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Released: 7/11/23
In this episode of That’s Pediatrics, our hosts talk with Elizabeth “Liz” Miller, MD, PhD, chief of Adolescent and Young Adult Medicine at UPMC Children's Hospital of Pittsburgh.
In this episode our experts discuss:
Elizabeth Miller, MD, PhD, is chief of Adolescent and Young Adult Medicine at UPMC Children's Hospital of Pittsburgh and professor of Pediatrics at the University of Pittsburgh School of Medicine. Trained in medical anthropology as well as internal medicine and pediatrics, Dr. Miller’s research has included examination of sex trafficking among adolescents in Asia, teen dating abuse, and reproductive health, with a focus on underserved youth populations including pregnant and parenting teens; and foster, homeless, and gang-affiliated youth. Her current research focuses on the impact of gender-based violence on young women’s reproductive health.
She conducts research on brief clinical interventions to reduce partner violence and unintended pregnancy, funded by the National Institute of Child Health and Human Development and the National Institute of Justice. In addition, she is conducting a study of a sexual violence prevention program entitled; Coaching Boys into Men; which involves training coaches to talk to their young male athletes about stopping violence against women, funded by the Centers for Disease Control and Prevention. She is also involved in projects to reduce gender-based violence and improve adolescent and young adult women’s health in India and Japan.
Allison “Alli” Williams, MD, is a pediatric hospitalist and is certified by the American Board of Pediatrics. She is a member of the Paul C. Gaffney Division of Pediatric Hospitalist Medicine, medical-surgical co-management team director, and assistant professor at the University of Pittsburgh School of Medicine. Dr. Williams received her medical degree from Herbert Wertheim College of Medicine at Florida International University in Miami, Florida, and completed her residency at UPMC Children’s Hospital of Pittsburgh. Her clinical interests include non-RSV bronchiolitis, febrile neonates, and the enhanced of patient care through medical-surgical co-management.
Sameer Agnihotri, PhD, is director of the Brain Tumor Biology and Therapy Lab and an assistant professor at the University of Pittsburgh School of Medicine. Dr. Agnihotri earned his bachelor’s degree in biology, specializing in genetics, followed by his doctorate degree in medical biophysics, both at the University of Toronto. While there, he used genetic screens to identify novel drivers of glioblastoma, an incurable brain tumor. He subsequently completed his post-doctoral fellowship at the Arthur and Sonia Labatt Brain Tumor Research Centre at the Hospital for Sick Children, in Toronto, and the Princess Margaret Cancer Centre, Division of Neuro-oncology Research, also in Toronto. Dr. Agnihotri’s lab studies pediatric and adult high-grade gliomas.
The Pittsburgh Study
The Pittsburgh Study | Pitt Pediatrics
Youtube: Raising the Bar with The Pittsburgh Study
The Pittsburgh Study: Learning with Communities About Child Health and Thriving | NIH National Library of Medicine
Adolescent and Young Adult Medicine | CHP.edu
Coaching Boys Into Men
“What Exactly Do You Mean by Thrive?” A Partnership that Digs Deep to Lift Pittsburgh Kids | PittMed Magazine
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Voiceover: This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgements when advising their patients. Patients in need of medical care should consult their personal care provider. Welcome to "That's Pediatrics", where we sit down with physicians, scientists, and experts to discuss the latest discoveries and innovations in pediatric healthcare.
Dr. Alli Williams: Hi, I'm Alli Williams. I'm one of the pediatric hospitalists here at UPMC Children's Hospital of Pittsburgh.
Dr. Sameer Agnihotri: I'm Sameer Agnihotri. I'm a scientist here at Children's Hospital.
Dr. Williams: And we are so excited to have Dr. Liz Miller from Adolescent Medicine here on our podcast of That's Pediatrics.
So I guess just to start, I would love to ask, since we are in the new year at Pittsburgh, or by the time this airs maybe even later, what is one of your favorite things to do when the weather starts getting better around Pittsburgh?
Dr. Liz Miller: So there's so much to love about spring in Pittsburgh, as you know, and I think some of my favorite activities is walking and hiking and running in our area parks, both Schenley and Frick just bring me so much joy.
Dr. Williams: Oh, I know. I haven't been as much with my family. I think this year's the year to go explore those a little bit more. There's so many different types of trails there, which is a lot of fun.
