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E., McKenzie, J. E., Bailey, A. P., Sharma, V., Moller, C. I., Badcock, P. B., ... & Meader, N. (2021). New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database of Systematic Reviews, (5). Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Papola, D., Ebert, D., & Karyotaki, E. (2023). Psychological treatment of depression: A systematic overview of a ‘Meta-Analytic Research Domain’. Journal of affective disorders, 335, 141–151. What is Driving the Increase in Childhood Chronic Disease? Rising rates of childhood chronic disease are likely being driven by a combination of factors, including the food children are eating, the chemicals they are exposed to, the medications they are taking, and various changes to their lifestyle and behavior, particularly those related to physical activity, sleep and the use of technology. This report focuses on these four major drivers. The foodAmerican children are eating TheAmerican food system is safe but could be healthier. Most American children’s diets are dominated by ultra-processed foods (UPFs) high in added sugars, chemical additives, and saturated fats, while lacking sufficient intakes of fruits and vegetables. This modern diet has been linked to a range of chronic diseases, including obesity, type 2 diabetes, cardiovascular disease, and certain cancers. 44 The excessive consumption of UPFs has led to a depletion of essential micronutrients and dietary fiber, while increasing the consumption of sugars and carbohydrates, which negatively affects overall health. 45 • Nearly 70% of an American child’s calories today comes from ultra-processed foods 46 (increased from zero 100 years ago), many of which are designed to override satiety mechanisms and increase caloric intake. • UPFs makeup over 50% of the diets of pregnant and postpartummothers. 47 American children’s exposure to environmental chemicals The cumulative load of thousands of synthetic chemicals that our children are exposed to through the food they eat, the water they drink, and the air they breathe may pose risks to their long-term health, including neurodevelopmental and endocrine effects. • Over 40,000 chemicals are registered for use in the U.S. 48 • Pesticides, microplastics, and dioxins are commonly found in the blood and urine of American children and pregnant women—some at alarming levels. 49 50 51 • Children are particularly vulnerable to chemicals during critical stages of development—in utero, infancy, early childhood, and puberty. Research suggests that for some chemicals, this cumulative load of exposures may bedriving be driving higher rates of chronic child- hood diseases. 525354 Yet, current risk assessment methods may not allow us to fully understand how these exposures affect human health. American children’s pervasive technology use Over the past four decades, American children have transitioned from an active, play-based childhood to a sedentary, technology-driven lifestyle, contributing to declines in physical and mental health. Specifically, these declines have been driven by increased screen time, reduced physical activity, and psychosocial stressors like loneliness, chronic stress, and sleep deprivation. • Teens average nearly 9 hours of non-school screen time each day. 55 56 • Over 70% of children, and 85% of teens, fail to meet the 2024 federal guideline of 60 minutes of daily moderate-to-vigorous physi- cal activity. 57 58 • Nearly 80% of U.S. high school students do not sleep at least 8 hours per night, up from 69% in 2009. 59 • Persistent sadness and hopelessness among U.S. high school students surged between 2011 to 2021 from 28% to 42%, with female students’ suicidal ideation rising 58% from 19% to 30%. 60 • In 2024, 73% of 16–24-year-olds reported loneliness, with 15% of young men having no close friendships—a fivefold increase since 1990. 61