Chicago Children Research Articles

Childhood Exposure to Firearm Violence in Chicago and Its Impact on Mental Health

ObjectiveTo describe how often Chicago children are exposed to firearm violence, the types of exposure, and the parent-reported impact of these exposures on child mental health symptoms. MethodsData were collected in May-July 2022 using the Voices of Child Health in Chicago Parent Panel Survey, administered to parents with children aged 2–17 years from all 77 Chicago neighborhoods. Firearm violence exposure was characterized as indirect (hearing gunshots or knowing someone who was shot) or direct (witnessing a shooting, being threatened with a firearm, being shot at but not injured, or being shot and injured). Parents indicated if children in their household had any of the following mental health symptoms associated with firearm violence exposure: fear, anxiety, sadness, isolation, difficulty concentrating, difficulty in school, or aggression. Chi-squared tests and multivariable logistic regression models were used for statistical analysis. ResultsResponses were received from 989 Chicago parents. More than one third (37%) of children were exposed to firearm violence with an indirect exposure prevalence of 32% and a direct exposure prevalence of 10%. Mental health symptoms associated with firearm violence exposure were reported for 20% of children. Mental health symptoms were reported for 7% of children without firearm violence exposure compared to 31% with indirect exposure (aOR 6.2, 95% CI: 3.7, 10.6) and 68% with direct exposure (aOR 36.1, 95% CI: 16.6, 78.6) ConclusionsChicago children with indirect and direct exposure to firearm violence had more parent-reported mental health symptoms than unexposed children. Trauma informed care approaches to mitigate the negative mental health effects of both direct and indirect firearm violence exposure are critical.

Environmental inequality and disparities in school readiness: The role of neurotoxic lead.

Developmental science has increasingly scrutinized how environmental hazards influence child outcomes, but few studies examine how contaminants affect disparities in early skill formation. Linking research on environmental inequality and early childhood development, this study assessed whether differences in exposure to neurotoxic lead explain sociodemographic gaps in school readiness. Using panel data tracking a representative sample of 1266 Chicago children (50% female, 16% White, 30% Black, 49% Hispanic, μage = 5.2 months at baseline, collected 1994-2002), analyses quantified the contribution of lead contamination to class and racial disparities in vocabulary skills and attention problems at ages 4 and 5. Results suggested that lead contamination explains 15%-25% and 33%-66% of the disparities in each outcome, respectively, although imprecise estimates preclude drawing firm inferences about attention problems.

Lead Health Fairs: A Community-Based Approach to Addressing Lead Exposure in Chicago.

Lead exposure has been linked to neurological, reproductive, and developmental effects, and approximately 3.5% of Chicago children under the age of 3 years have elevated blood lead levels. The aim of this research was to provide outreach opportunities to address the issue of lead exposure in water and soil. A series of seven community-based health fairs were held with a combined approach of screening and education accomplished through partnerships with organizations established within underserved communities that leveraged resources. Community members attending the fairs brought in samples of soil from their yards and tap water for lead testing. Lead concentrations in the soil samples had a mean value of 305.7 parts per million, and 30% of the samples were above the Environmental Protection Agency's action level for children's play lots. The mean lead concentration in tap water was 8.3 parts per billion, with 6% of sample testing above the Environmental Protection Agency's action level. There was no significant correlation between the lead levels in water and soil (p = .21), and there was no significant difference between the average lead concentrations in different areas of the city. A multifaceted approach was utilized to educate and engage and ultimately empower the communities affected by exposure to lead in urban settings.

Promoting Safe Firearm Storage in an Urban Neighborhood: The Views of Parents Concerning the Role of Health Care Providers.

Pediatric clinics are uniquely positioned to assess and advocate for the health and safety of Chicago's children in relation to accidental firearm-related injury and death. The best means of counseling families should be tailored to the individual community and patient population. We aimed to determine rates of firearm ownership and attitudes towards counseling about firearms in a community on the west side of Chicago with high rates of gun violence. An anonymous survey about gun ownership was administered at a federally qualified health center. The survey was completed by 206 adults with children less than 18 living in the home. A minority of participants (8.3%; n = 17) indicated that a gun was kept in or around the home. The majority of firearm owners reported using safe storage practices. However, just over half of the gun owners and non-gun owners had a favorable opinion of counseling about firearm safety in healthcare settings. Other strategies in addition to physician counseling will be required to promote safe firearm storage in this neighborhood with high rates of community violence.

