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Parents, caregivers, and pediatric patients increasingly rely on the internet to understand complex diagnoses and treatment options. However, much of this content is unregulated with poorly defined quality, accuracy, and readability standards. The objective of this study is to summarize existing literature evaluating the quality of online pediatric neurosurgical information and to identify opportunities to improve digital content. A systematic review was conducted using PubMed, MEDLINE, and Web of Science to identify studies evaluating the quality and readability of online content related to neurosurgical conditions and procedures. Articles were excluded if they lacked original data, did not use validated quality assessment tools, or did not focus on neurosurgical content. A total of 42 studies evaluating 1,456 websites and 1,960 videos were included, representing more than 251 million cumulative views. Of these, 6 studies focused on pediatric populations. Among pediatric-specific studies, the mean DISCERN score was 36.6 ± 13.2 (16-80 scale), the JAMA Benchmark score was 2.68 ± 0.83 (0-4 scale), and the Global Quality Score was 3.05 ± 0.67 (1-5 scale), indicating low to moderate quality overall. Pediatric-focused content demonstrated marginally higher quality scores compared to adult-only studies, though both groups fell below accepted standards. Readability analyses demonstrated that most resources exceeded recommended reading levels for patients and caregivers. This review demonstrates substantial variability and overall moderate to poor quality in online pediatric neurosurgery content related. Dedicated studies evaluating pediatric-specific resources remain limited, and existing content frequently fails to meet the readability and quality standards appropriate for caregivers and families.

Despite widespread adoption and investment of resources nationally, the pediatric acute care cardiology (ACC) model of care has not been previously evaluated prospectively. To test the hypothesis that adoption of an ACC model will be associated with improved clinical outcomes. This single-center prospective quality improvement study was conducted in a 26-bed ACC unit of a high surgical volume, freestanding children's hospital. The baseline period was May 15 to October 31, 2023, and the intervention period was November 1, 2023, to November 30, 2024. All ACC unit encounters during the baseline and intervention periods were included. Data sources were hospital administrative data, local Pediatric Acute Care Cardiology Collaborative registry, and Patient and Family Experience (PFE) scores. Full-scale change in the model of care: transitioned unit leadership from hospital pediatrics to cardiology, changed attending of record for medical patients to cardiologist, hired nurse practitioners as frontline clinicians, integrated residents into the team, implemented multidisciplinary family-centered rounding, updated communication processes, and transitioned cardiology fellows to in-house overnight call. Complication rate and back transfer to the intensive care unit (ICU) were outcome measures, discharge time was a process measure, 7-day unplanned readmissions and length of stay (LOS) were balancing measures. Standard rules for identifying special cause variation (SCV) were applied. The percentage of patients and families with positive PFE scores (defined as scores of 9 or 10) before and after the intervention were compared using an independent t test. Hypothesis was formulated prior to data collection. There were 483 encounters (45.2% among children aged 1-18 years) in the baseline period and 973 (52.7% among children aged 1-18 years) in the intervention period. Outcome and process measures significantly improved showing SCV following adoption of the ACC model (mean complications: baseline, 23.6% vs intervention, 16.0%; mean back transfer to ICU: baseline, 11.4% vs intervention, 6.9%; mean patient discharge time: baseline, 15.37 hours vs intervention, 14.43 hours). LOS and 7-day unplanned readmissions were unchanged, suggesting no major inadvertent negative consequences of the ACC model. Mean LOS for medical patients decreased (7.83 vs 4.97 days). PFE improved after the intervention (median [SD], preintervention: 76.9% [3.7] vs postintervention: 82.9% [4.3]; P = .04). In this quality improvement study of an ACC model, multiple outcomes improved without evidence of negative consequences. These clinical improvements may justify necessary investment of resources to support ACC models. Adaptation of this model for other subspecialties may help address pediatric resident workforce changes. Ongoing evaluation of resource utilization, sustainability of improvement, and newly embedded improvement efforts is underway.

This JAMA Insights discusses vibriosis, an infection with noncholera species of Vibrio, including its clinical presentation and diagnosis, risk factors, and effective treatments.

