Study: Highly educated Black women experience poorer maternal outcomes

Findings revealed at the 2023 Pediatric Academic Societies Meeting

Reports and Proceedings

PEDIATRIC ACADEMIC SOCIETIES

Black mothers with a master’s or doctorate degree experienced some of the worst birth outcomes, compared to Black mothers with less education and white mothers with the same or less education, according to a new study. The research will be presented at the Pediatric Academic Societies (PAS) 2023 Meeting, held April 27-May 1 in Washington, D.C.

Researchers examined how educational achievement and race affected preterm births and low birth weights for babies born to non-Hispanic Black and white women over the age of 25. The study used birth certificate records obtained from the Ohio Department of Health within Franklin County, Ohio from 2016 to 2021.

As education increased, the Black-White racial disparities in birth outcomes worsened. More than 10% of Black mothers with a master’s degree or doctorate had a preterm or very preterm birth, compared to less than 6% of white mothers with the same level of education. Low birth weight was more common for babies born to Black individuals with an advanced degree (9.58%), compared to white individuals (3.56%) with a master’s degree or doctorate.

According to the study, Black mothers with an advanced degree had similar outcomes (10.39% preterm or very preterm birth; 9.58% low birth weight) to white mothers with a high school degree (10.48% preterm or very preterm birth; 8.26% low birth weight).

Chart: Percent Preterm/Very Preterm Birth & Low Birth Weight, by Race and Education:

	Percent Preterm or Very Preterm Birth	Percent Low Birth Weight
Non-Hispanic Black Women
< High School	9.37%	8.4%
High School	11.52%	10.6%
Some College	10.99%	10.23%
Bachelor’s Degree	8.61%	7.32%
Master’s or Doctorate Degree	10.93%	9.58%
Non-Hispanic White Women
< High School	15.65%	14.13%
High School	10.48%	8.26%
Some College	8.1%	5.68%
Bachelor’s Degree	5.74%	3.79%
Master’s or Doctorate Degree	5.57%	3.56%

 

“As we continue to grapple with the Black maternal health crisis, the results of this study highlight an overlooked inequity that we must pay attention to,” said Kierra S. Barnett, Ph.D., M.P.H., research scientist at the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, and presenting author. “There is a clear disconnect between the benefits we assume education should have on our health and what educated Black mothers are experiencing in our society.”

Study authors called for additional research to assess alternate factors contributing to poor maternal health outcomes for Black women and immediate solutions to minimize the burden on Black families.

# # #

EDITOR:

Dr. Barnett will present “Education Isn’t Enough: Birth Outcomes at the Intersection of Race and Maternal Education” on Monday, May 1 at 12:00 p.m. ET.

Reporters interested in an interview with Dr. Barnett should contact Amber Fraley at amber.fraley@pasmeeting.org.

About the Pediatric Academic Societies Meeting
The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting and like us on Facebook PASMeeting.

Abstract: Education Isn’t Enough: Birth Outcomes at the Intersection of Race and Maternal Education

Presenting Author: Kierra S. Barnett, PhD, MPH

Organization
The Research Institute at Nationwide Children's Hospital

Topic:
Health Equity/Social Determinants of Health

Background
Black-White racial inequities in rates of preterm birth (PTB) and low birth weight (LBW) are persistent. While differential maternal education is often hypothesized as a contributing risk factor in disparities, previous literature suggests that the benefits of more education are not experienced equally across racial groups and the nuanced role of advanced education is understudied due to the common practice of all post high school education into a single category.

Objective
To examine associations between race, maternal education, and odds of PTB and LBW.

Design/Methods
Birth certificate records from the Ohio Department of Health for all singleton births within Franklin County, Ohio from 2016 to 2021 (n=58,391) were used to calculaterates of PTB (< 37 weeks gestation), very PTB (< 32 weeks gestation) and LBW (< 2,500g at birth) for birthing people 25 years and older who identified as non- Hispanic Black (NHB) and/or non-Hispanic White (NHW). Education was categorized into five groups: less than high school, high school, some college, bachelor’s degree and masters or doctorate degree. Generalized linear mixed models with random intercepts at census tracts were fitted to examine the interaction between race and education, controlling for maternal age, marital status, parity, prenatal care, smoking during pregnancy, health insurance status, having 1 or more risk factors for poor birth outcomes in their medical history, and the Index of Concentration of Extremes to assess racial and economic segregation at the neighborhood level.

