Researchers find children’s health broadly declining in the United States

 A new study led by researchers at Children’s Hospital of Philadelphia (CHOP) has found that children’s health in the United States is declining across several key measurements ranging from increased chronic illnesses, higher rates of physical and mental health conditions and related symptoms, and increased mortality rates compared with other countries. The study also reveals that the issues are broad and systemic and require new ways of thinking about supporting and prioritizing the health of children. The findings were published this week in the Journal of the American Medical Association (JAMA).

The health of children provides an important foundation for the overall health of a country, with healthy children more likely to grow up to be healthy adults. However, recent scientific assessments suggest that the United States is facing a major crisis with poor and worsening health for children, which has stimulated a strong interest in understanding the root causes of these issues.

Most studies focus on singular issues, like anxiety and obesity, but since they are conducted separately, there is a critical gap in knowledge. In this study, researchers suggested that a more effective response to these issues may be to address underlying systemic factors and identify areas to improve the developmental ecosystem for children growing up in America.

“In the course of conducting this study, there wasn’t a single statistic that was startling, but instead comprehensive data over several years including millions of children all pointed to the same trends, which was an overall decline in the health of children and youth,” said senior study author Christopher B. Forrest, MD, PhD, a Professor of Pediatrics at CHOP, Director of the Applied Clinical Research Center, and Director of PEDSnet.

In this study, the researchers utilized data from five nationally representative surveys, national mortality statistics, and a large database of pediatric electronic health records (EHRs) to assess changes in children’s health from 2007 to 2023. The study looked at more than 170 children’s health indicators, including chronic physical, developmental and mental health disorders, mortality, obesity, functional impairments, and physical and emotional symptoms.

The study found that from 2007 to 2022, the death rate for infants younger than 1 year was 1.78 (95% CI, 1.78-1.79) times higher and 1.80 (95% CI, 1.80-1.80) times higher in children between 1- and 19-years-old in the United States compared with 18 countries comparable high-income nations in the Organization for Economic Co-operation and Development (OECD). Prematurity and sudden unexpected infant death accounted for the widest disparities in infants and firearm-related incidents and motor vehicle crashes having the widest disparities among other children.

From 2011 to 2023, the prevalence of 3- to 17-year-old children with a chronic condition rose from 39.9% to 45.7% within the PEDSnet cohort of 10 pediatric medical centers and from 25.8% to 31.0% within the general population. Additionally, rates of obesity, early onset of menstruation, trouble sleeping, limitations in activity, physical symptoms, depressive symptoms and loneliness all increased during the study period.

While the authors strongly advocate for identifying and addressing the root causes associated with these issues, they also strongly advocate for broader methods of addressing them. A developmental ecosystem that connects human relationships, environments and social systems that supports children, particularly those in low-income and marginalized communities, needs to be prioritized and supported with more high-quality early childhood education, better family support, safer neighborhoods and culturally attuned care.

“Children are naturally resilient and adaptive,” Forrest said. “If we can improve the ecosystems that surround them and meet the challenges we identified in this study, we can lay the foundation for a healthier future for our nation’s youth.”

This study was supported by institutional funds managed by the Applied Clinical Research Center at CHOP.

Forrest et al, “Trends in US Children’s Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms.” JAMA. Online July 7, 2025. DOI: 10.1001/jama.2025.9855.

Older characters in young adult literature may be pushing out younger readers

Despite its name, the young adult genre is increasingly dominated by stories about older teens and even adults. But as protagonists get older, younger readers are getting left behind, a University of Mississippi study indicates.  

Ally Watkins, research and instruction librarian at the J.D. Williams Library, published her research into the increasing age of young adult protagonists in the New Review of Children's Literature and Librarianship.  

“I think it's important for any reader to see themselves in a book, whether that be through age or ethnicity or interest or culture,” she said. “But there’s a huge difference in what a 17-year-old is going through and what a 14-year-old is going through, and if the 14-year-old can’t relate to the characters, they might give up. That’s not what we want.”  

Watkins reviewed 10 years of New York Times bestselling young adult novels and found that protagonists are more likely to be 17 years old or older, with fewer and fewer novels focusing on characters in the 13- to 15-year-old range.  

Librarians have been talking about the aging protagonist problem for years, but they have not had research to back up that anecdotal claim, Watkins said.  

“I worked in public libraries for a really long time in youth services,” she said. “So, my colleagues and I were ordering books and reading the galleys, and we saw this problem in real time.  

“One of the things we kept asking ourselves was, ‘Are we losing our younger readers because of this?’” 

During her research, Watkins said she often went to her local library, the Lafayette County and Oxford Public Library, to review the books on the bestseller list. During those visits, she spoke often with Meridith Wulff, head librarian, about the problem.  

