COVID-19

Adolescents Born Preterm Were Less Likely to Engage in Unhealthy Behaviors During the COVID-19 Pandemic

Posted on by Jodi Snare

Adolescents who were born preterm were less likely to report unhealthy behaviors during the COVID-19 pandemic, according to a recent ECHO Cohort study led by Michael O’Shea, MD, MPH, of the University of North Carolina, Chapel Hill.

The COVID-19 pandemic affected many adolescents’ mental health, daily routines, and social lives. Some adolescents may have been especially vulnerable, including those born preterm (<37 weeks). Previous research suggests adolescents born preterm may be less likely to take part in unhealthy behaviors, such as drinking alcohol or using marijuana.

Using data from more than 2,000 adolescents participating from 13 ECHO Cohort Study Sites across the United States, researchers compared self-reported measures of health and well-being among adolescents born at different stages of pregnancy. Participants completed surveys between March 2020 and March 2023 that assessed overall health, life satisfaction, and sense of meaning and purpose.

ECHO researchers looked at self-reported surveys from over 2,000 adolescents from thirteen ECHO Cohort Study Sites across the United States to better understand how adolescents born at different stages of pregnancy coped with the COVID-19 pandemic. Participants completed surveys about changes in healthy behaviors, unhealthy behaviors, social connection, and how the pandemic affected their lives between April 2022 and June 2022.

Compared with adolescents born at term, adolescents born preterm were less likely to say they drank alcohol, used marijuana, or took part in at least one unhealthy behavior. Healthy or prosocial behaviors were common across all adolescents included in this study. More than half of the adolescents reported doing at least one positive activity, such as spending more time with family, reading, doing puzzles, practicing mindfulness, or talking with others. Girls born preterm showed more pronounced differences in positive and unhealthy behaviors. Girls born extremely preterm (<28 weeks) were more likely to report healthy or prosocial behaviors. Adolescents born moderate or late preterm (between 28 and 37 weeks) reported feeling more socially connected during the pandemic, compared to before the pandemic, but they were also more likely to say the pandemic had a negative overall effect on their lives.

The findings of this study suggest that adolescents employed multiple strategies to cope with the psychological stressors associated with the pandemic and that adolescents born preterm, as compared to those born at term, were less likely take part in an unhealthy behavior and equally likely to take part in a healthy coping behavior.

The study authors suggest that in future national crises similar to the COVID-19 pandemic, these findings may help physicians and parents be better prepared to support adolescents, including adolescents born preterm. Additional studies could also help researchers identify counseling strategies that support healthy coping, family communication, and adolescent well-being during future pandemics, natural disasters, or other major disruptions.

This collaborative research, titled “Child health-related behaviors, social connectedness, and impact of the COVID-19 pandemic on children born preterm in the ECHO Cohort,” is published in BMC Pediatrics.

Adolescents Born Preterm Were Less Likely to Engage in Unhealthy Behaviors During the COVID-19 Pandemic

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Adolescents Born Preterm Were Less Likely to Engage in Unhealthy Behaviors During the COVID-19 Pandemic

Authors: Michael O’Shea, et al.

KEY TAKEAWAYS:

  • Compared with adolescents born at term, adolescents born preterm were less likely to say they drank alcohol, used marijuana, or took part in at least one unhealthy behavior during the COVID-19 pandemic.
  • Adolescents born moderate or late preterm (between 28 and 37 weeks) reported feeling more socially connected during the pandemic, compared to before the pandemic, but they were also more likely to say the pandemic had a negative overall effect on their lives.

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Adolescents Born Preterm Were Less Likely to Engage in Unhealthy Behaviors During the COVID-19 Pandemic

 

Who sponsored this study?

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

 

Why was this study needed?