Results
Among NHB birthing people, those with a master’s or doctorate degree experienced some of the worst birth outcomes. However, among NHW birthing people, birth outcomes steadily improved as education increased. Regression models demonstrated that the Black-White disparity worsened as education increased. Among those without a high school education, the odds of PTB, Very PTB and LBW was lower among NHB compared to NHW birthing people (aOR =0.67, 0.51 and 0.61 respectively). Compared to NHW birthing people with a master’s or doctorate degree, the odds of PTB, Very PTB and LBW were 35% (95% CI: 1.07, 1.69), 251% (95% CI: 2.20, 5.61) and 120% (95% CI: 1.76, 2.76) higher among NHB birthing people with similar education after controlling for all covariates.

Conclusion(s)
Contrary to the social gradient in health, NHB birthing people with advanced degrees experienced some of the worst health outcomes compared to other NHB and NHW birthing people. Additional research is needed to assess individual and macro-level factors that contribute to this phenomenon.

Tables and Images
Table 1 MCH education.jpg
Table 2 aOR MCH educaion.jpg

Study: Black youth most likely to receive drug restraints for mental health

Findings revealed at the 2023 Pediatric Academic Societies Meeting

Reports and Proceedings

PEDIATRIC ACADEMIC SOCIETIES

Non-Hispanic Black youth between the ages of 5 and 18 years old are more likely to undergo pharmacologic restraint during mental health crises than children of other races and ethnicities. The findings will be presented at the Pediatric Academic Societies (PAS) 2023 Meeting, held April 27-May 1 in Washington, D.C. 

The study examined records of 61,503 children admitted to 41 non-psychiatric U.S. children’s hospitals between 2018 and 2022 due to mental health conditions such as autism, anxiety, psychotic disorders, self-injury or suicide, and trauma. Approximately 11.9% received pharmacologic restraint, a deliberate form of medication administered when there are acute safety concerns to staff and/or patient. The records were obtained from the Children’s Hospital Association’s Pediatric Health Information System database.

Among the 7,309 children who experienced pharmacologic restraint over the study period, 14.8% of children were Non-Hispanic Black, compared to 12.3% Hispanic, 11.6% Asian, 11.1% Non-Hispanic White, and 9.5% of other races and ethnicities.

Findings also showed that despite female hospitalizations (68.3%) outweighing those of males (31.7%), when evaluating for racial and ethnic differences in pharmacologic restraint by sex, Non-Hispanic Black male youth were more likely to undergo restraint. No differences were found among female sex and race/ethnicity.

“The study results reveal stark disparities in our hospitals’ care systems and point to evidence of interpersonal and structural racism in de-escalation of mental health crises,” said Ryan M. Wolf, M.D., pediatric hospital medicine fellow at Monroe Carell Jr. Children's Hospital at Vanderbilt and presenting author. “As America’s youth mental health crisis continues to grow, this data has drastic implications for evaluating pharmacologic restraint use during mental health crises.” 

Researchers advocate that future studies should emphasize solutions to provide more equitable, preventive care for child and adolescent mental health patients that prioritizes their safety and minimizes disparities in health care facilities.

# # #

EDITOR:

Dr. Wolf will present “Racial/Ethnic Disparities in Pharmacologic Restraint Use for Children Hospitalized in Mental Health Crises” on Monday, May 1 at 8 a.m. ET.

Reporters interested in an interview with Dr. Wolf should contact Amber Fraley at amber.fraley@pasmeeting.org.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting and like us on Facebook PASMeeting.

Abstract: Racial/Ethnic Disparities in Pharmacologic Restraint Use for Children Hospitalized in Mental Health Crises

Presenting Author: Ryan M. Wolf, MD

Organization

Monroe Carell Jr. Children's Hospital at Vanderbilt

Topic

Hospital Medicine: Clinical

Background

Children experiencing mental health crises are increasingly admitted to children’s hospitals awaiting inpatient psychiatric placement. For management of acute agitation, verbal de-escalation, pharmacologic restraint, and/or physical restraint are used. Little is known about racial/ethnic disparities of pharmacologic restraint use for hospitalized children.

Objective

Using a health equity lens, we examined the association between pharmacologic restraint use and race/ethnicity among children admitted for mental health conditions in acute care, non-psychiatric children’s hospitals.

Design/Methods

We performed a retrospective cohort study of children (5-18 years) admitted for a primary mental health condition from 2018-2022 at 41 US children's hospitals using the Pediatric Health Information System. Mental health conditions were defined using discharge diagnosis codes using a validated algorithm. Race/ethnicity data are reported by each      acute agitation (Table 2 footnote). Race/ethnicity was considered as a sociopolitical construct and associations with pharmacologic restraint use were assessed using generalized linear mixed models with adjustment for clinical and demographic factors and then stratified by sex. To address potential misclassification, we performed a sensitivity analysis restricting the definition of pharmacological restraint to haloperidol, olanzapine, and ziprasidone.

