Michigan Public Health Institute

In the United States, female youth have been experiencing high levels of mental health challenges, including depression. Many factors increase the risk of developing mental health issues, including exposure to traumatic events, like the Flint water crisis. To better understand this connection, this study aims to answer the question: How do depression symptoms in this Flint Registry sample of girls compare with national norms and how are child depression symptoms related to parental/caregiver depression symptoms and perceived stress? The cohort included 539 girls, ages 6-17, and their parents who were Flint residents and had completed a baseline survey for their child and themselves during 2019-2021 and a follow-up survey (2020-2022). The Behavior Assessment System for Children (BASC-3) measured child depression symptoms; the Quality of Life in Neurological Disorders (Neuro-QoL) depression subscale and Perceived Stress Scale Short Form (PSS-4) measured adult depressive symptoms and perceived stress. Statistical analysis included One-Sample Chi-Square and Bayesian correlation and regression analysis. At enrolment, the prevalence of at-risk or clinically significant depression symptoms in Flint girls was higher than in the general population (23.6% vs. 15.9%, p < 0.01). At follow-up, the prevalence decreased, yet there was still a significant difference between Flint girls (19.3%) and the general population (p < 0.05). Child measures of depressive symptoms at follow-up were significantly correlated with caregiver measures of depression and stress at both time points. Child depression symptoms at baseline and caregiver depression and stress were predictive of child depressive symptoms at follow-up. Results reveal high rates of depressive symptoms after a manmade environmental disaster, as well as a relationship between female youth mental wellness and caregiver well-being. Being able to understand and identify depression symptoms in both children and caregivers is an important aspect of public health services and reinforces the call for expanding mental health screening and treatment.

There is little understanding of the circumstances behind fatal pediatric opioid poisonings. Our objective was to characterize opioid fatalities according to child, family, and household factors. We used data from the National Fatality Review-Case Reporting System to describe the circumstances behind the deaths of children 0 to 17 years of age who died of an opioid poisoning (ie, prescription opioid, heroin, illicit fentanyl) between 2004 and 2020. Decedents were stratified into age groups: 0-4, 5-9, 10-14, and 15-17 years. The majority (65.3%) of the 1696 fatal opioid poisonings occurred in the child's own home. Prescription opioids contributed to 91.8% of deaths, heroin contributed to 5.4%, and illicit fentanyl to 7.7%. Co-poisonings with nonopioid substances occurred in 43.2% of deaths. Among 0- to 4-year-olds, 33.9% died of homicide and 45.0% had a primary caregiver with a history of substance use/abuse. Among 10- to 14-year-olds and 15- to 17-year-olds, respectively, 42.0% and 72.8% of decedents had a history of substance use/abuse. In each age group, at least 25.0% of children were victims of previous child maltreatment. A history of maltreatment and substance use-whether on the part of the caregiver or the child-are common factors surrounding fatal pediatric opioid poisonings, the majority of which occur in the child's own home. Families with children of all ages would benefit from interventions focused on opioid prescribing, storage, disposal, and misuse. These findings also underscore the urgency of ensuring that access to naloxone becomes universal for families with a history of maltreatment and/or substance use.

Describe characteristics of sudden unexpected infant deaths (SUID) occurring on shared or nonshared sleep surfaces. We examined SUID among residents of 23 US jurisdictions who died during 2011 to 2020. We calculated frequencies and percentages of demographic, sleep environment, and other characteristics by sleep surface sharing status and reported differences of at least 5% between surface sharing and nonsharing infants. Of 7595 SUID cases, 59.5% were sleep surface sharing when they died. Compared with nonsharing infants, sharing infants were more often aged 0 to 3 months, non-Hispanic Black, publicly insured, found supine, found in an adult bed or chair/couch, had a higher number of unsafe sleep factors present, were exposed to maternal cigarette smoking prenatally, were supervised by a parent at the time of death, or had a supervisor who was impaired by drugs or alcohol at the time of death. At least 76% of all SUID had multiple unsafe sleep factors present. Among surface-sharing SUID, most were sharing with adults only (68.2%), in an adult bed (75.9%), and with 1 other person (51.6%). Surface sharing was more common among multiples than singletons. Among SUID, surface sharing and nonsharing infants varied by age at death, race and ethnicity, insurance type, presence of unsafe sleep factors, prenatal smoke exposure, and supervisor impairment. Most SUID, regardless of sleep location, had multiple unsafe sleep factors present, demonstrating the need for comprehensive safe sleep counseling for every family at every encounter.

*University of Michigan Medical School, Ann Arbor, Michigan †Department of Surgery, Michigan Medicine, Ann Arbor, Michigan ‡Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan Conflicts of Interest and Source of Funding: Luca Borah reported short-term funding from the National Institutes of Health. Victor Agbafe reported consulting payments for his fellowship with Third Culture Capital. Unrelated to the current work, Dr. Scott reported receiving funding from the Agency for Healthcare Research and Quality as principal investigator on grant K08-HS028672 and co-investigator on grant R01-HS027788 and reported receiving salary support from Blue Cross Blue Shield of Michigan through the initiative known as Michigan Social Health Interventions to Eliminate Disparities. No other disclosures were reported. [email protected]

RNA vaccines for cancer and cancer-causing infectious agents are recognized as new therapeutics and are perceived as potential alternatives to conventional vaccines. Cancer is a leading cause of death worldwide, and infections (certain viruses, bacteria, and parasites) are linked to about 15–20% of cancers. Since the last decade, developments in genomics methodologies have provided a valuable tool to analyze the specific mutations, fusions, and translocations of the driver genes in specific cancer tissues. The landscape of the mutations identified by genome sequencing and data analysis can be a vital route to personalized medicine. This chapter will discuss the present state of mRNA vaccine development and ongoing clinical trials in oncology.