Egg allergy is among the most common food allergies in infants. Allergy prevention guidelines have been updated globally based on evidence that earlier egg introduction reduces the risk of egg allergy, and these guidelines have been adopted widely. However, the association of this guideline change with the prevalence of egg allergy is unclear. To estimate the change in population prevalence of egg allergy after a guideline update recommending earlier introduction of egg into the infant diet. This cross-sectional study included infants aged 11 to 15 months in 2 population-based samples, recruited using identical methods when attending their 12-month immunization visit at immunization centers in Melbourne, Australia, before (2007-2011) and after (2018-2019) an update to allergy prevention guidelines. To isolate an association between a change in prevalence of egg allergy and the guideline change, direct regression standardization was used to estimate prevalence in the 2018-2019 sample had the distribution of known risk factors remained the same as in the 2007-2011 sample. Multiple imputation was used to address missing data. Prespecified subgroup analyses were conducted for infants with early eczema and stratified by parent country of birth. Data were analyzed between March 2025 and March 2026. Data on demographics, food allergy risk factors, egg introduction, and reactions were collected via questionnaires. Infants underwent skin prick tests to egg, and those with positive results underwent oral food challenges. A total of 7209 of 9500 eligible infants were included from 2 cohorts: 5276 infants (median [IQR] age, 12.4 [12.2-12.9] months; 50.8% [2665 of 5244] males; response rate, 76% [5276 of 6957]) from the 2007-2011 cohort and 1933 infants (median [IQR] age, 12.5 [12.2-13.0] months; 51.8% [1001 of 1932] males; response rate, 76% [1933 of 2543]) from the 2018-2019 cohort. The median (IQR) age at egg introduction decreased from 8 (6-10) months in 2007-2011 to 6 (6-8) months in 2018-2019. After adjusting for known allergy risk factors, the prevalence of egg allergy decreased from 9.2% in 2007-2011 to 7.6% in 2018-2019 (adjusted absolute difference, -1.6 [95% CI, -3.3 to -0.005] percentage points). In infants with early eczema, egg allergy decreased from 34.6% to 21.9% (adjusted absolute difference, -12.7 [95% CI, -20.0 to -5.4] percentage points). This study provides population-level evidence that updated infant feeding guidelines recommending earlier introduction of egg led to measurable reductions in the population prevalence of egg allergy. The findings suggest that guideline updates informed by randomized trial evidence may be associated with a reduction in food allergy prevalence when implemented effectively.

Although US opioid overdose deaths have recently declined, mortality remains higher than before the COVID-19 pandemic, and the role of naloxone in opioid-associated out-of-hospital cardiac arrest (OA-OHCA) remains uncertain. The American Heart Association has identified a critical evidence gap regarding the role of naloxone in resuscitation care. To assess the association between naloxone administered by emergency medical services (EMS) clinicians and outcomes in patients with suspected OA-OHCA. This retrospective cohort study of adults (aged ≥18 years) with EMS-treated OHCA used data from the California Resuscitation Outcomes Consortium from January 1, 2021, to December 31, 2022. The primary cohort was patients with OA-OHCA, identified using the Naloxone Cardiac Arrest Decision Instrument (NACARDI) as age younger than 50 years and unwitnessed cardiac arrest. Additional analyses were conducted in patients with EMS-presumed drug-related OHCA and all patients with OHCA. Data were analyzed between November 2024 and July 2025. Naloxone administration during EMS resuscitation. The primary outcome was survival to hospital discharge. Secondary outcomes were favorable neurologic outcome and return of spontaneous circulation (ROSC). Inverse probability weighted regression was used to estimate naloxone treatment effects as absolute risk differences (ARDs). Among 3811 patients meeting NACARDI criteria (median patient age, 37 years [IQR, 30-43 years]; 2792 [73.3%] male), 1251 (32.8%) received naloxone and 2560 (67.2%) did not. Survival to hospital discharge occurred in 101 patients (8.1%) who received naloxone vs 112 (4.4%) who did not. Favorable neurologic outcome occurred in 92 (7.4%) vs 84 (3.3%) and sustained ROSC in 177 (14.1%) vs 245 (9.6%), respectively. After adjustment for patient, OHCA incident, and agency-level factors, naloxone was associated with improved survival to hospital discharge (ARD, 2.75 percentage points [pp]; 95% CI, 1.25 to 4.26 pp), favorable neurologic outcome (ARD, 3.18 pp; 95% CI, 1.79 to 4.57 pp), and sustained ROSC (ARD, 3.27 pp; 95% CI, 1.11 to 5.43 pp). In sensitivity analyses of patients who received epinephrine, naloxone was not associated with improved survival to hospital discharge (adjusted ARD, 0.31 pp; 95% CI, -0.09 to 1.58 pp) or the other clinical outcomes. In this cohort study, among patients with suspected OA-OHCA, EMS-administered naloxone was associated with improved survival and neurologic status and sustained ROSC. These findings support the need for a randomized trial to assess the effects of naloxone in opioid-associated cardiac arrest.

