The longitudinal study is a major undertaking that aims to identify opportunities and assets that lead to positive change for youth.Mary Niederberger
Stories about how opportunity or lack thereof may affect the future of Pittsburgh youth.
It’s a quiet Monday morning and sunshine streams through the windows of Shellie Groom’s preschool class at Pittsburgh Beechwood PreK-5 as her pint-sized pupils choose their first activities of the day.
Some decide to play with blocks, others work with shapes and one chooses time at the sand table. They don’t know it, but their play is not without purpose. It’s aimed at helping the 3- and 4-year-olds learn colors, shapes, letters and numbers.
There’s something else the tots don’t know: Their activities are expected to contribute to a large body of best practices for successful academic and health outcomes for children. Those outcomes will be compiled and shared over much of the next two decades as part of The Pittsburgh Study.
The study, organized and sponsored by UPMC Children’s Hospital of Pittsburgh, aims to follow local children from birth to age 18 to identify what factors contribute to their physical and mental health and successful educational outcomes.
Its organizers say it is currently the largest community-partnered intervention study following children from before birth to adulthood. The Pittsburgh Study aims to recruit between 20,000 and 25,000 children from Southwestern Pennsylvania over the next two decades. Recruitment will start in early 2020.
Among its major focuses are premature birth, infant mortality, asthma prevalence, obesity and weight and violence among youth.
“These are the things that truly truncate the potential of our young people,” said Terence Dermody, chair of the pediatrics department at Children’s. Dermody initiated the study after coming to UPMC Children’s from Vanderbilt Children’s Hospital in 2016.
The study’s tentacles will reach into areas that include finding ways to create racial equity among children, including closing the racial achievement gap and improving literacy among students in Pittsburgh Public Schools. It will combine the expertise of medical professionals, university researchers, social service professionals and community members.
The study is co-directed by Elizabeth Miller, chief of adolescent and young adult medicine at Children’s, and Val Chavis, who is the community mentor for graduating medical students and postdoctoral research scholars at the University of Pittsburgh and former director of the East Hills and Mon Valley Family Support Centers operated by the Urban League of Greater Pittsburgh.
Dermody said pediatricians consider it a victory when a child “achieves their educational milestones, is in good health and thriving and ready to become an adult.”
When recruitment begins early next year, the study will start by forming an early childhood cohort with infants and toddlers through age 4. Other cohorts will follow at various intervals with the expectation that children from all age groups will be enrolled by mid-2021.
Dermody said the factors being explored in The Pittsburgh Study have been covered in other studies but not over such a long period of time with the same kids.
When developing The Pittsburgh Study, the team reviewed other studies such as:
Another major difference is that previous studies on childhood health have been performed to document deficits and risks, but The Pittsburgh Study seeks to document and replicate positives through a practice known as bright-spotting.
Bright-spotting involves identifying factors that lead to positive childhood outcomes in vulnerable neighborhoods or among vulnerable populations where negative outcomes have become the norm, said Kristin Ray, a pediatrician and director of health systems improvements at Children’s Community Pediatrics.
“In the past so much has been focused on the negative. But now, we want to focus on what is called positive deviance,” Ray said.
There is also a planned component that will focus on the health of expectant mothers.
Dermody was attracted to Pittsburgh from Vanderbilt because of the area’s stable population, a factor that makes it one of the few places where such a longitudinal study could be accomplished, he said. In other more transient cities, it would be difficult, if not impossible, to expect to study the same children over an 18-year span, Dermody said.
“I’m not sure it could be done anywhere else. [Pittsburgh is] a city of the size that one can conceive of a longitudinal study that enrolls a good portion of the population, across the population,” he added.
A component of the study is data gathering and mapping by the Western Pennsylvania Regional Data Center [WPRDC]. The center is creating a Child Health Data Hub — a map of Southwestern Pennsylvania broken down by neighborhoods, or perhaps smaller segments, that will include numerous data points about child health. The Allegheny County portion of the map is expected to be the most detailed.
“We will identify the kind of data that will really help a community,” said Robert Gradeck, WPRDC project director.
The data points will include publicly available data from county and state agencies as well as data gathered throughout The Pittsburgh Study. Among the data points will be children’s lead exposure, social service use and access to green spaces.
The site is expected to launch publicly in early 2020.
So far, The Pittsburgh Study has received funding from UPMC Children’s, the pediatrics department of the University of Pittsburgh School of Medicine, the Children’s Hospital of Pittsburgh Foundation, the Shear Family Foundation, the Grable Foundation*, the National Institutes of Health and the Centers for Disease Control and Prevention.
Ray was introduced to the idea of bright-spotting when reading about a study that identified unexpected positive outcomes in health in Appalachia’s 420 counties. The analysis identified 42 counties as “bright spots” because of the “better than expected outcomes” given the resources that existed there.
It prompted Ray to ask: “Where are there outcomes that are better than expected for kids? What can we learn about the strengths and assets and ways in those communities where people have been able to lift up kids’ health?”
She’s currently using the method to study “low acuity emergency room visits” — when children are brought to the emergency room for conditions that could be treated by a primary care physician [PCP]. She’s looking at data from areas that show “structural disadvantage” based on such factors as income levels, household crowding and access to a vehicle.