Mark Schuster

Harvard University | Harvard

Objective: Discrimination exposure has a detrimental impact on mental health, increasing the risk of depression, anxiety, and posttraumatic stress. The impact discrimination exposure has on mental health is likely mediated by neural processes associated with emotion expression and regulation. However, the specific neural processes that mediate the...

OBJECTIVES Examine family safety-reporting after implementing a parent–nurse–physician–leader coproduced, health literacy-informed, family safety-reporting intervention for hospitalized families of children with medical complexity. METHODS We implemented an English and Spanish mobile family-safety-reporting tool, staff and family education, and pr...

Adolescent substance use is linked with negative future outcomes (e.g., depression, anxiety, substance use disorder). Given that the brain undergoes significant maturation during adolescence, this developmental period may represent a time of particular vulnerability to substance use. Neuroimaging research has largely focused on heavy or binge patte...

In Part 3 of this 3-part series, we focus on the importance of transitioning young adult patients to adult care to ensure their optimal health and well-being into adulthood. The articles in this section bring to light the unique needs of these adolescents and how to better help them and their families navigate this time of transition. Available to...

In book 2 of this 3-part series, we are pleased to present an extensive collection of adolescent health articles that address contraception and sexuality education, counseling the pregnant adolescent patient, confidential care when considering abortion, HPV trends, providing care after sexual assault. Types of reproductive health services can vary...

Exposure to violence during childhood can lead to functional changes in brain regions that are important for emotion expression and regulation, which may increase susceptibility to internalizing disorders in adulthood. Specifically, childhood violence exposure can disrupt the functional connectivity among brain regions that include the prefrontal c...

Objective: To evaluate the measurement properties of a set of six items designed to elicit narrative accounts of pediatric inpatient experience. Data sources: Data came from 163 participants recruited from a probability-based online panel of U.S. adults. Participants were family members of a child who had an overnight hospital stay in the past 1...

BACKGROUND AND OBJECTIVES Nationally, 54.2% of youth are fully vaccinated for human papilloma virus (HPV) with persistent gender and racial/ethnic disparities. We used a quality improvement approach to improve completion of the HPV vaccine series by age 13 years. As a secondary aim, we examined racial/ethnic and gender differences in vaccine uptake...

Objective This study examined differences and identified developmental predictors of oral, vaginal, and anal intercourse initiation across generational status among Latina/o adolescents of both genders. More specifically, we compare generational status and gender differences in the longitudinal predictions from parent-child sex communication and da...

The prefrontal cortex (PFC), hippocampus, and amygdala play an important role in emotional health. However, adverse life events (e.g., violence exposure) affect the function of these brain regions, which may lead to disorders such as depression and anxiety. Depression and anxiety disproportionately affect women compared to men, and this disparity m...

BACKGROUND AND OBJECTIVES Despite compelling evidence that patients and families report valid and unique safety information, particularly for children with medical complexity (CMC), hospitals typically do not proactively solicit patient or family concerns about patient safety. We sought to understand parent, staff, and hospital leader perspectives...

Importance In the United States, adolescents who are lesbian, gay, or bisexual (LGB) face disparities across physical and mental health outcomes compared with non-LGB youth, yet few studies have looked at patterns of health care utilization by sexual orientation. Objective To compare health care utilization indicators for LGB and non-LGB youth. D...

We evaluate how two aspects of socioeconomic status, parental objective and subjective social status, are associated with health-related quality of life in three racial/ethnic groups during pre- to mid-adolescent development, using growth curve modeling. In a longitudinal cohort study, 4,048 Black, Latinx, or White adolescents were assessed in 5th,...

Neighborhood disadvantage and community violence are common in poor, urban communities and are risk factors for emotional dysfunction. Emotional processes are supported by neural circuitry that includes the prefrontal cortex, hippocampus, amygdala, and hypothalamus. These brain regions are connected by white matter pathways that include the cingulu...

Study Objective As recent efforts to improve culturally competent clinical care (CCCC) have largely overlooked older LGB adults, we conducted a scoping review of position statements, empirical, and non-empirical research and suggest action steps. Methods We followed PRISMA Extension for Scoping Reviews Guidelines and searched for articles 1/1/11-3...