Results

The cohort included 61503 hospitalizations (Table 1). Of those, 7309 (11.9%) had pharmacologic restraint use. Compared to Non-Hispanic Black children, those identifying as Non-Hispanic White, Asian, or other race/ethnicity were significantly less likely to receive pharmacologic restraints (range of adjusted odds ratios [aORs]: 0.68-0.82) (Table 2). When stratified by sex, observed racial/ethnic differences were magnified in males (aORs 0.49-0.68), and attenuated in females (aORs 0.83-0.93). In our sensitivity analysis, we observed significant and stronger negative associations with restraint use for all racial/ethnic groups (aORs 0.52- 0.64) as compared to Non-Hispanic Black youth.

Conclusion(s)

Non-Hispanic Black children, especially males, were significantly more likely to receive pharmacologic restraints than non-Hispanic White, Asian, and Hispanic children while hospitalized for mental health crises. Future work should focus on ways to promote more equitable care, such as implicit bias and verbal de-escalation training and standardized de-escalation protocols.

Tables and Images

Table 1 PAS 2023.png

Table 2 PAS 2023.png

Study: Lenient gun laws pose threat to public safety

Findings revealed at the 2023 Pediatric Academic Societies Meeting

Reports and Proceedings

PEDIATRIC ACADEMIC SOCIETIES

Children in states with minimal firearm policies have a significantly higher death rate compared to those in states with strict gun laws, according to a new national study. The research will be presented at the Pediatric Academic Societies (PAS) 2023 Meeting, held April 27-May 1 in Washington, D.C. 

The study analyzed 6,491 pediatric firearm-related deaths between 2016 and 2020 from the Centers for Disease Control and Prevention, along with state rankings for firearm legislation from Giffords Law Center, a national nonprofit that tracks and analyzes firearm legislation in all 50 states. States are ranked on the strength of gun laws on a scale from least lenient to most lenient.

Researchers further explored financial implications of gun laws by analyzing the average value of statistical life—a measure of the tradeoff between death risk and money—and found that due to the increased number of deaths in states with more lenient gun laws, residents pay an increased cost to enhance their safety and reduce their risk of injury.

“The unsettling results of this study have dire implications for the health and public safety of children across the United States,” said Amber McKenna, M.D., resident physician at LSU Health Shreveport Pediatrics and presenting author. “The data is clear: more restrictive firearm laws will keep more children alive.”

These findings represent a need to explore frameworks that prioritize public safety.

# # #

EDITOR:

Dr. McKenna will present “Impact of State Legislation on Pediatric Firearm Injuries” on Saturday, April 29 at 12:15 p.m. ET.

Reporters interested in an interview with Dr. McKenna should contact Amber Fraley at amber.fraley@pasmeeting.org.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting and like us on Facebook PASMeeting.

Abstract: Impact of State Legislation on Pediatric Firearm Injuries

Presenting Author: Amber McKenna, M.D.

Organization

LSU Health Shreveport Pediatrics

Topic

Hospital Medicine: Systems/Population-based Research

Background

Firearm injuries are now the leading cause of death for children and young adults. There is a wide variation in state legislation surrounding firearms.

Objective

To evaluate the impact of restrictiveness of state legislation for firearms on the mortality and the economic impact due to firearm injuries, using publicly available data.

Design/Methods

Data was obtained from Center for Disease Control and Prevention (CDC) from 2015-2020 for children 0-18 years. Fatal firearm injuries were included and data from each state was obtained. State ranking for firearm legislation was obtained from Giffords Law Center. States were ranked 1-12, for each year, 1 being most restrictive and 12 being the least. Average medical cost and Value of Statistical Life (VSL) average for each state were also obtained from CDC WONDER database. VSL estimates the “willingness to pay for small aggregate reductions in mortality risk” and the “dollar that a large group of people would be to pay for a in their risks of dying in a year, such that we would one fewer death the group that year on average (United States Environmental Protection Agency). 

Results

From 2016-2020 we had a total of 6491 deaths in children 0-18 years. There was a significant correlation between death rate per100,000 population and gun control law ranking for states (Spearman’s Rho correlation 0.589; p< 0.001). There was a correlation between combined costs and gun control law ranking (Spearman’s Rho correlation 0.228; p< 0.001). Also, there was a significant correlation between VSL average and gun control law ranking (Spearman’s Rho correlation 0.231; p< 0.001), which indicates that the states with lenient gun control laws, as a group pay a larger dollar amount for their population to decrease the risk of mortality due to firearm injuries.