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This cohort study investigates the association of newborn sex with parental acceptance of vitamin K prophylaxis and hepatitis B vaccine in the US.

Kawasaki disease (KD) remains a clinical diagnosis without an objective molecular test. Early identification is critical to prevent coronary artery complications through timely intravenous immunoglobulin therapy. To validate a 2-gene whole-blood quantitative polymerase chain reaction (qPCR) assay measuring IFI27 and MCEMP1 expression for distinguishing KD from other pediatric febrile illnesses. This multicenter diagnostic study was conducted in Taiwan and Shanghai, China. Patient blood samples were collected prospectively between 2012 and 2023 in Taiwan and between 2022 and 2023 in Shanghai and analyzed retrospectively from children younger than 8 years with KD and febrile controls (FCs) with viral, bacterial, or mixed infections. Data were analyzed from January 2022 to August 2025. Diagnostic accuracy of a prespecified 2-gene KD score derived from change in cycle threshold values normalized to glyceraldehyde 3-phosphate dehydrogenase, assessed by area under the receiver operating characteristic curve (AUC), sensitivity, specificity, predictive values, and likelihood ratios. A total of 541 children (mean [SD] age, 3.7 [1.9] years; 300 [55.5%] male), including 243 children with KD and 298 febrile controls, were analyzed. The KD score achieved an AUC of 0.91 (95% CI, 0.88-0.94), with a sensitivity of 94% (95% CI, 93%-97%) and a specificity of 82% (95% CI, 78%-86%). The positive likelihood ratio was 5.12, and the negative likelihood ratio was 0.05. Performance was consistent across cohorts, including incomplete KD, diverse FC etiologies, and coronary artery phenotypes. The assay was implemented as a laboratory-developed test. Analytical validation demonstrated high linearity (R2&#x2009;>&#x2009;0.99), precision (coefficient of variation <5%), and sample stability for up to 6 days at 4 &#xb0;C or for 24 hours at room temperature. This diagnostic study found that a 2-gene laboratory-developed whole-blood qPCR assay measuring IFI27 and MCEMP1 expression accurately distinguished KD from other febrile illnesses using standard molecular platforms. Prospective evaluation in broader populations is warranted to determine its clinical utility for reducing diagnostic delay and coronary complications.

Rising health care costs could make it tougher for households with children to meet their health-related social needs (HRSNs), ie, accessing food, paying bills, and living in quality housing. To examine the association between out-of-pocket medical financial burdens among households with children and HRSNs. This retrospective cohort study used data from the US Census Bureau's Survey of Income and Program Participation 2014, 2018, 2020, 2021, and 2022 panels. Households with children who participate in the first 3 years of each 4-year panel were included. Analyses were performed between October 6, 2025, and February 27, 2026. Households spending either 5% or 10% or more of their income on out-of-pocket medical costs and experiences of out-of-pocket financial burdens. Household reports of food insecurity, difficulty paying bills (mortgage or rent and utilities), and living in poor-quality housing (eg, chronic plumbing problems) in the third year of each panel. Inverse probability of treatment weights were used to account for socioeconomic and health-related characteristics that could confound the association between out-of-pocket burdens and later HRSNs. Logistic regressions were used to estimate the association between out-of-pocket burden in the second year of each panel and HRSNs in the third year. The analytic sample included 6940 households (number of householders [weighted percentage]: 3222 aged 18-44 years [49.0%], 3891 female [54.5%]). Exposure to both 5% out-of-pocket burdens (odds ratio, 1.80; 95% CI, 1.31-2.48) and 10% out-of-pocket burdens (odds ratio, 1.90; 95% CI, 1.32-2.75) in year 2 were associated with a greater likelihood of food insecurity in year 3. No associations were found between out-of-pocket spending in year 2 and difficulty paying bills or living in poor-quality housing in year 3. The findings of this cohort study of US households with children suggest that high out-of-pocket medical costs may make it more difficult for households to afford HRSNs, potentially contributing to adverse health outcomes.