Part 1 of this first-of-its-kind 3-part series can help show how to break down the cycles of ignorance, shame, and toxic stress that harm children who identify as LGBTQ+ and improve their chances of leading happy, healthy adult lives. https://shop.aap.org/pediatric-collections-lgbtq-support-and-care-part-1-combatting-stigma-and-discrimination/

Objective Childhood physical and sexual abuse are stressful experiences that may alter the emotional response to future stressors. Stress-related emotional function is supported by brain regions that include the prefrontal cortex (PFC), hippocampus, and amygdala. The present study investigated whether childhood physical and sexual abuse are associa...

Introduction Although adolescents often co-use alcohol, cigarettes, and cannabis, little is known about sex and racial/ethnic differences in the co-use of these substances. Therefore, this investigation examined sex and racial/ethnic differences in alcohol, cigarette, and cannabis co-use in a large and ethnically diverse. Methods: Participants were...

Chronic childhood stress is linked to greater susceptibility to internalizing disorders in adulthood. Specifically, chronic stress leads to changes in brain connectivity patterns, and, in turn, affects psychological functioning. Violence exposure, a chronic stressor, increases stress reactivity and disrupts emotion regulation processes. However, it...

Background: Children insured by Medicaid have higher readmission rates than privately insured children. However, little is known about whether this disparity has changed over time. Methods: Data from the 2010 to 2017 Healthcare Cost and Utilization Project Nationwide Readmissions Database were used to compare trends in 30-day readmission rates f...

Purpose Previous studies showed associations between soft drink consumption and mental health problems in adolescents, but the direction of these effects is unknown. This study examines the hypotheses that soft drink consumption predicts aggression and depressive symptoms over time and that these mental health problems predict soft drink consumptio...

Purpose Stressful life events (SLEs) increase allostatic load and require adaptation. Experiencing SLEs has been associated with decreased health-related quality of life (HRQOL) among adolescents. This study examined racial/ethnic and developmental differences in the relationship between SLEs and HRQOL from preadolescence to midadolescence. Method...

Adolescent risky sexual behaviors can result in negative consequences such as sexually transmitted infection. However, much research effort has been placed on understanding individual characteristics, rather than the role of neighborhood environment. This study addressed the prospective effects of neighborhood and family functioning in preadolescen...

Objective: To determine the correlation between hospital 30-day risk-standardized readmission rates (RSRRs) in elderly adults and those in nonelderly adults and children. Data sources/study setting: US hospitals (n = 1760 hospitals admitting adult patients and 235 hospitals admitting both adult and pediatric patients) in the 2013-2014 Nationwide...

Background: Hospitals are rapidly increasing efforts to improve the pediatric inpatient experience. However, hospitals often do not know what to target for improvement. To determine what matters most to families, we assessed which aspects of experience have the strongest relationships with parents' willingness to recommend a hospital. Methods: C...

Purpose: School social capital incorporates the intangible prosocial resources from social networks, including expectations and social norms, found in a school environment. School social capital may influence health behaviors such as smoking. This study examined the association of school social capital with smoking behaviors from childhood into ad...

Purpose: This study examines trends in Medicare beneficiaries' mental health care use from 2009 to 2014 by gender minority and disability status. Methods: Using 2009 to 2014 Medicare claims, we modeled mental health care use (outpatient mental health care, inpatient mental health care, and psychotropic drugs) over time, adjusting for age and behav...

Background: General population surveys are increasingly offering broader response options for questions on sexual orientation-for example, not only gay or lesbian, but also "something else" (SE) and "don't know" (DK). However, these additional response options are potentially confusing for those who may not know what the terms mean. Researchers st...

Purpose To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL) and overall health status among Black, Latino, and White youth during adolescence; (2) whether socioeconomic status (SES) and family contextual variables influence disparities; and (3) whether disparities are consistent from pre- to early- to mid-adolescence....

Purpose This article aims to (1) evaluate whether bullying typology predicts violent injury; (2) longitudinally examine whether violent injury trajectories differ across bullying typology as children age; and (3) longitudinally determine whether children who consistently reported perpetration or victimization (i.e., reported bullying at fifth, seve...

Purpose: To evaluate the relationship between sociodemographics and the prevalence of bullying victimization and perpetration using single-item and multiple-item measures. Methods: Longitudinal survey data were obtained from 4297 children at fifth, seventh, and tenth grade in three U.S. cities. Bullying victimization and perpetration were measur...

