Faculty Bibliography

BACKGROUND:The Starting Early Program (StEP) promotes healthy nutrition during early life and leads to healthier child weight, but whether dietary patterns contribute to weight or mediate StEP weight outcomes has not been studied. OBJECTIVES/OBJECTIVE:This secondary analysis identified infant dietary patterns in StEP, determined associations between dietary patterns and child weight outcomes, and examined whether dietary patterns mediated the relationship between StEP and child weight. METHODS:-score (WFAz) and likelihood of being classified as overweight (WFA ≥85th percentile) were assessed using linear and logistic multivariable regression models. Mediation was used to assess intervention effects on WFAz via impacts on infant dietary patterns. RESULTS:Four classes of infant dietary patterns were identified: Breastfed-High variety, Formula fed-High variety, Formula fed-Low variety, and Mixed fed-Low variety. Compared to the Breastfed-High variety class, infants in the Formula fed-Low variety class had higher WFAz and were more likely to be classified as overweight at 24 and 36 months. Participation in StEP increased membership in Breastfed-High variety, which mediated the association between StEP and lower WFAz at 24 months. CONCLUSIONS:Infant dietary patterns were identified, and some were associated with child overweight. StEP was associated with a dietary pattern most consistent with guidelines, which mediated intervention effects on child weight.

Almost five years after COVID-19 emerged, multiple scientific uncertainties remain about why some people experience ongoing symptoms long after being infected with SARS-CoV-2 (Long COVID). The pathophysiology underlying Long COVID and its potential to represent several endotypes are still under investigation. These scientific uncertainties around Long COVID have been cited as a reason to delay treatment trials until the disease is better understood. In this paper, a group of bioethicists, clinician-scientists and people with lived experience with Long COVID argue that it is ethically imperative to conduct trials of disease-modifying treatments for Long COVID now. Furthermore, we argue that although conducting such trials can pose ethical challenges, these challenges can be overcome through careful research priority-setting, rigorous trial design, fair participant selection, and ensuring that the risk-benefit profile is favorable.

OBJECTIVE:Little is known about patterns of anxiety and depressive symptoms (ADS) beginning in infancy, particularly in the U.S. It is also unclear how early harsh discipline predicts these symptoms over time. We aimed to describe longitudinal patterns of ADS from 18 months through 6 years of age and examine whether those patterns are associated with harsh discipline at 18 months. METHODS:We performed a secondary analysis of parent-child dyads in a study focused on early relational health and school readiness in low-income families in the U.S. We used group-based trajectory modeling to identify distinct patterns of ADS between 18 months and 6 years. Multinomial logistic regression was used to examine the relationship between harsh discipline (total, physical, and verbal) and trajectory group membership. RESULTS:We identified three ADS trajectories: low (29%), moderate (61%), and high (10%). Children who experienced more total harsh discipline were at greater risk of belonging to the moderate (relative risk ratio (RRR), 1.98; 95% CI, 1.19-3.32) and high groups (RRR, 2.76; 95% CI, 1.32-5.77) than the low group. After disaggregating harsh discipline into physical and verbal components and controlling for each other, harsh verbal discipline alone significantly predicted membership in the moderate group only (RRR, 1.62; 95% CI, 1.10-2.38). CONCLUSIONS:Approximately 10% of the sample developed persistent ADS starting in infancy with harsh discipline as a risk factor. Findings underscore the importance of addressing harsh discipline in early anticipatory guidance.

OBJECTIVES/OBJECTIVE:Given the known link between maternal and child mental health, it is likely that children whose mothers experienced more distress because of the COVID-19 pandemic were at greater risk for increased behavior problems. Yet research to date has not tested this hypothesis among families who were hit hardest by the pandemic-those with low incomes and from Black and Hispanic backgrounds. Research is also needed that focuses on young children and uses a longitudinal design. DESIGN/METHODS:We harmonized data from 4 cohorts originally designed to study pediatric parenting interventions with underresourced families in 2 US cities. We examined, first, whether maternal distress because of the pandemic was associated with change over the next 1 to 2 years in preschool-aged children's anxiety/depression and aggression, and second, whether such associations were moderated by maternal depression. RESULTS:Maternal pandemic-related distress predicted a small increase in child aggression but no change in anxiety/depression. There was no moderation by maternal depression. CONCLUSION/CONCLUSIONS:Among families at risk of the most severe health and financial hardships because of the pandemic, maternal pandemic-related distress was associated with increases in child aggression 1 to 2 years later. Maternal mental health must be made a priority in the future disasters not only in its own right but also because of possible spillover effects on young children.

OBJECTIVES/OBJECTIVE:Much research has documented disruptions to parent well-being and family functioning because of the COVID-19 pandemic in the United States, but little is known about how parents' provision of cognitive stimulation to young children has been affected. This question is of added importance for families with low incomes, who were disproportionately disadvantaged by the pandemic. The current study examined whether and how provision of cognitive stimulation at home, as measured by the parent-reported StimQ2, changed for parents with low incomes after onset of the COVID-19 pandemic. We examined scores on a total scale and subscales tapping multiple aspects of verbal responsivity and reading. DESIGN/METHODS:Data from 7 cohorts of families with low incomes across 3 US cities were de-identified and combined into a single analytic sample for secondary analysis. Cohorts ranged in timing relative to the onset of the pandemic (i.e., as early as 2015 and as late as April 2023). Each study contributed data from families assessed at multiple timepoints between birth and age 4 years. RESULTS:Total scores on the StimQ2 increased after the onset of the COVID-19 pandemic. Subscales reflecting reading stayed the same (quantity) or declined (quality), whereas subscales reflecting verbal responsivity increased. CONCLUSION/CONCLUSIONS:Relative to prepandemic levels, low-income parents' child-directed speech and responsivity increased postpandemic, but the quantity of parent-child reading was unchanged and its quality declined. Findings suggest the possibility of stability or improvement among parents with low incomes during the pandemic and opportunities for intervention.

OBJECTIVE:Pediatric Long COVID (LC) is an infection-associated chronic condition following SARS-CoV-2 infection. While research has begun to elucidate clinical phenotypes, functional impacts are not well described. METHODS:Cross-sectional data from the NIH-funded Researching COVID to Enhance Recovery (RECOVER) pediatric observational cohort was analyzed to assess associations in school-age children (6 to 11 years) and adolescents (12 to 17 years) between LC and caregiver-reported school-related functional outcomes. LC was defined using RECOVER age group-specific symptom-based LC research indices. The primary outcome was worsening of child grades. Secondary outcomes included difficulty paying attention, limited fun with friends, and having an Individualized Education Program (IEP). Using age-stratified analyses, children with and without LC were matched based on age, sex, and dates of infection and enrollment, to estimate risk ratios (RRs) between LC and each outcome. RESULTS:The cohort included 1,976 children (406 school-age, 1,570 adolescent). 18% of school-age children and 29% of adolescents with LC had reported worsened grades, compared to 7% and 11% without LC, respectively [school-age: adjusted RR 2.18 (95% CI: 1.15-4.11); adolescent: adjusted RR 2.39 (95% CI: 1.86-3.06)]. In both age groups, children with LC were more likely to have difficulty paying attention, limited fun with friends, and IEPs. CONCLUSIONS:LC in school-age children and adolescents was negatively associated with functional school-related outcomes, including academic performance, attention, and peer interactions. As LC affects a substantial proportion of U.S. children, these findings highlight the urgent need to develop, provide, and evaluate school-related services for children and adolescents with LC.

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.

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.

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.