Wulff said she and Erica Brady, the library’s youth specialist, have noticed young teenagers and their guardians looking for books that fall between middle-grade and young adult genres, since the young adult section often features more mature themes and older characters.  

“So much of the research shows how important it is for kids to see themselves reflected in the books they read, and that includes books with characters that share traits like their age,” Wulff said.  “When young people read about characters similar to themselves, it validates their own lived experiences and helps them feel less alone.  

“It also plays a huge role in developing empathy, especially when a character shares their age but has a different background or experience.” 

Watkins harkened back to the heyday of young adult novels – the early 2000s and 2010s – when bestsellers like an 11-year-old Harry Potter sat on the shelves alongside Louis Lowry’s 12-year-old protagonist in “The Giver.” Even Stanley Yelnats, the main character in “Holes” by Louis Sachar, is 14.  

More contemporary bestsellers – including Adam Silvera’s “They Both Die at the End,” Angie Thomas’ “The Hate U Give” or Kristen Ciccarelli’s “The Heartless Hunter” – feature main characters who are 17 or older.  

As the young adult genre has spiked in recent years, so too has the age of its readers. According to publishing trends, YA titles with older protagonists often sell better — particularly among adult readers, and more than a quarter of young adult genre readers are 28 or older.  

These older readers could be driving the trend in older protagonists, Watkins said.  

“It’s not really clear why protagonists are getting older, but I think many of the people who were reading YA back in the 2010s are still reading YA now,” Watkins said. “And that’s great – everybody should be able to read whatever they want.  

“But I think when adult readers are influencing the market for younger people, that's where there's a problem.” 

For librarians, educators and parents, the shift means that choosing a book for a young teen may be a little more difficult than simply referring to the category.  

“One of the five laws of librarian science is ‘for every book its reader,’” Watkins said. “People who work with young readers just need to be aware of the trends so that they can personalize their reading recommendations and make sure that the right book is reaching the right reader. 

“If younger readers want to read up, that's great. But if a younger reader wants to read a book about a 14-year-old, I want that to be available for them, too.” 

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Journal

New Review of Children s Literature and Librarianship

DOI

10.1080/13614541.2025.2513193 

 

Do Pensions Enhance Teacher Effort and Selective Retention?

 Theoretical rationales for employer-provided pensions often focus on their ability to increase employee effort and selectively retain quality workers. This study tested these hypotheses using rich administrative data on public school teachers around the pension-eligibility threshold. 

When teachers cross the threshold, their effective compensation drops by over 50 percent of salary due to sharply reduced pension accrual rates. Standard economic models predict this compensation reduction should decrease teacher effort and output, yet the researchers observe no such decline. This suggests that yearly pension accruals near retirement do not meaningfully increase effort. 

Similarly, if pensions selectively retained better teachers, one would expect average teacher quality to decline when the retentive incentive disappears at the threshold. Instead, the researchers find no change in the composition of teacher quality, suggesting pensions do not selectively retain higher-performing workers in late career.

Teens report spending 21% of each driving trip looking at their phone

 

A new study offers a stark reminder of how pervasive cell phone use while driving is for young people, as findings demonstrate teen drivers spend an average of 21.1% of each trip viewing their mobile behind the wheel.   

In a questionnaire completed by more than 1,100 teen drivers across the US, the young motorists estimated that 26.5% of these glances were for two seconds or longer, a duration which dramatically increases their risk for a crash. 

Results, published in the peer-reviewed journal Traffic Injury Prevention, show the most common reason for the distraction was entertainment (65%), followed by texting (40%) and navigation (30%). 

“Distracted driving is a serious public health threat and particularly concerning among young drivers. Driving distracted doesn’t just put the driver at risk of injury or death, it puts everyone else on the road in danger of an accident,” says lead author Rebecca Robbins, PhD, Department of Medicine, Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system.  
 
Distracted driving significantly increases the risk of crashes.  
Across the US, 35 states have banned all types of phone usage for young drivers. However, in a previous national study, 91.8% of adolescents still report “regularly engaging” in at least one distracted driving behavior per trip – such as texting, talking on the phone, or using it for music. 

In this new paper, a team of researchers from Mass General Brigham; Harvard University; the Center For Vehicle, Driver, and Safety Systems at Virginia Tech Transportation Institute; the University of Massachusetts; and the Technical University of Munich, wanted to identify the factors influencing teens in engaging in distracted driving. 

In order to further explore attitudes, social norms, and perceived behavioral control, the authors conducted 20 interviews with high school students. The beliefs identified were incorporated into a 38-item questionnaire, which was put to a US geographic sample of 1,126 participants across the Northeast, Midwest, West, and South. 