Well, we are very excited to have you here today to talk about, not just Pittsburgh, but everything else that's going on in Pittsburgh with your wonderful career. The first question about specifically what you do I'd love to ask is just tell me about your career journey. How did get to where you are?
Dr. Miller: Well, thank you Sameer, Allie for having me today, this is so much fun. So for our audience, I'm Liz Miller. I use she/her pronouns, have had the immense privilege of directing adolescent and young adult health here at Children's Hospital of Pittsburgh. It'll be almost 12 years in June-
Dr. Williams: Wow.
Dr. Agnihotri: Wow.
Dr. Miller: That I have been here. I have to share with you a little bit about my journey. I was born and raised in Kobe, Japan and came to the US just as I was turning 17 for college. Did undergraduate and then graduate school and medical school in the East Coast, and then my spouse and I, after 20 years in Boston, moved out to California.
Dr. Williams: That's a change.
Dr. Agnihotri: Yeah.
Dr. Miller: It was a change. I got a random call from Dr. Perlmutter, our then department chair saying, "We would love for you to think about a job in adolescent medicine here in Children's Hospital of Pittsburgh." I was like, "I think you got the wrong number." He's like, "No, no, no, no, we love the research that you do. We would love to have you come here." I said, "Oh, this is so very interesting, I will be back in touch."
Dr. Williams: Yeah.
Dr. Miller: That evening I went home to share with my spouse that I got this call from a place called Pittsburgh. My spouse being from Cleveland, bursts out laughing, pulls out a map of the United States and he's like, "Cleveland, Pittsburgh, you're going to go see that.”
Dr. Miller: So, that was how we end up here in Pittsburgh. To share with you, right at the time, I was like, "Really?" I do community partnered research. I do work on the margins of the margins around sexual violence and partner violence prevention. I work with young people who've been system involved, whether child welfare or criminal court, I work with unhoused youth. This is really on the margins of the margins, and not many people think about this as research.
Of course our then department chair, Dr. Perlmutter said, "Yes, but you have NIH money."
Dr. Williams: Ah, yes.
Dr. Agnihotri: Right.
Dr. Miller: So, he actually amazingly created a beautiful space for community partnered research for me here, and I am forever grateful. I had the opportunity also to work with the University of Pittsburgh's Clinical and Translational Science Institute, which is one of the many, many centers across the country to help move research from bench to bedside to community and into public health, and was brought on to be a co-director of the community engagement core for that clinical and translational science institute.
So, what has been amazing for me about being in Pittsburgh is being allowed to flourish, right? Not just like, "Oh, we'll tolerate Liz Miller doing her kumbaya research over here," but much more like, "We love this community engagement work that you do. We really appreciate the idea of centering community voices in this space."
That has really been what brings me so much joy about working within the UPMC Children's Hospital at Pittsburgh space. At Pitt, it is really that sensibility that we have as an academic community and as a hospital, our commitment to child health and health equity and thriving has always been there.
Dr. Agnihotri: Wow, that is fascinating. I can only imagine how much little research is done in this space, let alone translational research. Can you highlight a few projects that you're involved with and what that entails, please?
Dr. Miller: So, I'm going to start actually by saying that we are recording this in a week where we have seen more young people shot and killed in Pittsburgh, and in a week when our Centers for Disease Control and Prevention highlighted the most recent youth behavior survey data. Where nationally we're seeing an extraordinary number of young people reporting thinking about suicide, having increased depression and more of our female identified young people reporting experiences of sexual violence, as well as young people who identify as LGBTQIA+.
This is a tremendously difficult time for our young people as we emerge from the COVID-19 pandemic, so an area of research that I have been focusing on for now three decades has been sexual violence and partner violence prevention. This week I think is really underscored how critically important it is to do violence prevention work.
Some of the projects, Sameer, have included working with athletic coaches to train them to talk to their athletes about the critical importance of stopping sexual violence and dating violence, and the role that athletes have as leaders in our community. We have demonstrated in both high school and middle school that this program called Coaching Boys Into Men is highly effective in reducing partner violence and sexual violence.
The real challenge for us in this work is getting evidence-based practice shared, disseminated, implemented in community, and much of my recent efforts in this space has been in what we call implementation science, right? How do we actually get what we know works into the hands of people and support them so they can actually do these evidence-based programs? One of the ways to do that is actually centering community partners more in our work.