Dual-process theories may be effective at predicting adolescent smoking; however, little is known about the effectiveness of these models across race/ethnicity and gender. Adolescents (N = 4035) completed biopsychosocial and tobacco-related perception measures in Grade 7 and reported on smoking initiation in Grade 10. Using structural equation mode...

Purpose: The extent to which disparities affect all sexual minority women (SMW) versus specific subgroups of lesbian, bisexual, or other women remains unclear, in part due to inconsistent analysis of available data. We propose an integrated approach that aggregates subgroups to maximize power to detect broadly applicable disparities, then tests fo...

Background: Health reform and policy initiatives over the last 2 decades have led to significant changes in pediatric clinical practice. However, little is known about recent trends in pediatric hospitalizations and readmissions at a national level. Methods: Data from the 2010-2016 Healthcare Cost and Utilization Project Nationwide Readmissions...

Objectives: Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, we do so using the Global Assessment of Pediatric Patien...

Importance Pediatric hospital medicine is a relatively new and growing specialty. However, research remains inconclusive on outcomes for inpatients cared for by pediatric hospitalists compared with those cared for by general pediatricians. Objective To analyze outcomes, adverse events (AEs), and types of AEs associated with care provided for pedia...

Objective This study examined how parental general monitoring (PGM), which refers to parental awareness of adolescents’ activities in various domains, is associated with adolescents’ weight status and related behaviors and whether these relationships differ among racial/ethnic groups. Methods Data are from 4,088 Black, Latino, and White youth asse...

Background Research suggests that an immigrant paradox exists where those who were not born in the United States (1st generation) have significantly better health than those who were born in the U.S. (2nd generation or more). The aim of the current study was to examine the immigrant paradox with respect to tobacco-related perceptions and parenting...

The articles included in this collection on bullying provide a wide lens through which to view this complexity.

The articles included in this collection on bullying provide a wide lens through which to view this complexity.

Objective: Comparison of readmission rates requires adjustment for case-mix (ie, differences in patient populations), but previously only claims data were available for this purpose. We examined whether incorporation of relatively readily available clinical data improves prediction of pediatric readmissions and thus might enhance case-mix adjustme...

: media-1vid110.1542/5789657761001PEDS-VA_2017-3360Video Abstract BACKGROUND: Patient safety concerns over the past 2 decades have prompted widespread efforts to reduce adverse events (AEs). It is unclear whether these efforts have resulted in reductions in hospital-wide AE rates. We used a validated safety surveillance tool, the Global Assessment...

Background/Objectives Despite rising skin cancer rates in children, multiple studies reveal inadequate youth sun‐protective behavior (eg, sunscreen use). Using Healthy Passages data for fifth‐graders, we set out to determine sunscreen adherence in these children and investigated factors related to sunscreen performance. Methods Survey data were co...

Background: Most US hospitals conduct patient experience surveys by mail or telephone after discharge to assess patient/family-centeredness of care. Pediatric response rates are usually very low, especially for black, Latino, and low-income respondents. We investigated whether day of discharge surveying using tablets improves response rates and re...

Objective: To identify opportunities to improve care value for children with disabilities (CWD), we examined CWD prevalence within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities, children with chronic con...

Introduction To improve patient safety, the Centers for Medicare & Medicaid Services (CMS) has promoted systematically measuring and reporting harm due to patient care. The CMS’s Partnership for Patients program identified 9 hospital-acquired conditions (HACs) for reduction, to make care safer, more reliable, and less costly. However, the proportio...

In Reply Mr Chen and Mr Patel raise a number of important issues related to understanding the cost of quality measures. We agree that there is value in considering a variety of costs and ways of conceptualizing and calculating them.

Few evidence-based school obesity-prevention programs are disseminated. We used community-based participatory research principles to disseminate an evidence-based middle-school obesity-prevention program, Students for Nutrition and eXercise (SNaX), to a large, primarily Latino, school district. In the 2014–2015 school year, we trained a district “c...

Objective Despite growing interest in children and young people’s (CYP) perspectives on healthcare, they continue to be excluded from many patient experience surveys. This study investigated the feasibility of, and additional information gained by, measuring CYP experiences of a recent hospital admission. Design Cross-sectional analysis of nationa...

Youth living with socially devalued characteristics (e.g., minority sexual orientation, race, and/or ethnicity; disability; obesity) experience frequent bullying. This stigma-based bullying undermines youths' wellbeing and academic achievement, with lifelong consequences. The National Academies of Sciences, Engineering, and Medicine recommends deve...

