Pub Date : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5816
Robert C Whitaker,Tracy Dearth-Wesley,Allison N Herman,Micah C Jordan
ImportanceLoneliness and perceived social isolation, with their negative health impacts, are increasing. It is not known whether adolescents with greater levels of family connection experience greater social connection as adults.ObjectiveTo determine the association between adolescents' sense of connection with their families and their overall social connection in adulthood.Design, Setting, and ParticipantsThis cohort study of a nationally representative US sample used data from 5 survey waves of The National Longitudinal Study of Adolescent to Adult Health: I (1994-1995), II (1996), III (2001-2002), IV (2008-2009), and V (2016-2018). Wave I involved 20 745 adolescents (grades 7-12), and 7293 participated in all 4 subsequent waves. Data were analyzed from April through November 2025.ExposureQuartiles of adolescent family connection were created using responses to 5 items asked in wave II, and covariates, including indicators of socioeconomic status, were assessed at wave I.Main Outcomes and MeasuresAdult social connection was assessed at waves IV and V with a score (0-6) created by summing 6 binary measures (no = 0, yes = 1) across 3 dimensions of social connection: structure ([1] participated in weekly activities with relatives/friends or neighbors, [2] had >2 close friends), function ([3] high perceived social support, [4] never felt isolated), and quality ([5] very close with either parent figure, [6] high relationship satisfaction with partner).ResultsThe analytic sample contained 7018 of the 7293 respondents to all 5 waves. The mean (SD) ages at waves II, IV, and V were 16.3 (1.8), 28.2 (1.8), and 37.3 (1.9) years, respectively, and 4097 respondents (49.7%) were female. The covariate-adjusted prevalence of high social connection in adulthood (score ≥4) increased across increasing quartiles of family connection in adolescence: 16.1% (95% CI, 13.4%-18.9%) for low, 22.0% (95% CI, 18.9%-25.1%) for medium-low, 28.6% (95% CI, 25.1%-32.1%) for medium-high, and 39.5% (95% CI, 36.2%-42.8%) for high family connection. The prevalence of high social connection in adulthood was 23.4 (95% CI, 19.2-27.6) percentage points greater in those in the highest quartile of adolescent family connection than those in the lowest quartile.Conclusions and RelevanceIn this cohort study, among US adolescents, those reporting higher family connection had higher levels of social connection as adults up to 2 decades later. These findings suggest that increasing family connection during adolescence may help reduce the burden of adult social disconnection.
{"title":"Family Connection in Adolescence and Social Connection in Adulthood.","authors":"Robert C Whitaker,Tracy Dearth-Wesley,Allison N Herman,Micah C Jordan","doi":"10.1001/jamapediatrics.2025.5816","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5816","url":null,"abstract":"ImportanceLoneliness and perceived social isolation, with their negative health impacts, are increasing. It is not known whether adolescents with greater levels of family connection experience greater social connection as adults.ObjectiveTo determine the association between adolescents' sense of connection with their families and their overall social connection in adulthood.Design, Setting, and ParticipantsThis cohort study of a nationally representative US sample used data from 5 survey waves of The National Longitudinal Study of Adolescent to Adult Health: I (1994-1995), II (1996), III (2001-2002), IV (2008-2009), and V (2016-2018). Wave I involved 20 745 adolescents (grades 7-12), and 7293 participated in all 4 subsequent waves. Data were analyzed from April through November 2025.ExposureQuartiles of adolescent family connection were created using responses to 5 items asked in wave II, and covariates, including indicators of socioeconomic status, were assessed at wave I.Main Outcomes and MeasuresAdult social connection was assessed at waves IV and V with a score (0-6) created by summing 6 binary measures (no = 0, yes = 1) across 3 dimensions of social connection: structure ([1] participated in weekly activities with relatives/friends or neighbors, [2] had >2 close friends), function ([3] high perceived social support, [4] never felt isolated), and quality ([5] very close with either parent figure, [6] high relationship satisfaction with partner).ResultsThe analytic sample contained 7018 of the 7293 respondents to all 5 waves. The mean (SD) ages at waves II, IV, and V were 16.3 (1.8), 28.2 (1.8), and 37.3 (1.9) years, respectively, and 4097 respondents (49.7%) were female. The covariate-adjusted prevalence of high social connection in adulthood (score ≥4) increased across increasing quartiles of family connection in adolescence: 16.1% (95% CI, 13.4%-18.9%) for low, 22.0% (95% CI, 18.9%-25.1%) for medium-low, 28.6% (95% CI, 25.1%-32.1%) for medium-high, and 39.5% (95% CI, 36.2%-42.8%) for high family connection. The prevalence of high social connection in adulthood was 23.4 (95% CI, 19.2-27.6) percentage points greater in those in the highest quartile of adolescent family connection than those in the lowest quartile.Conclusions and RelevanceIn this cohort study, among US adolescents, those reporting higher family connection had higher levels of social connection as adults up to 2 decades later. These findings suggest that increasing family connection during adolescence may help reduce the burden of adult social disconnection.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"30 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5964
Lauren E Wisk, Kathryn M Leifheit
{"title":"Important Role of Social Policies to Prevent Child Maltreatment.","authors":"Lauren E Wisk, Kathryn M Leifheit","doi":"10.1001/jamapediatrics.2025.5964","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5964","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":18.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5714
Darja Beinenson, Jacqueline Joyce, Gabrielle Becka, Marcus Graham, Claudia Morris, John N. Constantino, Justine W. Welsh
This quality improvement study examines the implementation of a substance use screening tool among youth presenting with behavioral and mental health crises in pediatric emergency departments.
