New ECHO Research Finds Significant Changes in Children’s Sleep Habits during the COVID-19 Pandemic

Maristella Lucchini, PhD

Collaborative ECHO research led by Maristella Lucchini, PhD of Columbia University Irving Medical Center investigates changes in childhood sleep behaviors during the COVID-19 pandemic. The researchers looked at data from 528 children across the United States and found that, during the COVID-19 pandemic, children went to bed later, woke up later, and took longer to fall asleep, but their overall time spent asleep did not change. The study also found that children in minority communities went to bed later, slept less, and took naps more frequently. This research, titled “Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study,” is published in Pediatric Research.

This study included children aged 4 to 12 from 14 ECHO cohorts across the United States. The ECHO Program’s Sleep Health of Children and Adolescents Questionnaire was used to evaluate children’s sleep habits before the pandemic began and at two time periods during the pandemic. The researchers also collected sociodemographic information from self-reports and medical records.

ECHO researchers found significant changes in children’s sleep habits, as well as differences in children’s sleep behaviors between racial/ethnic groups. However, parental knowledge of the importance of sleep might have contributed to children sleep health. Interviews with 38 participant caregivers revealed they prioritized routines to maintain their children’s amount of sleep but were generally more flexible about bedtimes.

“This is the first study investigating changes in childhood sleep habits in the United States during the COVID-19 pandemic using data collected before and during the pandemic,” said Dr. Lucchini. “The results highlight potential targets for future interventions and support the need to examine and address the root causes of racial and ethnic sleep disparities in childhood.”

Using data from the same cohort of children, ECHO researchers are in the process of analyzing and publishing results on changes in diet, physical activity, and screen time during the COVID-19 pandemic.

Read the research summary.

During the COVID-19 Pandemic, Children’s Sleep Schedules Changed, But Their Time Asleep Stayed the Same

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During the COVID-19 Pandemic, Children's Sleep Schedules Changed, But Their Time Asleep Stayed the Same

Authors: Maristella Lucchini, et al.

 

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

 

What were the study results?

During the COVID-19 pandemic, children in the United States went to bed later, woke up later, and took longer to fall asleep, but their overall time spent asleep did not change. Interviews with caregivers revealed that they prioritized routines to maintain their children’s amount of sleep but were more flexible about bedtime. Across all time periods studied, children from racial and ethnic minority communities went to bed later, slept less, and napped more often.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

 

What was the study's impact?

This is one of the first studies investigating changes in childhood sleep habits in the United States during the COVID-19 pandemic using data collected before and during the pandemic. The researchers found significant changes in children’s sleep habits, as well as differences in children’s sleep behaviors between racial/ethnic groups. These results highlight potential areas for future research and support the need to examine and address root causes of racial/ethnic sleep disparities in childhood.

 

Why was this study needed?

Sleep health during childhood is important for overall health and brain development. Poor sleep can increase a child’s risk for chronic illnesses, behavioral problems, and poor memory. Factors that affect sleep health may have been significantly impacted by the COVID-19 pandemic due to lockdowns and curfews, increased stress, and changes in social support. Many studies have shown that, due to systemic and structural inequities, the pandemic has affected the health behaviors of children differently based on their socioeconomic status, race, and ethnicity. These differences may worsen existing gaps in children’s health.

Several studies have reported on how the pandemic has affected childhood sleep habits, but few of these studies involved children in the United States. Most previous studies have relied on self-reported or time-limited data and have focused primarily on early stages of the pandemic. The goal of this study was to investigate changes in nighttime sleep habits and frequency of daytime naps during the COVID-19 pandemic.

 

Who was involved?

This study included 528 children aged 4 to 12 from 14 ECHO cohorts across the United States. The caregivers of 38 participants provided additional information about how they thought their children’s sleep habits may have been affected by the COVID-19 pandemic.

 

What happened during the study?

The researchers compared data from before the pandemic with data collected at two different time periods during the pandemic. They used this data to examine the length of time it took children to fall asleep, time spent asleep at night during the week and on weekends, and the frequency of later bedtimes and daytime naps. They also collected sociodemographic information (child sex, age, race and ethnicity, maternal education) from self-reports and medical records.

 

What happens next?

ECHO researchers are currently analyzing and publishing results on changes in diet, physical activity, and screen time during the COVID-19 pandemic from the same cohort of children.

 

Where can I learn more?

Access the full journal article, titled “Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study,” in Pediatric Research.

 

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 4, 2022

 

Access the associated article.

Read More Research Summaries about COVID

 

How has the COVID-19 pandemic affected children’s health behaviors?

