Higher fluoride levels during pregnancy = differences in children's cognition scores

  Pregnant mothers who lived in neighborhoods where public drinking water fluoride levels were near or above the current U.S. recommended levels, tended to have children who scored lower on tests of fluid reasoning as fluoride levels increased, according to a new study supported by the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program. The findings are published in the American Journal of Epidemiology.

Fluoride occurs naturally in some water sources and is commonly added to public water systems to help prevent cavities. The paper’s authors note that a recent National Toxicology Program review examined evidence linking fluoride exposure levels above 1,500 micrograms per liter in drinking water with lower IQ scores in children. However, most U.S. public water systems have lower fluoride levels, and questions remain about associations at lower levels typically found in the United States.

ECHO researchers looked at whether fluoride levels in public drinking water during pregnancy were related to cognitive scores assessed during childhood.

"This study addresses an important gap by evaluating prenatal water fluoride and child cognition in a large U.S. sample," said lead author Katrina Simon, PhD, in the Department of Environmental Health Sciences of Columbia University Mailman School of Public Health. "Findings from this work offer evidence that can inform ongoing guidance aimed at supporting children's development."

Researchers reported that children whose mothers had higher estimated fluoride levels in public drinking water during pregnancy tended to score lower on tests of fluid cognition that include problem-solving, memory, attention, and the ability to adapt to new information. Higher water fluoride levels were only linked to lower fluid cognition scores when water fluoride levels were near and above 675 micrograms per liter, which is close to the current U.S. Public Health Service recommended level of 700 micrograms, or 0.7 milligrams, per liter for fluoridated water. The current regulatory level set by EPA is higher at 4,000 micrograms per liter. Above 675 micrograms per liter, each 500 micrograms per liter increase in fluoride was associated with an average 3.36-point lower score on the standardized fluid cognition scale.

Researchers also found that the relationship between prenatal fluoride levels and cognition was specific to fluid cognition. Importantly, the study did not identify a link between fluoride and crystallized cognition, which includes learned knowledge such as vocabulary, across all ages.

In addition, the associations appeared stronger when cognition was assessed at a younger age. Children younger than 7 years of age showed larger differences in cognition scores associated with higher prenatal fluoride exposure compared to older children. Additional research is needed to better understand these age-related findings. 

The study included 2,514 children born between 2006 and 2019 who completed cognitive testing between ages 3 and 17.

To estimate prenatal water fluoride exposure, researchers linked publicly available drinking water fluoride measurements to residential address information collected during pregnancy from ECHO participants. The study focused specifically on fluoride levels in public drinking water systems and did not measure total fluoride exposure from all possible sources, such as toothpaste, tea, foods, supplements, bottled water, or private wells.

Researchers then compared these estimates with children's performance on NIH Toolbox cognition assessments, while accounting for factors such as parental education, parental age, prenatal tobacco exposure, child sex, season of conception, and neighborhood characteristics.

“Because our study used fluoride measurements from public water systems that are collected as part of routine drinking water monitoring, the findings may help inform future evaluations of public drinking water guidelines,” said co-senior author Anne Nigra, PhD, also of Columbia University Mailman School of Public Health.

Community water fluoridation has long been used as a public health measure intended to reduce tooth decay. The current study does not evaluate the overall benefits and risks of community water fluoridation

“This study adds to a large body of work that looks at how early exposure to environmental contaminants may be associated with the development of the thinking and learning processes that are important for children’s developmental outcomes,” said co-senior author Amy Margolis, PhD, of The Ohio State University Wexner Medical Center and College of Medicine. “Continuing to study fluoride and other exposures will be integral in best supporting children’s environmental health and well-being.”

The researchers emphasize that this was an observational study. The findings demonstrate an association between prenatal fluoride exposure and children's cognition, but they do not prove that fluoride caused differences in cognitive performance. 

The authors noted that future research could focus on when children may be most sensitive to fluoride exposure and examine both potential developmental risks and dental health benefits to better understand relationships between fluoride exposure and child health. 

A full list of co-authors and their institutions can be found in the paper.

 

About ECHO 
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org. Read the Research Summary on the ECHO website.

NYCPS 8th graders could be getting into more competitive schools

 Many New York City eighth-graders – particularly those from underserved communities – aren’t applying to academically competitive high schools where they could succeed, according to new Cornell University research.