Responses indicate that many young drivers believe and understand that distraction at the wheel was associated with negative outcomes, and that their important social referents (like their parents and friends) think they should not drive distracted. 

However, they believe their peers also drive distracted, highlighting the perceived social norm of the behavior. 
 
Another finding from the survey suggests, however, that most teen drivers have a “strong belief” in their ability to withstand the pressure to drive distracted. 

“We found that while young drivers recognize the advantages of using smartphone features like GPS, they also understand the heightened risk of accidents associated with distracted driving,” said Dr. Robbins – who specializes in developing research that uses marketing and communication tools and technologies to design persuasive behavior change interventions to improve sleep and circadian health. 

“Encouraging the use of ‘Do Not Disturb’ mode, keeping phones out of reach and ensuring teens get adequate sleep are effective strategies to mitigate this dangerous behavior.” 
 
The paper aims to assist educators, parents, and local education leaders in creating message-based promotions.  
 
One campaign, the experts suggest, could be aimed at debunking the belief that phone use at the wheel allows one to be productive while driving. 

A limitation of the research is the small sample size used for the semi-structured interviews (n=20), “which may not accurately represent the broader high school-aged driving population,” state the authors. 
 
“In addition,” the authors write, “we excluded schools in urban areas during the qualitative phase, given the lower prevalence of driver’s licenses in these regions. Thus, our results may need to be replicated among urban adolescent drivers to ensure broader applicability”. 
 
However, the authors state that their questionnaire could be used again to interview more young drivers. Such future quantitative research deploying the survey, they write, “can first assess the presence and the strength of these beliefs, then investigate their relationship to behavioral intentions and actual behaviors”. 
 
“This approach can help to illuminate the beliefs most strongly linked to behavioral intentions, guiding the development of targeted interventions,” they conclude. 

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Journal

Traffic Injury Prevention

Group work and discussion help to build student confidence using math in science lessons

 

Group work and giving students time to discuss their work helps to build their confidence in using math in science lessons, a new study shows.

Researchers have found discussion is important because students use different ways to solve problems even if they have been in the same class, taught by the same teacher.

Previous analysis has shown students often find it difficult to use maths in science, even if they have been successful in mathematics courses.

This new study identifies four different ways students attempt to solve math problems in science, even when in the same class.

Opportunity within the classroom to talk, discuss and construct answers collectively to quantitative problems is likely to be as valuable as with any other kind of science learning.

The study was carried out by Victoria Wong, Taro Fujita, Alison Hill and Stuart Ruffle from the University of Exeter.

Dr Wong said: “Our research shows the impact of the different modes of thinking students have. Some are happy to accept numerical answers, others want to understand what they mean and relate to science. Each can lead to successful outcomes and solutions.

“Identifying these patterns in student discourse is an important step to understand how students bring mathematics and science together in problem solving.

“Giving students the opportunity to work through problems in groups exposes them to different ways of thinking about the problem than they might have engaged with had they worked on their own. Learning science is about learning to use scientific words, and talk and discussion amongst students in the classroom is critical to supporting them in developing their use of this language, including mathematical language.

“Learning science is a process of learning the language of science, including words, diagrams, equations and symbols, and using them in a recognisably scientific way.”

Some students who took part in the research showed science-dominant thinking – they used science knowledge to drive doing maths and tried to relate everything back to science. Others did the same with math – they were interested in the numbers and less keen on relating that back to the science specific situation.

Other students were most keen on searching for the right equation, they wanted to pull out all different pieces of information and try and work out how to fit it together. This led to their working becoming less systematic and taking longer. Others had a mental schema, they had a clear idea about how to solve the problem, which made them faster and more confident.

Researchers interviewed students in groups and encouraging them to talk to each other as they worked through problems was a successful strategy to gain insight into students’ thinking processes.

The 21 students – six undergraduate bioscience students and 15 Year 10 and 11 pupils - were interviewed in six small groups of 3 or 4 for between 25 and 40 minutes. The interviews consisted of a series of science problems which used mathematical ideas. The interviews were video and audio recorded. Students were given large sheets of paper and each a different coloured pen and encouraged to write, note or draw anything they wished as they solved the problems.

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Journal

International Journal of Science Education

DOI

10.1080/09500693.2025.2488399 

Sibling study finds early education boosts brain power

 

Columbia public health researchers use innovative family comparisons to isolate schooling’s cognitive benefits, finding the strongest impacts in early education and those from disadvantaged backgrounds

How much does education actually sharpen the mind? A study published in the Journal of Human Capital may help settle this long-standing debate by comparing adult siblings in Indonesia. Led by Yuan Zhang, assistant professor of Sociomedical Sciences in the Robert N. Butler Columbia Aging Center at Columbia University Mailman School of Public Health, the research reveals education’s impact on adult cognition—particularly for people from disadvantaged backgrounds.