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This cross-sectional study examines national insurance claims data to examine the efficacy of influenza vaccination in US children aged 2 to 5 years.

Previous studies suggest endogenous ovarian hormones significantly increase binge-eating (BE) risk in females. Approximately 85% of women use combined oral contraceptives (COCs) that mimic the riskiest hormonal milieu for BE (ie, elevated estradiol and progesterone postovulation). The effects of COCs on BE risk remain unknown. To examine the associations of COCs with BE. This population-based longitudinal survey study collected daily reports of COC active vs inactive pill use and BE across 49 consecutive days in women from the Michigan State University Twin Registry. Analyses examined within-person changes in a continuous measure of BE (ie, emotional eating [EE]) when women were using active hormone pills vs inactive pills. Data were collected from 2017 to 2024. Participants were women already using monophasic COCs. Analyses examined the full sample as well as women with clinically defined BE episodes. Data were analyzed from April 2024 to November 2025. COC pill type (active vs inactive pills). The outcome of interest was within-person changes in EE between inactive vs active hormone pills, controlling for negative affect. Changes across 2 pill packs were examined for replication. Analyses also examined weight preoccupation (WP) as a control outcome, given its lack of past associations with ovarian hormones. Primary models focused on the full sample; sensitivity analyses examined women with clinically defined BE. A total of 422 women (mean [SD] age, 21.95 [3.10] years) were included in the full sample. Significant within-person increases in EE were observed in the full sample during active hormone vs inactive pills in both cycles (cycle 1: &#x3b2;&#x2009;=&#x2009;0.11 [95% CI, 0.06 to 0.16]; cycle 2: &#x3b2;&#x2009;=&#x2009;0.07 [95% CI, 0.04 to 0.10]). Increases were not mediated by changes in negative affect and were observed in the subsample of 51 women (mean [SD] age, 22.44 [3.57] years) with clinically defined BE episodes (cycle 1: &#x3b2;&#x2009;=&#x2009;0.13 [95% CI, -0.07 to 0.33]; cycle 2: &#x3b2;&#x2009;=&#x2009;0.12 [95% CI, 0.02 to 0.23]. Importantly, no significant changes in WP were observed across pill type, and post hoc analyses of negative affect as the outcome showed more modest COC outcomes. This intensive, daily survey study of COC use found a specific association of active COC pills with risk for EE. Future studies are needed to identify for whom COCs are most risky to inform personalized medicine and identify contraceptive options that may be less likely to impact BE or EE.

This Viewpoint discusses the growing presence of synthetic peptides in enhancement drug use and outlines regulatory gaps created by the blurring of boundaries between medicine and illicit use.

Youth mental health (MH) emergency department (ED) visits are increasing. Neighborhood opportunity may influence the prevalence of youth MH disorders and how frequently they seek MH care in an ED. To determine differences in rates of youth MH ED visits across zip code levels of neighborhood opportunity. This was a retrospective population-based cross-sectional study using the Hospital Industry Data Institute dataset, which provided all ED visit encounters that occurred at 254 nonpsychiatric acute care hospitals in Kansas and Missouri during federal fiscal years 2022 and 2023. Participants included youth aged 5 to 19 years in Kansas and Missouri. The American Community Survey provided population data. These data were analyzed from January to February 2024. The primary exposure was zip code-level neighborhood opportunity, measured by the Child Opportunity Index 3.0 (COI), which is categorized into 5 levels for analysis and presentation. Covariates included state, rural and urban commuting areas, health professional shortage areas, age, sex, and year. Annual rates of ED visits with a primary MH diagnosis per 1000 youth. A multivariable Poisson regression model calculated adjusted rate ratios (aRR) and 95% CI after adjustment for covariates. There were 52&#x202f;362 MH ED visits among 1.79 million youth (57.5% female and 42.5% male) aged 5 to 19 years in Kansas and Missouri. Most of the visits occurred in Missouri (78.5%), in female patients (57.5%), in youth aged 15 to 19 years (57.8%), and in youth living in urban areas (69.5%). Rates of MH ED visits per 1000 youth decreased significantly as COI increased from 17.0 in zip codes with very low COI to 10.1 in zip codes with very high COI (17.0; 95% CI, 15.2-19.0; P&#x2009;<&#x2009;.001). In adjusted modeling, rates of MH ED visits were 1.74 times higher (95% CI, 1.54-1.98) in zip codes with very low COI relative to zip codes with very high COI (10.1; 95% CI, 9.0-11.4; P&#x2009;<&#x2009;.001). In this study, youth living in lower opportunity zip codes had significantly greater rates of MH ED visits compared with youth in higher opportunity zip codes. Further investigation is necessary to examine causal mechanisms and to determine where additional resources should be directed to optimize youth MH well-being.

