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Children and COVID-19 Research Library

UNICEF Innocenti's curated library of COVID-19 + Children research

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A schema of toxic stress informed by racism, transgenerational stress, and disadvantage

AUTHOR(S)
Felesia R. Bowen; Linda A. Lewandowski; Julia A. Snethen (et al.)

Published: October 2021   Journal: Journal of Pediatric Health Care

The Toxic Stress Schema (TSS) is an ecological framework with a social justice lens for identifying and alleviating stress and strengthening social determinants of health for children and families of color impacted by the COVID-19 pandemic and the cumulative effects of racism and generational, systemic inequities. Relevant literature is reviewed, and examples were provided to illustrate the differential impacts of the “stress superstorm” of 2020 had on children of color based on their family's position on the advantage–disadvantage continuum.

Health disparities and their effects on children and their caregivers during the Coronavirus disease 2019 pandemic

AUTHOR(S)
Lynn C. Smitherman; William Christopher Golden; Jennifer R. Walton

Published: October 2021   Journal: Pediatric Clinics of North America

Health disparities are defined as differences among specific populations in the ability to achieve full health potential (as measured by differences in incidence, prevalence, mortality, burden of disease, and other adverse health conditions). Among children, multiple factors contribute to these disparities, including economic stability, and access to health care. According to the Annie E. Casey Foundation, before the current pandemic, 12 million children in the United States were living in poverty in 2019, including one-third of African American and Native American children and 25% of Latinx children.8 During the same period, of the 4.4 million children without health insurance, 14% were Native American, 9% were of Hispanic descent, and 18% were immigrants. At present, owing to the impact of the pandemic on job security, more than 50% of African American, Latinx, and multiethnic adults are now without medical insurance, directly affecting the health security of their children.8 With the onset of the pandemic and the social and political upheaval felt by many disenfranchised communities, these well-documented disparities (and the importance of addressing them) have again been brought to the attention of the medical community. This overview will examine the effects of these health disparities in various populations of children in this country. We will first examine the historical context of health disparities, how they developed, and why they still exist. We will then examine how specifically the COVID-19 pandemic impacted these disparities among children and adolescents, both directly and indirectly. Finally, we hope to provide some recommendations to reduce these disparities.

COVID-19 vaccine sentiments among African American or black adolescents in rural Alabama

AUTHOR(S)
Henna Budhwani; Tiffani Maycock; Wilnadia Murrell (et al.)

Published: September 2021   Journal: Journal of Adolescent Health
Considering the urgent need to increase vaccine uptake in Alabama, a rural state with the lowest levels of COVID-19 vaccination in the country, we conducted an exploratory study to elucidate sentiments toward vaccination among African American or Black adolescents. We conducted in-depth interviews with 15-17 year olds in rural Alabama (N=28). About 54% of our sample were female. Nearly a third lived with an older family member; 18% knew someone who contracted COVID-19. Using Rapid Qualitative Analysis, three COVID-19 vaccine-related themes emerged: influence of community leaders and older family members, fear of side effects and mis-information, and institutional distrust.
Longitudinal impact of childhood adversity on early adolescent mental health during the COVID-19 pandemic in the ABCD study® cohort: does race or ethnicity moderate findings?

AUTHOR(S)
Elizabeth A. Stinson; Ryan M. Sullivan; Bridgette J. Peteet (et al.)

Published: September 2021   Journal: Biological Psychiatry Global Open Science

During the COVID-19 pandemic in the United States, mental health among youth has been negatively impacted. Youth with a history of adverse childhood experiences (ACEs), as well as youth from minoritized racial-ethnic backgrounds, may be especially vulnerable to experiencing COVID-19-related distress. The current aims are to examine whether exposure to pre-pandemic ACEs predicts mental health during the COVID-19 pandemic in youth and whether racial-ethnic background moderated these effects. From May to August 2020, 7,983 youth (Mage= 12.5, range= 10.6-14.6 years old) in the Adolescent Brain Cognitive Development StudySM (ABCD Study®) completed at least one of three online surveys measuring the impact of the pandemic on their mental health. Data was evaluated in relation to youth’s pre-pandemic mental health and ACEs.

Brief report: impact of the COVID-19 Pandemic on Asian American families with children with developmental disabilities

AUTHOR(S)
Sarah Dababnah; Irang Kim; Yao Wang (et al.)