The COVID-19 pandemic affected many adolescents’ mental health, daily routines, and social lives. Some adolescents may have been especially vulnerable, including those born preterm (<37 weeks). Previous research suggests adolescents born preterm may be less likely to take part in unhealthy behaviors, such as drinking alcohol or using marijuana. ECHO researchers wanted to know whether adolescents born preterm responded to the pandemic differently from adolescents born at term. They looked at health-related behaviors, social connection, and how adolescents felt the pandemic affected their lives.

 

What were the study results?

Adolescents born preterm were less likely to report unhealthy behaviors during the COVID-19 pandemic. Compared with adolescents born at term, adolescents born preterm were less likely to say they drank alcohol, used marijuana, or took part in at least one unhealthy behavior. Healthy or prosocial behaviors were common across all adolescents included in this study. More than half of the adolescents reported doing at least one positive activity, such as spending more time with family, reading, doing puzzles, practicing mindfulness, or talking with others.

Girls born preterm showed more pronounced differences in positive and unhealthy behaviors. Girls born extremely preterm (<28 weeks) were more likely to report healthy or prosocial behaviors. Adolescents born moderate or late preterm (between 28 and 37 weeks) reported feeling more socially connected during the pandemic, compared to before the pandemic, but they were also more likely to say the pandemic had a negative overall effect on their lives.

 

What was the study's impact?

The findings of this study suggest that adolescents employed multiple strategies to cope with the psychological stressors associated with the pandemic and that adolescents born preterm, as compared to those born at term, were less likely to take part in an unhealthy behavior and equally likely to take part in a healthy coping behavior. The study authors suggest that in future national crises similar to the COVID-19 pandemic, these findings may help physicians and parents be better prepared to support adolescents, including adolescents born preterm. Additional studies could also help researchers identify counseling strategies that support healthy coping, family communication, and adolescent well-being during future pandemics, natural disasters, or other major disruptions.

 

Who was involved?

The study included 2,135 adolescents age 13 to 21 years and their caregivers from 13 ECHO Cohort Study Sites. Of these participants, 419 were born extremely preterm, 118 were born moderate or late preterm, and 1,598 were born at term.

 

What happened during the study?

Participants completed ECHO COVID-19 questionnaires between April 2020 and June 2022. The questionnaires asked adolescents about changes in healthy behaviors, unhealthy behaviors, social connection, and how the pandemic affected their lives. Researchers compared responses from adolescents born extremely preterm, adolescents born moderate or late preterm, and adolescents born at term. They also considered factors such as age, timing of questionnaire completion, caregiver education, and differences by child sex.

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

 

Where can I learn more?

Access the full journal article, titled “Child health-related behaviors, social connectedness, and impact of the COVID-19 pandemic on children born preterm in the ECHO Cohort,” in BMC Pediatrics.

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

Published July 20, 2026

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Teens Born Extremely Preterm Report Positive Well-Being During the COVID-19 Pandemic

Posted on by Jodi Snare

Teens who were born extremely preterm—before 28 weeks of pregnancy—reported overall health similar to their peers born at term during the COVID-19 pandemic, according to a new ECHO Cohort study led by Elisabeth McGowan, MD, of Brown University. The findings suggest that many teens born extremely early may experience positive well-being and resilience, even during times of significant disruption.

The COVID-19 pandemic changed daily life for children and teens across the United States. School closures, reduced social activities, and changes to family routines raised concerns about how young people were coping emotionally and socially. Researchers were particularly interested in understanding how these challenges affected teens born preterm, who are often considered at greater risk for health and developmental difficulties.

Using data from more than 4,000 teens participating in the ECHO Cohort, researchers compared self-reported measures of health and well-being among teens born at different stages of pregnancy. Participants completed surveys between March 2020 and March 2023 that assessed overall health, life satisfaction, and sense of meaning and purpose.

The researchers found that teens born extremely preterm reported overall health similar to peers born at term. After accounting for demographic differences, they also reported higher life satisfaction and a stronger sense of meaning and purpose. Participants born moderately preterm or late preterm reported levels of well-being similar to those born at term.

