March 12, 2021
In This Issue

Research Spotlight:
Recruiting Adolescents for E-Cigarette Clinical Trial

CPCE In the News:
COVID-19 News

Upcoming Events

Recent Publications
Recruiting Adolescents for E-cigarette Clinical
Trial Proves Difficult
E-cigarette use among adolescents is rampant. In fact, over 20% of high school students report using e-cigarettes, according to school-based national estimates. To date, access to evidence-based treatment recommendations for adolescent e-cigarette use is limited, indicating the need for additional research designed to determine effective interventions. 
 
As trusted sources of health information, pediatricians are uniquely positioned to implement systems to identify e-cigarette users and connect them to available clinical trials. A recent study conducted by members of the CPCE faculty leveraged a large pediatric healthcare system to identify and recruit adolescent e-cigarette users for a vaping cessation clinical trial. 
 
The team of CPCE researchers included Brian Jenssen, MD, MSHPChloe Hannan, MSMary Kate Kelly, MPH, and Alexander Fiks, MD, MSCE. Recruitment of adolescents occurred through 25 practices within Children’s Hospital of Philadelphia’s (CHOP’s) Pediatric Research Consortium (PeRC). Adolescent e-cigarette screenings were incorporated into routine clinical practice and embedded into the electronic health record (EHR). Clinicians were prompted to ask, “In the past year, have you used a tobacco product, like cigarettes, e-cigarettes, or cigarillos?” If adolescents answered yes, additional questions asked about frequency of use, product of choice, and interest in treatment and referral to the study. 
 
To participate in the study, adolescents had to speak English, live in Pennsylvania, have a cell phone, be between 14-21 years old, and screen positive for current e-cigarette use.  
 
Despite access to over 93,000 adolescent patients within the primary care network, ultimately 52 adolescent e-cigarette users were referred, 15 subjects enrolled, and of that, six participants enrolled in the cessation program. Only 2.4% of adolescents reported any e-cigarette use, in contrast to the larger numbers reported by school-based national estimates. 
 
Based on these findings, incorporating e-cigarette screening prompts into the EHR may not be enough to identify users. The discrepancy in e-cigarette use reported in the pediatric healthcare setting versus the school setting suggests new methods for screening and identifying users may be needed to recruit for such trials.  
COVID-19 News

As vaccines become available to the public, our experts shared their recommendations on how to safely resume gathering with loved ones. David Rubin, MD, MSCE spoke with ABC News about the opportunity for families to travel and reunite once fully vaccinated. Susan Coffin, MD, MPH spoke with Yahoo!Life about how to approach adolescent birthday parties, encouraging folks to stay outdoors, socially distanced, while wearing masks.
 
Stay up to date at our COVID-19 News page.
Upcoming Events & Announcements

CPCE Team Receive Meritorious Poster Award
At the Pediatric Research Annual Meeting on March 10, a team of CPCE researchers received the Meritorious Poster Award for their abstract Early Childhood Wellness Priorities of Urban Parents and Pediatric Primary Care Providers. Chloe Hannan, MS was the presenting author, other authors on the abstract included Stephanie Mayne, PhD, MHS, Jen Faerber, and Alex Fiks, MD, MSCE. Congratulations to all involved!

APA Cornet Announces Search for New Director
The Board of the Academic Pediatrics Association is opening an active search for a Director for the COntinuity Research NETwork (CORNET), the national, practice-based research network of more than 125 pediatric residency programs. CORNET reaches more than 6,000 pediatric residents and 1 million children across the country. Interested candidates should submit their CV, a statement of interest, a letter of support from their Department Chair, and contact information for three personal references to be called by the search committee to cornet@academicpeds.org by March 31, 2021. Learn more about the role here.

Distracted Driving: Not Just About Teens and Cell Phones
Date: March 17
Time: 12 pm - 1 pm
Distracted driving is a major contributor to motor vehicle crashes. Many think it’s just about teens and cell phones—but it is more than just that combination. This lecture will describe our current knowledge about distracted driving, how to reduce this risky driving behavior and keep people safe on the road. Learn more and register here.