BackgroundSuicide is a leading cause of death among children in the United States (US). The COVID-19 pandemic raised concerns that suicide rates will increase. Multidisciplinary child death review (CDR) teams examine the circumstances of child deaths, identifying risk and protective factors and recommending prevention strategies.AimsIdentify factors associated with suicides during the COVID-19 pandemic.MethodsThe National Fatality Review Case Reporting System (NFR-CRS) is a web-based platform documenting circumstances of child deaths reviewed by CDR teams. In April 2021 a COVID-19 question that asked whether COVID-19 directly or indirectly impacted the death was added. Suicides among children ages 10–17 occurring during 2020–2021 were studied. Demographic characteristics, life stressors, and social/mental health histories were compared for COVID-19 impacted suicides and non-COVID-19 impacted suicides using descriptive statistics; chi-squared statistics assessed statistical significance.Results550 suicides were included for study. Youth whose suicide was impacted by COVID-19 (n=142) experienced significantly more isolation (61% vs 14%), school problems (42% vs 19%), and witnessing violence (14% vs 3%) compared to non-COVID-19 impacted suicides (n=408). Significantly more COVID-19 impacted youth had depression (43% vs 24%) and/or anxiety disorder (23% vs 12%) diagnoses.ConclusionsFlexibility within the NFR-CRS permitted the rapid addition of pandemic-related questions, thereby, providing opportunities to examine the pandemic’s impact on children’s deaths. Although suicide rates cannot be calculated using NFR-CRS data, significant factors associated with suicide are identified that can facilitate screening and mental health delivery.Learning OutcomesUnderstand the impact of the COVID-19 pandemic on youth suicide in the US.

BackgroundAlthough nutrients in fruits and vegetables are necessary for proper development and disease prevention, most US children consume fewer servings than recommended. Prescriptions for fruits and vegetables, written by physicians to exchange for fresh produce, address access and affordability challenges while emphasizing the vital role of diet in health promotion and disease prevention. Michigan’s first fruit and vegetable prescription program (FVPP) exclusively for children was introduced in 2016 at one large pediatric clinic in Flint and expanded to a second clinic in 2018. The program provides one $15 prescription for fresh produce to all pediatric patients at every office visit. Prescriptions are redeemable at a year-round farmers’ market or a local mobile market. The current study will assess the impact of this FVPP on diet, food security, and weight status of youth.MethodsDemographically similar pediatric patient groups with varying levels of exposure to the FVPP at baseline will be compared: high exposure (> 24 months), moderate exposure (12–24 months), and no previous exposure. Data collection will focus on youth ages 8–16 years. A total of 700 caregiver-child dyads (one caregiver and one child per household) will be enrolled in the study, with approximately 200 dyads at clinic 1 (high exposure); 200 dyads at clinic 2 (moderate exposure), and 300 dyads at clinic 3 (no previous exposure). Children with no previous exposure will be introduced to the FVPP, and changes in diet, food security, and weight status will be tracked over two years. Specific aims are to (1) compare baseline diet, food security, and weight status between pediatric patients with varying levels of exposure to the FVPP; (2) measure changes in diet, food security, and weight status before and after never-before-exposed children are introduced to the FVPP; and (3) compare mean 12- and 24-month follow-up measures of diet, food security, and weight status in the initial no exposure group to baseline measures in the high exposure group.DiscussionCompletion of study aims will provide evidence for the effectiveness of pediatric FVPPs and insights regarding the duration and intensity of exposure necessary to influence change.Trial registrationThe study was registered through clinicaltrials.gov [ID: NCT04767282] on February 23, 2021.

ABSTRACT National Guard soldiers experience unique reintegration challenges. In addition to managing the consequences of combat-related trauma, they also navigate multiple transitions between military and civilian life. Despite these obstacles, many soldiers report positive outcomes and personal growth due to deployment, a phenomenon most commonly referred to in the literature as posttraumatic growth (PTG). The current study explored PTG in National Guard soldiers using a multidimensional longitudinal approach, with the goal of validating reports of PTG in soldiers. Data were collected from National Guard soldiers at pre-deployment, reintegration, one year post-deployment and two years post-deployment. Informed by PTG theory, three PTG constructs were measured (perceived ability to handle stress, social support seeking, and purpose in life) at each of the four time points, with increases in these constructs indicating growth. Potential predictors of growth in these PTG constructs were also explored. Results from a repeated measure latent profile analysis indicated that PTG did occur in certain soldiers, and that higher optimism and less severe PTSD symptoms predict this growth. These findings emphasize the importance of making efforts to facilitate PTG in soldiers.