These findings add to a growing body of research suggesting that being born very early does not necessarily lead to poorer self-reported quality of life or well-being later in life. The results also highlight the importance of asking young people directly about their experiences and perspectives rather than relying solely on medical or developmental measures.

“Positive health attributes have the potential to provide resilience and help mitigate negative exposures or experiences,” said Dr. McGowan. “By understanding characteristics that lead to resilience, particularly among high-risk groups of children, we hope to allow for identification as well as replication of strategies that help buffer against times of stress.”

McGowan noted that more studies are needed to better understand why some teens born extremely preterm report positive well-being. Future research could examine how factors such as ongoing health challenges, mental health, family support, school environments, and community resources may shape their experiences.

The study included 4,093 biological mother-child pairs from 38 ECHO Cohort Study Sites across the United States. Participants were ages 10–18 years and provided information about their health and well-being during the pandemic.

The study, “Self-reported Positive Health Outcomes During the COVID-19 Pandemic Among Adolescents Born Preterm in the ECHO Cohort,” was published in the Journal of Perinatology.

Teens Born Before 28 Weeks of Pregnancy Report Positive Well-Being During the COVID-19 Pandemic

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Teens Born Before 28 Weeks of Pregnancy Report Positive Well-Being During the COVID-19 Pandemic

Authors: Elisabeth McGowan, et al.

 

Who sponsored this study?

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

 

Why was this study needed?

The COVID-19 pandemic disrupted children’s daily lives, schooling, social connections, and family routines in ways that may have affected their mental health and overall well-being. Teens who were born before 28 weeks of pregnancy, which is considered extremely preterm birth, are often thought to be at higher risk for health and developmental challenges. Prior studies found that many people who were born early say their quality of life is about the same as people born at full term. Less is understood about how teens born preterm feel about their health and well-being during the major stress and disruptions of the pandemic. ECHO researchers wanted to understand whether teens born early experienced the pandemic differently than their peers and whether they showed signs of resilience during this challenging time.

 

What were the study results?

During the COVID-19 pandemic, adolescents born extremely preterm reported overall health similar to adolescents born at term. After accounting for key demographic factors, they also reported higher life satisfaction and a stronger sense of meaning and purpose. Adolescents born moderately (born at 28-33 weeks) or late preterm (born at 34-36 weeks) did not differ meaningfully from those born at term. These findings suggest that, in this study, adolescents born extremely preterm showed signs of positive well-being during a difficult period.

 

What was the study's impact?

This study highlights that adolescents born extremely preterm may have strengths and resilience that are not captured by focusing only on medical risks or challenges. These findings challenge assumptions that children born very early will report worse well-being and highlight the importance of asking young people directly how they view their own health and lives.

 

Who was involved?

Participants included 4,093 biological mother and child pairs from 38 ECHO Cohort Study Sites across the United States, including adolescents born preterm (less than 37 weeks) and adolescents born at term (more than 37 weeks). The children, ages 10–18 years, had data about how far along the pregnancy was when they were born and at least one self-reported survey on well-being collected between March 2020 and March 2023.

 

What happened during the study?

Researchers used ECHO Cohort data to compare positive health outcomes reported by adolescents based on how early or full-term they were born. Adolescents completed validated PROMIS questionnaires (Pediatric Global Health, Life Satisfaction, and Meaning and Purpose) during the pandemic period (March 2020–March 2023).

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

What happens next?

Future research could help researchers explore why teens born extremely early may report better well-being by looking at things like ongoing health challenges, depression or anxiety, and the support they receive at home, at school, and in their communities.

 

Where can I learn more?

Access the full journal article, titled “Self-reported Positive Health Outcomes During the COVID-19 Pandemic Among Adolescents Born Preterm in the ECHO Cohort,” in the Journal of Perinatology.

