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Lurie Children’s Home Voices of Child Health Academic Publications

Academic Publications

You can browse our academic publications below, and click on the title to find the full publication.

Modifiable and Non-Modifiable Risk Factors of Child Mental Health During the COVID-19 Pandemic

Academic Pediatrics, 2026

Objective: To examine modifiable and non-modifiable risk factors for child mental health during the COVID-19 pandemic. Methods: Data were collected through the Voices of Child Health in Chicago Parent Panel Survey, administered between October and November 2021 in English and Spanish. Eligible caregivers had a child between 0 and 17 years old and lived in Chicago. Caregivers reported on their pandemic experiences and their child’s mental health. Logistic regression identified associations between modifiable risk factors and worsening mental health during the COVID-19 pandemic. Rao-Scott chi-squared tests were used to test differences in child mental health across demographic groups. Results: A total of 1115 Chicago caregivers reported on 1895 children. Worse family functioning (OR = 3.53, 95%CI: 1.89–6.62), seeking extra support (OR = 5.99, 95% CI: 3.60–9.96), and missed milestones (OR = 6.32, 95%CI: 2.37–16.84) were significantly associated with worsening mental health in children. The proportion of children with worsening mental health differed across child race and ethnicity and survey language (P<.05 and P<.001, respectively). A higher proportion of Asian/other-race children had worsening mental health compared with other race and ethnicities (20% vs 9%–10%, P<.05). Conclusion: Worse family functioning and missed milestones contributed significantly to worsening child mental health during the COVID-19 pandemic. Caregivers who sought extra support for their child had higher odds of having a child with worsening mental health, which may indicate that caregivers recognized their child’s deteriorating mental health and took steps to address it. Worsening mental health among Asian/other-race children may be due to exposure to racism. These findings may help inform interventions in future times of stress.

Post-Pandemic Youth Mental Health: A Serial Cross-Sectional Survey of Illinois Parents with Four Timepoints

Academic Pediatrics, 2026

Objectives: Youth mental health was declining before the COVID-19 pandemic and worsened during the pandemic, yet less is known for the post-pandemic period. We examined parents' reports of youth mental health between 2022 and 2024. Methods: We administered serial cross-sectional surveys to four independent samples of Illinois parents in 6/2022, 5/2023, 10/2023, 3/2024, in English and Spanish, through the QualtricsXM panel (convenience sample of adults who agree to take surveys). Parents read a list of 14 youth mental health symptoms and indicated, for one randomly selected 2-17-year-old child, if the child experienced each symptom less often, the same amount, or more often than a year ago; or never. Parents indicated their own stress levels. Results: At each timepoint, symptoms of irritability were most commonly reported, with different expression across developmental periods: tantrums in early childhood; easy frustration in school-age children. Approximately half of parents reported their child experienced ≥1 mental health symptom more often at each timepoint (6/2022: 49.7%, 5/2023: 51.6%, 10/2023: 53.9%, 3/2024: 48.7%). Multivariable logistic regressions indicated parent stress was associated with higher odds of the child having ≥1 mental health symptom more often (6/2022 aOR:3.37, 5/2023 aOR:2.07, 10/2023 aOR:1.76, 3/2024 aOR:3.31). Conclusions: At four survey timepoints over 2 years, approximately half of 2-17-year-old youth experienced mental health symptoms more often than they had before. This was most evident via transdiagnostic irritability symptoms. Screening for mental health, beginning in toddlerhood, and preventive interventions for parents and youth are potential mechanisms to mitigate the youth mental health crisis.