本质量改进研究考察了在儿科急诊科表现为行为和精神健康危机的青少年中物质使用筛查工具的实施情况。
{"title":"Substance Use Screening in Pediatric Emergency Departments for Youth in Behavioral Crisis","authors":"Darja Beinenson, Jacqueline Joyce, Gabrielle Becka, Marcus Graham, Claudia Morris, John N. Constantino, Justine W. Welsh","doi":"10.1001/jamapediatrics.2025.5714","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5714","url":null,"abstract":"This quality improvement study examines the implementation of a substance use screening tool among youth presenting with behavioral and mental health crises in pediatric emergency departments.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146048221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5788
Elizabeth Barnert,Paul H Wise
{"title":"Safeguarding the Health of Children in Carceral Custody.","authors":"Elizabeth Barnert,Paul H Wise","doi":"10.1001/jamapediatrics.2025.5788","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5788","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5724
Mickey A Emmanuel,Mikhail Goldenberg,Lindsay A Thompson
{"title":"What Parents Should Know About Fire Safety.","authors":"Mickey A Emmanuel,Mikhail Goldenberg,Lindsay A Thompson","doi":"10.1001/jamapediatrics.2025.5724","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5724","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"179 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5822
Youngjin Stephanie Hong, Jessica Pac, Lawrence M. Berger
Importance Universal pre-kindergarten (UPK) programs are expanding across the US. Given the detrimental consequences of child maltreatment on children’s health and well-being, it is important to assess whether high-quality, full-time UPK programs can function as a population-level child maltreatment prevention strategy. Objective To examine the association between provision of a full-time UPK program and child protective services (CPS) investigation rates by leveraging the implementation of New York City’s Pre-K for All program. Design, Setting, and Participants This cross-sectional study used county-year-child age–level data from the 2010 to 2019 National Child Abuse and Neglect Data System Child Files to compare CPS investigation rate trajectories for children aged 4 and 8 years before and after UPK implementation. The data were analyzed from January to May 2025. Exposure Implementation of the UPK program. Main Outcomes and Measures The primary outcome was the rate of CPS investigations per 1000 children overall and for child neglect and child physical abuse. The investigation rate trajectories were compared using difference-in-differences and event study methods. Results A total of 1 606 525 children (mean [SD] age, 5.9 [2.0] years; 820 519 males [51%]) were included in the study. Of these children, 555 003 (35%) identified as Hispanic, 382 662 (24%) as non-Hispanic Black, 444 285 as non-Hispanic White (28%), and 213 576 children (13%) identified as other non-Hispanic race or ethnicities. The difference-in-differences analysis estimated that UPK implementation was associated with 4.0 (95% CI, −6.77 to −1.11) fewer CPS investigations per 1000 children aged 4 years relative to investigations among children aged 8 years. This finding was attributable to reductions in the rate of child neglect investigations, with no statistically significant change in physical abuse investigations. The event study models illustrate that UPK implementation led to greater reductions in CPS investigations over time, reaching a reduction of 8.0 (95% CI, −11.72 to −5.10) fewer neglect investigations per 1000 children 2 years after implementation. Moreover, the subgroup analyses by race and ethnicity show that reductions in neglect investigations were disproportionately concentrated among racial and ethnic minority populations, particularly the non-Hispanic Black population, which had a reduction of 80 (95% CI, −176.47 to −17.02) neglect investigations per 1000 children 2 years after implementation. Conclusions and Relevance This study found that UPK may be associated with reduced CPS involvement, particularly for child neglect, and may help mitigate racial and ethnic disparities in CPS involvement. Reductions in child neglect associated with UPK could benefit children’s health and well-being in the short- and long-term; these findings offer insights for policymakers and advocates regarding broader benefits associated with UPK.
{"title":"Universal Pre-Kindergarten for Child Maltreatment Prevention","authors":"Youngjin Stephanie Hong, Jessica Pac, Lawrence M. Berger","doi":"10.1001/jamapediatrics.2025.5822","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5822","url":null,"abstract":"Importance Universal pre-kindergarten (UPK) programs are expanding across the US. Given the detrimental consequences of child maltreatment on children’s health and well-being, it is important to assess whether high-quality, full-time UPK programs can function as a population-level child maltreatment prevention strategy. Objective To examine the association between provision of a full-time UPK program and child protective services (CPS) investigation rates by leveraging the implementation of New York City’s Pre-K for All program. Design, Setting, and Participants This cross-sectional study used county-year-child age–level data from the 2010 to 2019 National Child Abuse and Neglect Data System Child Files to compare CPS investigation rate trajectories for children aged 4 and 8 years before and after UPK implementation. The data were analyzed from January to May 2025. Exposure Implementation of the UPK program. Main Outcomes and Measures The primary outcome was the rate of CPS investigations per 1000 children overall and for child neglect and child physical abuse. The investigation rate trajectories were compared using difference-in-differences and event study methods. Results A total of 1 606 525 children (mean [SD] age, 5.9 [2.0] years; 820 519 males [51%]) were included in the study. Of these children, 555 003 (35%) identified as Hispanic, 382 662 (24%) as non-Hispanic Black, 444 285 as non-Hispanic White (28%), and 213 576 children (13%) identified as other non-Hispanic race or ethnicities. The difference-in-differences analysis estimated that UPK implementation was associated with 4.0 (95% CI, −6.77 to −1.11) fewer CPS investigations per 1000 children aged 4 years relative to investigations among children aged 8 years. This finding was attributable to reductions in the rate of child neglect investigations, with no statistically significant change in physical abuse investigations. The event study models illustrate that UPK implementation led to greater reductions in CPS investigations over time, reaching a reduction of 8.0 (95% CI, −11.72 to −5.10) fewer neglect investigations per 1000 children 2 years after implementation. Moreover, the subgroup analyses by race and ethnicity show that reductions in neglect investigations were disproportionately concentrated among racial and ethnic minority populations, particularly the non-Hispanic Black population, which had a reduction of 80 (95% CI, −176.47 to −17.02) neglect investigations per 1000 children 2 years after implementation. Conclusions and Relevance This study found that UPK may be associated with reduced CPS involvement, particularly for child neglect, and may help mitigate racial and ethnic disparities in CPS involvement. Reductions in child neglect associated with UPK could benefit children’s health and well-being in the short- and long-term; these findings offer insights for policymakers and advocates regarding broader benefits associated with UPK.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"64 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146048222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1001/jamapediatrics.2025.5858
Nassr Nama,Stephanie Liebert,Mario Abaji,Amy DeLaroche,Kristy Carlin,Teresa Jewell,David D'Arienzo,Alastair Fung,David Gremse,Joshua L Bonkowsky,Maida Chen,Eyal Sagiv,Bruce Herman,Elise Lu,Peter J Gill,Joel S Tieder,Eric R Coon
ImportanceSince the introduction of the brief resolved unexplained event (BRUE) terminology, underpowered and conflicting research has led to persistent clinical uncertainty regarding the frequency of adverse outcomes, prognostic risk factors, and the diagnostic testing utility, contributing to wide practice variations.ObjectiveTo (1) establish the frequency of serious underlying diagnoses and 3-month mortality after a BRUE in infants; (2) identify prognostic risk factors; and (3) quantify the diagnostic yield of common investigations.Data SourcesPubMed, Embase, Cochrane, and gray literature sources from January 2016 through July 2025.Study SelectionCohort studies, case-control studies, and clinical trials of infants meeting 2016 American Academy of Pediatrics diagnostic criteria for BRUE.Data Extraction and SynthesisData were extracted by 1 reviewer and verified by a second. Random-effects meta-analyses were used to pool data. Grading of Recommendations Assessment, Development, and Evaluation was used to assess certainty in evidence.Main Outcomes and MeasuresThe primary outcomes were pooled prevalence of serious underlying diagnosis and 3-month cumulative mortality. Secondary outcomes included prognostic risk factors and diagnostic yield of specific tests.ResultsFrom 664 citations, 24 studies (6603 infants) were included. The pooled prevalence of a serious underlying diagnosis was 6.0% (95% CI, 4.6%-7.9%; high certainty), and cumulative 3-month mortality was 1 death per 1851 infants (95% CI, 1 death per 597-5739 infants; moderate certainty). A history of multiple events (risk difference [RD], 3.7%; 95% CI, 1.7%-6.2%; high certainty) and prematurity (RD, 2.6%; 95% CI, 0.6%-5.2%; high certainty) were associated with increased risk of serious underlying diagnosis, while being aged 60 days or younger was not (RD, -0.5%; 95% CI, -2.7% to 3.0%; high certainty). Routine investigations were exceedingly low yield: metabolic panels had 0% yield (95% CI, 0%-0.5%; number needed to test [NNT] = 852; moderate certainty), electrocardiograms, 0.2% yield (95% CI, 0.0%-0.9%; NNT = 623; high certainty); and chest radiographs, 0.4% yield (95% CI, 0.2%-1.0%; NNT = 256; high certainty).Conclusions and RelevanceThis systematic review and meta-analysis found that infant mortality after a BRUE was exceedingly rare, and a serious underlying diagnosis was present in a small but important group of infants; most routine diagnostic tests added little value and not infrequently had false-positive results. Clinical focus should therefore shift from blanket investigations to a targeted, risk-informed approach grounded in a few reliable higher-risk features. These findings provide a robust evidence basis for guideline revision.
