John R. Meurer

Background: Schools play a central role in child development and socialization and can function as protective environments that mitigate the effects of adversity. Building on the Social Ecological Model and Community School Transformation, we propose a “Schools-as-Neighborhoods” framework that conceptualizes schools as intentionally designed microenvironments capable of generating social capital, promoting positive childhood experiences, and buffering harmful neighborhood exposures through trauma-informed programming. Methods: We conducted a convergent mixed-methods study across four public and charter schools in Milwaukee, Wisconsin, serving grades five through nine. STRYV365’s peak team and Brain Agents gamified intervention were implemented between 2022–2024. Quantitative surveys and qualitative data assessed students’ lived experiences, exposure to adversity, emotional awareness, coping skills, and school connectedness/climate across multiple waves. Results: Across the four schools (n = 1626 students), baseline academic proficiency was low, and exposure to adversity was high among surveyed participants (n = 321), including bereavement (74%) and family incarceration (56%). Despite these challenges, qualitative findings revealed strengthened emotional regulation, empathy, motivation, and goal setting among students engaged in trauma-informed programming. Teachers reported improved peer interaction and community building during sustained implementation. Conclusion: The Schools-as-Neighborhoods framework highlights the value of trauma-informed, relationship-centered school environments in promoting student well-being. By positioning schools as cohesive ecosystems that foster belonging and cultivate social capital, this approach offers educators and policymakers a pathway for mitigating the effects of hostile lived environments and supporting students’ mental health, social development, and engagement in learning.

Introduction: The study objective was to evaluate whether the formation and funding of team science-guided Integrated Clinical Research Ensembles (ICREs) enhance individual faculty productivity, measured by publication and impact factor adjusted citation rates. The setting was a multi-institutional NIH Clinical and Translational Science Award-supported hub. Methods: Monthly faculty publication and impact factor adjusted citation rates were analyzed using data extracted from the hub-managed Faculty Collaboration Database (FCD). The FCD imports indexed publications for all faculty members across four academic institutions, drawing from PubMed and faculty curriculum vitae. Monthly publication counts were modeled using Poisson regression, fitted using generalized estimating equations to account for clustering of observed monthly publication rates of individual faculty. Publication rates were compared before and after ICRE formation and funding, and between faculty in and outside ICREs. Results: Before joining ensemble teams, ICRE faculty had an 87% higher monthly publication rate than non-ICRE faculty. As ICREs were funded, the monthly publication rate increased an average 72% compared to baseline levels and future citation rates determined by journal impact factors increased by 150%. Conclusions: Faculty publication and citation rates significantly increased following ICRE funding, demonstrating the potential of structured team science models to boost academic productivity and influence. Faculty inclined to participate in team science through formalized ICREs were already among the more productive faculty.

Background: Adverse childhood experiences such as violence, substance use, and family disruption disproportionately affect youth in urban communities, increasing the risk of emotional and behavioral challenges. Social-emotional learning (SEL) and trauma-informed programming are effective strategies for mitigating these effects, fostering resilience, and promoting mental well-being. Game-based learning is a promising, engaging method for delivering SEL content. STRYV365 developed Brain Agents, a trauma-informed, game-based SEL intervention aimed at improving emotional regulation, coping strategies, and interpersonal skills among students in grades 5 through 9. Objective: This study explored students’ experiences with and perceptions of Brain Agents, evaluating its effectiveness in fostering SEL skills and resilience across 4 diverse urban schools in Milwaukee, Wisconsin. Methods: A cluster-randomized, incomplete block factorial crossover design was implemented from 2022-2024. Of 1626 eligible students, 329 (20%) had caregiver consent and student assent. Among these, 180 students in grades 5‐9 played Brain Agents at school over 4‐5 weeks, for an average of 10 sessions and 23 minutes per session. SEL-related outcomes were assessed using surveys, focus groups, and interviews. Qualitative data were analyzed using Dedoose software, with thematic coding conducted by multiple coders to ensure reliability. Results: Student demographics included 189/321 (58.9%) Black, 112/321 (34.9%) White, and 221/321 (68.8%) from economically disadvantaged backgrounds. Baseline surveys of 277 children revealed that 202 (72.9%) of students had experienced the death of someone close, 147 (53.1%) had a close contact incarcerated, and 39 (14.1%) reported feeling nervous or anxious daily. Strengths included 230 (83.0%) students reporting life satisfaction and 183 (66.1%) able to calm down when upset. Game performance data from 328 students indicated varying levels of achievement, with a median of 3 (IQR 1.5-4) missions completed, 4 (IQR 2-6) stars earned, 8 positive energies collected, and 2 (IQR 1-2.5) crew members rescued. Grades 7‐8 had the highest engagement, while grade 9 students had the lowest participation. Qualitative analysis from 62 participants identified 8 core themes: qualities of most pride, neighborhood relationships, challenges in life, emotions associated with loss of control, coping strategies, future goals, experiences with Brain Agents, and suggestions to improve the game. Students most frequently cited anger as a cause of emotional dysregulation and named coping strategies such as self-calming, asking for help, and perseverance. Feedback on Brain Agents highlighted improved focus, emotional control, and critical thinking, with younger students more positively engaged. Suggested improvements included better graphics, more customization, and cooperative play. Conclusions: Brain Agents was positively received by students, particularly those in earlier grades, and demonstrated potential as an effective trauma-informed SEL tool. The findings support the role of game-based interventions in enhancing resilience and emotional intelligence among youth exposed to adversity. Broader implementation may extend benefits to diverse student populations and settings.