Conclusion(s)

Over a six-year period we observe states with lenient firearm legislation have high mortality and higher value of statistical life average. Appropriate gun control laws will benefit in reducing the mortality and decrease the financial burden on the state population.

Tables and Images

Screen Shot 2023-01-04 at 4.39.24 PM.png

Study: Los Angeles county's growing youth firearm crisis

Findings revealed at the 2023 Pediatric Academic Societies Meeting

Reports and Proceedings

PEDIATRIC ACADEMIC SOCIETIES

The majority of pediatric firearm injuries in Los Angeles County occur in neighborhoods with limited social, health and educational opportunity, according to a new study exploring incidents from 2010 to 2021. The research will be presented during the Pediatric Academic Societies (PAS) 2023 Meeting taking place April 27-May 1 in Washington, D.C.

Researchers from Children’s Hospital Los Angeles analyzed firearm injuries in 1,383 children under 18 years old using records from the Trauma and Emergency Medicine Information System, which contains data from 15 trauma centers in LA County. Researchers applied the national Childhood Opportunity Index—a measure of factors that contribute to healthy, productive childhood development—to understand how a lack of resources in a child’s environment relates to firearm injury exposure. The Index is administered by Brandeis University.

The study noted the highest rates of pediatric firearm injuries among children were in neighborhoods with very low (62.7%) and low (22.6%) opportunity, compared to areas with moderate (10.5%), high (3.0%) and very high (1.3%) opportunity.

Findings also revealed that approximately 9.7 pediatric firearm injuries per year occurred for every 100,000 children in neighborhoods with a very low level of opportunity, compared to approximately 0.5 incidences for every 100,000 children living in a very high opportunity environment.  

“Firearms are the leading cause of deaths in children across the United States and this data speaks volumes that a child’s individual risk is far from equal,” says Abigail Brenner, M.D., pediatric resident physician at Children’s Hospital Los Angeles and presenting author. “We must advocate for children who are disproportionately exposed to firearm injuries and prevent the issue from growing.”

These findings represent a pressing need for targeted advocacy and policy that advances community-level interventions and support, according to the authors.

###

EDITOR:

Dr. Brenner will present “Where You Live Matters: Examining Firearm Injuries and Childhood Opportunity Index in LA County” on Sunday, April 30 at 11:15 a.m. ET.

Reporters interested in an interview with Dr. Brenner should contact Amber Fraley at amber.fraley@pasmeeting.org.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting and like us on Facebook PASMeeting.

Abstract: Where You Live Matters: Examining Firearm Injuries and Childhood Opportunity Index in LA County

Presenting Author: Abigail Brenner, M.D.

Organization

Children’s Hospital Los Angeles

Topic

Injury Prevention

Background

Firearm injuries are the leading cause of pediatric death in the United States, and the neighborhood a child lives in influences their exposure to firearms. Childhood opportunity index (COI) is a metric that combines information across three domains: education, health and environment, and social and environment to create a measurement of neighborhood opportunity. Better understanding the relationship between COI and pediatric firearm injury can lead to more focused interventions on a public health and policy level.

Objective

To examine the association between firearm injuries and COI in Los Angeles (LA) County.

Design/Methods

A retrospective cohort study of children < 18 years old from 2010-2021 was performed using the Trauma and Emergency Medicine Information System database, which contains data on firearm injuries evaluated in 15 LA County trauma centers. Population data for each zip code was collected using the Annual Commuter Survey data. Zip code level COI data was collected from Diversity Data Kids. Firearm injury incidence per 100,000 children was determined for each COI using total population < 18 years in LA County in each COI level (very low, low, moderate, high, and very high). Odds ratios based on absolute frequency of firearm injury per COI level and total population per COI level were calculated to determine the association between COI and firearm injury; very high COI was used as the reference group.

Results

The final analysis included 1383 pediatric firearm injury victims, with a median (IQR) age of 16.0 (15.0, 17.0) years. The highest incidence of firearm injury occurred in children from very low COI representing 62.7% of total occurrences. When compared to children from very high COI, children from very low or low COI neighborhoods were at significantly higher risk of experiencing firearm injury (OR 19.89 (12.47-31.71), OR 9.62 [5.98-15.48], respectively) (Table 1).

Conclusion(s)

Children in neighborhoods with very low opportunity are disproportionately exposed to firearm injury. This represents an important area for advocacy and policy in highlighting the need for community level interventions and support when considering pediatric firearm injury.

