teens

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

<< Back to Research Summaries

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

Read the associated article.

Download this summary

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

Read More Research Summaries

For Teens’ Mental Health, Strong Friendships Matter More Than Social Media Use, NIH Study Finds

Posted on by Jodi Snare

Teens who report strong, high-quality friendships tend to have better mental health—an influence that appears nearly three times stronger than the link between social media use and mental health challenges, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Today’s teens spend a lot of time online. This has raised concerns about how digital interactions affect teens’ well-being. As social media use has grown, some wonder if it’s playing a role in the rise of teen mental health challenges. Such concerns prompted the U.S. Surgeon General to issue a warning in 2023 about the potential impact of social media on youth mental health.

“Social media use does not occur in a vacuum—it’s one piece of a much larger picture,” said Courtney K. Blackwell, PhD, of Northwestern University’s Feinberg School of Medicine. “Our study found that peer relationships seem to matter a lot more than social media when it comes to teen mental health outcomes.”

In the study, researchers found that a teen with strong, supportive friendships is likely to experience positive mental health, regardless of how much time they spend on social media. By contrast, teens who report poor-quality friendships and nearly the same level of social media use are more likely to report poor mental health. In comparison, the amount of time spent using social media had a much smaller influence on teen mental health outcomes.

Teens ages 13 to 18 reported how much time they spend on social media and whether they use it actively (like posting and commenting) or passively (like scrolling and browsing). Researchers used the PROMIS® assessment tools and the Strengths and Difficulties Questionnaire to measure their mental well-being, including life satisfaction, sense of purpose, symptoms of depression, and the quality of their friendships.

A 2021 national survey of 8th and 10th graders, cited in the U.S. Surgeon General’s report on social media and youth mental health, found that teens spent an average of 3.5 hours daily on social media. More recently, a 2023 Gallup survey of 13- to 19-year-olds reported that the average had increased to 4.8 hours per day.

The study included 963 teens aged 13 to 18 from across the United States. Teens completed surveys on social media habits, peer relationship quality, and mental health outcomes. The results provide insight into how social media use and mental health influence each other during the teenage years, extending beyond negative outcomes like anxiety and depression to also include positive mental health indicators.

“Instead of just focusing on limiting adolescents’ social media use, perhaps emphasizing ways to bolster the quality of their social relationships would help address the current youth mental health crisis in the U.S.,” said Dr. Blackwell.

Looking ahead, the research team plans to use data collected over time to understand better how social media use and mental health influence each other during this sensitive development period. Future studies could focus on improving peer relationship quality as a pathway to better teen mental health outcomes.

This collaborative research was published in the Journal of Adolescent Health.

 

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on X.

Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

<< Back to Research Summaries

Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

Authors: Courtney K. Blackwell, 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?

Teens spend a significant amount of time using social media, raising questions about how their digital and social experiences intersect. Recent concerns outlined by the U.S. Surgeon General’s Advisory suggest potential negative influences of social media on youth mental health. A 2021 national survey of 8th and 10th graders, cited in the U.S. Surgeon General’s report on social media and youth mental health, found that teens spent an average of 3.5 hours per day on social media. More recently, a 2023 Gallup survey of 13- to 19-year-olds reported that the average had increased to 4.8 hours per day.  While a large number of previous studies focus on negative mental health outcomes such as depression and anxiety, ECHO researchers examined teen social media use in relation to both positive and negative mental health effects.

 

What were the study results?

High-quality peer relationships were the strongest predictor of teen well-being, regardless of social media use, with a magnitude nearly three times as large as the association between social media use and poor mental health. Teens who reported high quality peer relationships were more likely to experience positive mental health, while teens who reported poor quality relationships were more likely to report worse mental health, even at similar levels of social media use.

 

What was the study's impact?

The study highlights the importance of improving the quality of peer relationships rather than merely limiting social media use to enhance teens’ mental health.

 

Who was involved?

The study included 963 teens aged 13 to 18 from three ECHO Cohort Study Sites across the United States.

 

What happened during the study?

Teens ages 13 to 18 reported how much time they spend on social media and whether they use it actively (like posting and commenting) or passively (like scrolling and browsing). Researchers used the PROMIS® assessment tools and the Strengths and Difficulties Questionnaire to measure teens’ mental well-being, including life satisfaction, sense of purpose, symptoms of depression, and the quality of their friendships.

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?

Studying social media use and mental health over the course of adolescence could help researchers better understand how these factors influence each other throughout this sensitive stage of development. Future research could also focus on finding ways to strengthen peer relationships to support teens' mental health.

 

Where can I learn more?

Access the full journal article, titled “Adolescent social media use and mental health in the Environmental influences on Child Health Outcomes (ECHO),” in the Journal of Adolescent Health.

 

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

Published February 5, 2025

Download this summary

Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds