Peer-reviewed article

Child health-related behaviors, social connectedness, and impact of the COVID-19 pandemic on children born preterm in the ECHO Cohort.

O'Shea TM, McGrath M, Douglas J, Blackwell CK, Ganiban J et al. · 20 Jul 2026

Abstract

Background We evaluated the impact of the COVID-19 pandemic on adolescents born preterm versus at term. Methods This prospective cohort study included participants aged 13-21 years in the Environmental influences on Child Health Outcomes (ECHO) Cohort. Participants completed questionnaires from April 2020 to June 2022 about their behaviors during the pandemic and the impact of the pandemic on their social connectedness and overall well-being. Analyses compared adolescents born extremely preterm (before 28 weeks of gestation; n = 419) and those born moderate or late preterm (≥ 28 weeks and < 37 week; n = 118) with those born at term (n = 1,598). Associations were expressed as adjusted prevalence ratios (PRadj) and 95% confidence intervals (CIs). Results Adolescents in both preterm groups were less likely than those born at term to participate in unhealthy behaviors, such as drinking alcohol and using marijuana (moderate preterm: PRadj 0.78 [95% CI 0.61, 0.99]; extremely preterm: PRadj 0.74 [95% CI 0.58, 0.94]). Girls born extremely preterm were more likely to report health-promoting/prosocial behaviors (PRadj 1.15 [95% CI 1.06, 1.25]). Participants born moderate or late preterm reported feeling more socially connected during the pandemic compared with pre-pandemic (PRadj 1.29 [95% CI 1.09, 1.52]); nonetheless, this group was more likely to report a negative overall impact of the pandemic on their lives (PRadj 0.84 [95% CI 0.76, 0.92]). Conclusion During the COVID-19 pandemic, adolescent behaviors and self-reported impact differed for participants born preterm compared with those born at term. These findings can inform counseling for parents and adolescents during future national crises.