Respiratory Health Disparities Among Chicago Children

Respiratory Health Disparities Among Chicago Children

Disparities persist in asthma-related emergency department visits among Chicago children

Disparities persist in asthma-related emergency department visits among Chicago children

Engaging end-users in intervention research study design

ABSTRACTObjective: Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) Plan is a 3-arm multicenter pragmatic trial to evaluate asthma interventions in high-risk Chicago children presenting to emergency departments (ED) with asthma. A formative evaluation with end-users to provide input into the trial design and outcome instruments was conducted prior to trial initiation. Methods: A multi-level data gathering framework from the field of design and standard qualitative methods was employed. This included one focus group with asthma Community Health Workers (N = 8), two focus groups with caregivers of children with asthma (N = 9), in-home interviews with caregivers (N = 9), key informant interviews at six EDs and outpatient clinical sites (N = 19), and ED tours and observations (N = 6). Data were presented, discussed, and organized into themes. Results: Data indicated that changes to the study design and discharge tool were warranted. A key insight was that ED discharge protocols typically place patient education at a single inopportune time, as families are preparing to leave the ED. At this point in time, families are less receptive to education due to fatigue and a desire to expedite the discharge process. The trial design was modified to reposition the discharge asthma plan to occur at earlier “teachable moments.” Delivery of the asthma discharge plan was assigned to study-employed ED coordinators instead of ED providers and staff. Other potential challenges to study recruitment and implementation were raised and addressed. Conclusions: Engagement of end-users in the design phase of implementation research is critical to improve research feasibility and relevance.

THE RACIAL ECOLOGY OF LEAD POISONING

AbstractThis paper examines the racial ecology of lead exposure as a form of environmental inequity, one with both historical and contemporary significance. Drawing on comprehensive data from over one million blood tests administered to Chicago children from 1995-2013 and matched to over 2300 geographic block groups, we address two major questions: (1) What is the nature of the relationship between neighborhood-level racial composition and variability in children’s elevated lead prevalence levels? And (2) what is the nature of the relationship between neighborhood-level racial composition and rates of change in children’s prevalence levels over time within neighborhoods? We further assess an array of structural explanations for observed racial disparities, including socioeconomic status, type and age of housing, proximity to freeways and smelting plants, and systematic observations of housing decay and neighborhood disorder. Overall, our theoretical framework posits lead toxicity as a major environmental pathway through which racial segregation has contributed to the legacy of Black disadvantage in the United States. Our findings support this hypothesis and show alarming racial disparities in toxic exposure, even after accounting for possible structural explanations. At the same time, however, our longitudinal results show the power of public health policies to reduce racial inequities.

Pediatric-Type Nodal Follicular Lymphoma in Children and Adults Is Nearly Genetically Silent and Biologically Distinct from Typical Follicular Lymphoma

