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Growing Up in a Syndemic: COVID-19’s Impact on Minoritized Mothers and Children
limjr [at] chop.edu (By Jillian Rose Lim)
Children develop faster in their first 5 years than any other time in their life. As new sights, smells, and sounds stimulate their senses, they accumulate new experiences and build bonds that can last a lifetime. During that window, supporting the mental well-being of mothers and caregivers of these little ones is paramount. But when the COVID-19 outbreak hit in 2020, Children's Hospital of Philadelphia psychiatrist Wanjikũ Njoroge, MD, was aware that minoritized mothers faced disproportionately greater challenges. Unprecedented as it was, the pandemic had widened known racial disparities underlying systems such as education, housing, and healthcare.
Dr. Njoroge conceived of a research project funded by the National Institutes of Health that examined how the "syndemic" — that is, the pandemic alongside systemic conditions such as structural and interpersonal racism — impacted the mental health and well-being of Black mothers.
Working directly with mothers, children, and families through interviews, observations, and assessments, Dr. Njoroge seeks to identify the specific maternal or environmental factors that critically influence a child's early neurodevelopment.
"The pandemic was such an unprecedented global health crisis that many of us were trying to find ways to help families navigate this unparalleled event, including referencing earlier work in these and related areas," said Dr. Njoroge, who is also founder and director of CHOP's Young Child Clinic. "We know this pandemic has had disproportionate impacts on many Americans, Black and brown people, senior citizens, lower-resourced communities, etc. We also are beginning to see the impact the pandemic has had on children and adolescents. Our hope is that our current work will be helpful to not only the parents that participate, but also to help parents with very young children in the future."
Environment and Early Development
Health equity researchers have long been interested in how structural racism and other social determinants of health, such as food and job security, can impact an individual's well-being. Only a few studies, however, have focused specifically on how these determinants affect very young children.
In 2021, Dr. Njoroge and her colleagues reviewed evidence of the impact that different forms of racism have on both maternal well-being and that of their developing children. They concluded structural racism's effect on parenting practices and a mother's mental health could be one mechanism by which a young child's socioemotional development is adversely affected.. The next step was to study in more detail the ways in which this might occur.
Dr. Njoroge's project, "Prenatal to Preschool (P2P): The Impact of the Pandemic on Mothers and Children, With a Focus on Syndemic Effects on Black Families," follows Black and non-Latinx White mothers in Philadelphia and their young children over several years. Because Black women have been disproportionately impacted by both the COVID-19 pandemic and endemic conditions during the all-important peripartum period, the project provides an opportunity to better understand how these inequities also affected their children. Identifying these mechanisms will inform the development of targeted and culturally-informed interventions.
"The goal is to better understand the mechanisms that specifically impact families with very young children, as well as better understanding factors which may lead to resilience," Dr. Njoroge said. "When thinking about Philadelphia, the structural or systemic barriers mirror that of other large cities across the United States with the history of redlining neighborhoods and the continuing impacts on Black families today."
From Prenatal to Preschool
For the mixed-methods longitudinal study, Dr. Njoroge and colleagues recruited pregnant women early in the pandemic, around April of 2020. With the children turning two years old this year, the researchers also sought the help of their families, including fathers or supporting relatives. Currently, both primary and secondary caregivers are completing online questionnaires and participating in observational assessments of mother-toddler interactions.
"Through observing play, we are able to gain a wealth of information about the ways in which these dyads communicate both verbally and non-verbally, observe different interaction styles, and measure child behaviors from their ability to regulate their emotions — excitement, anger, frustration, joy, and the like," Dr. Njoroge said.
Over the next several years, the participating families will continue more observational assessments and complete annual questionnaires while mothers will continue to participate in semi-structured and qualitative interviews. The researchers will also interview a sub-sample of Black women to learn more about the impact of the syndemic on their mental health, parenting practices, perceptions of their child's early development, and trust in the healthcare system. The goal, says Dr. Njoroge, is to accumulate a wealth of both qualitative and quantitative data.
"P2P allows us to parse exposures in early development in ways that are tailored and personalized towards individual and, importantly, larger environmental vulnerabilities and resilience, whilst addressing the specific needs of diverse families and children," Dr. Njoroge said. "Thus, with this knowledge we are laying the foundation for curating data necessary to develop a precision medicine framework for understanding the early impact of multiple adverse events on developmental trajectories of very young children."
With an overwhelming amount of participation from the recruited families, Dr. Njoroge hopes to be able to report the first findings as early as next year.
By deeply characterizing the experiences of women and children impacted by the syndemic, she hopes the findings will fill a gap in current literature about structural racism and child development and help to inform the development of future interventions.
"As a health equity researcher and an infant-preschool psychiatrist, my goal is to create targeted, culturally informed preventive interventions and increase access to care for historically marginalized and underserved communities to achieve mental health equity for all very young children and their families," Dr. Njoroge said.