The COVID-19 pandemic has heightened awareness of health disparities in vulnerable populations across the nation. One way that health disparities become apparent are when a health outcome occurs disproportionately in one group — such as a particular gender, age group, socioeconomic group or race — when compared to others.

Florida ranks among the highest states in the country for health disparities, with the worst health outcomes consistently experienced by those who are uninsured, and by children who live in poverty. Physician researchers at Johns Hopkins All Children’s Hospital and their collaborators have embarked on an innovative research study designed to understand the social, economic and health impact of the COVID-19 pandemic upon a diverse population of young children (birth to 8 years old) and their families within the Tampa Bay region, and to identify key factors that make children most vulnerable to the pandemic’s damaging effects on their social, economic, emotional and physical health. 

In 2014, the Johns Hopkins All Children’s PREDICT study (Prospective Research on the Early Determinants of Child Health Trajectory) was launched as a multi-year effort to follow more than 400 mother-child pairs in their life course and describe genetic, physiologic and behavioral factors that impact overall child health. With the PREDICT study providing a ready population of children and families living and growing in the Tampa Bay region before the onset of the COVID-19 epidemic, study leaders Raquel Hernandez, M.D., M.P.H. (a Johns Hopkins All Children’s-based assistant professor of pediatrics in the Johns Hopkins University School of Medicine) and Sara Johnson, Ph.D. (an associate professor of pediatrics based on the main campus of Johns Hopkins in Baltimore) jumped at the opportunity to initiate a PREDICT COVID-19 Impact study that builds off of PREDICT, in which child and family health factors could be compared pre- versus post-pandemic. 

“Based on a wealth of recent studies, we now know that child health is heavily affected by social factors (a concept known as “social determinants of health”) — which are the conditions in which people are born, grow, live, work and age that are interrelated to complex social and economic factors. To know which interventions and support mechanisms are needed to have children and families overcome the COVID-19 pandemic, we need a focused way to study and describe these novel factors,” Johnson explains. 

Over the last decade, investigators have learned that various pediatric health outcomes, including autism, pediatric obesity and other chronic disease, are intricately related with factors such as families’ neighborhood environments, access to high-quality foods, and the families’ support systems. Johnson added that in order to expand our knowledge of pediatric health issues, concerted efforts to take social determinants of health into account are urgently needed. Studies like PREDICT COVID-19 Impact are allowing investigators and physicians to better understand why underserved racial/ethnic and socio-economic groups are at higher risk for conditions like COVID-19 while uncovering potential interventions targeting the social determinants of health can be a critical component, in conjunction with clinical interventions like medication therapies, to achieve the best outcomes for vulnerable patients.

The current PREDICT COVID-19 Impact sub-study was funded by the Johns Hopkins Alliance for a Healthier World COVID Launchpad Grant and a COVID-19 research grant from the Johns Hopkins All Children Foundation. The study will survey families about how their routines, stressors, supports, child care, and health and wellbeing have been affected by the pandemic using a questionnaire developed by a multidisciplinary team including Johnson, Hernandez, and colleagues Rachel J. Thornton M.D., Ph.D., and Heather Volk, Ph.D. The study was developed as part of the new Program in Pediatric Health Equities Research at the Johns Hopkins All Children’s Institute for Clinical and Translational Research. The Pediatric Health Equities Research Program, directed by Hernandez, has helped to establish the Johns Hopkins All Children’s Community Research Advisory Board — a diverse collection of leaders from community organizations including the Department of Health, the Hispanic Services Council and Metro Inclusive Health among other community partners. 

“Our mission as a hospital has always been to provide the best care for all children — regardless of race/ethnicity, socio-economic status or ZIP code,” Hernandez emphasizes. “To do this, we have to redouble our efforts in describing and understanding the social determinants of health of our patients and families. We hope this study can advance our knowledge on how to optimize health through the pandemic and begin post-pandemic recovery efforts for our most vulnerable families locally and beyond.”