So, one of the most exciting projects, initiatives that I've been working on for almost five years now is what we fondly call The Pittsburgh Study. So The Pittsburgh Study was the brainchild of our now leader in the Department of Pediatrics, our department chair, Dr. Terry Dermody. He wanted to do a study to better understand what are the factors that contribute to child health and thriving and for children being able to finish high school on time.
As he sort of launched this idea in June of 2018, there was a fair amount of questions that came from our community partner saying, "Do we really need another study, another survey, more observational study?" What was initially proposed was a longitudinal study following babies born in Allegheny County and following them out 20 years.
Dr. Williams: Oh wow.
Dr. Williams: That's extensive.
Dr. Miller: Right. It was very extensive and actually was modeled on the National Children's Study, which was a congressionally legislated study that actually never quite got off the ground. The thought was because people hardly ever leave Pittsburgh, that this would be a great place to do a longitudinal study. In fact, some of the most nationally recognized longitudinal studies of children and young people have come out of Pittsburgh.
That said, the community partners were like, "In so many of our neighborhoods with concentrated disadvantage, what we hear from community members over and over is we've been surveyed and surveyed and surveyed again. We have never seen the results of those studies, much less any impact from those studies."
Dr. Williams: It's a really difficult barrier to start out with.
Dr. Miller: Right? With that comes huge amount of mistrust of the research enterprise, and frankly, the really ways in which racism has seeped into our scientific practices, and the need for us to listen to community members in terms of how our research can be designed in ways that feel meaningful, relevant, and impactful.
So with that pushback, what was amazing about Dr. Dermody was he said to me, he said, "Liz, I know very little about community partnered work and this is what you do, and what are your thoughts about directing The Pittsburgh Study?" I said, "I think it would be very exciting as long as you're willing for us to take it in a little different direction."
So enter my dear friend Val Chavis, who at the time had been working in one of our family support centers for about 17 years. At the time was the director of the East Hills Family Support Center. Val had taught my public health students, social work students, medical students about the impact of racism on health and healthcare. Just a phenomenal educator.
So, I called Val and I was like, "So, here's the deal. I'm being asked to do this study and I need a partner. You're my first go-to person, because you really understand the critical need to educate us health professionals and investigators about how to do our work differently."
Dr. Miller: Val was like, "Okay."
Dr. Williams: How willing, that's so wonderful.
Dr. Miller: Just amazing to have these kinds of connections and to be able to pull in that level of expertise and wisdom. So, Val actually came to the building here at UPMC Children's to meet in Dr. Dermody's big conference room with a bunch of scientists in a bunch of white coats, and the only person of color in the room.
As we were talking about The Pittsburgh Study, Val goes, "So, excuse me, this word thriving, what does that mean to you? Because I suspect that the word thriving means something very different for me and would mean something very different for my neighbors."
Dr. Williams: Oh, interesting. Thriving as in the study thriving or, yeah, just thriving in life?
Dr. Miller: Right? Exactly, thriving in life. What does thriving mean when we talk about children thriving? What exactly is that, right?
Dr. Williams: Yeah, that's big.
Dr. Miller: It's really interesting, because I mean, it was this opening into this moment where we were like, "Huh, where is the science of thriving now and where could it potentially go?" So, what we did was actually start doing a pretty deep literature review into what and who's measuring things around flourishing and wellbeing, and there is definitely that focus.
As we looked, it was really focused on the individual child, their sense of emotion regulation, how well they're interacting with people, those kinds of things, and some parent report right around a child "thriving." Val was like, "But don't you think safe places to play, clean air, parents who feel supported, where's that?"
So, what we launched as one of the early parts of The Pittsburgh Study were a series of listening sessions with community partners. Val helped us organize these listening sessions in neighborhoods that are often forgotten in our Allegheny County broader Pittsburgh region. We asked community members, what does child thriving mean to you? We actually used a really rigorous approach called concept mapping.
So you do a lot of brainstorming of ideas, and then you sort and rate those ideas. We asked health professionals and community organization leaders to participate, as well as individual community members.
Dr. Williams: Did you ask schools as well for that?
Dr. Miller: Mm-hmm.
Dr. Williams: Okay.
Dr. Miller: Yep, we asked teachers, librarians, right?
Dr. Williams: Wow, yeah.
Dr. Miller: It was really truly like these kind of listening sessions, but using this really systematic approach so we could say, "Here's the whole range if you start opening things up to think about child thriving." At the time, our senior scientist, Dr. Anna Ettinger, led this work and she has since moved on from The Pittsburgh Study, but I'm immensely grateful to her, because she compiled all of that, plus what we had found in the literature review.
