Faculty Bibliography

Digital media, including television, the internet, social media, video games, and interactive assistants, form the digital ecosystem. When this digital ecosystem is designed with children's unique developmental needs in mind, it can support learning and well-being. In contrast, digital ecosystems that prioritize engagement and commercialization often encourage prolonged use, which in turn can displace healthy behaviors (eg, movement behaviors, sleep), and contribute to negative outcomes. This policy statement follows the conceptual framework of the socioecological model, depicting nested circles of care including: children's own characteristics, their caregivers, the digital ecosystem, as well as broader societal systems. Given the interconnected nature of these influences and systems, "media and children" cannot be viewed solely through the lens of individual child behaviors or screen limits alone. Recommendations are provided for families, pediatric providers, practitioners (eg, psychologists, social workers, counselors, educators, researchers), industry, and policy makers, aiming to provide strengths-based solutions and promote a more child-centered digital ecosystem.

The digital ecosystem now comprises immersive technologies, including but not limited to the internet, algorithms, artificial intelligence, social media, apps, video games, TV, interactive agents, tablets, wearable technology, and mobile devices. In recent decades, research on digital media has more closely aligned with the varied ways that families use digital media. The traditional notion of "screen time" therefore represents just the tip of the iceberg of families' experiences with devices. Beneath the visible surface lies a vast structure of policy, community, and economic incentives that deeply shape children's interactions with technology. This technical report reviews the evidence that situates children's health and well-being in the conceptual framework of Bronfenbrenner's socioecological model and the concentric systems that shape children's relationships with digital media. These systems include children's own characteristics, their caregivers (eg, parents), digital ecosystem, and systems and structures (eg, policy, community) that deeply shape their experiences. Given the outsized influences of digital ecosystems on children's experiences, "media and children" cannot be examined in isolation or reduced to individual screen behaviors alone. Instead, it must be viewed through the broader context of these nested influences, with a review of the evidence primarily from the United States.

OBJECTIVE:To explore attitudes and preferences related to remote nutrition education programming for Latino families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and primary care. DESIGN/METHODS:Community-engaged, qualitative, thematic analysis of interviews and focus groups. SETTING/METHODS:Prenatal and pediatric primary care and WIC sites in Manhattan, Queens, and Nassau Counties, New York. PARTICIPANTS/METHODS:Four stakeholder groups: (1) past participants of a primary care-based obesity prevention program (Starting Early Program Prenatal) for Latino families that transitioned to remote delivery because of coronavirus disease 2019 (n = 40), (2) Latina WIC participants, including pregnant women and mothers of young children (n = 40), (3) Starting Early Program Prenatal staff (n = 6), and (4) WIC staff (n = 16). PHENOMENON OF INTEREST/METHODS:Attitudes and preferences related to in-person vs remote nutrition education programming. ANALYSIS/METHODS:Focus groups and interviews were audio-recorded, transcribed, and analyzed for emergent themes using reflexive thematic analysis. RESULTS:Four themes emerged: (1) valuing in-person social connection while recognizing barriers to in-person gathering, (2) navigating distraction-related barriers to remote engagement, (3) consistent content delivery but uncertain quality of remote programs, and (4) coronavirus disease 2019 pandemic-related contextual factors. CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Future remote programs in WIC may benefit from incorporating opportunities for social interaction, explicit discussion of anticipated barriers, and strategies to overcome them.

OBJECTIVE:To assess associations between exposure to intrauterine SARS-CoV-2 and subsequent child neurodevelopment in a large, diverse cohort with confirmation of maternal SARS-CoV-2 status. STUDY DESIGN/METHODS:edition (ASQ-3) and at 18 months with the ASQ Social-Emotional (ASQ-SE) and the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). We compared exposed and unexposed infants' ASQ-3 total and subdomain scores, ASQ-SE and M-CHAT-R scores, and proportions meeting published referral thresholds, using multivariable linear and logistic regression. RESULTS:Among 1179 participants enrolled, 1008 (85.5%) had exposure, with 806 (80.0%) exposed during Omicron predominance. Of those with known timing, 349 (41.4%) and 295 (35.0%) were exposed in the second and third trimesters of pregnancy respectively. Exposure was not associated with differences in ASQ-3 (adjusted difference: -0.61, 95% CI: -10.03, 8.81) or ASQ-3 subdomains at 12 months, ASQ-SE at 18 months (adjusted difference: 0.19, 95% CI: -4.02, 4.41), or M-CHAT-R scores. Findings were similar for proportions meeting referral thresholds, and when stratified by variant or by trimester. CONCLUSIONS:In this multicenter cohort largely exposed since Omicron and in second or third trimester, intrauterine SARS-CoV-2 exposure was not associated with neurodevelopmental screening outcomes through 18 months of age. Further assessments of the impact of intrauterine SARS-CoV-2 on neurodevelopment beyond 18 months of age are needed.