Parent and youth worry about school shootings and connections with youth well-being and stress: A cross-sectional survey study

Journal of Health Advocacy, 2025

Background: Rising rates of school shootings, firearm-related deaths, and gun sales in the U.S. have intensified the ongoing youth mental health crisis, contributing to widespread trauma and fear among young people. In cities like Chicago, where community gun violence is prevalent, youth face compounded mental health challenges shaped by both personal and collective exposure to violence. As a result, there is an urgent need to better understand how gun violence impacts youth mental health to inform effective public health and community-based interventions. Objectives: This study aimed to assess worry about school shootings among Chicago parents and youth, and to better understand how a youth’s level of worry about a shooting happening at their school is associated with their well-being and stress level. Methods: A cross-sectional study was conducted from October-November 2022 through the Voices of Child Health in Chicago (VOCHIC) Parent Panel Survey, which surveyed parents from all 77 neighborhoods in Chicago about their own and their child’s level of worry about a shooting occurring at the child’s school or daycare setting. Inclusion criteria included being ≥18 years old, living in Chicago, and being the parent/guardian of at least one child aged 0-17 years living in the same household. Parents with one or more children between the ages of 12-17 years were also asked about their child’s levels of well-being and stress. Results: Surveys were completed by 1,129 Chicago parents. Two-thirds of parents reported being very/somewhat worried (67%) and 40% said their child was very/somewhat worried about a shooting happening at their child’s school or daycare. Means difference tests indicated that higher parent-reported child worry was associated with lower reported levels of youth well-being and higher reported levels of youth stress, even for children with relatively low parent-reported levels of worry. Conclusion: In 2022, Chicago parents of school-aged children reported high levels of worry about a school shooting happening at their child’s school. Although worry among youth was reported by their parents as being lower than their own level of worry, any level of parent-reported youth worry about a school shooting was associated with worse reported emotional outcomes for the youth. Policy Implications: Our results reveal that, based on parents’ perceptions, a child’s worry about a shooting happening at their own school or daycare takes a toll on their mental health. This finding highlights the urgent need for legislation and action to prevent school shootings to protect not only the physical health and safety of youth but also their mental health.

Parental Intake of Eicosapentaenoic and Docosahexaenoic Acids in a Diverse, Urban City in the United States Is Associated with Indicators of Children's Health Potential

Nutrients, 2025

Background/Objectives: Parents achieving recommended eicosapentaenoic (EPA) and docosahexaenoic (DHA) acid intake can improve the health of parents and their children. Evidence links higher DHA intake to lower preterm birth (PTB) risk. With parental intake poorly defined, the objective is to characterize EPA and DHA intake by parents with children in households in a diverse, urban city. Methods: Parents with ≥1 child in the household completed a validated seven-question food frequency questionnaire to assess consumption of foods contributing most to EPA and DHA intake in American diets during the cross-sectional Voices of Child Health in Chicago Panel Survey (May-July 2022). Female respondents reported prior PTB. Home/residence information was linked to the Childhood Opportunity Index (COI). Multivariable linear regression and survey-weighted models evaluated parental characteristics associated with EPA+DHA intake. Pairwise comparisons estimated intake differences (mean (SE)) among groups. Results: Chicago parents (n = 1057) reported lower-than-recommended EPA+DHA intake and mothers consumed less compared to fathers (difference: 27.1 (11.4) mg/d; p = 0.02). Prior PTB was associated with lower EPA+DHA intake, yet DHA-containing supplement use, which occurred in ~25% of parents, was associated with higher intake (p < 0.05). Lower household income and a lower COI were associated with lower intake while parental race and ethnicity categories were also associated with intake (all p < 0.05); intake differed for mothers and fathers based on Black race and Hispanic ethnicity categories. Conclusions: The findings suggest that efforts aimed at improving parental EPA+DHA intake to improve the health of families should account for multidimensional influences on household food choices.