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People with spina bifida historically have worse survival. Despite health care improvements, survival improvement data are mixed. To compare survival for people with spina bifida to an unaffected cohort and to determine if survival for people with spina bifida has improved from 1950 to 2020. This retrospective cohort study was conducted using state databases to determine survival of individuals with spina bifida and an unaffected population. Demographic, health care, and epidemiological data were extracted from the Utah Population Database from the period January 1950 to December 2019. People with spina bifida were matched by birth year, sex, and county of residence to Utah residents without spina bifida. Data were analyzed from March 2025 to April 2026. Diagnosis of spina bifida. The primary outcome was all-cause mortality. Survival rates for people with spina bifida were compared to an unaffected cohort. Interaction terms were used to determine if geography or birth decade modified survival. The secondary analysis quantified longitudinal trends in survival among those with spina bifida from 1950 to 2020. A total of 942 people with spina bifida (487 female [51.7%]) were matched by birth year, sex, and county of residence to 9420 Utah residents without spina bifida (4870 female [51.7%]). Cohorts were similar in demographics but differed by median (IQR) birth weight (spina bifida: 3118 g [2693-3480]; unaffected cohort: 3330 g [3010-3630]; P&#x2009;<&#x2009;.001) and gestational age at birth (spina bifida: 39 weeks [37-40]; unaffected cohort: 39 weeks [38-40]; P&#x2009;<&#x2009;.001). Deaths occurred in 270 spina bifida cases (29%; 1.7/100 person-years) and 257 controls (2.7%; 0.1/100 person-years) (P&#x2009;<&#x2009;.001). Compared to the unaffected cohort, spina bifida survival was worse at 1 month (hazard ratio [HR], 23.8; 95% CI, 18.0-31.5), 1 year (HR, 15.7; 95% CI, 13.0-19.1), 10 years (HR, 10.7; 95% CI, 8.6-13.3), and 30 years (HR, 8.9; 95% CI, 6.9-11.5). Geography did not modify mortality risk. Decadal survival improvements in spina bifida paralleled the unaffected cohort. Compared to those born in the 1980s, survival was worse for those born with the condition in the 1950s and 1960s (1960s 1-year HR: 3.1; 95% CI, 2.0-5.0; 1960s 30-year HR: 3.2; 95% CI, 1.4-7.3). Also relative to the 1980s, there was improved survival for those born with spina bifida in more recent decades at many but not all time points (1990s 20-year HR: 0.4; 95% CI, 0.1-1.2 vs 2000s 20-year HR: 0.2; 95% CI, 0.0-0.7). Per the results of this cohort study, survival for those with spina bifida improved markedly between 1950 and 2010, yet it was still substantially worse than population levels. Spina bifida survival did not improve faster than the unaffected population, suggesting ongoing unmet health care needs for spina bifida survival.

