesota Student Survey (N=110,904), we calculated univariate and multivariate analyses to characterize the health status and care utilization of youth who have experienced PI, past-year homelessness, or both. Results. We observed higher prevalence of homelessness among youth with a history of PI compared to those without. The group with dual PI-homelessness experience had a higher proportion of youth that were younger, male, and non-white; and living in poverty or urban areas compared to youth with PI history only. Even after accounting for demographic factors, the dual PI-homelessness group evidenced higher expected odds for several physical health conditions (e.g., asthma, diabetes), and differences in care utilization indicators relative to individual PI and homelessness groups. Discussion. Findings suggest that PI may be over-represented among recently homeless youth and that youth with such dual experience possess distinct, and often elevated, health service needs. Health, education, housing, and other systems may need intersectoral strategies to better identify and support this at-risk subset of youth through clinical and policy approaches.Item “Many people know nothing about us”: narrative medicine applications at a student-run free clinic(Journal of Interprofessional Care, 2023-06-09) So, Marvin; Sedarski, Emma; Parries, Megan; Sick, BrianNarrative medicine is an approach to healthcare that acknowledges the stories of patients’ lives both within and beyond the clinical setting. Narrative medicine has been increasingly recognized as a promising tool to support modern educational needs in health professions training, such as interprofessional practice, while enhancing quality of care. Here, we describe the development, implementation, and application of a narrative medicine program at the University of Minnesota Phillips Neighborhood Clinic. First, in a qualitative analysis of patient stories (n = 12) we identified themes regarding the value of the storytelling experience; patients’ personal journeys; and patients’ experiences in healthcare and other systems. Second, an interprofessional educational activity for student volunteers (n = 57) leveraging a patient narrative was observed to be satisfactory, significantly improve attitudes toward the underserved, and enhance quality of care from the perspectives of trainees. Together, findings from the two studies imply the potential benefits of broader incorporation of narrative medicine into interprofessional service settings, for both learners and patients.Item Parental Incarceration and Child Development: Considerations for Physicians(Twin Cities Medical Society, 2021-06) So, Marvin; Shlafer, RebeccaItem Positive Early Childhood Experiences and School Readiness among United States Preschoolers(Journal of Pediatrics, 2023-07-31) So, Marvin; Woodward, Krista P; Shlafer, Rebecca J; Testa, Alexander; Davis, Laurel; Jackson, Dylan BObjectives: To characterize the relationship between positive early childhood experiences (PECEs) and school readiness, and assess whether the PECEs-school readiness relationship was robust to and/or differed across levels of adverse childhood experiences (ACEs). Methods: We analyzed national data on children ages 3-5 from 2016-2020 (N = 26,871) to examine associations between key PECE domains (nurturing relationships, home learning opportunities, safe and stable environments, and family routines) with being on-track for school readiness, defined using a pilot, multidimensional measure called “Healthy and Ready to Learn.” Weighted univariate, bivariate, and multivariable analyses were conducted to generate nationally representative estimates. Multivariable models adjusted for sociodemographic factors and were assessed both with and without cumulative ACE exposure. Results: Two-fifths of children were healthy and ready to learn. Exposure to PECEs was associated with higher school readiness, irrespective of relative ACE exposure. Compared with those with low PECEs, children with moderate (adjusted odds ratio [aOR]: 2.19, 95% confidence interval [CI]: 1.86, 2.58) and high (aOR: 4.37, 95% CI: 3.58, 5.34) PECEs had greater odds for being healthy and ready to learn, net of both sociodemographic factors and ACE exposure. Significant associations were robust across demographic groups (eg, race and ethnicity), ACE levels, and ACE types (eg, parental incarceration). Conclusions: Increasing PECEs correspond with greater likelihood of possessing capacities key for school functioning, even amidst ACEs. In concert with efforts to ameliorate early life trauma, caregivers, health care providers, educators, and systems can consider boosting PECEs to foster healthy development in childhood