Key Findings

• Each additional year of education completed during the first nine years of schooling nearly doubled adult quantitative and abstract reasoning skills.
• Children of less-educated mothers saw a large cognitive gain from basic schooling compared to peers with more-educated mothers, but the benefits diminished at higher levels of their own education. In contrast, among children of more-educated mothers, the cognitive benefits of education were more consistent across all levels of education.
• These cognitive benefits aren’t fleeting. Decades after participants left school, those with more education maintained sharper quantitative skills and abstract reasoning abilities.

“Our study demonstrates education’s unique power to disrupt cycles of disadvantage,” says Zhang. “This lifelong dividend underscores schooling’s role not just in childhood development but in sustaining cognitive health across the adult lifespan. These results are a roadmap for reducing inequality. Early investments in universal basic education pay double dividends—stronger minds today and healthier aging tomorrow.”

Sibling Study

The team analyzed over 20 years of data from Indonesian families with a remarkably high recontact rate. By comparing brothers and sisters—who share genetics, parents, and childhood environments—researchers isolated education’s unique effects on quantitative and abstract reasoning separate from family background factors common to siblings.

“Imagine two siblings raised together,” explains Zhang. “If one sister completes high school while her sister only finishes primary school, any cognitive differences between them in adulthood are likely due to those extra years of education—not family background.”

To validate this approach, researchers conducted a placebo-type test using height, which schooling doesn’t affect. While education initially appeared linked to height when comparing individuals among those studied, this connection vanished when comparing siblings—confirming their method’s rigor.

Additional co-authors of the paper “Education and Adult Cognition in a Low-Income Setting: Differences among Adult Siblings” Elizabeth Frankenberg, University of North Carolina at Chapel Hill, and Duncan Thomas, Duke University.

The study is funded by the National Institute on Aging (grant AG070274) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD050924, HD091058).

The authors declare they have no other relevant financial or nonfinancial interests to disclose.

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Journal

Journal of Human Capital

DOI

10.1086/734385 

Support networks may be the missing link for college students who seek help for excessive drinking

 

College students who want help overcoming high-risk drinking could benefit from a two-pronged approach that combines an individual-focused psychological theory with social network analysis.

That’s according to a new study from Texas A&M University School of Public Health Assistant Professor Benjamin Montemayor and former doctoral student Sara Flores, both in the Department of Health Behavior.

High-risk drinking is defined as drinking resulting in a blood alcohol concentration of 0.08% or higher, the legal threshold for intoxication in the United States.

For more than three decades, between 30% and 40% of college students in the United States have engaged in this behavior, and today, about 16% meet the criteria for alcohol use disorder, informally known as alcoholism.

“Still, less than 10% seek help, even when they know they have a problem and even though many colleges and universities have significantly expanded their mental health and substance use resources in recent years,” Montemayor said. “We wanted to understand what psychological and social factors might help bridge this gap.”

The research, published in the Journal of Studies on Alcohol and Drugs, combines the Reasoned Action Approach with social network analysis to provide a more comprehensive understanding of help-seeking intentions.

“The Reasoned Action Approach examines how our beliefs about a behavior, what we think others would expect, and our perceived control over the situation influence our intentions to go through with a behavior,” Flores said. “Integrating social network analysis lets us also explore how these students are influenced by the people closest to them regarding their intention to seek help.”

For the study, Flores analyzed data collected from 1,447 full-time college students aged 18 to 24 who reported consuming alcohol within the past year. Participants completed surveys about their alcohol use, attitudes toward seeking help and perceptions of alcohol use disorder stigma.

The students also identified up to five individuals to whom they felt closest, which Flores said provided insight into the social networks that may influence students’ decisions to seek support.

Statistical analyses revealed that the Reasoned Action Approach variables were important in shaping students’ intentions to seek help for alcohol use, accounting for nearly 40% of the variance in these intentions. The addition of social network characteristics increased the variance by a statistically significant 2.8%.

“This combination revealed something important that neither framework alone would have captured,” Flores said. “Students who believed that their closest connections strongly supported them in seeking help reported greater intentions to do so.”

This finding suggests that campus health services should leverage both frameworks, she said.

“Campus-based programs might consider not only addressing students’ perceptions about help-seeking but also identify and engage supportive friends and family members who may positively reinforce help-seeking intentions,” she said.

Flores noted that the research did not test the interventions directly.

“Still, it provides a theoretical foundation for creating more effective approaches to help students move from recognizing a drinking problem to seeking the help they need,” she said.

By Ann Kellett, Texas A&M University School of Public Health

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Journal

Journal of Studies on Alcohol and Drugs

DOI

10.15288/jsad.24-00280