Differences in Responsibility For Child Healthcare By Parent Gender: A Cross-sectional Study

Social Science and Medicine, 2025

Objectives: While prior work suggests that fathers are more involved in childcare than ever before, little is known about the balance of responsibility for scheduling child healthcare appointments and taking children to healthcare visits. In this study we sought to examine gender differences in parent responsibilities for healthcare-focused tasks. Methods: We collected data through the Voices of Child Health in Chicago Parent Panel Survey in October-November 2021. Parents reported who was primarily responsible for: scheduling child healthcare appointments, taking the child to well-child visits, and taking the child to sick visits. Results: The sample included 1,142 parents. Mother respondents (n = 760) were more likely than father respondents (n = 379) to report being responsible for scheduling appointments (91.8% vs. 50.8%), taking children to well-child visits (89.8% vs. 59.5%) and sick visits (87.6% vs. 56.0%). Mothers were more than twice as likely as fathers to report being responsible for all three healthcare tasks (82.9% vs. 40.0%) (all comparisons p < .0001). Gender differences persisted across demographic characteristics and employment status. In adjusted logistic regression models, mothers had higher odds than fathers of being responsible for child healthcare tasks. Post-hoc analyses revealed that gender differences were not present among parents in same-sex couples. Conclusions: Pediatricians have the opportunity to promote fathers' involvement in healthcare-focused tasks for children. Encouraging fathers to enter practice contact information in their phone is a simple action to reduce social and family expectations that mothers should be the primary point of contact with healthcare providers, and may be a move toward inclusivity.

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

Academic Pediatrics, 2024

Objective: To 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. Methods: Data 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. Results: Responses 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) CONCLUSIONS: Chicago 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.

What Parents Are Missing: Parental Knowledge of Adult-Use Cannabis Legislation and Health Effects, and Communication with Adolescents

Substance Use & Misuse, 2024

Background: The cannabis regulation landscape is ever evolving, and it may be difficult for parents to stay up to date. This study aimed to assess parental knowledge of recent cannabis legislation and cannabis health effects, as well as communication around cannabis use. Materials and Methods: Data were collected through the 2020 Voices of Child Health in Chicago Parent Panel Survey. Parents were asked about the veracity of statements on cannabis legislation and health effects, and about communication with their children. Descriptive statistics were calculated to characterize response frequencies. Rao-Scott chi-square test explored differences in the proportion of parents who answered all questions correctly or got at least one question wrong. Results: 75% and 74% of parents answered at least one legislation or health items incorrectly, respectively. Most parents reported talking to their children about legislation (56%), not using cannabis (75%) and rules around drug use (90%). Conclusions: While parents reported communicating with their children about cannabis, the majority had gaps in their knowledge. The results of this study indicate a need for effective cannabis education interventions.

Parent Awareness of and Attitudes Toward Gender-Affirming Pediatric Health Care: A Cross-Sectional Survey

Journal of Adoloscent Health, 2024

Purpose: We aimed to characterize parent attitudes toward gender-affirming healthcare for transgender youth, from a general parent sample in a diverse urban setting. Methods: We surveyed Chicago parents through the Voices of Child Health in Chicago Parent Panel Survey via web and phone in English and Spanish from May-July 2022. We used both probability-based and nonprobability-based sampling, with calibration weights for the nonprobability sample. Parents responded about their awareness of a debate about and support for autonomy in gender-affirming healthcare for transgender youth and provided demographic information. We used descriptive analyses and logistic regression to examine predictors of awareness and support. Data were weighted to be representative of Chicago's parent population. Results: Surveys were completed by 1,059 parents. The survey completion rate for the probability sample was 43.1% (a completion rate was not available for the nonprobability sample from online, opt-in surveys). Most parents were unaware of the debate about gender-affirming healthcare (56.0%). More than two-thirds of parents (68.9%) support decisions about gender-affirming healthcare being left to children, their parents, and their doctor. Parents who were aware of the debate were more likely to support gender-affirming healthcare (83.7%) than parents who were not aware (57.2%, p < .0001). Parents who were aware of the debate had higher odds of supporting gender-affirming care for youth (adjusted odds ratio = 3.00, 95% confidence interval: 1.93-4.66) in a multivariable logistic regression model. Discussion: Broad parent support for gender-affirming healthcare for transgender youth is an important perspective to consider in policy discussions at state and federal levels.