Then we took all those results and went back to our community partners saying, "So, it looks like our thriving framework actually needs to include not only the individual child and their health and wellbeing, but that of their families, safety. Where do kids have fun and joy? And are we thinking about healthy and vibrant communities? Are we thinking about healthy environments like clean air, clean water? Where and how do we bring in racial justice, inclusion, accessibility?"
It was mind-blowing to have a thriving framework and then start looking at measures to say for The Pittsburgh Study, what are all of the different measures for healthy environments, for vibrant communities, for play, for happiness, for family support, right? And start actually pulling from the literature, noting where there were gaps in areas that we're going to have to develop as part of The Pittsburgh Study, but also be able to have this sort of compendium of measures of thriving.
So you would say that alone, pretty darn cool for research and for science, but what's amazing when you shift the center of gravity of work to community members, one of our core team leads, Dr. Jamil Bey who is a geographer by training and runs a non-profit organization called the UrbanKind Institute. So, he really has the UrbanKind Institute sitting in this space translating what are the barriers that get in the way of thriving for children, youth, and families. Jamil goes, "Well, that's super nice that we came up with this thriving framework, but that's not enough."
Dr. Williams: Oh, no.
Dr. Miller: Right?
Dr. Miller: "How do we take that framework and actually put that in the hands of our community members?"
Dr. Miller: So with actually funding that we obtained during the pandemic, we're able to actually work with community members to turn that framework into an app that individual community members can use to look at in my neighborhood, where are we? Where are we in terms of child safety? Where are we in terms of healthy environments? Where are we in playgrounds? Where are we in having places that are safe and supportive for our young people?
Dr. Miller: So, we have what we call our Child Thriving Matrix tool. So again, to have community partners go, "Yeah, not enough, let's push this." We have now obtained funding first from NIH, the National Institutes of Health to design the app, and then recently received funding from the Centers for Disease Control and Prevention to evaluate not only the use of this app, but what happens when you use it as a tool to get community members thinking about transforming their neighborhoods.
So it's about building community leadership, about building community organizing skills, about building that sense of hope and optimism that our communities need, right? Because I started this conversation with doom and gloom, right?
Dr. Williams: Right.
Dr. Miller: We are losing far too many of our young people to gun violence, to substance use, to suicide, but we have to hold on to our love for our neighbors, to hope, to optimism. So the CDC, the Centers for Disease Control and Prevention, is funding us to evaluate this kind of what we call a collective efficacy. That sense that in our neighborhood, we can make a difference as a preventive measure for community violence. We're going to be doing this across 20 neighborhoods as a randomized trial.
Dr. Williams: Oh my goodness.
Dr. Miller: Super exciting.
Dr. Williams: That's huge.
Dr. Agnihotri: That is amazing.
Dr. Miller: Right? It's so much fun, right? This is, I think, the part that often gets missed for our trainees who are like, "I don't know if I could do research." I'm like, "Look at how much joy could come from doing research, and in particular community partnered research." This is really thinking about how we can co-create our research to have impact on child thriving.
Dr. Williams: The journey of that story is just so mind-boggling. I mean, we started by hearing about The Pittsburgh Study, which is going to track kids from birth until high school and go from there, and figuring out that it's not just that end goal, there's so many important steps in between when you work with community partners. Which I think for someone who does not do research and doesn't know the research world very well is astounding, the work you do and the steps you take to answer a question that you haven't even gotten to yet, right?
Dr. Miller: Right.
Dr. Williams: It's amazing.
Dr. Miller: Well, and to add to that actually, and I think Allie you would appreciate this as a clinician, is that we need answers today.
Dr. Miller: Right? We don't want to wait 20 years-
Dr. Williams: 20 years.
Dr. Miller: And neither do our community partners, right? So, what we have built in The Pittsburgh Study is also kind of an incubator for evaluating these interventions. So, what I just described to you in terms of the Child Thriving Matrix sits in a scientific committee called the Policy in Place Committee, right? It's a committee focused on thinking about neighborhood transformation, and it is co-led by Jason Beery, who works for the UrbanKind Institute, so a community leader, and Dr. Mary Ohmer, who is a professor in the School of Social Work.
We have a community collaborative, currently our steering committee for this work, that is made up of people coming from all walks of life, including community members who are individual advocates in their neighborhoods, as well as members of our health department and Department of Human Services. So, we have now scientific committees at every developmental stage from pregnancy all the way into adolescence.