In partnership with New York City Public Schools (NYCPS), the research team is putting its findings into practice to help combat the phenomenon, known as “undermatching.”

“It’s a crazy complex process for how students apply and then match with high schools in New York City,” said Nikhil Garg, assistant professor of operations research and information engineering at Cornell Tech and the Cornell Duffield College of Engineering. “With that flexibility and equality of access comes the challenge of figuring out how to navigate 900 options and decide which ones to apply to,” says Garg, a co-author of the paper, “Connecting Application Behavior to Undermatching in New York City School Choice,” published Aug. 18 in Nature Cities.

The researchers analyzed data from nearly 59,000 students who participated in New York City’s high school admissions process during the 2022-23 school year. They looked not only at where students were admitted, but where they could have been admitted had they applied to different schools. By combining admissions data with a model of how students choose schools under uncertainty, the team assessed whether students could have applied to higher-performing programs, and where their application behavior may have limited their options.

The researchers found that, on average, New York City students enrolled in schools that admitted about 64% of applicants, even though they could have been admitted to schools that admitted only about 37% of applicants, suggesting many students were not applying to the most competitive schools within reach.

This gap was highest for students with the most competitive applications, and for Black, Hispanic and lower-income applicants – a finding that raised questions about whether the complexity of the application process itself was driving inequities in student behavior and outcomes, the researchers said.

A second paper examines how personalized recommendation systems can help students navigate the high school admissions process. Led by doctoral student Erica Chiang, the new system developed by researchers and deployed by partners at NYCPS delivered personalized email recommendations to applicants during the 2025-26 admissions cycle.

Messages were sent to students attending middle schools that historically sent relatively few students to high-performing high schools and highlighted nearby programs where students had a strong predicted chance of admission. In a randomized controlled trial, students who received the recommendations were 59% more likely to apply to a recommended program than students who did not receive them.

Providing recommendations in a capacity-constrained admissions system presents unique challenges, the researchers found. “Since each school has a limited number of seats, one student’s choices can affect outcomes for others,” Chiang said. “Recommending the same school to too many students could make the school more competitive than students were led to expect, and that could harm students or decrease trust in the match process.”

Ultimately, Garg said success will be measured by whether the system helps the city deliver on its promise of equitable access. “The vision is to close the gap between the goals of the system and the on-the-ground realities,” he said. “We want to make sure that the difficulty of the process is not preventing students from accessing the schools they are entitled to attend.”

For additional information, read this Cornell Chronicle story.

School program combining social-emotional learning with breathwork increased social connectedness

 among girls carrying the heaviest trauma histories

School-based mental health programs face a persistent problem: the students who need help most often benefit least. A new UCLA study found the reverse. Among teenage girls in a program combining structured breathing techniques with social-emotional learning, those who had experienced the highest levels of childhood trauma showed the largest gains in social connectedness, according to findings published in the Journal of Research on Adolescence.

The results arrive as young people increasingly report loneliness and turn to technology, rather than to each other, for friendship and emotional support. Girls who have faced significant childhood adversity are already at heightened risk for anxiety, depression, substance misuse and academic failure.

The trial randomly assigned two Southern California high schools to receive the SKY Schools program, developed by the nonprofit International Association for Human Values, either during the study period or after it. The SKY Schools program combines a social-emotional learning curriculum with SKY Breathing, which is short for Sudarshan Kriya Yoga, a technique that uses specific rhythms of breath to regulate the body’s stress response.

The study followed 174 female teenagers with varying levels of adverse childhood experiences, or ACEs. More than 93% of students at both schools were Latinx, and the two groups were comparable at the outset in levels of childhood adversity and in social connectedness. The wait-list comparison school received the program after the study period ended.

Students in the intervention group completed the four-week SKY Schools curriculum, then practiced the breathing techniques together during their physical education classes every school day for the following eight weeks: about five minutes of short breathing techniques on four days each week and one 25-minute SKY Breathing session on the fifth for a total of 40 sessions. During this time, students in the comparison school completed the assessments on the same timeline without receiving the intervention.