Parental Attitudes on Social Media Monitoring for Youth: Cross-Sectional Survey Study

JMIR Pediatrics and Parenting, 2023

Background: Online environments dominate the daily lives of American youth and pose evolving challenges to their health and well-being. Recent national poll data indicate that social media overuse, internet safety, and online bullying are among parents' top child health concerns, particularly during the COVID-19 pandemic. While parents are uniquely positioned to help youth navigate social media, their attitudes on monitoring media use may be impacted by a myriad of personal and family factors. Objective: This study aimed to examine factors associated with parental attitudes about monitoring social media use among youth. Methods: Data were analyzed from the Voices of Child Health in Chicago Parent Panel Survey, administered to parents over the web and by telephone. Parents with at least 1 child aged ≥11 years responded to questions about bullying and social media monitoring from May to July 2020. The primary outcome was their response to the following question: "Do you think parents should monitor their children's use of social media platforms such as Facebook, Twitter, and Instagram?" Bivariate analyses and multivariable logistic regression were used to examine parental agreement with frequent social media monitoring and concerns about bullying, adjusted for sociodemographic characteristics. Analyses were weighted to represent the parent population of Chicago. Results: Among 1613 survey respondents, the analyzed sample included 808 parents with at least 1 child aged ≥11 years. Overall, 62.9% (n=566) of parents agreed with frequent parental monitoring of their children's social media use. Compared with parents aged ≤35 years, parents who were >35 years old were significantly less likely to agree with frequent social media monitoring (adjusted odds ratio [aOR] 0.45, 95% CI 0.25-0.81). Parents expressing a high level of concern regarding the effects of bullying were more likely to agree with frequent monitoring of youth social media (aOR 2.15, 95% CI 1.24-3.73). Conclusions: Parents' personal characteristics and concerns about bullying may influence their attitudes toward monitoring social media use among youth. Given the potential impact of these attitudes on parental monitoring behaviors and the subsequent health impact on youth, pediatricians should consider these factors when counseling about bullying and social media. Child health professionals can support families in developing a safe media use plan that fits family circumstances.

Adverse Childhood Experiences, Child Behavioral Health Needs, and Family Characteristics Associated with the Presence of a Firearm in the Home: a Survey of Parents in Chicago

Injury Epidemiology, 2023

Background: Firearm violence is the leading cause of pediatric mortality in the USA. The presence of a firearm in the home poses an immense risk to children with increased rates of suicide and unintentional injury by firearm. Recent literature has not explored child ACEs and child behavioral health needs with the presence of a firearm in the home. The objective of this study was to explore an association between these factors, parent health, family experience with firearm violence, and demographics, and the presence of a firearm in the home. Results: Overall, 382 of 1,436 (weighted to 22.0%) responding parents reported the presence of a firearm in the home. In an adjusted model, the odds ratio of firearm presence increased incrementally with a child's increasing exposure to ACEs. Compared to a child in the household exposed to no ACEs, a child in the household exposed to two or more ACEs was associated with a 5.16 times higher odds of firearm presence in the home (95% confidence interval (CI) 2.92-9.10). Similarly, a child in the household who had used behavioral health services was associated with a 2.10 times higher odds of firearm presence in the home (95% CI 1.35-3.26), compared to a child in the household who had not. Presence of firearm in the home was also associated with higher household income, younger parent age (under 35 years), and male parent gender. Conclusions: Chicago parents have higher odds of reporting the presence of a firearm in the home when living in a household with a child exposed to ACEs and with behavioral health needs. These findings could inform future public health interventions and targeted safe storage messaging to prevent pediatric firearm injury in the home.