Authors: Traci Bekelman, et al.

 

Changes in Body Mass Index (BMI) during the COVID-19 Pandemic

Authors: Emily Knapp, Aruna Chandran, et al.

 

Youth Well-being During COVID-19

Author(s): Courtney K. Blackwell, et al.

Childhood Obesity and the COVID-19 Pandemic

September is Childhood Obesity Awareness Month. Obesity can affect children’s physical and psychosocial health and can lead to substantial health problems later in life, including type 2 diabetes and heart disease.

Obesity is one of ECHO’s five child health outcome areas. This month’s Research Spotlight highlights a recent ECHO study that found that school-age children, on average, gained weight at a higher rate during the first year of the COVID-19 pandemic than they did during the couple of years before.

ECHO researchers also asked what behaviors could explain this excess pandemic-related weight gain. In another recent study of children from before to during the pandemic, they found that screen time—both educational and recreational—increased substantially, whereas sleep duration, diet, and physical activity hardly changed. Screen time takes many forms in kids’ lives these days. Reducing non-productive screen time can lead to less weight gain in children and adolescents.

Both of these studies suggested worse effects among Hispanic or non-Hispanic Black children. Research leading to reducing health disparities and improving health equity are ECHO priorities.

Both of these studies also took advantage of the fact that ECHO began before the pandemic and continues during these many months since it began. That means that ECHO is one of the very few large research programs that has followed individual children over time (“longitudinally”) to see how the pandemic has affected them and their families. Many ECHO researchers are characterizing these wide-ranging effects, and are starting to identify solutions that may offer resilience in the face of hardships.

In addition to my enthusiasm about the burgeoning research coming from ECHO, I am also excited to announce that the next phase of ECHO is within sight. The ECHO Program Office recently released Cohort Funding Opportunity Announcements (FOAs) to invite applications to extend and expand the ECHO Cohort to further investigate the influences of a broad range of early exposures from society to biology, including the preconception period, across ECHO’s five key child health outcome areas among diverse populations.

Frequently Asked Questions and pre-recorded informational webinars regarding these funding opportunities are now available on the NIH ECHO website. I encourage your to use our toolkit to share these FOAs with your networks.

ECHO Researchers Investigate How the COVID-19 Pandemic Affected Children’s Health Behaviors

Collaborative ECHO research led by Traci Bekelman, PhD, MPH of the University of Colorado, Anschutz Medical Campus investigates how the COVID-19 pandemic affected children’s diet, physical activity, screen time, and sleep. The study found that children’s screen time increased significantly during the pandemic with Hispanic children and non-Hispanic Black children having the most noticeable increase in screen time. The amount of time children spent asleep also increased, but only among children whose sleep time was below the recommended range before the pandemic. The study didn’t find any significant increase in the amounts of sugary drinks and unhealthy snack foods children consumed in the full study sample, but it did find a more noticeable increase among Hispanic children and older children.

This research, titled “Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children,” is published in the International Journal of Environmental Research and Public Health.

This study included 347 children between the ages of 4 to 12 and their caregivers recruited from ECHO cohorts in California, Colorado, North Dakota, and New Hampshire. Of these participants, 47% percent were female and 62% were non-Hispanic White. ECHO researchers compared children’s diet, physical activity, screen time, and sleep data collected before the pandemic (July 2019 to March 2020) to data collected during the pandemic (December 2020 to April 2021).

For many children, public health measures to mitigate the spread of the COVID-19 pandemic disrupted their daily routines, and prevented them from using community resources, such as parks and organized sports. During the first few months of the pandemic, we know that there were changes in children’s health behaviors—such as their diet, screen time, physical activity, and sleep habits. However, there are limited data on what happened to children’s health behaviors after the earliest, most restrictive lockdown period.

“Our study is one of the first to report that increases in screen time persisted into 2021,” said Dr. Bekelman. “Screen time has been linked to physical and mental health outcomes in children, so it will be important to provide families with more support to help them re-establish healthy routines.”

In the future, researchers will continue to investigate children’s health behaviors at other points in the pandemic to reveal whether changes are sustained, and the pathways by which social and economic disruption impacted children’s behaviors. Future studies can also look at changes in more nuanced measures of health behaviors among more diverse groups of children.

Read the research summary.