Experiencing four or more ACEs is considered a high level of childhood adversity and is associated with substantially greater risk for mental and physical health problems later in life. Girls in the intervention group who experienced four or more ACEs reported a 7% increase in social connectedness. This was a significantly larger improvement than among peers in the low-ACE intervention group or in the high- and low-ACE wait-list groups.

“What’s striking is that the girls who needed help the most benefited the most,” said Dara Ghahremani, research professor at UCLA’s Semel Institute for Neuroscience and Human Behavior and the study’s senior author. “These are adolescents who have already faced significant adversity, and we found that a relatively simple, scalable approach combining social-emotional skills training with breathing techniques can help them feel more connected and develop a greater sense of belonging. When students are better able to regulate their own stress, they're better able to connect with the people around them.”

“That connectedness matters enormously for protecting mental health during a developmental period when isolation can have lasting consequences,” Ghahremani said.

The results point toward something schools can act on now. As districts nationwide search for low-cost, scalable ways to support student wellbeing and amid persistent disparities in mental health access for Latinx communities, the study offers early evidence that breath-based, trauma-informed social-emotional programs may be a promising tool, particularly for the students who need it most.

SKY Schools is offered by the International Association for Human Values, a nonprofit organization. The program provides social-emotional learning for students and educators, centered on SKY Breathing. In addition to breathing techniques, it incorporates stretching and games involving physical activity, alongside training in self-regulation, leadership and conflict management.

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Journal

Journal of Research on Adolescence

DOI

10.1111/jora.70228  

White paper on building and scaling competency-based education programs

 

University of Phoenix has released a new white paper detailing the institution's approach to designing, implementing and scaling competency-based education (CBE) programs for working adult learners. Drawing on more than six years of program development and experience supporting more than 5,000 CBE graduates, the publication provides insights into the strategies, technologies and continuous improvement processes used to build the University's competency-based education model.

The white paper, “A Holistic Perspective to Creating Successful CBE Programs at Scale,” explores how the University designed and launched a competency-based education framework as an alternative learning modality within select programs. The publication outlines the development of a non-term academic structure, the redesign of courses around demonstrated competencies, and the implementation of learning tools and technologies intended to support adult learners.

“Competency-based education allows us to rethink traditional approaches to program design and content delivery with the needs of working adults at the center of the learning process,” said Marc Booker, Ph.D., vice provost of Strategy at University of Phoenix and co-author of the paper. “This white paper shares the lessons we learned throughout that journey, from building the initial framework for this innovative design to continuously refining the model. We hope these insights contribute to ongoing conversations about how institutions can create flexible pathways that help learners advance their education while demonstrating learning in a competency based framework that strengthen skills signals to employers.”

Designing a Competency-Based Education Model for Adult Learners

According to the white paper, the University's competency-based education model was developed to support learners seeking greater flexibility in how they progress through graduate-level coursework. The CBE framework was engineered to operate within a non-term academic structure and was built through a comprehensive redesign of program courses focused on demonstrated mastery of competencies.

The publication details how the University leveraged learning technologies and support systems designed to improve the student experience while reducing the cost of program delivery.

Continuous Improvement Through Feedback and Innovation

The white paper also examines the role of agile methodologies and continuous improvement practices in the evolution of the competency-based education model. Student and faculty feedback informed ongoing adjustments to academic and support services, enabling the University to refine program delivery and address emerging learner needs.

These iterative improvements contributed to the growth of the University's competency-based education offerings and the expansion of programs that have now served more than 5,000 graduates over a little more than six years.

Sharing Lessons Learned in Scaling Competency-Based Education

Developed as a resource for higher education leaders and practitioners, the white paper offers a behind-the-scenes perspective on the challenges, opportunities and operational considerations involved in designing and scaling competency-based education programs.

As detailed in the publication, the framework created a pathway through which qualified students in select graduate programs may complete a degree in less than one year for less than $11,000, while maintaining a focus on educational quality, learner support and workforce-relevant skill development.

