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What Does Health Vulnerability Data Tell Us?

November 22, 2023

In a recently released article in Pediatrics entitled, “Cumulative Health Vulnerabilities Among Adolescents,” Gabrielle DiFiore, MPH, and colleagues from the Children’s Hospital of Philadelphia conducted a cross-sectional analysis of medical records of 40,197 teens (13–18-year-olds) seen over a 1-year period at Children’s Hospital of Philadelphia Care Network practices, which span urban, suburban, and semi-rural locations (10.1542/peds.2023-062657). Using results of a comprehensive self-reported adolescent health questionnaire and the Patient Health Questionnaire-Modified (PHQ-9-M) contained in the medical record, as well as patient demographics (address and the neighborhood Child Opportunity Index (COI) score), they asked if any of 5 key health vulnerabilities were associated with neighborhood opportunity as measured by the COI (see below). Specifically, they aimed to characterize the prevalence of health vulnerabilities and to determine co-occurrence with respect to age and neighborhood opportunity.

How was neighborhood opportunity measured? The COI is an equity tool that describes the neighborhoods where children live, learn, and play using address-based information about the 3 unique domains. Domains included, with examples, are:

  • Education: the number and quality of early childhood education centers
  • Health and environment: access to healthy foods and green spaces
  • Social and economic indicators: the employment rate and the number of single-headed households1

What are health vulnerabilities? Examples and those studied here include:

  • Tobacco use (using an e-cigarette, vaping device, or other tobacco products)
  • Substance use (using marijuana or drinking alcohol)
  • Firearm access
  • Condomless sexual intercourse
  • Depressive symptoms (PHQ-9-M score ≥11 or endorsement of suicidality)

What is known about these risky health exposures is that not only do they peak in adolescence, and each have their own worrisome health implications, but additionally when an individual has two or more health vulnerabilities this can create intersectionality, or “overlapping and interdependent systems of discrimination or disadvantage”2 with higher risk of morbidity and mortality, as noted by the authors.3,4

Returning to the study, the authors then used multivariable logistic regression to estimate the associations of neighborhood COI with teens reporting ≥ 2 health vulnerabilities, adjusting for age and sex of the patient, as well as insurance and race and ethnicity in a second model.

There are a lot of fascinating results in this paper, and I am just touching the tip of the iceberg here. Among teens studied:

  • 7% had at least one health vulnerability, most commonly firearm access
  • 9% had at least two health vulnerabilities, most commonly the combination of substance and tobacco use

And while not surprising, health vulnerabilities were more common among older teens and more prevalent among those living in neighborhoods with a lower COI. What struck me most was the worrisomely high rates of health vulnerabilities in teens living across all neighborhoods as shown in Table 3 of the article. There are many points to be made here, including the need to enhance service delivery to those living in neighborhoods with low COI. But my take-home was the need to create interventions that target more than one health risk simultaneously, for example, attempts to decrease substance use may prove ineffective without tackling depressive symptoms at the same time. There’s a lot to learn and think about in this excellent article—let us know your own take-home points!

References

  1. Noelke C, McArdle N, Baek M, et al. (2020). Child Opportunity Index 2.0 Technical Documentation. Retrieved from diversitydatakids.org/researchlibrary/research-brief/how-we-built-it. https://www.diversitydatakids.org/sites/default/files/2020-02/ddk_coi2.0_technical_documentation_20200212.pdf. Accessed October 30, 2023
  2. Oxford University Press. (2022, September). Intersectionality. In Oxford English dictionary. Retrieved October 30, 2023
  3. Jackson JM, Seth P, DiClemente RJ, Lin A. Association of Depressive Symptoms and Substance Use With Risky Sexual Behavior and Sexually Transmitted Infections Among African American Female Adolescents Seeking Sexual Health Care. Am J Public Health. 2015;105(10):2137-2142
  4. Haasz M, Myers MG, Rowhani-Rahbar A, et al. Firearms Availability Among High-School Age Youth With Recent Depression or Suicidality. Pediatrics. 2023;151(6):e2022059532
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