Pediatric-type nodal follicular lymphoma (PTNFL) is a variant of follicular lymphoma (FL) characterized by localized presentation and excellent behavior despite its often high-grade histologic appearance. We recently identified high proliferation index and the absence of BCL2, BCL6, and IRF4 gene rearrangements as defining features of PTNFL in both children and adults (Louissaint, Blood 2012). In contrast to typical FL, children with PTNFL consistently have persistent remissions after surgical excision alone. Therefore, it is critically important to identify PTNFL in order to avoid unnecessary therapy. Considering the unique clinical behavior of PTNFL, we hypothesized that the mutational landscape of this disease would differ from that of typical FL. Twenty-four cases were collected from several institutions (MGH, Brigham & Women's, Weill Cornell, Chicago Children's, Boston Children's, University of Pittsburgh, SUNY Downstate, and Stanford). PTNFL was defined by the following criteria: 1) nodal involvement, 2) architectural effacement by a clonal follicular proliferation, 3) high proliferation index and 4) absence of both MUM1/IRF4 expression and BCL2/BCL6 rearrangements by FISH. All cases presented with localized nodal involvement and demonstrated no evidence of recurrence or progression after chemotherapy (n=5), radiation (n=3) or surgical excision alone (n=13) (therapeutic approach to be confirmed in 3 cases), with a median follow-up of 33.1 months (range 10-124 months). Subjects ranged in age from 4-60 years, including 14 children (4-18 years; median 15) and 10 adults (20-60 years; median 29.5). Whole exome sequencing performed on 7 PTNFL cases showed a strikingly low mutation burden (7.1 non-silent mutations/exome), more than an order of magnitude lower than the exomic mutation burden of typical FLs (Green, PNAS 2015; Pasqualucci, Cell Rep 2015). Given these findings, we pursued targeted exome capture and next-generation sequencing for 112 genes previously reported to be recurrently mutated in FL across a panel of 20 PTNFLs. Targeted sequencing (mean depth, 250) again demonstrated very low mutation burden in PTNFL, with a median number of non-silent mutations of 1.67/case compared with 4 mutations/case (P<0.001) in our published analysis of ~300 typical FLs requiring therapy usung the same gene panel (Pastore, Lancet Onc 2015). There were no differences in the median frequencies of mutations among adult and pediatric PTNFLs (1.57/case vs 1.80/case; p=0.752). We also sequenced 17 limited-stage typical FLs using the same 112 gene panel. TNFRSF14 was the most frequently mutated gene in PTNFL, with similar frequencies in PTNFL and limited-stage typical FL (29% vs. 41%; p=0.76). CREBBP mutations, which occur in most cases of advanced-stage FL, were seen in 82% of limited-stage typical FLs and only 4% of PTFLs (p<0.0001). Mutations in all other commonly mutated genes (e.g. BCL2, MLL2, GNA13) were also present in <10% of PTNFLs. SNP-based whole-genome analysis using OncoScan FFPE Assay kit to interrogate copy number was performed on 17 cases of PTNFL and 11 cases of limited stage typical FL. PTNFLs showed an average of 0.18 alterations/case compared with 4.27 alterations/case in limited stage FLs (p<0.0001). Taken together, these molecular genetic findings demonstrate that PTNFL in both children and adults has a strikingly low number of genetic aberrations, including an absence of mutations common in typical FL. The findings provide further evidence that PTNFL has a unique biology that is shared in adult and pediatric cases but is distinct from both limited and advanced stage typical FL. The absence of mutations in commonly mutated genes is an additional criterion, along with clinical and histologic factors, that may guide the diagnosis of PTNFL in both children and adults. DisclosuresSouth:Lineagen Corporation: Consultancy; ARUP Laboratories: Employment; Affymetrix: Consultancy, Honoraria; Illumina: Consultancy, Honoraria. Hasserjian:Promedior: Consultancy.

Rapid Learning in a Children's Museum via Analogical Comparison.

We tested whether analogical training could help children learn a key principle of elementary engineering-namely, the use of a diagonal brace to stabilize a structure. The context for this learning was a construction activity at the Chicago Children's Museum, in which children and their families build a model skyscraper together. The results indicate that even a single brief analogical comparison can confer insight. The results also reveal conditions that support analogical learning.

Play For All at Chicago Children's Museum: A History and Overview

AbstractIn 2004, Chicago Children's Museum founded the Play For All initiative, which creates a community where play and learning connect for visitors of all abilities. The Play For All team discovered that families with children with disabilities were looking for an opportunity to explore and enjoy the museum without limitations and the fear of being judged. CCM also learned that being ADA compliant was not enough; being accessible and inclusive meant going above and beyond the ADA. Children's museums are a rare treat where almost everything should be interactive and ready to be played with. The Play For All team has made significant changes to the exhibits, staff training, and programming at Chicago Children's Museum by working with local families with disabilities and partner organizations. A culture shift has taken place within CCM. Play For All is now a top priority when decisions are being made.