The white paper was authored by a multidisciplinary team of University of Phoenix faculty and leaders with expertise in competency-based education, student success, learning innovation and academic strategy. Authors include Dan Barker, director of student services; Marc Booker, Ph.D., vice provost of strategy; Justin Hallock, senior director of change management and Prosci Certified Change Practitioner; Niraj Kohli, practitioner faculty; Leanna Montoya, senior faculty training specialist; Mary Elizabeth Smith, director of learning innovation strategy in the Center for Teaching and Learning; Joe Tate, senior director of program and policy implementation and associate faculty; Kari Vorderlwandwehr, senior faculty training specialist; and Roy Whitmore, program chair in the College of Business and Information Technology.

The white paper is available for download here.

Can dogs help teens cope with peer stress?

New study links certain teen–dog relationship qualities to healthier coping strategies among adolescents with social anxiety

About one in 10 teenagers experience social anxiety—persistent and disruptive worries about being judged by their classmates and other peers. In a new study of adolescents with social anxiety, researchers at Cummings School of Veterinary Medicine at Tufts University found that certain qualities of teens’ relationships with their pet dogs were associated with healthier ways of coping with peer-related stress. 

The study, published in the Journal of Adolescence, analyzed survey responses from 514 U.S. adolescents ages 13 to 17 and a parent of each teenager surveyed. Researchers examined whether specific aspects of the teen–dog relationship—such as affection, companionship, caring for the dog, emotional support, friction, and viewing the dog as a substitute for people—were linked to different coping styles.  

The findings suggest that the nuances of a teen’s unique relationship with their dog may affect how a pet dog contributes to healthy development, sometimes in unexpected ways. For example, the researchers expected that feeling emotional support from a dog would be linked more often to healthier coping strategies and less often to maladaptive ones. However, the results indicated the opposite: feelings of emotional support were less likely to be associated with positive thinking and more likely to be associated with persistently dwelling on negative thoughts. 

The researchers undertook the study to assess how dogs may help teens cope with social stressors in a positive way during a life stage that can feel a bit like an emotional rollercoaster.  

“During adolescence, teenagers develop their sense of self,” said Megan Mueller, Ph.D., the study’s senior author and an associate professor in the Department of Comparative Pathobiology at Cummings School. “Teenagers undergo a natural shift, with peers replacing parents as their primary relationships. There’s naturally some emotional churn during this transition, which can cause a lot of anxiety for some kids.”  

“Dogs in many ways bridge the space between family and peers,” continued Mueller, who is also director of the Pets and Wellbeing (PAW) Lab at Cummings School. “They’re obviously not your parents, but they’re part of the family unit and may serve as a familiar source of comfort. We were curious if relationships with companion animals, and dogs in particular, may be one way of supporting effective coping through social support and emotion regulation.” 

For the study, the researchers selected teen participants with high levels of social anxiety. Both teens and parents responded to questionnaires collecting data about the teen’s relationship with their dog and how the teen copes with stress from peers. The scientists used statistical models to identify links between specific aspects of the dog-human relationship and various coping behaviors reported by the teens and parents. 

“We wanted to see if certain dog-relationship qualities were associated with either productive or less-effective coping strategies,” said Nicole Mason, the study’s lead author and a Ph.D. student at Cummings School.   

The study found that companionship and caring for the dog both were linked to adolescents coping with peer stress in healthier ways, such as through problem solving, positive thinking, emotional regulation, and emotional expression.  

Feeling affection toward a dog was not significantly associated with either healthier or less-healthy coping styles. 

Friction—like getting frustrated over a dog’s shoe-chewing habit—was linked to less-healthy coping strategies for peer stress, such as avoidance, denial, rumination, and emotional numbing.  

Viewing dogs as substitutes for people—for example, reporting that the pet dog is a more important friend than any peer—also was linked to less-healthy coping strategies. “One possible explanation is that a dog becoming a teen’s main source of social support may reflect a lack of other social connections,” said Mueller.  

“Future studies will help us understand that relationship and other potential dynamics at play more clearly,” Mueller said. “We’re now following teens and their dogs over time to better understand how these relationships develop and whether factors such as a dog’s personality, behavior, and compatibility with a teen influence their coping and well-being."  

From Google to ChatGPT: Students are changing how they search for knowledge

Bar-Ilan University research finds AI is reshaping information-seeking behavior worldwide, with the greatest impact in non-English-speaking countries

Students around the world are increasingly turning to artificial intelligence tools such as ChatGPT to find answers to questions about physics, according to a new study led by researchers at Bar-Ilan University.