 

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

Published April 27, 2026

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Teens Born Before 28 Weeks of Pregnancy Report Positive Well-Being During the COVID-19 Pandemic

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Family Lifestyle and Behavior Changes During COVID-19 Pandemic Associated with Youth Mental Health

Posted on by Jodi Snare

Children and teens who experienced significant changes in their lifestyle and health behaviors during the COVID-19 pandemic may be more likely to experience symptoms of pandemic-related post-traumatic stress (PTS), according to a recent ECHO Cohort study led by Amy Margolis, PhD of The Ohio State University.

The United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. To understand how changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic influenced youth PTS symptoms, researchers collected information from 7,786 children and 1,353 teens and young adults and their parents or caregivers across the United States between April 2020 and August 2021.

Key Takeaways include:

  • Two groups of families were identified based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.
  • Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes.
  • Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children. Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores.
  • Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors associated with PTSS scores. Stability in these areas was linked to lower PTSS scores.
  • The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

This study provides valuable insight that could help improve youth mental health now and in the wake of future public health emergencies. It demonstrates the importance of stability in health behaviors, access to healthcare, and the ability for parents to isolate safely as key factors in reducing youth PTS symptoms.

This collaborative research, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” is published in the Journal of Clinical Child & Adolescent Psychology.

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ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

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ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

Authors: Amy Margolis, Andrew Law, et al.

 

Who sponsored this study?

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

 

Why was this study needed?

The United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. This study examined changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic and evaluated whether these changes were associated with youth pandemic-related post-traumatic stress (PTS) symptoms.

 

What were the study results?

The study identified two groups of families based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.

Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes. Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children.  Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores. Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors related to PTSS scores. Stability in these areas was linked to lower PTSS scores. The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

 

What was the study's impact?

This study provides valuable insight that could help improve youth mental health now and in the wake of future public health emergencies. It demonstrates the importance of stability in health behaviors, access to healthcare, and the ability to isolate safely as key factors in reducing youth PTS symptoms.

 

Who was involved?

The participants included 9,139 youth and their parents or caregivers from across the United States, including 7,786 children (aged 2-12 years) and 1,353 teens and young adults (aged 13-21 years).

 

What happened during the study?

The study looked at information from ECHO families between April 2020 and August 2021 to understand how the pandemic affected them. Researchers grouped families into different categories based on their experiences and background characteristics from before the pandemic. The researchers then looked at symptoms of PTS in both children and teens within these family groups. The study explored how COVID-19 influenced family hardships, changes in parent and child behavior, and the ways families coped.

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

What happens next?

Future studies could help researchers examine what factors contribute to ongoing PTS symptoms or the occurrence of mental health diagnoses. Interviewing participants about acute stress when collecting PTSS survey responses could also help researchers confirm the validity of the survey.

 

Where can I learn more?

Access the full journal article, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” in the Journal of Clinical Child & Adolescent Psychology.

 

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

Published October 17, 2025

Read the associated article.

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ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

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Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

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Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

Authors: Lauren Shuffrey, Anahid Akbaryan, et al.

 

Who sponsored this study?

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

 

Why was this study needed?

The COVID-19 pandemic disrupted family patterns and children’s environments, both of which play a role in early brain development. Early childhood is a period of rapid brain growth and increased sensitivity to environmental influences, making the early social environment important for children's health and well-being. Previous research raised concerns about the development of infants born during the pandemic, but there is limited evidence on how the pandemic affected the behavioral and emotional well-being of toddlers. In this study, researchers wanted to look at the association between growing up during the pandemic and behavioral outcomes in toddler-aged children.

 

What were the study results?

The study found that children who experienced the pandemic had fewer emotional and behavioral problems compared to children born and assessed before the onset of the pandemic, based on results from the Preschool Child Behavior Checklist (CBCL). Specifically, their scores for internalizing problems, such as anxiety or sadness, were about 1.5 to 2 points lower, and their scores for externalizing problems, such as aggression or hyperactivity, were about 1.7 to 3.2 points lower than those born and assessed before the pandemic.

Although these differences were small, researchers report that they were consistent. The study also found that these links between growing up during the pandemic and lower emotional and behavioral problems were significantly stronger for children whose mothers did not have a bachelor’s degree.