Drexel University Dornsife School of Public Health 2021 Population Health Symposium
Dates: April 7-8, 2021
This year’s inaugural symposium will bring together researchers, health practitioners, students, and the public at large to learn about the intersection of racism and health and discuss how we can collectively propose sustainable solutions towards health equity. Learn more and register here.
 
13th Annual University of Pennsylvania Conference on Statistical Issues in Clinical Trials
Date: April 12, 2021
Time: 8:30 am - 4:30 pm
Continuing its longstanding collaboration with the Department of Biostatistics, Epidemiology and Informatics at the University of Pennsylvania, the ASA, NISS and SCT is delighted to announce the 13th Annual Conference on Statistical Issues in Clinical Trials: Cluster Randomized Trials (CRTs) - Challenges and Opportunities. Learn more and register here.

*For CPCE/PolicyLab Virtual Seminar Series: If you would like to participate in any of the virtual events and did not receive an Outlook invitation, please contact crosss2@email.chop.edu
Recent Publications

This multicenter retrospective study by Andrew C. Glatz, MD, MSCE and his research team sought to perform a balanced multicenter comparison of staged repair (SR) (initial palliation [IP] and subsequent complete repair [CR]) versus primary repair (PR) treatment strategies. Comparing SR or PR for management of neonates with sTOF, adjusted for patient-related factors, early mortality and neonatal morbidity were lower in the SR group, but cumulative morbidity and reinterventions favored the PR group, findings suggesting potential benefits to each strategy.

Hospitals treating patients with greater diagnosis diversity may have higher fixed and overhead costs. Chris Feudtner, MD, PhD, MPH and his colleagues ran a retrospective analysis to assess the relationship between hospitals' diagnosis diversity and cost per hospitalization for children. Hospital diagnosis diversity index (HDDI) was significantly ( < .001) higher in freestanding children’s hospitals (FCHs) and nonfreestanding children’s hospitals (NFCHs) (median 9.2 and 6.4 times higher, respectively) than nonchildren’s hospitals (NCHs). Across all hospitals, greater HDDI was associated ( = .002) with increased cost. Adjusting for HDDI resulted in a nonsignificant ( = .1) difference in cost across hospital types.

Ariel Williamson, PhD and her team have reviewed the benefits of treatment with positive airway pressure for the childhood obstructive sleep apnea syndrome and presented a socio-ecological framework to enhance our understanding of positive airway pressure adherence predictors and important targets of comprehensive positive airway pressure treatment models across different pediatric populations. Although positive airway pressure is clearly a beneficial treatment for pediatric obstructive sleep apnea syndrome, additional research is needed to evaluate socio-ecological factors.

Little is known regarding why certain individuals abandon mobile health (mHealth) tools. Guided by a mHealth engagement framework, Alexandra M. Psihogios, PhD, Lisa Schwartz, PhD, and their colleagues evaluated contextual predictors of objective engagement with an app for adolescents and young adults (AYA) who survived cancer. Self-reported uninterrupted app access (β = -0.56, p < .001), iPhone (vs. Android) ownership (β = 0.30, p < .001), and receiving the intervention in the summer (β = -0.20, p = .01) predicted more active days. Lower depressed mood (β = -0.30, p = .047) and uninterrupted app access (β = -0.50, p < .001) predicted more messages read.

Little is known about pediatric ethics consultations' contextual attributes, which may influence how ethically problematic situations are perceived and addressed. Jennifer Walter, MD, PhD, MS, Chris Feudtner, MD, PhD, MPH, and their research team analyzed data regarding 245 pediatric clinical ethics consultations performed between 2013 and 2018 at a large children's hospital. Their analyses suggest that Pediatric ethics consultations have contextual attributes that in exploratory analyses are associated with specific types of problems and, to a lesser degree, with the cumulative ethics consultation process.