Purpose Positive childhood experiences build a sense of belonging and connection and predict school success and wellness. The peak team curriculum creates positive childhood experiences to build resilient mindsets and relationships for youth struggling with toxic stress. The purpose of this study was to survey the strengths and needs of predominantly Black students, grades 4–7, in a public charter school and to evaluate the impact of peak team. This research is crucial due to the high levels of toxic stress faced by these students, which can significantly impact their academic and emotional development. Methods In late 2020 and early 2021, 270 and then 210 students completed a 41-question survey; 25 teachers and school administrators participated in focus groups. Results Surveys showed that participating students had pride, optimism, emotional awareness, and caring, supportive families. Most distrusted neighbors who were not helpful, experienced loss from death and incarceration of loved ones, and had been stressed by the COVID-19 pandemic. Teachers and administrators valued the peak team approach and recommended expansion of services. Teachers noted significant improvements in student engagement, emotional regulation, and social interactions, highlighting the program's positive impact on students' behavior and emotional well-being. Conclusion Surveys of students help to inform school health practice by revealing the strengths of children and their challenges needing attention. The peak team program had a positive impact by improving emotional regulation, fostering supportive relationships, and building resilience. Pride, optimism, emotional awareness, and caring families improve educational success and lifelong wellbeing. Trauma-informed programs teach children how to calm themselves, regulate emotions and behaviors, tap their strengths, and build resiliency to cope.

BACKGROUND Children are shaped by the events in their lives, some of which may be traumatic. Consequently, it is vital that children develop skills to understand and cope with stress and emotions. Such skills can be fostered in schools through trauma informed programs and the promotion of social emotional learning (SEL). One tool that can be used to teach these schools is videogames. Previous studies in Europe have shown that videogames can be used to improve youth mental health and emotional intelligence. A videogame Brain Agents was developed by Night City and Colombia College Chicago and produced by STRYV365, a non-profit based in Milwaukee. The game immerses players in narrative scenarios that emphasize the value of practicing resilience, being in touch with emotions and wellbeing, and establishing positive social relationships through storyline and minigames. OBJECTIVE We hypothesize that Brain Agents use by students in grades 5-9 in four Milwaukee schools will improve their SEL and resiliency. · Specific Aims: We aim to evaluate the effectiveness of Brain Agents. METHODS In academic years 2022-24, a cluster randomized, incomplete block factorial design of interventions was developed in four schools and five grade levels. During four semesters over two years, students in classes are exposed to Brain Agents, another STRYV365 coaching program called peak team, both, or no intervention each semester. With parent consent, students participate in focus groups or interviews at the end each semester Transcripts of the sessions were analyzed using a qualitative positivist paradigm and eight core themes were coded in the software program Dedoose. RESULTS Eight core themes were identifiedincluding: experience with Brain Agents, awareness of and ability to control emotions, future goals, traits proud of, current challenges, and perceptions of neighborhood. Students overall reported positive experiences with the game andoffered suggestions on how to improve it. Most reported that feelings of anger were the cause of loss of emotional control and many voiced differing strategies to self-calm. Students also reported many extrinsic and intrinsic traits that they were proud of as well as educational, career, and extracurricular goals. CONCLUSIONS Many students reported positive experiences with the Brain Agents although some reported problems and glitches. Similar to previous studies, this study suggests that videogames can promote emotional intelligence with students learning emotional awareness and coping strategies. As one of the first studies of its kind in the US, this study shows that gamification can be used to promote SEL in schools and children with traumatic backgrounds.