Tables and Images

Table 1.png

 

Research shows coaches who lead with empathy get more out of athletes – and here’s how

Book Announcement

TAYLOR & FRANCIS GROUP

Gone are the days of dictatorial leaders in sport, screaming from the side-lines and insulting their players, and instead we are seeing an era of emotionally intelligent leaders who demonstrate an understanding of other people while getting effective results.

The question is, how do you become an empathic leader in elite sports and will it really drive success?

Psychologist Peter Sear PhD has carried out in-depth interviews with coaches of nine different elite sports across the world to gather a series of insights, which he has backed up by the latest research.

His research suggests that ultimately, empathic leadership motivates teams, encourages loyalty, and improves chances of success.

Dr Sear explains: “The head coaches who are leading with empathy are getting more out of athletes.

“The consensus is that to have success as a leader in elite sport in the modern era, you must have an empathic approach.”

The environment of elite sports

The requirements of elite sports can create a setting for turbulent emotions, because of results, performances, the reactions of fans, and interpretations of the media. Athletes have the additional and ever-present pressures to perform, stay mentally and physically fit, injury-free, and at a certain weight.

With all these pressures, how can empathic leaders in charge of the top teams get the best from their athletes?

With philosophical and practical evidence, combined with Dr Sear’s experience in working in elite sport, he has created a model with seven key aspects of empathic leadership.

In his new book published today, Empathic Leadership: Lessons From Elite Sport, Dr Sear gives clear practical advice on the ways readers can improve their leadership, ranging from relationship management, building trust, and establishing a strong line of communication.

“There is no advantage to ruling with fear – you are just losing out on powerful knowledge of your team and your athletes,” he explains. “Success as a leader depends on your knowledge and understanding of people, their emotions, perspectives, and intentions, as well as the relationships you have with them. It is in these vital areas that empathy will give you an advantage.”

Key skills for leaders

Dr Sear suggests there are seven key aspects of empathy to master – including self-empathy, which means understanding your own emotions and how they impact others.

He argues: “Understanding what motivates your players and what hinders them will improve the quality of your decision-making as a leader. If you can understand when to push your players and when to support them, and identify who has potential and who is no longer emotionally invested, you’ll make better decisions.

“Understanding the unique character of each athlete allows you to develop them effectively according to their needs, and get the best from them.”

Skills need to include effective communication, understanding body language and having clear boundaries to be able to make difficult decisions such as when to bench a player.

But Dr Sear is keen to stress that empathy is not the same thing psychologically as being gentle, and explains: “Empathy doesn’t equate to being soft and gentle at all times, sometimes you need to recognize that one person might need to be pushed while that other player might need a friendly ear.”

Knowledge is power

Empathic Leadership demonstrates that leaders who have more empathy ultimately have more control and more knowledge, which enables better team management.

“Empathic leaders become strong leaders, through respect, appreciation, and behaviors such as listening, which enhances their prestige,” he explains. “Empathy inspires team members to go above and beyond their obligations. Ultimately, this means that the empathic leader yields more power.

Dr Sear also suggests that humans are innately more prone to respond to an empathic leader.

He explains: “This way of leading suits humans better psychologically. Through empathic communication and empathic relationships, emotions can be managed and needs met. The experience of work is valued, with high levels of wellbeing, which manifests in confidence and peak performance.”

 

Further information

About the author

Peter Sear is a psychologist, writer, and consultant. He gained his PhD from Loughborough University London, UK, with his thesis Understanding Empathic Leadership in Elite Sport. He also holds a master's degree in Jung and Post-Jungian Studies, a master’s degree in Human Resource Management and Industrial Relations, and a BSc (Hons) in Psychology. He is a Member of the British Psychological Society and a Fellow of the Royal Society for Arts.

Study: Medicaid enrollment among immigrant children higher in sanctuary states

Findings revealed at the 2023 Pediatric Academic Societies Meeting

Reports and Proceedings

PEDIATRIC ACADEMIC SOCIETIES

Low-income immigrant children in sanctuary states were nearly 10% more likely to be enrolled in Medicaid in the years following the 2018 announcement of the revised “public charge” rule, according to a new national study. Researchers examined trends in children’s Medicaid enrollment in sanctuary states—states that limit collaboration with federal Immigration and Customs Enforcement personnel. The research will be presented at the Pediatric Academic Societies (PAS) 2023 Meeting, held April 27-May 1 in Washington, D.C. 

Researchers explored Medicaid enrollment rates among low-income immigrant children following a 2018 federal rule denying immigrants permanent residency based on participation in public programs, including Medicaid for adults but not for children.

Researchers found that Medicaid enrollment among low-income immigrant children in sanctuary states— Calif., Colo., Conn., Ill., N.Y., Ore., R.I., Vt., and Wash.—increased after the 2018 rule update. Medicaid enrollment rates among low-income immigrant children in non-sanctuary states decreased during the same period.