Conducting a Pediatric Randomized Clinical Trial During a Pandemic: A Shift to Virtual Procedures

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Conducting a Pediatric Randomized Clinical Trial During a Pandemic: A Shift to Virtual Procedures

Authors: James Roberts, Sheva Chervinskiy, Russell McCulloh, Jessica Snowden, Paul Darden, Thao-Ly Phan, Erin Dawley, Victoria Reynolds, Crystal Lim, Lee Pyles, DeAnn Hubberd, Jaime Baldner, Lora Lawrence, Ann Davis

 

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, National Institutes of Health.

 

What was done?

The study's goal was to enroll 128 children aged 6 to 12 years old and one parent at four rural clinics over 10 weeks. However, the trial was paused after 6 weeks due to COVID-19. Over the next 12 weeks, the trial resumed using virtual visits where investigators completed enrollment, obtained informed consent, and assessed height and weight of children. Because all study activity was virtual, digital scales and height measurement equipment were shipped to participants' homes, and a second virtual visit was conducted to monitor these measurements. Some participants who did not have internet and needed support for virtual visits received internet-enabled tablets.

 

What was found?

When the trial was paused, 42 patients had been enrolled. When the trial resumed virtually, 28 of the 42 continued in the trial, and an additional 89 new participants were enrolled for a total of 117 children. Flexibility was key to solving problems and continuing to enroll and retain participants.

The investigators discovered the challenges and benefits of conducting a virtual trial of this nature. Some challenges to conducting a virtual trial include unreliable equipment delivery, unreturned study equipment, slow Internet speeds and/or poor Internet access in rural areas, and the added costs of buying and shipping equipment and mailing other study materials. However, the benefits of a virtual trial included the ability to conduct study visits at other times of the day, including evenings and weekends. For example, research staff could conduct study visits at any time of the day, and study-related travel was limited.

 

What do the results mean?

The lessons learned from this trial can be applied by any study team recruiting participants from rural areas for a clinical trial. These include:

  • Virtual visits and procedures enable successful recruitment and retention of participants from rural areas.
  • Research teams must be agile, flexible, and willing to adapt study procedures to meet clinic resources and unanticipated situations.
  • While there are considerable additional expenses for buying and shipping study equipment to participants, these costs may be offset by decreased travel to and from rural areas by study staff.

 

Why was this study conducted?

In the United States, children living in rural areas have higher rates of being overweight. Unfortunately, children from rural areas seldom participate in clinical research trials. A clinical research trial on changing lifestyle behaviors in rural children who were overweight started in early 2020 but, due to the COVID-19 pandemic, had to switch to virtual procedures instead of in-person visits. Sharing the solutions to problems faced and the lessons learned in completing this trial may help other research teams recruit participants living in rural areas.

 

Appreciation:

The authors appreciate the children, families, and clinics whose participation made the research possible.

 

You can read the full publication here: https://doi.org/10.1017/cts.2022.453

 

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Read More Research Summaries about COVID

Did COVID-19 pandemic experiences contribute to symptoms of traumatic stress in mothers in the U.S.?

Authors: Tracy Bastain, Amy Margolis, et al.

Changes in children sleep habits during the COVID-19 pandemic

Authors: Maristella Lucchini, et al.

 

Changes in Body Mass Index (BMI) during the COVID-19 Pandemic

Authors: Emily Knapp, Aruna Chandran, et al.

 

Youth Well-being During COVID-19

Author(s): Courtney K. Blackwell, et al.

During the COVID-19 Pandemic, Children’s Screen Time Increased

<< Back to Research Summaries

During the COVID-19 Pandemic, Children's Screen Time Increased

Authors: Traci Bekelman, et al.

 

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

 

What were the study results?

The study found that overall children’s screen time increased significantly during the pandemic with Hispanic children and non-Hispanic Black children having the most noticeable increase in screen time. The study didn’t find any significant increase in the amounts of sugary drinks and unhealthy snack foods children consumed during the pandemic, but it did find a more noticeable increase among Hispanic children and older children. The amount of time children spent asleep increased but only among children whose sleep time was below the recommended range before the pandemic.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

 

What was the study's impact?

This study shows how the disruptions caused by the COVID-19 pandemic affected children’s daily lives. The results of this study suggest that the pandemic may have worsened sociodemographic disparities for some child health behaviors, particularly in relation to the amount of time children spent looking at screens. This research suggests that families may need more support to re-establish healthy routines and reduce the negative effects of the pandemic on their children’s health behaviors.

 

Why was this study needed?

For many children, public health measures to mitigate the spread of the COVID-19 pandemic disrupted their daily routines, and prevented them from using community resources, such as parks and organized sports. During the first few months of the pandemic, there were changes in children’s health behaviors—such as diet, screen time, physical activity, and sleep habits. However, there are limited data on what happened to children’s health behaviors after the earliest, most restrictive lockdown period. This is an important topic because children’s health behaviors have been linked to their overall mental and physical health, academic achievement, and quality of life.