Background: Studies examining the association between asthma and hospitalization among children and youth with coronavirus disease 2019 (COVID-19) have yielded mixed results. Both asthma and COVID-19 hospitalization are characterized by racial, ethnic and socioeconomic disparities which also pattern geographically, yet no studies to date have adjusted for neighborhood context in the assessment of this association. Methods: Mixed effects logistic regression was used to estimate the association between asthma and hospitalization due to COVID-19 in a sample of 28,997 children and youth diagnosed with COVID-19 in Milwaukee County, Wisconsin, from March 1, 2020, to May 31, 2022. Models adjusted for individual-level sociodemographic factors (age, gender, race, ethnicity and city/suburb residence) and season of diagnosis were examined as moderators. Random intercepts by census tract accounted for geographic variation in neighborhood factors and census tract-level measures of education, health and environment, and social and economic factors were assessed via childhood opportunity indices. Results: Asthma history was statistically significantly associated with hospitalization due to COVID-19 among children and youth. Hospitalization rates varied statistically significantly by census tract, and results were unchanged after accounting for childhood opportunity indices and census tract. Season of diagnosis was not found to moderate the effect of asthma history on COVID-19 hospitalization. Conclusion: : Our study suggests that asthma history is a risk factor for hospitalization in the context of COVID-19 infection among children and youth, warranting observation and follow-up of children with asthma as well as continued measures to prevent COVID-19 in this population.

Prior research on racial/ethnic disparities in COVID-19 mortality has often not considered to what extent they reflect COVID-19–specific factors, versus preexisting health differences. This study examines how racial/ethnic disparities in COVID-19 mortality vary with age, sex, and time period over April-December 2020 in the United States, using mortality from other natural causes as a proxy for underlying health. We study a novel measure, the COVID excess mortality percentage (CEMP), defined as the COVID-19 mortality rate divided by the non-COVID natural mortality rate, converted to a percentage, where the CEMP denominator controls (albeit imperfectly) for differences in population health. Disparities measured using CEMP deviate substantially from those in prior research. In particular, we find very high disparities (up to 12:1) in CEMP rates for Hispanics versus Whites, particularly for nonelderly men. Asians also have elevated CEMP rates versus Whites, which were obscured in prior work by lower overall Asian mortality. Native Americans and Blacks have significant disparities compared with White populations, but CEMP ratios to Whites are lower than ratios reported in other work. This is because the higher COVID-19 mortality for Blacks and Native Americans comes partly from higher general mortality risk and partly from COVID-specific risk.

Child anxiety and depression increased in recent years, while access to health care improved in some ways and worsened in others. The purpose of this study was to understand the prevalence of child anxiety and depression during the COVID-19 pandemic, unmet mental health care need among children with these conditions, and whether disparities exist by race/ethnicity and sex. A cross-sectional secondary data analysis was conducted using the 2021 National Survey of Children’s Health (ages 3–17 years, unweighted n = 42,175). Parent/caregiver-reported child anxiety and depression prevalence was greater among non-Hispanic White children than those of other racial/ethnic groups and females compared to males, after adjusting for covariates. Unmet mental health care need among children with anxiety and depression was greater among Hispanic children than those of other racial/ethnic groups, after adjusting for covariates. In conclusion, this study identified a disparity in unmet need between Hispanic children and those of other races and ethnicities. Implications for policy and practice are discussed.

Maternal mortality rates are strongly predicted by overall health. We propose a method for measuring health-adjusted maternal mortality rates, which uses mortality from other natural causes to proxy for overall health. We apply the method to assess: (i) the extent to which pregnancy increases the risk of natural-cause mortality; and (ii) the differences between unadjusted and health-adjusted minority/White maternal mortality rates. Black and Native American have much higher unadjusted maternal mortality rates than White mothers; while Hispanics, Asians, and Whites have similar rates. The health-adjusted picture is very different. Health-adjusted maternal mortality ratios for Blacks, Native Americans, Hispanics, Asians and relative to Whites, are all greater than 1.0, and are similar at 1.3–1.5:1. These ratios vary with maternal age, with small disparities for ages 20-24 but much larger disparities over age 30. Health-adjusted mortality rates vary greatly across states, with New Jersey’s rate over 3.5 times the California rate. The increased mortality risk from pregnancy, relative to background risk of natural mortality from other causes, follows a U-shape over maternal ages 15-44.

This online appendix provides additional methods details and results for Franchi et al. (2024), The Disappearing COVID-naïve population and Comparative Roche vs. Abbott Test Sensitivity: Evidence from antibody seroprevalence in Milwaukee County, Wisconsin, available at https://ssrn.com/abstract=4678996.