“Federal immigration policies can serve as political determinants of health, denying children in immigrant families access to health insurance and medical care,” said Marine-Ayan Ibrahim Aibo, medical student at Perelman School of Medicine at the University of Pennsylvania and presenting author. “States can break barriers to care that federal immigration policies create and ensure every child receives the care they need.”

The study looked at 3,943 immigrant children from the U.S. Census Bureau and U.S. Bureau of Labor and Statistics’ Current Population Survey to compare Medicaid enrollment in sanctuary and non-sanctuary states, adjusting for race, ethnicity, state, year, and Medicaid expansion status.

# # #

EDITOR:

Ms. Ibrahim Aibo will present “Association of State Sanctuary Policies with Medicaid Participation Among Immigrant Children Following the Revised Public Charge Rule” on Monday, May 1 at 9:15 a.m. ET.

Reporters interested in an interview with Ms. Ibrahim Aibo should contact Amber Fraley at amber.fraley@pasmeeting.org.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting and like us on Facebook PASMeeting.

Abstract: Association of State Sanctuary Policies with Medicaid Participation Among Immigrant Children Following the Revised Public Charge Rule

Presenting Author: Marine-Ayan Ibrahim Aibo, B.A.

Organization

Perelman School of Medicine at the University of Pennsylvania

Topic

Health Equity/Social Determinants of Health

Background

Immigration policies are political determinants of health that can impact children’s access to health-promoting government benefit programs. From 2011-2017, nine US states enacted statewide sanctuary policies designed to limit state collaboration with federal Immigration and Customs Enforcement and protect immigrants’ health and well being. In 2018, the Trump administration announced a plan to revise the federal “public charge” rule to deny legal permanent resident status to immigrants based on their participation in benefit programs, including Medicaid for adults but not children. 

Objective

To assess whether state-level sanctuary immigration policies may protect access to health care for immigrant children, we compared Medicaid participation among immigrant children in sanctuary vs. non-sanctuary states before and after the 2018 announcement of the revised public charge rule.

Design/Methods

We used 2015-2021 Current Population Survey nationally representative data to compare Medicaid participation among low-income immigrant children living in sanctuary vs. non-sanctuary states. Immigration status was determined by self report; documentation status was not assessed. We then used difference-indifferences regression modeling to assess the change in Medicaid participation among immigrant children in sanctuary relative to non sanctuary states, after adjusting for race, ethnicity, state, year, and Medicaid expansion status.

Results

Our sample included 3,943 immigrant children with household incomes < 150% of the federal poverty level. Sanctuary and non-sanctuary states had similar rates of child poverty, and sanctuary states had a greater baseline proportion of Latinx residents (Table 1). Although children’s Medicaid participation was not considered in the revised public charge rule, Medicaid participation among immigrant children in non-sanctuary states declined after the rule was announced. In contrast, Medicaid participation among immigrant children in sanctuary states increased during this time period (Figure 2). In adjusted difference-in-differences models, immigrant children in sanctuary states had a 9.8% greater probability of Medicaid participation (95% CI 2.9-16.6%, p=0.005) relative to children in non-sanctuary states, following the public charge rule.

Conclusion(s)

Following the revised public charge rule, low-income immigrant children in states with sanctuary immigration policies were more likely to receive Medicaid than children in non-sanctuary states. Sanctuary policies may protect against the harmful effects of federal legislation on immigrant children.

Tables and Images

Figure 1.png

Table 1.png

Figure 2.png

 

Trudeau suggests China uses slave labor in lithium production

Reuters | April 28, 2023 |

Justin Trudeau. (Image courtesy of Trudeau’s press team).

Canadian Prime Minister Justin Trudeau on Friday suggested that China uses slave labor in the production of lithium as he discussed Canada’s efforts to ramp up production of the critical metal used in electric vehicle and other batteries.


Canada last fall announced a tougher policy on critical mineral investment – particularly from dominant producer China – as it worked to shore up its domestic supply of critical minerals after the global pandemic exposed supply chain problems that caused major production disruptions.

Canada has significant sources of lithium, Trudeau said, but China has made strategic choices over the decades that have made it by far the world’s largest producer of the lithium used in cell phones and electric vehicles.

“If we’re honest … the lithium produced in Canada is going to be more expensive. Because we don’t use slave labor,” Trudeau said in remarks at the Council on Foreign Relations in New York.

“Because we put forward environmental responsibility as something we actually expect to be abided by. Because we count on working with, in partnership with indigenous peoples, paying their living wages, expecting security and safety standards.”