 

Who was involved?

The study included 347 children between the ages of 4 to 12 years and their caregivers recruited from ECHO cohorts in California, Colorado, North Dakota, and New Hampshire. Of those participants, 47% percent were female, and 62% were non-Hispanic White.

 

What happened during the study?

ECHO researchers collected data on children’s diet, physical activity, screen time, and sleep habits before and during the pandemic. The researchers also surveyed caregivers on how they thought their children’s health behaviors had changed during the pandemic. This study also explored how sociodemographic factors affected children’s health behaviors to identify children who are more likely to experience less recommended changes in behaviors.

 

What happens next?

This research may help us identify ways to support families with children in future public health emergencies. The ECHO Program is currently working to study changes in other related health behaviors. This includes changes in how well children follow national dietary guidelines, use of social media, and bedtimes/wake-up times.

 

Where can I learn more?

Access the full journal article, titled “Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children,” in the International Journal of Environmental Research and Public Health.

 

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 19, 2022

 

Access the associated article.

Read More Research Summaries about COVID

 

Changes in Body Mass Index (BMI) during the COVID-19 Pandemic

Authors: Emily Knapp, Aruna Chandran, et al.

 

Youth Well-being During COVID-19

Author(s): Courtney K. Blackwell, et al.

NIH Program Study Finds Increased Weight Gain in Children During the COVID-19 Pandemic

FOR IMMEDIATE RELEASE

 

Children gained weight at a faster rate during the COVID-19 pandemic compared to previous years, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Childhood obesity is a serious health condition that can affect long-term health and quality of life. At the beginning of the COVID-19 pandemic, health experts were concerned that the closure of schools and recreational facilities could cause an increase in childhood obesity due to a reduction in physical activity and dietary changes.

ECHO researchers analyzed changes in children’s body mass index (BMI) before and during the pandemic and investigated whether changes in BMI varied based on race, ethnicity, prepandemic BMI, or household income. In general, children gained weight at an increased rate during the pandemic but children in higher income households were at a lower risk of excess weight gain.

“This study highlights the need for interventions to mitigate the physical and mental health consequences of the COVID-19 pandemic,” said Emily Knapp, PhD. “The conditions faced by families during the COVID-19 pandemic may have led to an acceleration of weight gain in children. This study highlights the need to support less resourced families, who have borne the worst consequences of the pandemic.”

Dr. Knapp and Aruna Chandran, MD, ECHO Program investigators at Johns Hopkins Bloomberg School of Public Health, led this collaborative research effort published in Pediatrics.

Knapp, E. A. et al. Changes in BMI During the COVID-19 Pandemic. DOI: 10.1542/peds.2022-056552

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency Emily Knapp, PhD Aruna Chandran, MD conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

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ECHO Researchers Investigate Child Weight Gain During the COVID-19 Pandemic

Collaborative ECHO research led by Emily Knapp, PhD and Aruna Chandran, MD of Johns Hopkins Bloomberg School of Public Health investigates the effects of the COVID-19 pandemic on children’s body mass index (BMI), an estimation of overall body fat. The study looked at the BMI of 1,966 children ages 2 through 18 years old from 38 ECHO cohorts across the United States during the COVID-19 pandemic. The results of this study suggest that, on average, children gained weight at a higher rate during the pandemic. This research, titled “Changes in BMI during the COVID-19 Pandemic,” is published in Pediatrics.

Childhood obesity is a serious health condition that can affect long-term health and quality of life. At the start of the COVID-19 pandemic, there was concern among researchers and doctors that the closure of schools and the cancellation of recreation and sport activities would cause an increase in childhood obesity.

To understand the pandemic’s impact on children’s weight, researchers analyzed yearly changes in children’s body mass index (BMI) before and during the pandemic, considering each child’s age and sex. The researchers also investigated whether changes in BMI were different across specific sociodemographic traits including race, ethnicity, pre-pandemic BMI, and household income.

The results of this study indicated that on average children gained weight at an increased rate during the pandemic, and children who had obesity before the pandemic gained weight at a faster rate compared to children who were at a healthy weight pre-pandemic. Additionally, children in higher income households were at a lower risk of excess BMI gain during the pandemic.