Background and objectives: Reducing readmissions is a major health care system goal. There is a gap in our understanding of pediatric readmission patterns after mental health (MH) admissions. With this study, we aimed to characterize the prevalence of readmissions after MH admissions, to identify patient-level factors and costs associated with rea...

Background: Risk-adjustment algorithms typically incorporate demographic and clinical variables to equalize compensation to insurers for enrollees who vary in expected cost, but including information about enrollees' socioeconomic background is controversial. Methods: We studied 1 182 847 continuously insured 0 to 19-year-olds using 2008-2012 Bl...

Rationale: Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care. Objective: We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore the role of patient-centered care. Methods: Using a longitudinal multi-site survey of US parents and adolescents, we a...

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth experience significant bullying that undermines their mental and physical health. National health organizations have called for the development of innovative strategies to address LGBTQ bullying. Pediatricians and other clinicians, medical and public health students, interdisciplinary res...

Less than 2 decades after publication of the National Academy of Medicine’s (formerly the Institute of Medicine) Crossing the Quality Chasm: A New Health System for the 21st Century, quality measurement has become routine and widespread throughout the US health care system.¹ From accountability to accreditation, from quality improvement to research...

Background: Miscommunications lead to medical errors and suboptimal hospital experience. Parent-provider miscommunications are understudied. Objectives: (1) Examine characteristics of parent-provider miscommunications about hospitalized children, (2) describe associations among parent-provider miscommunications, parent-reported errors, and hospi...

Background and objective: Lower respiratory infections (LRIs) are among the most common reasons for pediatric hospitalization and among the diagnoses with the highest number of readmissions. Characterizing LRI readmissions would help guide efforts to prevent them. We assessed variation in pediatric LRI readmission rates, risk factors for readmissi...

Purpose Few studies have examined the early development of a broad range of health issues of importance in adolescence in Latina (female) youth, despite their being potentially a vulnerable group. This study compared suicide and depressive symptoms, substance use, violence exposure, injury prevention, obesity, and health-related quality of life amo...

Background: Parents of children with chronic illness consistently report suboptimal preparation for transition from pediatric- to adult-focused health care. Little data are available on transition preparation for low-income youth in particular. Methods: We conducted a mailed survey of youth with chronic illness enrolled in 2 large Medicaid healt...

Importance Opioid use disorder (OUD) frequently begins in adolescence and young adulthood. Intervening early with pharmacotherapy is recommended by major professional organizations. No prior national studies have examined the extent to which adolescents and young adults (collectively termed youth) with OUD receive pharmacotherapy. Objective To ide...

Objective: To determine the effect of state-level dependent coverage expansion (DCE) with and without other state health reforms on exit from dependent coverage for adolescents and young adults (AYA). Data sources: Administrative longitudinal data for 131,542 privately insured AYA in Massachusetts (DCE with other reforms) versus Maine and New Ha...

Background: Peer victimization is common among youth and associated with substance use. Yet, few studies have examined these associations longitudinally or the psychological processes whereby peer victimization leads to substance use. The current study examined whether peer victimization in early adolescence is associated with alcohol, marijuana,...

Aims Patients‘ perspectives are essential to understanding the quality of healthcare services. Despite the importance of children and young people’s (CYP) experience of healthcare, they have traditionally been excluded from many patient experience surveys. This study aimed to investigate the feasibility of, and additional information gained by, mea...

Background: Making national comparisons of family experience of inpatient pediatric care has been limited by the lack of a publicly available survey. The Agency for Healthcare Research and Quality and Centers for Medicare & Medicaid Services commissioned development of the Child Hospital Consumer Assessment of Healthcare Providers and Systems Surv...

Objective: The quality of primary care delivered to Medicaid-insured children with disabilities (CWD) is unknown. We used the newly validated CWD algorithm (CWDA) to examine CWD prevalence among Medicaid enrollees 1 to 18 years old, primary care quality for CWD, and differences in primary care quality for CWD and non-CWD. Methods: Cross-sectiona...

Supporting children’s health and development often starts with supporting parents. A National Academies of Sciences, Engineering, and Medicine report aims to inform the development of a framework for policies, practices, and research to strengthen parents’ capacity to nurture young children.