A representative for the Chinese Embassy in Ottawa did not respond to a request for comment.

The United States has alleged use of forced labor by China in sectors including mining and construction. Last year, a US law took effect banning imports from China’s Xinjiang region over concerns about forced labor.

Chinese firms own, operate or finance most of the Democratic Republic of Congo’s cobalt mines, the Labor Department said in a recent report. “Our research shows that lithium-ion batteries are produced with an input – cobalt – made by child labor,” it said.

In December, the United Auto Workers union called on automakers to shift their entire supply chain out of China’s Xinjiang region after a report by Britain’s Sheffield Hallam University suggested that nearly every major automaker has significant exposure to products made with forced labor.

China denies abuses in Xinjiang, a major cotton producer that also supplies much of the world’s materials for solar panels.

Diplomatic tensions between Canada and China have been running high since the detention of Huawei Technologies executive Meng Wanzhou in 2018 and Beijing’s subsequent arrest of two Canadians on spying charges.

In November, Canada ordered three Chinese companies to divest from Canadian critical minerals, citing national security. China in response accused Ottawa of using national security as a pretext and said the divestment order broke international commerce and market rules.

(By Doina Chiacu and Ismail Shakil; Editing by Bill Berkrot and Sharon Singleton)

Glencore deal for Teck would face stringent review, Trudeau says
Bloomberg News | April 28, 2023 |

Image: Screenshot from CPAC on Youtube

Teck Resources Ltd. is a “great company” that’s important to Canada’s economy, and any takeover bid for the miner will have to get through a “rigorous process” to win government approval, Canadian Prime Minister Justin Trudeau said.


The company’s tense fight with Glencore Plc is “certainly something that we’re looking very, very carefully at because it is important to have these great companies in Canada,” Trudeau said Friday in an interview on Bloomberg Television. He promised that, if the government is asked to approve a deal, it will be consistent in applying Canada’s takeover rules “so investors can know what they’re getting into.”

Teck has been trying to fend off an approach from Glencore Plc, but the Vancouver-based company suffered a setback this week when it couldn’t get enough shareholder support for its own plan to separate its metals and coal divisions.

“What’s more important to me is the company behaving the right way towards the environment, whether it’s a local company or a foreign multinational,” Trudeau said. “We have high and stringent expectations, not just on environmental issues but on partnership with indigenous peoples.”

The possibility of the Teck — Canada’s largest diversified base metals producer — being taken over by Glencore has become a broader political issue.

British Columbia Premier David Eby has weighed in against it. The federal government stopped short of that: In a letter to Vancouver’s board of trade this week, Deputy Prime Minister Chrystia Freeland said Canada needs companies like Teck as part of its strategy to move toward cleaner forms of energy.

“The mining of critical minerals is key to the future — and only companies that make serious commitments to ESG and strong partnerships with Indigenous peoples will succeed,” Freeland wrote. “Rest assured that the federal government is following this very closely.”

Any acquisition of Teck would have to undergo a government review, with the final decision likely to fall on the desk of Industry Minister Francois-Philippe Champagne, who signed Freeland’s letter with Natural Resources Minister Jonathan Wilkinson.

Large-scale mining takeovers have been a sensitive topic in Canada ever since a wave of deals more than 15 years ago took out some of the sector’s biggest players, including nickel miner Inco Ltd. and aluminum producer Alcan Inc.

In 2010, when BHP Group proposed a takeover of Potash Corp. of Saskatchewan, the government of then-Prime Minister Stephen Harper blocked it on the grounds that it would not be of “net benefit” to the country.

(By Brian Platt and David Westin, with assistance from Randy Thanthong-Knight and Stephen Wicary)

Brazil’s Mura people report threats amid pressure to approve Amazon potash mine

Reuters | April 28, 2023 |

Image from Brazil Potash.

Leaders of Brazil’s Mura people said on Friday tensions have risen in the Autazes region where they live after a federal agency crew visited the area to discuss potentially demarcating their ancestral land, which overlaps with an area where a Canadian company wants to build a potash mine.


Speaking at a press conference hosted by federal prosecutors in the state of Amazonas, two Mura leaders said their communities have received renewed threats after Funai, the federal indigenous agency, visited the region in late March to start demarcation discussions of the Soares/Urucurituba territory, where Potassio do Brasil plans to build the $2.5 billion project.

Sergio, a Mura leader, said false information began to circulate after Funai showed up, including that the agency would “take away farmers’ land.” Sergio said Funai’s mission was only to explain a potential future demarcation, which is a long process. But the area is rife with conflict, with Amazonian tribes having suffered for decades with farmers’ encroaching on their reservations.