Published: September 2021   Journal: Journal of Developmental and Physical Disabilities
Discrimination against Asians and Asian Americans increased during the COVID-19 pandemic. Yet, even prior to the pandemic, little research explored the experiences of Asian American families of children with autism and other developmental disabilities. This brief report summarizes the results of a survey conducted between May and July 2020, in the immediate aftermath of state and local lockdowns due to the pandemic. Twenty-five Asian American caregivers of children with autism and other developmental disabilities completed the survey and reported on the pandemic’s impact on their household. Most of the caregivers were mothers, immigrants, Chinese, raising children with autism, and highly educated. Participants’ primary concerns were the disruption of their children’s educational and therapeutic services. We discuss research limitations and implications.
SNAP participation among low-income US households stays stagnant while food insecurity escalates in the months following the COVID-19 pandemic

AUTHOR(S)
Punam Ohri-Vachaspati; Francesco Acciai; Robin S. DeWeese

Published: September 2021   Journal: Preventive Medicine Reports
The COVID-19 pandemic led to increased food-insecurity rates, particularly among low-income households. Participation in the Supplemental Nutrition Assistance Program (SNAP) was expected to rise in response. This study surveyed 931 US residents from households with annual incomes below $50,000 to collect information on food security and food assistance program participation in the year prior to the pandemic and in the first four months of the pandemic, along with household and individual-level demographics. Food insecurity increased from 31% prior to the pandemic to 39% in the first four months of the pandemic, while SNAP participation stagnated. Even more alarmingly, among low-income households that were also food-insecure, 47% participated in SNAP prior to the pandemic but only 39% did so in the first four months following the pandemic’s onset. In particular, Black households, households with children, and those in the lowest income category experienced the largest declines in SNAP participation. Food assistance programs designed to alleviate hunger should facilitate participation among the most vulnerable, especially when these groups are faced with multiple challenges, like during the COVID-19 pandemic.
Considerations for mitigating COVID-19 related risks in schools

AUTHOR(S)
Amy Gimma; Sham Lal

Published: September 2021   Journal: The Lancet Regional Health - Americas
As the new school year begins in the United States, school districts will be tasked with providing in-person teaching while keeping children and school staff safe, an increasingly difficult goal in the presence of the COVID-19 delta variant. This study aims to provide updated interpretations of past and newly published studies to assist in assessing risk in schools, and to add additional perspectives on addressing the social determinants of learning and on the role of race and other social factors. It advocates for the continued implementation of risk mitigation strategies in schools, including mandatory mask policies, improved ventilation, and convenient access to vaccinations for those eligible, as recommended by the CDC, and to use this opportunity to make long-term improvements to our schools as a matter of urgency.
Examining the role of psychosocial influences on black maternal health during the COVID-19 pandemic

AUTHOR(S)
Keri Carvalho; Anna Kheyfets; Blessing Lawrence (et al.)

Published: August 2021   Journal: Maternal and Child Health Journal

Due to the disproportionate impact of COVID-19 on communities of color, racial disparities in maternal mortality and morbidity are likely to increase. However, neighborhood and social support factors have yet to be discussed as potential mechanisms by which COVID-19 can exacerbate racial disparities. This study examined literature on the role of neighborhood factors and social support on maternal health outcomes and provided analytical perspective on the potential impacts of COVID-19 on Black birthing people.

Are the kids really alright? Impact of COVID-19 on mental health in a majority Black American sample of schoolchildren

AUTHOR(S)
Amanpreet Bhogal; Breanna Borg; Tanja Jovanovic (et al.)

Published: August 2021   Journal: Psychiatry Research
Children from historically disadvantaged groups (racial minorities, lower socioeconomic status [SES]) may be particularly susceptible to mental health consequences during the COVID-19 pandemic. This study examined the impact of the pandemic, including mental health symptoms and COVID-19-related fears and behaviors, in a sample of majority Black American (72%) children (n=64, ages 7–10, 24 female) from an urban area with high infection rates.
Health equity, schooling hesitancy, and the social determinants of learning

AUTHOR(S)
Meira Levinson; Alan C. Geller; Joseph G. Allen (et al.)

Published: August 2021   Journal: The Lancet Regional Health - Americas
At least 62 million K-12 students in North America—disproportionately low-income children of color— have been physically out of school for over a year due to the COVID-19 pandemic. These children are at risk of significant academic, social, mental, and physical harm now and in the long-term. We review the literature about school safety and the conditions that shape families’ and teachers’ choices to return to in-person schooling. We identify four causes of schooling hesitancy in the U.S. even where schools can be safely reopened: high community transmission rates; the politicization of school re-openings; long-term racialized disinvestment in urban districts; and parents’ rational calculations about their family's vulnerability due to the social determinants of health.
Racial discrimination as a cumulative risk factor affecting parental stress on the psychological distress of Korean Americans (both US- and foreign-born) amid COVID-19: structural equation modeling

AUTHOR(S)
Hyejoon Park; Shinwoo Choi; Keeyoon Noh (et al.)