{"title":"Infant Outcomes, Risk Factors, and Diagnostic Yield After a Brief Resolved Unexplained Event: A Systematic Review and Meta-Analysis.","authors":"Nassr Nama,Stephanie Liebert,Mario Abaji,Amy DeLaroche,Kristy Carlin,Teresa Jewell,David D'Arienzo,Alastair Fung,David Gremse,Joshua L Bonkowsky,Maida Chen,Eyal Sagiv,Bruce Herman,Elise Lu,Peter J Gill,Joel S Tieder,Eric R Coon","doi":"10.1001/jamapediatrics.2025.5858","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.5858","url":null,"abstract":"ImportanceSince the introduction of the brief resolved unexplained event (BRUE) terminology, underpowered and conflicting research has led to persistent clinical uncertainty regarding the frequency of adverse outcomes, prognostic risk factors, and the diagnostic testing utility, contributing to wide practice variations.ObjectiveTo (1) establish the frequency of serious underlying diagnoses and 3-month mortality after a BRUE in infants; (2) identify prognostic risk factors; and (3) quantify the diagnostic yield of common investigations.Data SourcesPubMed, Embase, Cochrane, and gray literature sources from January 2016 through July 2025.Study SelectionCohort studies, case-control studies, and clinical trials of infants meeting 2016 American Academy of Pediatrics diagnostic criteria for BRUE.Data Extraction and SynthesisData were extracted by 1 reviewer and verified by a second. Random-effects meta-analyses were used to pool data. Grading of Recommendations Assessment, Development, and Evaluation was used to assess certainty in evidence.Main Outcomes and MeasuresThe primary outcomes were pooled prevalence of serious underlying diagnosis and 3-month cumulative mortality. Secondary outcomes included prognostic risk factors and diagnostic yield of specific tests.ResultsFrom 664 citations, 24 studies (6603 infants) were included. The pooled prevalence of a serious underlying diagnosis was 6.0% (95% CI, 4.6%-7.9%; high certainty), and cumulative 3-month mortality was 1 death per 1851 infants (95% CI, 1 death per 597-5739 infants; moderate certainty). A history of multiple events (risk difference [RD], 3.7%; 95% CI, 1.7%-6.2%; high certainty) and prematurity (RD, 2.6%; 95% CI, 0.6%-5.2%; high certainty) were associated with increased risk of serious underlying diagnosis, while being aged 60 days or younger was not (RD, -0.5%; 95% CI, -2.7% to 3.0%; high certainty). Routine investigations were exceedingly low yield: metabolic panels had 0% yield (95% CI, 0%-0.5%; number needed to test [NNT] = 852; moderate certainty), electrocardiograms, 0.2% yield (95% CI, 0.0%-0.9%; NNT = 623; high certainty); and chest radiographs, 0.4% yield (95% CI, 0.2%-1.0%; NNT = 256; high certainty).Conclusions and RelevanceThis systematic review and meta-analysis found that infant mortality after a BRUE was exceedingly rare, and a serious underlying diagnosis was present in a small but important group of infants; most routine diagnostic tests added little value and not infrequently had false-positive results. Clinical focus should therefore shift from blanket investigations to a targeted, risk-informed approach grounded in a few reliable higher-risk features. These findings provide a robust evidence basis for guideline revision.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"88 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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