Faculty Bibliography

Several reports have described increases in children's behavior problems since the onset of the COVID-19 pandemic, but few were based on prospective data or represented groups who disproportionately experienced pandemic-related hardships. This study followed low-income and racially diverse young children from 3 U.S. cities-New York, NY, Pittsburgh, PA, and Tulsa, OK-with repeated measures of child behavior between 2016 and 2023. A total of 1,124 children were included (50% female; 48% Hispanic/Latine; 30% Black; 22% White/Other race/ethnicity; aged 3-7 at pandemic onset). Results reveal different patterns of behavior change by city. In New York, children's behavior stayed the same or slightly improved following the pandemic onset, whereas it stayed the same or got slightly worse in Tulsa, and got worse in Pittsburgh. Future studies of pandemic impacts should consider regional variation.

BACKGROUND:Efficacy of health-care based Early Relational Health (ERH) parenting interventions like PlayReadVIP and Smart Beginnings, are well-established, but limited research has examined parental perceptions of impact. OBJECTIVE:To explore parents' perceptions of how PlayReadVIP and SB support their parenting, generally and during the COVID-19 pandemic. METHODS:Nested sample of low-income parents enrolled in a two-site RCT of Smart Beginnings (SB), in New York City, NY (n = 40, 93% Latino) and Pittsburgh, PA (n = 40, 80% Black) and a single-site RCT of PlayReadVIP, Supporting Parents And Raising Resilient Kids (SPARRK), in Flint, MI (n = 40, 45% Black, 38% White). Interviews were audio taped and transcribed. Transcripts were coded using an iterative process of textual analysis until thematic saturation was reached. RESULTS:Four themes emerged: (1) Caregivers valued learning new, foundational parenting practices; (2) became more child-centered; (3) felt increased self-efficacy and empowerment; and (4) identified PlayReadVIP and SB as sources of support. CONCLUSIONS:Parents valued the ERH-aligned skills and concepts they learned in PlayReadVIP and SB and viewed the programs as sources of social support. Findings can inform and strengthen pediatric primary care-based parenting programs and have implications for feasibility, acceptability, and scaling of evidence-based and layered ERH programs. CLINICAL TRIAL REGISTRATION/BACKGROUND:Clinicaltrials.gov, NCT02459327, NCT03945552 https://clinicaltrials.gov/study/NCT02459327 , https://clinicaltrials.gov/study/NCT03945552 . IMPACT/CONCLUSIONS:Qualitative study demonstrating that parents value and learn Early Relational Health (ERH) skills from health-care based preventive parenting interventions. Findings inform adaptation, engagement, and scaling. Efficacy of parenting interventions (PlayReadVIP, Smart Beginnings) are well-established, but limited research has examined parental perceptions of impact. This study explores parents' experience with these programs to better understand core components and identify areas for adaptation and refinement. This study builds on prior quantitative work to demonstrate parents' perceived impact of and value in PlayReadVIP and Smart Beginnings. Parents reported participation in these programs/models resulted in enhancements to ERH, mind-mindedness, social support, and mental health.

OBJECTIVE:To examine if variation in session format and content of a prenatal obesity prevention program is associated with fruit and vegetable (FV) voucher redemption in Hispanic/Latino pregnant participants. METHODS:A secondary analysis of participants who received FV vouchers in a single-arm feasibility trial. We used linear regressions to assess associations between program session format (group vs individual) and FV voucher redemption rate, with session content (nutrition vs other lifestyle content [e.g., stress management or physical activity]) as a secondary predictor. RESULTS:Participants (n = 131) who attended a greater percentage of sessions in group format had increased voucher redemption rates (B = 0.37 [95% confidence interval, 0.05-0.70]. P = 0.03). Attending a higher percentage of group sessions with nutrition content rather than other lifestyle content was associated with a higher redemption rate (B = 0.19 [95% confidence interval, 0.002-0.38], P = 0.05). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Pairing FV voucher distribution with nutrition counseling delivered in a group format may increase utilization of FV vouchers.

OBJECTIVE:To evaluate whether the risk of long COVID among individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy differs from that of individuals who were not pregnant at time of virus acquisition. METHODS:We conducted a multicenter observational cohort study at 79 NIH RECOVER (Researching COVID to Enhance Recovery) sites. Individuals assigned female at birth aged 18-45 years with an index (first) SARS-CoV-2 infection on or after December 1, 2021, were included. The exposure was pregnancy (any gestational age) at the time of index SARS-CoV-2 infection. The primary outcome was long COVID 6 months after index infection , defined as RECOVER-Adult Long COVID Research Index score 11 or higher based on a detailed symptom survey. To account for confounding and differential selection between participants who were pregnant and not pregnant at infection, propensity score-matching methods were used to balance the groups on variables potentially associated with both pregnancy status and long COVID. RESULTS:Overall 2,423 participants were included; 580 (23.9%) were pregnant at index SARS-CoV-2 infection. The median age at infection was 33 years (interquartile range 28-38 years), and 2,131 of participants (90.0%) with known vaccination status were vaccinated. After propensity score matching, the adjusted long COVID prevalence estimates 6 months after index infection were 10.2% (95% CI, 6.2-14.3%) among those pregnant at infection and 10.6% (95% CI, 8.8-12.4%) among those not pregnant at infection. Pregnancy was not associated with a difference in adjusted risk of long COVID (adjusted risk ratio 0.96, 95% CI, 0.63-1.48). CONCLUSION/CONCLUSIONS:Acquisition of SARS-CoV-2 during pregnancy was not associated with a differential risk of long COVID at 6 months compared with similar-aged individuals who acquired SARS-CoV-2 outside of pregnancy.

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.

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.