The study, conducted by Dr. Yossi Ben-Zion and Omer Michaeli of Bar-Ilan University's Department of Physics in collaboration with Prof. Noah Finkelstein of the University of Colorado Boulder, was just published in Physical Review Physics Education Research.

Analyzing search data from more than 20 countries between 2022 and 2025, the researchers found a consistent decline in Google searches for physics concepts, alongside a similar decrease in visits to related Wikipedia articles, coinciding with the rapid adoption of generative AI tools.

“The findings do not suggest that students are learning less,” said Ben-Zion. “Rather, they indicate that many students are shifting from searching across multiple websites to receiving direct, conversational explanations from AI systems.”

One of the study's most striking findings is the difference between English-speaking and non-English-speaking countries. In the United States, the United Kingdom and Australia, Google searches for many physics topics remained relatively stable. In contrast, many non-English-speaking countries experienced substantial declines.

The researchers propose that AI may be acting as an educational equalizer by allowing students to receive clear, high-quality explanations in their native language rather than relying primarily on English-language educational resources.

“Generative AI has the potential to reduce the ‘language tax’ faced by millions of students,” the researchers explain. “By making complex scientific concepts more accessible in many languages, these tools may help democratize access to knowledge.”

The study also found that the transition to AI depends on the nature of the subject matter. Google searches declined much more sharply for physics topics that can be explained primarily through text and logical reasoning than for topics that rely heavily on diagrams, graphs and other visual representations.

According to the researchers, this pattern likely reflects the current strengths and limitations of large language models. While AI excels at generating clear verbal explanations, it remains less effective for learning tasks that require sophisticated visual understanding.

The research was based on Google Trends, Google's platform for tracking relative search activity over time and across countries. The team used searches for physics concepts as a proxy for learning-related information seeking. To determine whether the observed trend was unique to Google, they also analyzed page views for physics articles on Wikipedia in seven different languages and found similar patterns.

The findings offer one of the first large-scale, international looks at how generative AI is transforming students' information-seeking behavior, raising important questions about the future of science education and how educational resources should evolve in the AI era.

 

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Journal

Physical Review Physics Education Research

DOI

10.1103/g1vh-fl9s 

Video games built for prevention can reduce teen depression

 Few parents or teachers are likely to suggest that teenagers could benefit from playing more video games. But a new study suggests that a growing class of educational games may be a highly effective tool for treating and preventing depression in adolescents.

Dartmouth researchers recruited 532 high school students for one of the largest clinical trials of a video game designed to raise teens' awareness of mental health issues and substance abuse, according to a report in JAMA Network Open.

The team tracked 269 students who engaged with PlaySmart, a digital behavioral health game developed in the play2PREVENT Lab led by Lynn Fiellin, the study's senior author and a professor of biomedical data science and medicine in Dartmouth's Geisel School of Medicine. 

These students played the game for about an hour after school once a week for up to six weeks. The other 263 students in the trial played commercial role-playing games with no therapeutic content. The researchers followed up with both groups for one year.

One year after the trial, teenagers in the PlaySmart group reported reductions in symptoms of depression that matched or doubled the documented effects of general school-based programs, the study finds. They also reported having a more positive attitude toward seeking psychological care after only six weeks of gameplay.

"One of the biggest challenges in adolescent mental health is that many young people never receive care because of barriers including stigma, limited access to providers, or just not recognizing they could benefit from help," says Caroline Barry, the study's first author. 

"Because behavioral health games like PlaySmart are digital and self-guided, they have tremendous potential to reach adolescents across a wide range of settings who might not otherwise receive care, including communities where access to mental health services is very limited," says Barry, who is a postdoctoral research fellow in the play2PREVENT Lab and the Center for Technology and Behavioral Health (CTBH) at Dartmouth.

Better choices, better outcomes

In PlaySmart, players are the main character of a story in which they navigate scenarios based on experiences that the Fiellin Lab gathered from real teenagers and other stakeholders when they were first developing the game. Behavioral health experts in the lab documented instances of healthy and unhealthy decision-making and identified blind spots in teens' health knowledge.

The game presents students with a series of tasks and choices, such as identifying signs of depression in a friend's room or deciding to turn to a trusted adult for help with a difficult situation. Better choices lead to more positive outcomes for the player and other characters in the game, while bad choices lead to more negative outcomes. 