Targeted Vaccine Messaging to Promote COVID-19 Vaccines for Children and Youth

Pediatrics, 2023

Objectives: To assess the effectiveness of distinct message types in promoting coronavirus disease 2019 (COVID-19) vaccination intentions for parents of children and adolescents. Methods: We collected data through the Voices of Child Health in Chicago Parent Panel Survey from October to November 2021. Parents were randomly assigned to read 1 of 4 vaccine message types and then report their intentions to vaccinate each COVID-19-unvaccinated child (0-17 years) in their household (n = 1453). Results: The sample included 898 parents. Compared with a control group (37.5%), the proportion of parents who were very likely to vaccinate their children was higher when messages highlighted that other trusted parents have vaccinated their children (53.3%) or that the vaccine is safe and thoroughly tested (48.9%) but not when messages highlighted that the vaccine is well-tolerated (41.5%). After adjusting for parent and child characteristics, the odds of being very likely to vaccinate remained higher in the trusted parents group but not in the safe/thoroughly tested group. Unlike the control and well-tolerated groups, there were no racial/ethnic disparities in the unadjusted proportion of parents who were very likely to vaccinate in the trusted parents and safe/thoroughly tested groups. Message types affected the unadjusted proportion of COVID-19-unvaccinated parents who were very likely to vaccinate their children. Conclusions: Messages that focus on trusted parents choosing to vaccinate their children were more effective at promoting parents' COVID-19 vaccination intentions for their children than alternative messages. These findings have implications for public health messaging and pediatric providers' communications with parents.

Parental Concerns About Climate Change in a Major United States City

Academic Pediatrics, 2023

Objective: To examine climate change concerns among parents in Chicago, a large and diverse urban setting that experiences climate change-related weather events and rising water levels which have the potential to affect more than 1 million children living in the city. Methods: We collected data through the Voices of Child Health in Chicago Parent Panel Survey from May to July 2021. Parents indicated their personal level of worry about climate change, concern about the impact of climate change on themselves and their families, and how well they understood the issue of climate change. Parents also provided demographic information. Results: Parents reported high levels of concern about climate change in general and specifically about the impact on their families. Logistic regression indicated that parents who were Latine/Hispanic (vs White) and those who felt they understood climate change well (vs less well) had higher odds of reporting high levels of concern. Parents with some college (vs high school education or below) had lower odds of high concern. Conclusions: Parents indicated high levels of concern about climate change and its potential impact on their families. These results can help inform pediatricians' discussions with families about child health in the context of a changing climate.

Parental Perceptions on Use of Artificial Intelligence in Pediatric Acute Care

Academic Pediatrics, 2023

Background: Family engagement is critical in the implementation of artificial intelligence (AI)-based clinical decision support tools, which will play an increasing role in health care in the future. We sought to understand parental perceptions of computer-assisted health care of children in the emergency department (ED). Methods: We conducted a population-weighted household panel survey of parents with minor children in their home in a large US city to evaluate perceptions of the use of computer programs for the care of children with respiratory illness. We identified demographics associated with discomfort with AI using survey-weighted logistic regression. Results: Surveys were completed by 1620 parents (panel response rate = 49.7%). Most respondents were comfortable with the use of computer programs to determine the need for antibiotics (77.6%) or bloodwork (76.5%), and to interpret radiographs (77.5%). In multivariable analysis, Black non-Hispanic parents reported greater discomfort with AI relative to White non-Hispanic parents (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.03-2.70) as did younger parents (18-25 years) relative to parents ≥46 years (OR 2.48, 95% CI 1.31-4.67). The greatest perceived benefits of computer programs were finding something a human would miss (64.2%, 95% CI 60.9%-67.4%) and obtaining a more rapid diagnosis (59.6%; 56.2%-62.9%). Areas of greatest concern were diagnostic errors (63.0%, 95% CI 59.6%-66.4%), and recommending incorrect treatment (58.9%, 95% CI 55.5%-62.3%). Conclusions: Parents were generally receptive to computer-assisted management of children with respiratory illnesses in the ED, though reservations emerged. Black non-Hispanic and younger parents were more likely to express discomfort about AI.

Examining Access to Digital Technology by Race and Ethnicity and Child Health Status Among Chicago Families

JAMA Network Open, 2022

This cross-sectional study characterizes the type and quality of digital access among racially and ethnically as well as socioeconomically diverse households with children in Chicago.