Envisioning a Thoughtful and Caring Child Welfare System

sidney goldberg studied at New York University and also with psychologist Albert Ellis, founder of Rational Emotive Behavior Therapy. He now works as a college counselor in New York City. The child welfare system in the United States is not living up to its name. Rather than nurturing the intellectual potential, capacity for joy, and emotional wellness of foster children, the system too often takes a narrow approach to maintaining only the children’s physical well-being. I speak from my experience as a caseworker, administrator, and creator of a unique program in child welfare. Twenty-five years of butting up against the constraints of this system have made clear to me that the problem is structural. The occasional caseworker who would seek to nurture a child’s potential interests or passions would usually be thwarted by the limited paradigm around which the system is constructed. Year after year, most caseworkers go through the motions, while heeding the entrenched and narrow mandates set forth by their agencies as the lives of children under their care stagnate. I believe another system is possible — one that starts from the foundational premise that all people are capable of building satisfying lives through the pursuit of their interests — and that is staffed by workers who treat children and their parents with deep care and respect. To create such a system, we will need to transform the entire structure and pedagogy of social work school, drawing on insights gained through a careful look at the problems with the current system.

Using Evidence to Create Active Communities: Stories from the Field—Policy and Research with Chicago’s Child Care Centers: a Commentary to Accompany the Active Living Research Supplement to Annals of Behavioral Medicine

The Consortium to Lower Obesity in Chicago Children (CLOCC) is a nationally recognized childhood obesity prevention program housed at the Ann and Robert H. Lurie Children’s Hospital of Chicago [1]. This network connects hundreds of organizations to implement evidence-based approaches to protect children from the obesity epidemic. It has been identified as a leading community model by the Institute of Medicine, the American Medical Association, and the Centers for Disease Control and Prevention. CLOCC’s primary focus is on children aged 0 to 5 years, their caregivers, and their communities. Its work is led by a multi-disciplinary team of staff and advisors and guided by community partners from across the city. CLOCC’s partners cut across medicine, government, corporate, academic, advocacy, and other sectors. Currently, there are over 3,000 individuals representing over 1,200 organizations who participate in the consortium. Many are in the Chicago area and participate in a variety of consortium activities. Some are located outside of the city and state and participate through engagement with CLOCC’s website (www.clocc.net) or by receiving CLOCC’s weekly e-letter. A small subset of organizations and individuals provide leadership through CLOCC’s External Advisory Board and Executive Committee. CLOCC is creating and sustaining the types of multilevel collaborations recommended by our nation’s health leaders. The primary benefit of the consortium’s size is that there are substantial opportunities for collaboration and many partners can come together for specific projects, to advance policy, and to strengthen obesity prevention in Chicago and beyond. The size and diversity of the consortium help to facilitate the multi-sectoral work and focus of the consortium. Challenges that come with the magnitude of the consortium include the size of the staff that must be supported to manage the numerous projects and activities, the complexities of actively engaging such a diverse group of partners, and evaluating the impact of the consortium’s activities on the capacity of partners. However, some of these challenges are true for coalitions and consortia regardless of their size. When funding is available, CLOCC provides technical assistance to communities of varying size to support the development of local childhood obesity prevention consortia and includes discussions of the pros and cons of many of the approaches CLOCC takes. One of the collaborations CLOCC helped to create and sustain, the Inter-Departmental Task Force on Childhood Obesity (IDTF), recently contributed to an early childhood policy change in the City of Chicago. The IDTF is an awardwinning 11 city agency task force led by the Chicago Department of Public Health (CDPH) and facilitated by CLOCC. In 2009, CDPH and the Chicago Board of Health passed a joint resolution to improve child care standards related to nutrition, physical activity, and screen-time (e.g., television and computers). The standards prohibit the serving of sugar-sweetened beverages to all children and limit 100 % fruit juice to children 12 months of age and older. They allow only 1 % or nonfat dairy for children over the age of 2, unless greater fat content is medically prescribed. The standards set minimum minutes for physical activity (60 min for children ages C. T. Bozlak (*) University at Albany, School of Public Health, One University Place, Room 173, Rensselaer, NY 12144, USA e-mail: cbozlak@albany.edu

