Publications and Select Presentations

We compared COVID-19 outcomes in child care providers who continued to provide direct in-person child care during the first 3 months of the US COVID-19 pandemic with outcomes in those who did not in a sample of 57,335 US child care providers. Within the context of considerable infection mitigation efforts in US child care programs, exposure to child care during the early months of the US pandemic was not associated with an elevated risk for COVID-19 transmission to providers. These findings must be interpreted only within the context of background transmission rates and the considerable infection mitigation efforts implemented in child care programs.

Gilliam WS, Malik AA, Shafiq M, Klotz M, Reyes C, Humphries JE, Murray T, Elharake JA, Wilkinson D, Omer SB. COVID-19 transmission in US child care programs. Pediatrics. 2021;147(1):e2020031971. doi: 10.1542/peds.2020-031971

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Ensuring high coronavirus disease-2019 (COVID-19) vaccine uptake among US child care providers is crucial to mitigating the public health implications of child-staff and staff-child transmission of severe acute respiratory syndrome coronavirus 2. We conducted a multistate cross-sectional survey of the child care workforce (N = 20,013) in May 26 through June 23, 2021. COVID-19 vaccine uptake among US child care providers was higher than the US general adult population (78.2% versus 65%). Vaccination rates varied between states from 53.5% to 89.4%. Those who were younger, lower income, Black or African American, resided in states either in the Mountain West or the South, and/or worked in home-based child care programs reported the lowest rates of vaccination. State public health leaders and lawmakers should prioritize these subgroups to realize the largest gains in vaccine uptake among providers.

Patel KM, Malik AA, Lee A, Klotz M, Humphries JE, Murray T, Wilkinson D, Shafiq M, Yildirim I, Elharake JA, Diaz R, Reyes C, Omer SB, Gilliam WS. COVID-19 vaccine uptake among U.S. child care providers. Pediatrics. 2021;148(5):e2021053813. doi: 10.1542/peds.2021-053813

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We conducted a systematic search of the literature on PubMed and Collabovid of studies published January 2020-July 2021. Findings from five studies on children and 16 studies on college students reported that both groups reported feeling more anxious, depressed, fatigued, and distressed than prior to the pandemic. Several risk factors such as living in rural areas, low family socioeconomic status, and being a family member or friend to a healthcare worker were strongly associated with worse mental health outcomes. As schools and researchers discuss future strategies on how to combine on-site teaching with online courses, it is important to consider social contacts in students' mental health to support students at higher risk of social isolation during the COVID-19 pandemic.

Elharake JA, Akbar F, Malik AA, Gilliam W, Omer SB. Mental health impact of COVID-19 among children and college students: A systematic review. Child Psychiatry & Human Development. 2022;Online, January 11, 2022. doi: 10.1007/s10578-021-01297-1

To determine which states had issued legislative and/or regulatory directives requiring vaccination of childcare and/or school personnel (as of November 1, 2021), we reviewed official archives of executive orders for all 50 states and the District of Columbia (DC) and COVID-19 state databases maintained by the National Conference of State Legislatures and the National Academy for State Health Policy. While ten states (including DC) have issued directives requiring either COVID-19 vaccination or routine testing among school teachers, only half include childcare providers. This emerging trend suggests an unwarranted disparity between childcare and school settings in states’ efforts to promote vaccination, as the argument in favor of vaccinating the former is at least as strong as that of the latter. To ensure equitable consideration for the health and safety of childcare providers and school teachers alike, states should consider expanding directives to include childcare providers—as has been done by both New Jersey and Illinois—to bridge the COVID-19 vaccination gap between childcare providers and school teachers.

Patel K, Omer SB, Gilliam W. State vaccine mandates for COVID-19 – An emerging disparity between childcare providers and school teachers (November 9, 2021). Available at SSRN

To assess and quantify the relationship between the use of nonpharmaceutical interventions and COVID-19 vaccination among U.S. child care providers, we conducted a prospective cohort study of child care providers (N = 20,013) from all 50 states, the District of Columbia, and Puerto Rico. Nonpharmaceutical interventions were dichotomized as personal mitigation measures (e.g., masking, social distancing, handwashing) and classroom mitigation measures (e.g., temperature checks of staff/children, symptom screening for staff/children, cohorting). For each unendorsed personal mitigation measure during 2020, the likelihood of vaccination in 2021 decreased by 7%. No significant association was found between classroom mitigation measures and child care provider vaccination. Child care providers who used less personal mitigation measures were also less likely to get vaccinated for COVID-19 as an alternative form of protection.

Patel K, Shafiq M, Malik AA, Cobanoglu A, Klotz M, Humphries JE, Lee A, Murray T, Wilkinson D, Yildirim I, Elharake JA, Diaz R, Rojas R, Cohen AK, Reyes CR, Omer SB, Gilliam W. Relationship between the use of nonpharmaceutical interventions and COVID-19 vaccination among U.S. child care providers: A prospective cohort study. 2021 Dec 6; JVAC-D-21-03102, Available at SSRN.

Is child masking associated with reduced COVID-19-related childcare program closures? In this prospective survey of 6,654 child care professionals from all 50 states, child masking at baseline (May/June 2020) was associated with a 13% reduction in program closure within the following year, and continued child masking throughout the 1-year study period is associated with a 14% reduction in program closure. However, only 9% of child care programs reported child masking in 2020, compared to 33% in 2021. These results suggest that masking of children in childcare programs is associated with reduced program closures, supporting current masking recommendation in younger children provided by the Centers for Disease Control and Prevention.