Brazil’s path to potash production in the Amazon

A second Mura leader, Adnelson, reported threats “before and after” Funai’s visit, including a note left at the local indigenous council saying, “Someone will suffer the consequences if Potassio’s mine does not happen.”

Potassio do Brasil, a unit of Toronto-based Brazil Potash, has previously denied any coercion and said it has followed the consultation protocol strictly. Regarding the allegations made by the Mura leaders during the press conference, the firm said it was encouraged by the federal prosecutor working on the case, “leaving no other alternative for the company but the tireless search for justice.”

Federal prosecutor Fernando Soave said ongoing court-supervised Mura consultations have not been “free” or “in good faith,” citing threats against the Mura since the company began trying to approve the mine project.

The prosecutor reiterated that the Mura consultations should be suspended because demarcation studies have not concluded. A court decision is pending regarding that request.

“When consultations started, chaos descended,” Soave said, adding he has contacted state protection services to act on behalf of the indigenous community.

Potassio do Brasil needs three years to build the installations for the mine and aimed to start potash production there in 2026.

(By Ana Mano; Editing by Josie Kao and Leslie Adler)

Tokamak Energy magnet technology to be tested in USA

28 April 2023

Tokamak Energy of the UK is to send its gamma radiation cryostat system to the US Department of Energy's Sandia Laboratories in Albuquerque, New Mexico, so that it can be exposed to extreme conditions to test lifetime fusion power plant performance.

Tokamak Energy's HTS magnet (Image: Tokamak Energy)

The Oxfordshire-based company said that creating fusion energy requires strong magnetic fields to confine and control hydrogen fuel, which becomes a plasma several times hotter than the Sun inside a tokamak. Although most radiation from high-energy plasma neutrons will be absorbed by the tokamak's shielding, the magnets must be able to withstand secondary gamma rays to maintain efficient power plant operations.

Tokamak Energy built and commissioned its specialist gamma radiation cryostat system - a vacuum device to provide thermal insulation for the magnets - as part of its mission to deliver fusion power in the 2030s.

It said that test system will now be disassembled, shipped and rebuilt at the Gamma Irradiation Facility (GIF) based at Sandia Laboratories, which is one of the few places in the world capable of housing the system while exposing Tokamak Energy's high temperature superconducting (HTS) magnets to a power plant representative dose rates - sufficient in intensity and energy - of gamma radiation.

Research and analysis on sets of individual magnets will run for six months at the New Mexico facility, which is so powerful it can do a 60-year lifetime test in just two weeks.

"Our pioneering magnet technology must withstand extreme conditions to keep fusion power plants running in the future," said Rod Bateman, HTS Magnet Development Manager at Tokamak Energy. "The specialist Sandia Laboratory is ideally configured to test magnet durability and performance when exposed to gamma radiation. It is essential to push the boundaries now as we scale up our operations towards commercial fusion."

Don Hanson, GIF Facility Supervisor at Sandia National Laboratory, added: "The GIF is a unique facility that can provide high doses of gamma radiation to large test objects. We look forward to working with Tokamak Energy to advance fusion technologies."

In February, Tokamak Energy announced it had built a world-first set of new generation HTS magnets to be assembled and tested in fusion power plant-relevant scenarios. Its new Demo4 facility consists of 44 individual magnetic coils manufactured using 38 kilometres of ground-breaking HTS tape, which carries currents with zero electrical resistance and requires five times less cooling power than traditional superconducting materials.

The HTS tapes are multi-layered conductors made mostly of strong and conductive metals, but with a crucial internal coating of 'rare earth barium copper oxide' (REBCO) superconducting material. The tapes are typically 12mm wide and less than 0.1 mm thick, with REBCO deposited as a thin coating. When wound into coils, HTS tapes can generate much higher magnetic fields than conventional superconducting magnets, while taking up far less space and requiring far less cooling power.

Tokamak Energy's roadmap is for commercial fusion power plants deployed in the mid-2030s. To get there the plan is for completion of ST80-HTS in 2026 "to demonstrate the full potential of high temperature superconducting magnets" and to inform the design of its fusion pilot plant, ST-E1, which is slated to demonstrate the capability to deliver electricity - producing up to 200 MW of net electrical power - in the early 2030s.

In January, Tokamak said it had signed an agreement with Japan's Furukawa Electric to supply "several hundred kilometres" of HTS tape for its ST80-HTS prototype fusion device. The HTS tape has been developed and is being supplied by Furukawa, with the production of the tape under way at the group's SuperPower Inc's site in New York in the USA.

Researched and written by World Nuclear News