The Educare Chicago Research-Program Partnership and Follow-Up Study: Using Data on Program Graduates to Enhance Quality Improvement Efforts

Early childhood education programs that have succeeded in raising the quality and outcomes of their programs have done so, oftentimes, by championing a culture of continuous improvement. This includes comprehensive formative evaluation and routines of data feedback and discussion that support teaching staff to use child growth and classroom quality data to inform daily instructional decisions and interactions with families. This article provides a case illustration of how leaders and staff at 1 high-quality early childhood education program (Educare Chicago) use data and feedback from graduate children and families to inform and drive continuous quality improvement through a Research-Program Partnership, which is a dynamic interchange between researchers, program leadership, and practitioners. Research Findings: This article focuses on the utilization of longitudinal Follow-Up Study data obtained from Educare Chicago children and families as they transitioned into the elementary school system to inform early childhood program quality enhancement efforts. Quantitative data on school type, school quality, and teacher ratings of children and parents are included. The utilization of findings from qualitative data obtained from parents and Educare program staff are also discussed. Practice or Policy: Follow-Up Study key findings and program responses are described, in addition to the role of the Research-Program Partnership in fostering both these exchanges and a deeper understanding of how to use data from program graduates and their families. Implications for program practices specific to children and families’ transition to kindergarten, early mathematics instruction, and family engagement are discussed.

End of an Era: Farewell Chicago Children’s Memorial Hospital

End of an Era: Farewell Chicago Children’s Memorial Hospital

Comparison of Several Artistic Judgment Aptitude Dimensions Between Children in Chicago and Lisbon

Abstract This research examines measurability, statistical interrelationships and association with test IQ, and cultural robustness of several artistic judgment dimensions. Symmetry, Simplicity, Uniformity, and Expressiveness dimensions had been previously validated in a comprehensive study of professional artists and studied in Chicago with children of diverse cultural background. The fifth dimension, the Visual Aesthetic Sensitivity Test (VAST), rests on much weaker validity foundations but was included in this research because of wide use among empirical arts researchers. Cross-cultural comparison of these dimensions has never been reported. The study sample is a culturally homogeneous group of native Lisbon schoolchildren (modal age = 10 years, N = 48). Results showed adequate psychometric reliability for all dimensions (&amp;gt;.80) except VAST (.57). Means were statistically indistinguishable between Portuguese and American children on Simplicity and Uniformity, which support their aptitude foundations. Portuguese children showed significantly higher preference for asymmetry (Symmetry dimension), which indicates consistency with professional artists. However, Portuguese children showed much lower preference for Expressiveness than did Chicago children, which is the opposite direction of artistic expectations. With exception of VAST, these dimensions show considerable promise for cross-cultural and developmental research.

5-4-3-2-1 Go! Coordinating Pediatric Resident Education and Community Health Promotion to Address the Obesity Epidemic in Children and Youth

This study investigated the feasibility and effectiveness of training pediatric residents to conduct a brief clinic-based behavioral intervention in coordination with community dissemination of a health promotion message developed by the Consortium for Lowering Obesity in Chicago Children. A total of 113 residents completed a short (<60 minutes) online training program. Some (64) residents distributed interview contact cards to patients they saw in their continuity of care clinics after training; others (45) distributed cards before training. A researcher interviewed 75% of the 509 patients 4 weeks after the visit. More patients of trained residents reported positive changes in behaviors which have been associated with lower obesity rates: increased intake of fruits and vegetables (28% vs 16%, P < .01), increased intake of water (30% vs 19%, P < .01), increased physical activity (40% vs 29%, P < .03), and decreased television time (36% vs 24%, P < .01). Brief training using the 5-4-3-2-1-Go! message seems to be feasible and effective.