Researchers including Chén Kenyon, MD, MSHP studied the association of fine particulate matter (PM) and ozone (O) air pollutants with pediatric asthma exacerbation in the Philadelphia metropolitan region and evaluated potential effect modification by children's characteristics (e.g., race/ethnicity, atopic conditions) and environmental factors. They found small increases in odds of asthma exacerbation with higher pollutant concentrations, with positive associations (OR, comparing concentrations of 75 to 25 percentile) observed for PM during both warm (1.03, 95% CI: 0.98 - 1.08) and cold months (1.05, 95% CI: 1.02 - 1.07), and for O during cold months (1.08, 95% CI: 1.02 - 1.14).

Chén Kenyon, MD, MSHP, Aaron Masino, PhD, and their team curated a retrospective dataset to develop machine learning models to identify which individuals diagnosed with asthma before age 5 continue to experience asthma-related visits. Based on average NPV-Specificity area (ANSA), all models performed significantly better than random chance, with XGBoost obtaining the best performance (0.43 mean ANSA). Feature importance analysis indicated age of last asthma diagnosis under 5 years, total number of asthma related visits, self-identified black race, allergic rhinitis, and eczema as important features.

Group B (GBS) remains the most common cause of neonatal early-onset sepsis among term infants and a major cause of late-onset sepsis among both term and preterm infants. Miren Dhudasia, MPH, Dustin Flannery, DO, MSCE, Karen Puopolo, MD, PhD and their team review updates to guidance on preventing and managing GBS. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists published separate but aligned guidelines in 2019 and 2020 for the prevention and management of perinatal Group B (GBS) disease. Together, these replace prior consensus guidelines provided by the Centers for Disease Control and Prevention.

Stephanie Doupnik, MD, MSHP and her colleagues ran a retrospective analysis to describe the prevalence and characteristics of infection-related readmissions in children and to identify opportunities for readmission reduction and estimate associated cost savings. The overall 30-day readmission rate was 4.9%. Readmission rates varied substantially across infections and by presence/absence of a complex chronic condition (CCC) (CCC: range, 0%-21.6%; no CCC: range, 1.5%-8.6%). Bronchiolitis, pneumonia, and upper respiratory tract infections were among infections with the greatest number of potentially avoidable readmissions and cost savings for children with and without a CCC.

The aim of this qualitative study by Cadence Bowden, MSW, MPH, Stephanie Doupnik, MD, MSHP, and their team was to provide insight into how ED staff innovate processes of care and services for patients who have had episodes of self-harm by leveraging what is available on-site or in their communities. Interview respondents described 4 categories of strategies to improve the care of patients seen in the emergency department after an episode of self-harm, including: adapting the ED environment, improving efficiencies to provide mental health care, supporting the staff who provide direct care for patients, and leveraging community resources to improve access to mental health resources postdischarge.

Researchers including Maitry Sonagra, MPH and Sabrina Gmuca, MD, MSCE conducted a retrospective cohort study to determine the prevalence of and to identify the clinical characteristics associated with the presence of disordered eating among adolescents with chronic musculoskeletal pain (CMP) presenting to a pediatric rheumatology subspecialty pain clinic. Through multivariate logistic regression modeling, they found that disordered eating was associated with older age, higher functional disability, presence of abdominal pain, presence of gastrointestinal comorbidities, and presence of anxiety (all p < 0.05).

Mental health symptoms, stress, and low psychosocial resources are associated with preterm delivery. CPCE faculty member Heather Burris, MD, MPH and her team ran a prospective cohort study to identify groups of women with similar patterns of adverse psychosocial factors during pregnancy and determine whether the risk of preterm delivery differs among these groups. They identified three groups of pregnant women with similar patterns of adverse psychosocial factors. They did not observe a difference in the risk of preterm delivery among the classes.

About CPCE

We are a pediatric research center dedicated to discovering and sharing knowledge about best practices in pediatric care by facilitating, organizing and centralizing the performance of clinical effectiveness research -- research aimed at understanding the best ways to prevent, diagnose and treat diseases in children. CPCE’s multidisciplinary team conducts research on a diverse range of clinical effectiveness topics.

CPCE News is edited by Holly Burnside. Please feel free to contact us with questions or feedback.