Published: July 2021   Journal: Journal of Racial and Ethnic Health Disparities
This study examined the relationships of parental stress and racial discrimination to the psychological distress of Korean Americans (both US- and foreign-born) during the COVID-19 pandemic. It also explored whether racial discrimination moderated the effect of parental stress on psychological distress. Using primary data collected between May 24, 2020, and June 14, 2020, via an online questionnaire, confirmatory factor analysis and structural equation models were conducted on 339 Korean American parents.
Reimagining youth justice: how the dual crises of COVID-19 and racial injustice inform judicial policymaking and reform

AUTHOR(S)
Alysha Gagnon; Samahria Alpern

Published: July 2021   Journal: Juvenile and Family Court Journal
The COVID-19 pandemic and the rejuvenated movement for racial justice in 2020 have presented an opportunity to reimagine the roles, practices, and policies of juvenile and family court systems actors. In order to capture contemporary ideas about judicial practice and policy reforms, semi-structured interviews were conducted with Hon. Edwina Mendelson, Deputy Chief Administrative Judge for the Office of Justice Initiatives in New York State, and Hon. Steven Teske, Chief Judge of the Juvenile Court of Clayton County, Georgia. These interviews yielded several recommendations for judicial reform in youth justice (e.g., implement court-wide procedural justice practices, improve accessibility using technology). These recommendations can be used by systems actors across the country, particularly those interested in adapting their courtroom practices for a post-pandemic world.
The influence of adverse childhood experiences (ACEs), including the COVID-19 pandemic, and toxic stress on development and health outcomes of Latinx children in the USA: a review of the literature

AUTHOR(S)
Natalie Claypool; Arelis Moore de Peralta

Published: July 2021   Journal: International Journal on Child Maltreatment: Research, Policy and Practice
The purpose of this review is to synthesize existing literature to analyze the influence of the Adverse Childhood Experiences (ACEs), including the COVID-19 pandemic, and toxic stress on child development and lifelong health outcomes of Latinx children in the USA, utilizing the ACE framework. Without adequate protective factors, children’s early experiences with adversity and toxic stress have implications for their physiological, psychological, and social health. The COVID-19 pandemic has shown to exacerbate childhood adversity and toxic stress and has disproportionately harmed Latinx communities. In applying the ACE framework to US-Latinx populations, relevant findings concerning a potential failure of ACEs to accurately capture Latinx experiences of adversity were highlighted, as well as the need to classify the COVID-19 pandemic as an ACE. Research suggest that first-generation Latinx immigrants report lower-than-average rates of ACEs despite the various disparities ethnic minorities face in the USA.
SARS-CoV-2 infection and racial disparities in children: protective mechanisms and severe complications related to MIS-C

AUTHOR(S)
Sanjana Kurup; Regan Burgess; Fatou Tine (et al.)

Published: July 2021   Journal: Journal of Racial and Ethnic Health Disparities
A novel coronavirus has resulted in a pandemic with over 176 million confirmed cases and over 3.8 million recorded deaths. In the USA, SARS-CoV-2 infection has a significant burden on minority communities, especially Hispanic and Black communities, which are overrepresented in cases compared to their percentage in the population. SARS-CoV-2 infection can manifest differently in children and adults, with children tending to have less severe disease. A review of current literature was performed to identify the hypothesized protective immune mechanisms in children, and to describe the rare complication of multisystem inflammatory syndrome in children (MIS-C) that has been documented in children post-SARS-CoV-2 infection.
Association between race and COVID-19 outcomes among 2.6 million children in England

AUTHOR(S)
Defne Saatci; Tom A. Ranger; Cesar Garriga (et al.)

Published: June 2021   Journal: JAMA Pediatrics

Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. There is an established association between race and severe COVID-19 outcomes in adults in England; however, whether a similar association exists in children is unclear. This article aims to investigate the association between race and childhood COVID-19 testing and hospital outcomes.

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UNICEF Innocenti's Children and COVID-19 Library is a database collecting research from around the world on COVID-19 and its impacts on children and adolescents.

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UNICEF Innocenti is mobilizing a rapid research response in line with UNICEF’s global response to the COVID-19 crisis. The initiatives we’ve begun will provide the broad range of evidence needed to inform our work to scale up rapid assessment, develop urgent mitigating strategies in programming and advocacy, and preparation of interventions to respond to the medium and longer-term consequences of the COVID-19 crisis. The research projects cover a rapid review of evidence, education analysis, and social and economic policies.