50 Years Ago in The Journal of Pediatrics: Is There a Rheumatic Constitution?

Diamond EF. J Pediatr 1959;54:341-7 The mystery of widespread occurrence of streptococcal pharyngitis and yet relatively uncommon and unpredictable occurrence of rheumatic fever has intrigued the medical community for a century. Observant clinicians wondered whether gross physical characteristics might distinguish a rheumatic constitution—much as the prematurely gray, blue-eyed Nordic type is known to have a proclivity for pernicious anemia. By the 1950s, numerous authors had reported a preponderance of certain physical characteristics in children with rheumatic fever, spurring Diamond to formally evaluate a roster of Chicago children with rheumatic fever (sample size, 76-204, depending on factor studied). He sought a simple preponderance of certain features and used a formalized control group for assessing other characteristics. Unlike previously reported associations, Diamond found no preponderance in rheumatic children of race, hair or eye color, asthenic or pyknic body build, skin pallor, blood type, or salivary non-secretion of ABO substance (ie, probable secretion of Lewis substance). Diamond found a single significant constitutional factor—hyperextensibility of metacarpophalangeal joints—significantly more frequently in active and inactive rheumatic groups compared with control subjects. Diamond speculated that this finding may be an expression of an underlying biochemical abnormality of connective tissue. In The Journal in 2002, Barron et al (J Pediatr 2002;141:421-5) reported a case-control study performed in children referred to Johns Hopkins Hospital for chronic fatigue and found hyperextensibility of joints 3.5 times more frequently in these patients than in control children referred to the hospital's dermatology clinic. One wonders whether this finding in patients with chronic fatigue and rheumatic fever is merely deconditioning or whether it belies an underlying genetic disorder. Recent geographically confined outbreaks of rheumatic fever and use of modern molecular microbiology have focused attention on rheumatogenic strains of group A streptococcus. Family size, however, also has been a risk factor for rheumatic fever. It seems that the duration of the unsolved mystery alone and evidence from several corners suggest that there is room to consider relevant contributions to rheumatogenicity from the microbe, the host, and the environment.

Taking on childhood obesity in a big city: Consortium to Lower Obesity in Chicago Children (CLOCC)

A growing body of research on childhood obesity points to the increased risk of chronic disease from early childhood through adulthood, including coronary heart disease. There is growing consensus on the need to address childhood obesity at multiple levels (individual, family, community, societal). The Consortium to Lower Obesity in Chicago Children is a data-driven, multi-level, multi-sector, Chicago-wide initiative aimed at preventing childhood obesity. This report outlines how CLOCC was formed, how it is organized and conducts its work, its evaluation activities emerging results. Lessons learned and recommendations for other chronic disease prevention consortia are provided.

Why acute rheumatic fever has virtually disappeared in the U.S.

The explanation for the very substantial decline in incidence of acute rheumatic fever (ARF) in the U.S., particularly over the past 50 years, is unclear. Genetic changes in the host population and environmental issues like nutrition, crowding, and improved access to medical care have been suggested. It has also been proposed that certain M types of group A streptococci (GAS) include strains that are particularly rheumatogenic and that others are non-rheumatogenic. We compared the M type distribution of GAS from Chicago children with acute pharyngitis from 1961–1968 (when ARF was highly prevalent) to that of children from Chicago and across the U.S. in 2000–2004 (when ARF was rare), with attention to changes in prevalence of putative rheumatogenic and non-rheumatogenic types. The proposed rheumatogenic types 3, 5, 6, 14, 18, 19, and 29 comprised 49.7% of 468 pharyngeal isolates in 1961–1968 but only 10.6% of 450 Chicago isolates in 2000–2004 ( p < 0.001) and 17.9% of 3969 isolates nationwide in 2000–2004 ( p < 0.001). Significant declines in types 3, 5, and 6 and virtual disappearance of types 14, 18, 19, and 29 occurred between the two study periods. No change in the proportion of type 1 isolates, a highly heterogeneous group that includes some proposed rheumatogenic strains, was observed. The proportion of putative non-rheumatogenic GAS types 2, 4, 22, and 28 increased from 4.9% to about 28% of pharyngeal isolates in Chicago and nationwide between the two study periods ( p < 0.001). These data strongly support the concept of rheumatogenic strains of GAS and indicate that the marked decline in ARF in the U.S. from the 1960s to the 2000s is very likely due to replacement of rheumatogenic types by non-rheumatogenic types as the etiologic agents of acute streptococcal pharyngitis in children.