“This study highlights the need for interventions to mitigate the physical and mental health consequences of the COVID-19 pandemic,” said Dr. Knapp. “The conditions faced by families during the COVID-19 pandemic may have led to an acceleration of weight gain in children. This study highlights the need to support less resourced families, who have borne the worst consequences of the pandemic.”

Future studies can explore strategies to help families and communities thrive amidst the challenges faced during the ongoing COVID-19 pandemic. As the pandemic continues to alter children’s lives, it will be important to monitor changes in health outcomes among children and use these data to build programs to reduce health inequities.

Read the research summary.

During the Pandemic, Children Whose Parents Had Flexible Work Schedules and More Financial Security Were More Likely to Have Less Screen Time and More Sleep

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During the Pandemic, Children Whose Parents Had Flexible Work Schedules and More Financial Security Were More Likely to Have Less Screen Time and More Sleep

Authors: Traci Bekelman, Katherine Sauder, et al.

 

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

 

What were the study results?

Children with parents who were able to change their work schedule to care for their children during the pandemic had less screen time and slept longer at night. Children with parents who were stressed about money and access to food and therefore unable to change their work schedule, drank more sugary drinks, were less active, and slept less at night. Similar to pre-pandemic study results, what children ate and their level of physical activity differed by their age and sex.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

 

What was the study's impact?

This study shows how children’s diet, physical activity, and sleep behaviors during the pandemic were linked to the work schedules and stress of their parents. Parents stressed about money may need help getting their kids to be more active, eat better, use technology less, and sleep more.

 

Why was this study needed?

The COVID-19 pandemic changed family habits and financial situations for many. ECHO researchers wanted to know how parents' coping strategies, stress, and financial situations affected their children’s health behaviors during the first seven months of the pandemic.

 

Who was involved?

This study included 3,315 children between 3 and 17 years from 50 ECHO cohorts across the United States. Information about the children’s sex, age, race, and ethnicity were reported by a parent or found in their medical records.

 

What happened during the study?

Parents answered questions about their child’s diet, physical activity, screen time, and sleep during the first seven months of the COVID-19 pandemic. The parents also described how they were personally coping with the pandemic and what they were most stressed about.

 

What happens next?

ECHO researchers will continue to look at how financial stress and parents’ work schedules affect children’s health behaviors. This will help guide future strategies to encourage healthy behaviors among children even during stressful times like a pandemic.

 

Where can I learn more?

Access the full journal article, titled “Sociodemographic Variation in Children's Health Behaviors During the COVID-19 Pandemic,” in Childhood Obesity.

 

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published July 19, 2022

 

Access the associated article.

During the COVID-19 Pandemic, Children Gained Weight Faster

<< Back to Research Summaries

During the COVID-19 Pandemic, Children Gained Weight Faster

Authors: Emily Knapp, Aruna Chandran, et al.

 

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

 

What were the study results?

Results from this study show that during the COVID-19 pandemic, children gained weight at an increased rate compared to the years before the pandemic. Children who had obesity before the pandemic gained weight at a faster rate during the pandemic compared to children who were in a healthy weight range pre-pandemic. Children in higher income households were at a lower risk of excess weight gain during the pandemic.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

 

What was the study's impact?

This study highlights the need for programs and services to prevent and reduce the physical and mental health effects of the COVID-19 pandemic on children.

 

Why was this study needed?

Childhood obesity is a serious health condition that can affect long-term health and quality of life. There was concern among researchers and doctors that the COVID-19 pandemic may cause incidence of childhood obesity to increase due to the closure of schools and cancellation of recreational activities, leading to less physical activity and changes in eating habits.

 

Who was involved?

This study included 1,966 participants ages 2 through 18 years old from 38 ECHO cohorts across the United States.

 

What happened during the study?

The researchers compared annual changes in children’s body mass index (BMI)—a measure used to estimate body fat—before and during the pandemic. The researchers also took into account child’s age, sex, race and ethnicity, pre-pandemic BMI, mother’s education, and household income.

 

What happens next?

Future studies should explore strategies to support families during the COVID-19 pandemic. As the pandemic continues to alter children’s lives, it will be important to monitor changes in health outcomes among children and use these data to build programs to reduce health inequities.

 

Where can I learn more?

Access the full journal article, titled “Changes in BMI during the COVID-19 Pandemic” in Pediatrics.

 

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published June 30, 2022

 

Access the associated article.

Read More Research Summaries about Obesity and COVID

The Relationship Between Prenatal Obesity and Child Autism-related Social Behaviors

Author(s): Kristen Lyall, Christine Ladd-Acosta, et al.

Youth Well-being During COVID-19

Author(s): Courtney K. Blackwell, et al.