Murray TS, Malik AA, Shafiq M, Lee A, Harris C, Klotz M, Humphries JE, Patel KM, Wilkinson D, Yildirim I, Elharake JA, Diaz R, Reyes C, Omer SB, Gilliam WS. Association of child masking with COVID-19-related closures in US childcare programs. JAMA Network Open. 2022;5(1):e2141227. doi:10.1001/jamanetworkopen.2021.41227

• 03/25/2020 Webinar, Child Care Aware of America, Arlington, VA “Mapping the need for child care need for essential workers during the coronavirus outbreak” Available: https://info.childcareaware.org/webinar/ty/mapping-essential-care-demand?submissionGuid=90eb1873-ca69-4deb-8f65-1210f701c777
• 04/08/2020 Invited panelist, GSV Virtual Summit Series, Omidyar Network, “Before coronavirus, after disease – Early childhood learning”
• 09/10/2020 Keynote, National Workforce Registry Alliance Conference, Washington, DC, “COVID-19 transmission in U.S. child care programs”
• 10/16/2020 Child Care Aware of America, Arlington, VA, “COVID-19 transmission in U.S. child care programs – A national providers’ briefing”
• 10/19/2020 Invited presentation, Connecticut Early Childhood Alliance, Hartford, CT, “COVID-19 transmission in U.S. child care programs”
• 11/19/2020 Webinar, Yale-Scholastic Collaborative for Child and Family Resilience, “COVID and the youngest learners”
• 11/23/2020 VuMedi, “COVID-19 transmission in U.S. child care Programs,” Available: https://www.vumedi.com/video/covid-19-transmission-in-us-child-care-programs-are-children-efficient-covid-19-transmitters-what-ar/
• 11/24/2020 Invited panelist, National Governors Association, Washington, DC, “Child care and reopening”
• 11/30/2020 Invited presenter, National Research Conference on Early Childhood (U.S. Administration for Children & Families) Opening Session – Strategies to Support the Wellbeing of Young Children Impacted by Trauma, “Trauma, bias, and early childhood mental health consultation”
• 12/08/2020 Invited panelist, Bipartisan Policy Center, Washington, DC, 2020 Solutions Summit – Children and Families
• 03/26/2021 Invited panelist, Bipartisan Policy Center, Washington, DC, “Stressed out children, families, and early childhood teachers: How mental health support is essential to reopening America”
• 07/14/2021 Invited presentation, Mississippi Association of School Superintendents/Alliance Summer Convention, Biloxi, MS, “COVID-19 stress and implicit bias: Why school-based mental health supports have never been more needed than now”
• 08/26/2021 Invited presentation, Educational Equity Institute, “COVID-19 stress and racial bias: Why mental health supports have never been more needed than now”
• 09/28/2021 Invited presentation, Ohio Statewide CHILD ECMH-C Expansion Briefing, Department of Mental Health and Addiction Services, Columbus, OH (Virtual), “Preschool expulsions, politics, and the pandemic,” in “Ohio’s robust response to support children, families, and educators in a period of intense stress and trauma”
• 09/30/2021 Hosted webinar, “Opportunities to expand infant and early childhood mental health (IECMH) consultation through the American Rescue Plan Act (ARPA),” Children’s Equity Project, Arizona State University; Georgetown University Center for Child and Human Development; Yale University Zigler Center; ZERO TO THREE
• 10/07/2021 Invited research briefing, Interdepartmental Executive Order Workgroup (virtual, hosted by U.S. Administration for Children and Families, plus DHHS colleagues at ACL, CDC, CMS, HRSA, NIH, SAMHSA, U.S. Department of Education, & U.S. General Services Administration), “COVID-19 vaccine uptake among U.S. early care and education providers”
• 10/18/2021 Invited keynote (virtual), Advocates for Children of New Jersey, “Pandemic stress: Supporting young children, families, and the early childhood workforce”
• 11/08/2021 Invited research briefing, Interdepartmental Executive Order Workgroup (virtual, hosted by U.S. Administration for Children and Families, plus DHHS colleagues at ACL, CDC, CMS, HRSA, NIH, SAMHSA, U.S. Department of Education, & U.S. General Services Administration), “Effectiveness of infant and early childhood mental health consultation for preventing early childhood expulsions”
• 11/09/2021 Keynote, 2021 Equity and Inclusion Conference, Early Care and Learning Council, Albany, NY (virtual), “COVID-19 trauma, stress, and racial aggression as experienced by child care professionals and the children in their care”
• 11/10/2021 Keynote, National Workforce Registry Alliance Conference 2021 (virtual) – A Visible ECE Workforce: Using Data to Strengthen Equity Accountability, “COVID-19 child care providers study”
• 12/13/2021 Invited research briefing, Interdepartmental Executive Order Workgroup (virtual, hosted by U.S. Administration for Children and Families, plus DHHS colleagues at ACL, CDC, CMS, HRSA, NIH, SAMHSA, U.S. Department of Education, & U.S. General Services Administration), “COVID-19 Child Care Providers Study: Early childhood workforce well-being”