IMPORTANCE/UNASSIGNED:Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown. As child health is influenced by the environment in which they live and interact, adverse social determinants of health (SDOH) may contribute to the development of pediatric long COVID. OBJECTIVE/UNASSIGNED:To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n = 903) and adolescents (12-17 years; n = 3681) with SARS-CoV-2 infection history were included. Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded. Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024. EXPOSURE/UNASSIGNED:Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality. Latent classes were created within each domain and used in regression models. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices. RESULTS/UNASSIGNED:The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male. The number of latent classes varied by domain; the reference group was the class with the least adversity. In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID. After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23). Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID. Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID. Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.

OBJECTIVE:Early childhood advanced primary care models are promising ways of addressing child and family needs, but there is limited evidence to support short-term sustainability within current Medicaid payment structures. We evaluate claims-based outcomes associated with 3-2-1 IMPACT (IMPACT), an early childhood advanced primary care model, compared with the standard of care. METHODS:Using New York State Medicaid claims, we identified and matched children aged 1 to 35 months receiving care at 3 IMPACT sites and 3 comparison sites within a large public hospital system. Regression models were used to analyze use, expenditure, enrollment, and quality outcomes between groups. RESULTS:There were 6045 children at the treatment sites and 4832 matched children from the comparison sites. IMPACT was associated with a significant increase in 6 or more well-child visits and a decrease in emergency department visit rates. There was also a significant increase in 6 more well-child visits specifically for Black and Hispanic children seeking care at IMPACT sites compared with comparison sites. There were no significant differences in expenditures, other use types, or Medicaid enrollment across groups. CONCLUSION/CONCLUSIONS:An early childhood advanced primary care model that incorporates multiple evidence-based programs can show short-term, positive effects on preventative and acute care use and quality within Medicaid. These results highlight short-term strategies for sustainability while awaiting the long-term, cross-sector benefits expected from models like IMPACT. Future studies addressing additive model component effects and longer-term outcomes across mother-child dyadic and social-emotional outcomes are warranted.

We combined data from five cohorts of mothers of young children across three cities to understand how COVID-19 affected parenting among predominantly Black and Latine families with low incomes. We examined whether mothers reported that their parenting got worse, got better, or stayed the same; drew on a qualitative substudy to identify themes describing parenting experiences; and used quantitative data to identify psychosocial characteristics associated with changes in parenting. Forty-four percent of mothers reported their parenting stayed the same after COVID-19 onset, 32% reported improvements, and 24% reported their parenting got worse. Qualitative data illustrated that mothers whose parenting got better spent more and higher-quality time with children, whereas mothers whose parenting got worse did not maintain family routines, had financial worries, and exhibited harsh responses to child problem behaviors. Quantitative data showed that depression, social support, COVID-19-related distress, and parenting self-agency were all associated with reported changes in parenting.

PURPOSE/OBJECTIVE:In adolescents (12-17 years), it is unknown whether COVID-19 vaccination reduces progression from COVID-19 to Long COVID (LC) beyond preventing SARS-CoV-2 infection. We assessed the effect of vaccination among SARS-CoV-2 infected adolescents. METHODS AND RESULTS/RESULTS:Participants were recruited from over 60 US healthcare and community settings. The exposure was any COVID-19 vaccination 6 months prior to infection. The outcome was LC defined using the LC research index. Vaccinated (n = 724) and unvaccinated (n = 507) adolescents were matched on sex, infection date, and enrollment date. The risk of LC was 36 % lower (95 % CI, 17 %, 50 %) in vaccinated compared to unvaccinated participants. CONCLUSIONS:Vaccination reduces the risk of LC. Given the profound impact LC can have on the health and well-being of adolescents and the limited availability of treatments during this developmental stage, this supports vaccination as a strategy for preventing LC by demonstrating an important secondary prevention effect.