Background/objectives: Chronic physical health conditions are highly prevalent in youth, frequently persisting into adulthood and contributing to the current and future healthcare burden in the United States. Our study evaluates associations of chronic physical health conditions with depressive and physiological anxiety symptoms in a community sam...

Objective: Sugar-sweetened beverages (SSBs) are key contributors to obesity among youth. We investigated associations among parental and home-related factors (parental attitudes and consumption; home availability) regarding three types of SSBs-soda, sports drinks, and fruit-flavored drinks-with consumption of each type of SSB in a general school-b...

Objective: To assess parent and provider experience and shared understanding after a family-centered, multidisciplinary nighttime communication intervention (nurse-physician brief, family huddle, family update sheet). Methods: Prospective intervention study at a children's hospital from 5/2013-10/2013 (pre-intervention) and 5/2014-10/2014 (post-...

Background and objectives: Ordering rates for imaging studies and procedures may change if clinicians are shown the prices of those tests while they are ordering. We studied the effect of 2 forms of paid price information, single median price and paired internal/external median prices, on how often pediatric-focused and adult-oriented clinicians (...

Background and objectives: Many children with special health care needs (CSHCN) receive health care at home from family members, but the extent of this care is poorly quantified. This study's goals were to create a profile of CSHCN who receive family-provided health care and to quantify the extent of such care. Methods: We analyzed data from the...

Bullying of lesbian, gay, bisexual, and transgender (LGBT) youth is prevalent in the United States, and represents LGBT stigma when tied to sexual orientation and/or gender identity or expression. LGBT youth commonly report verbal, relational, and physical bullying, and damage to property. Bullying undermines the well-being of LGBT youth, with impl...

Objective: Examine the longitudinal association of generational status (first = child and parent born outside the United States; second = child born in the United States, parent born outside the United States; third = child and parent born in the United States) and parent and peer social factors considered in 5th grade with subsequent oral, vagina...

Background Despite recommendations that 11–12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low. Disparities exist, with Blacks and Latinos being less likely than Whites to complete the series. We aimed to identify and compare barriers to HPV immunization perceived b...

Objectives: We examined racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis and medication use and determined whether medication disparities were more likely due to underdiagnosis or undertreatment of African-American and Latino children, or overdiagnosis or overtreatment of white children. Methods: We used a p...

Background and objectives: Hospital readmission rates are increasingly used to assess quality. Little is known, however, about potential preventability of readmissions among children. Our objective was to evaluate potential preventability of 30-day readmissions using medical record review and interviews. Methods: A cross-sectional study in 305 c...

This study examined whether daily or almost daily lower-intensity physical activity was associated with reduced obesity, among 4824 African American, Hispanic, and White youth assessed in fifth and seventh grades. Regular lower-intensity physical activity was associated with reduced obesity only among Hispanic and White males and only in seventh gr...

One might have to go back to the era of racial desegregation of U.S. bathrooms to find a time when toilets received so much attention. Recently, several states have debated or passed legislation requiring people to use the public bathroom corresponding to their sex as "identified at birth" or "stated on a person's birth certificate."(1),(2) Some su...

Objective This aim of this study was to examine whether the construct of physical appearance perception differed among the three largest racial/ethnic groups in the United States using an adolescent sample. Methods Black (46%), Latino (31%), and White (23%) adolescents in Grade 10 from the Healthy Passages study (N = 4,005) completed the Harter’s S...

Background and objective: Efforts to advance patient safety have been hampered by the lack of high quality measures of adverse events (AEs). This study's objective was to develop and test the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, which measures hospital-wide rates of AEs and preventable AEs. Methods: Through a liter...

Objective: Recent policy initiatives aiming to reduce firearm morbidity focus on mental health and illness. However, few studies have simultaneously examined mental health and behavioral predictors within families, or their longitudinal association with newly acquiring a firearm. Methods: Population-based, longitudinal survey of 4251 parents of...

Background and objective: Communication breakdowns between members of the health care team compromise patient safety and experience. Communication breakdowns with parents, an important but often overlooked part of the health care team, are understudied. Parents may play a particularly important role in nighttime care given decreased staffing and i...

Objectives: This study examined the long-term effects on BMI of a randomized controlled trial of Students for Nutrition and Exercise, a 5-week, middle school-based obesity prevention intervention combining school-wide environmental changes, encouragement to eat healthy school cafeteria foods, and peer-led education and marketing. Methods: We ran...