 

What was the study's impact?

The study suggests that toddler-age children may have shown resilience despite the disruptions of the pandemic. These findings could help identify potential protective factors that could have buffered the impact of the pandemic on child behavior and inform future interventions to support children's well-being during and after global crises.

 

Who was involved?

The study included 3,438 toddlers (average age of 2 years) across the U.S. and Puerto Rico. Researchers grouped children based on when they were born and when they were assessed: before the pandemic, born before but assessed after March 2020, or both born and assessed during the pandemic.

 

What happened during the study?

During the study, researchers compared young children’s behavior and emotions before and during the pandemic using data from the ECHO Cohort collected between September 2009 and July 2023. Parents filled out the Preschool CBCL, a commonly used tool to assess the child’s emotions and behaviors, like anxiety, sadness, or hyperactivity. Researchers then analyzed these results to see how the pandemic may have affected children’s emotional and behavioral well-being.

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

What happens next?

Further research could help researchers identify potential protective factors that may have promoted resilience among children whose daily life was disrupted by the COVID-19 pandemic.

 

Where can I learn more?

Access the full journal article, titled “COVID-19 pandemic exposure and toddler behavioral health in the ECHO Program,” in JAMA Network Open.

 

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

Published September 3, 2025

Access the associated press release.

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Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

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COVID-19 Research Summaries

Toddlers Showed Slightly Fewer Behavioral Problems During COVID-19 Pandemic, NIH Study Finds

Posted on by Jodi Snare

Toddlers assessed during the COVID-19 pandemic had slightly fewer emotional and behavioral problems compared to children assessed before the pandemic, suggesting some toddlers may have shown resilience during this time. This finding comes from a study of over 3,000 children across the United States using data from the Environmental influences on Child Health Outcomes (ECHO) Cohort Consortium collected between September 2009 and July 2023.

The COVID-19 pandemic disrupted family patterns and children’s environments, both critical for early brain development and well-being. While earlier research raised concerns about infants born during the pandemic, there is limited information about how toddlers’ emotional and behavioral health might have been affected.

To explore this, the study examined data from 3,438 toddlers (average age of 2 years) across the U.S. and Puerto Rico. Researchers used the Preschool Child Behavior Checklist (CBCL), a parent-reported measure of child behavior and emotions, to compare children assessed before and during the pandemic.

Children were grouped based on when they were born and when their behavior was assessed: before the pandemic, born before but assessed after March 2020, or both born and assessed during the pandemic. Parents completed the CBCL, which asks about behaviors such as anxiety, sadness, and aggression. These reports helped researchers understand how growing up during the pandemic might have influenced toddler emotional and behavioral health.

Key findings include:

  • Children who experienced the pandemic had significantly lower scores for internalizing problems (such as anxiety and sadness) and externalizing problems (such as aggression or hyperactivity) compared to children assessed before the pandemic.
  • Internalizing problem scores were about 1.5 to 2 points lower, and externalizing problem scores were about 1.7 to 3.2 points lower than those born and assessed before the onset of the pandemic.
  • Although the differences were small, they were consistent. The associations were stronger among children whose mothers did not have a bachelor’s degree.

“Our findings suggest that even during periods of widespread pandemic-related disruption, toddler-aged children may have experienced opportunities for resilience,” said study author Anahid Akbaryan, a Research Associate at NYU Grossman School of Medicine. “Future research should explore within-home factors that may have supported child mental health outcomes during this time, such as consistent caregiving routines, household stability, and positive parental coping strategies to identify potential protective influences during times of instability.”

Study author Lauren Shuffrey, PhD, of NYU Grossman School of Medicine, added, “These findings suggest that some families may have adapted in ways that buffered young children from behavioral challenges during the pandemic, highlighting the importance of identifying and strengthening those protective supports.”

The researchers emphasized that further studies are needed to identify these protective factors and develop strategies to help families support child well-being during and after times of global disruptions.

This collaborative research is published in JAMA Network Open.

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.

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