Dr. Miller: So, five developmental cohorts and four what we call cross-cutting committees. So, a committee focused on improving our healthcare delivery system that Dr. Maya Ragavan is leading together with our Community Vitality Collaborative with an incredible group of community members who have worked with us throughout the COVID-19 pandemic on equitable vaccine distribution, equitable distribution of resources. We've moved into all kinds of what do we need to do to improve our healthcare delivery system to be able to better address the social and structural influences on health?
Other cross-cutting committees focus on data and translating data to action, so it's our data accessibility core. We have another focused on environmental justice called Healthy Environments and Strong Bodies. With each of those committees, we've structured it such that there is a community leader and a professional scientist working side by side sharing power, sharing decision-making, and every committee has greater than 50% community member representation.
Dr. Miller: It transforms the way we do our science, and the way in which we communicate our science, we talk about science, but we are also simultaneously building the workforce so that we can actually do research with impact.
So, just a delightful story around workforce development is that Val Chavis, who co-founded The Pittsburgh Study as it is today with me. Val is now working in the Department of Psychology as their community outreach coordinator, so moved from a family support center director into now being a Pitt, a University of Pittsburgh employee. We have numerous examples of community members who have developed skills to be able to now really be part of the research workforce.
Dr. Williams: I feel like there'd be pause for a reason, there's just so much to process with all of this wonderful work that you're doing. Is there anywhere, a website or any sort of resources that we can share with our listeners who want more information about this study or how they could potentially get involved with this study?
Dr. Miller: Yeah, so we are thrilled to welcome anybody to lean in and learn about The Pittsburgh Study. The website is very simple. It's thepittsburghstudy, one word, .org.
Dr. Agnihotri: Easy to remember.
Dr. Miller: It's very easy to remember.
Dr. Williams: That seems appropriate.
Dr. Miller: On that website will be upcoming summits and symposium and so forth, because we are really focused on how do we return research and data to participants and to communities, right?
Dr. Miller: This cannot be a study where we just survey people and say, "Thank you," right?
Dr. Miller: So in fact, with one of the thriving surveys that we've been doing, we had just gotten to 200 participants, so just at a place where we could start maybe analyzing the data. We actually emailed all the participants saying, "Hey, remember you did this survey. Just want you to know we finally got to 200 participants, we're going to start looking at the data and we'll let you know what we learn." It's so wonderful, because then you get these emails back from community members going, "Thank you so much for keeping me updated."
Dr. Miller: Right? That sensibility of we're building a community together is so fun. On that website we'll have those kinds of data sharing events. We have an upcoming Adolescent Health Research Symposium in April, on April 13th. We have another summit focused specifically on sharing data and the ethics of sharing data, May 2nd. Then in June, I'm most delighted that our youth leaders who have been working with us on numerous different interventions will be doing a youth-led summit.
Of course being young people, I'm like, "Could y'all just tell me what day and time we're going to do this," right? So, we'll get to a concrete date and time very soon, but it's going to be a really joyful event to allow young people the space to share the work that they've done over this academic year, share with each other, think about what they want to do next in terms of taking what they've learned and moving it into action.
Some of the work has included middle schoolers, and so these are seventh, eighth graders in the Steel Valley School District who are working with the Office of Child Development to develop their skills on how to engage a kindergarten class, so that these seventh and eighth graders can go into the kindergarten class to read to them.
Dr. Williams: That's nice, yeah.
Dr. Miller: Kind of really developing early childhood literacy skills, but hopefully getting at least a handful of those middle schoolers excited about becoming teachers.
Dr. Williams: Yeah. Oh, well, we are so excited that you were able to spend time with us today talking about your passion projects and this amazing study going on in Pittsburgh. I feel like we're going to have to have you back, because there's so much more that I want to talk about and so many more questions that I want to ask. But if you'd like to learn more about this study, you can go to that website, thepittsburghstudy.org, O-R-G, and we'll have to have Dr. Miller back to talk some more. So, thank you all for listening to That's Pediatrics.
Dr. Agnihotri: Thank you so much.
Dr. Miller: Thank you for having me.
Voiceover: You can find other episodes of That's Pediatrics on Apple Podcast, Google Podcast, Spotify, and YouTube. For more information about this podcast or our guests, please visit chp.edu/thatspediatrics.
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This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgements when advising their patients. Patients in need of medical care should consult their personal care provider.
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