Players also can work backward through the game to analyze their decision-making, learn recommended approaches to identifying and managing depression, and explore what might have happened had they made different choices.

"One of the biggest challenges in adolescent mental health is that many young people never receive care."

The PlaySmart trial was conducted from October 2021 to February 2024, with data analysis completed in November 2025. Students in the study were between the ages of 16 and 19 and recruited from school-based health programs across Connecticut, where Fiellin first established her lab when she was a faculty member at Yale University. 

They were eligible to participate if they had reported vaping or consuming alcohol, cannabis, or nonopioid drugs within the past 30 days, or if they reported heightened symptoms of depression. Anyone with prior opioid misuse was excluded from the study.

"Serious games for prevention and mental health promotion are a rapidly growing area, but the evidence base is still emerging," Fiellin says. "Few clinical trials in this space combine a randomized design with commercial games as an active control and a 12-month follow-up. The rigorous design of our study alone sets a high bar for demonstrating impact."

About 53% of the 532 students were male, the researchers report. Around 45% were Black and 38% were Hispanic, with both groups having reported among the nation's highest rates of sadness and hopelessness. 

Yet, exploratory analyses of the study data show no significant differences in PlaySmart's effect based on sex, race, grade level, food insecurity, or family history of substance use, Barry says. "The benefit held across all subgroups, which matters for an intervention meant to be delivered schoolwide or in communities broadly," she says.

Fiellin and Barry co-authored the study with Tyra Boomer, deputy director of the play2PREVENT Lab and a research project director in CTBH; Katie Haile, the Fiellin Lab's project manager and a research project director in CTBH; and Haiyi Xie, a Dartmouth professor of biomedical data science and community and family medicine who conducted statistical and data analysis. 

'Fully self-guided by students'

PlaySmart originated as one of 10 projects nationwide selected by an initiative from the National Institute on Drug Abuse and the National Institutes of Health called HEAL, or Helping to End Addiction Longterm, to design and test new interventions for opioid misuse.

The study in JAMA Network Open is the second in a planned series of papers evaluating various effects of PlaySmart that are all based on the same clinical trial. A study led by Boomer and published in the January issue of Nature Health reports that students in the PlaySmart group retained a greater awareness of the harms of opioid abuse following the conclusion of gameplay. 

The Dartmouth team's latest findings are significant when compared to what is normally achieved by universal preventative programs, such as those in a school, that target large populations before symptoms escalate. These can include classroom lessons or small, organized group conversations with teacher advisers where students focus on recognizing and addressing depression in themselves and in peers.

"These programs are delivered broadly, and adolescent mental health is influenced by many factors outside of any single intervention. That's why the prevention literature generally reports modest effect sizes," she says.

A pair of studies from 2017 and 2021 found that depression prevention programs result in small changes in how people score on the eight-point Patient Health Questionnaire, or PHQ-8, a self-reporting tool used in surveys and by clinicians to detect and monitor major depression. Scores range from 0 to 24, with the higher numbers indicating more severe symptoms. 

Teenagers in the PlaySmart group had PHQ-8 depression scores that were 1.12 points lower one year later than the scores of students who did not play the game. This difference is typical of universal and targeted prevention programs and at the upper end of what has been reported in existing studies.

"PlaySmart sits right at the top of the range and was achieved with an in-school digital behavioral health game that's fully self-guided by the students and requires no onsite clinician," Fiellin says. 

A comprehensive 2024 study of short-term school-based intervention programs also finds that marked reductions in PHQ-8 scores rarely last more than six months, with an average decrease of only 0.1 points a year later. "PlaySmart's effect at one year was more than double that benchmark and in a format schools can easily and consistently deliver," Fiellin says. 

PlaySmart is one of five games developed by Fiellin's group that have been implemented in several school districts and other youth-facing organizations. The games are provided through her spin-off company, Playbl, which is independent from her lab at Dartmouth. 

"Right now, PlaySmart is deployed to all students as a universal intervention geared toward prevention," Fiellin says. "However, our new findings suggest this game may have a critical role in increasing the access that young people identified as having more significant struggles with depressive symptoms have to an intervention."

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2026.29173