and beyond.Item The Promise and Pitfalls of Telemedicine: Children’s Mental Health During and Beyond COVID-19(Minnesota Medicine, 2022-09) So, Marvin; Honeycutt, ChaseThe COVID-19 pandemic created significant shifts for the lives of children, families, and the healthcare providers that serve them. Emergency mandates permitted expanded use of telemedicine models to address certain medical and behavioral health conditions. Using a clinical case example, this article illustrates the many challenges that families of children with mental health needs face in receiving—and optimally benefiting from—mental health screening, assessment, treatment, and care coordination. These barriers have long been documented prior to the pandemic, but merit renewed consideration as telemedicine takes on a larger role in the healthcare system, particularly for primary care providers. Implications for patient families, providers, and healthcare systems are discussed, which could inform clinical and policy activities to achieve behavioral health equity for children.Item Protective Factors Among Pregnant and Parenting Youth Experiencing Homelessness in Shelter: A Qualitative Exploratory Study(Adversity and Resilience Science, 2024-02-01) So, Marvin; Kaja, Sarah; Brar, Pooja; Mehus, Christopher; Woodlee, Christina; Gewirtz O'Brien, JannaPregnant and parenting youth experiencing homelessness (PPYEH) face considerable health and socioeconomic challenges. Although protective factors, such as positive adult relationships, are key elements for healthy development throughout adolescence and young adulthood, they remain less understood among PPYEH. Drawing on in-depth interviews with 11 female participants (ages 15–20) in a shelter-based health program, we conducted a qualitative analysis to explore protective factors among PPYEH. Guided by a theory-informed codebook, we identified individual, interpersonal, organizational, and community-level factors that supported the health of PPYEH. Individual factors included youths’ future orientation, sexual health and contraceptive knowledge, understanding/prioritization of personal and child health, self-efficacy and engagement in their parent role, and ability to navigate complex systems. Interpersonal factors included meaningful parent–child relationships and multidimensional support from family and school. Organizational factors included instrumental support from school and shelter, shelter rules and policies, and the benefit of the shelter compared to previous housing circumstances. Community factors included having access to and satisfaction with primary care, easy access to sexual and reproductive healthcare, and a network of professional supports. Societal-level protective factors were not identified. Findings demonstrate the value of understanding and enhancing protective factors within ongoing clinical, educational, and policy efforts to support PPYEH.Item Pushed Out and Drawn In: Exclusionary Discipline, Mental Health, and Protective Factors Among Youth in Public Schools(Journal of School Health, 2023-10-22) So, Marvin; Freese, Rebecca L.; Barnes, Andrew J.Background: Exclusionary discipline (ED) has long been an educational equity concern, but its relationship with student health and protective factors is less understood. Methods: Using population-based public school student data (N = 82,216), we examined associations between past-month ED and positive depression and anxiety screening instrument results. We also assessed whether each of 9 potential protective factors moderated the ED-mental health relationship by testing interaction effects. Results: Over 1 in 10 youth experienced past-month ED, with variation by sex, gender identity, special education status, poverty, region, race/ethnicity, and adverse childhood experiences. Net of sociodemographic factors, youth who experienced ED had higher likelihood for current depression (adjusted odds ratio [AOR]: 1.64, 95% confidence interval [CI]: 1.55, 1.73) and anxiety (AOR: 1.49, 95% CI: 1.41, 1.58) symptoms. Significant associations were robust across 5 racial/ethnic groups, except for anxiety among American Indian/Alaska Native youth. Individual, interpersonal, and school-level protective factors appeared to mitigate depression and anxiety regardless of disciplinary experience. Implications for School Health Policy, Practice, and Equity: Our findings document ED disproportionality and possible ramifications for emotional well-being. Conclusions: In concert with structural efforts to reduce reliance on ED, strategies that bolster protective factors may support youth already impacted by ED and/or mental health problems.Item Severed Medicines(Clinical Pediatrics, 2022-12) So, Marvin