Cold knife conization (CKC) and the loop electrosurgical excision procedure (LEEP) are standard treatments for cervical intraepithelial neoplasia and carcinoma in situ. However, the comparative long-term effectiveness of these procedures in promoting human papillomavirus (HPV) clearance and preventing recurrent cervical lesions remains uncertain. To compare the long-term incidence of HPV clearance and recurrence of cervical lesions after CKC or LEEP. This cohort study comprised 2 cohorts: a nationwide cohort from Sweden (cohort 1) and a multicenter hospital-based cohort from Fujian Province, China (cohort 2). The study dates were January 1, 1997, to December 31, 2013, for cohort 1 and from October 1, 2013, to October 1, 2022, for cohort 2. A target trial emulation framework was applied to evaluate the effectiveness of CKC vs LEEP, using inverse probability of censoring weighting to balance baseline covariates and address censoring. Women with cervical intraepithelial neoplasia or carcinoma in situ were included. Data were analyzed from October 1, 2024, to August 31, 2025. Cold knife conization or the loop electrosurgical excision procedure. The primary outcome was recurrence of cervical lesions. Secondary outcomes included HPV clearance at 3, 6, and 12 months (cohort 2). Weighted Cox models with hazard ratios (HRs) and 95% CIs were used to compare the recurrence of cervical lesions between CKC and LEEP, adjusting for clinical and demographic factors. The total sample size was 77&#x202f;001 women who underwent cervical conization in Sweden between 1997 and 2013. In cohort 1, after 22 years of follow-up, 16&#x202f;017 of 75&#x202f;497 (21.2%) women who underwent LEEP had recurrence, and 319 of 1504 (21.2%) women who underwent CKC had recurrence. In cohort 2, 65 of 3710 (1.8%) women who were treated with LEEP had recurrent cervical lesions compared with 11 (0.8%) recurrent cervical lesions among the 1340 women who were treated with CKC after 9 years of follow-up. In the hypothetical target trial, women who underwent CKC had a significantly lower risk of recurrence compared with those who underwent LEEP, with HR of 0.67 (95% CI, 0.65-0.68) in cohort 1 and 0.41 (95% CI, 0.21-0.79) in cohort 2. In addition, the HPV clearance rate after CKC was higher than that of LEEP at 3, 6, and 12 months in cohort 2. These findings suggest that among women with cervical intraepithelial neoplasia or carcinoma in situ, CKC was associated with a lower risk of recurrent cervical lesions and higher HPV clearance rates compared with LEEP.

Repetitive head impacts (RHIs) are associated with later-life neurodegeneration. Because soccer is the most widely played sport among youth worldwide, identifying early changes associated with RHI is important. To determine whether participation in 1 season of youth soccer is associated with changes in cognition, behavior, balance, brain structure or function, or blood biomarkers compared with noncontact sports. Prospective longitudinal cohort study at European centers (Munich, Germany; Leuven, Belgium; and Oslo, Norway). Male adolescent soccer players and noncontact athletes were each studied across a single competitive season with assessments at preseason, postseason, and 2 months later. Data were analyzed from January 2023 to March 2025. Soccer players were compared with noncontact athletes. In addition, self-reported heading of a soccer ball was assessed among soccer players as a measure of RHI. Cognition, behavior, balance, magnetic resonance imaging (brain structure, function, and biochemistry), and plasma biomarkers. Male adolescent soccer players (n&#x2009;=&#x2009;82; mean [SD] age, 14.8 [0.6] years) did not differ from noncontact sport athletes (n&#x2009;=&#x2009;47; mean [SD] age, 14.7 [0.7] years) in cognition, behavior, balance, cortical thickness, brain volumes, white-matter microstructure, or functional connectivity. At preseason, soccer players had higher total N-acetylaspartate (tNAA; &#x3b2;, -0.379 [95% CI, -0.627 to -0.131]; P&#x2009;=&#x2009;.003), glial fibrillary acidic protein (GFAP; &#x3b2;, -0.055 [95% CI, -0.103 to -0.006]; P&#x2009;=&#x2009;.03), and neurofilament light chain (NfL; &#x3b2;, -0.071 [95% CI, -0.122 to -0.020]; P&#x2009;=&#x2009;.01) than noncontact sport controls. Across the season, tNAA (&#x3b2;, 0.047 [95% CI, 0.020-0.074]; P&#x2009;=&#x2009;.001) declined in soccer players and increased in controls, converging by postseason. Group trajectories of GFAP and NfL did not differ between groups. Within soccer players, heading exposure was not significantly associated with changes in any outcome. In this cohort study of adolescent males, no statistically significant differences were detected over 1 season between soccer players and noncontact sport athletes in cognition, behavior, or brain structure and function. Group differences in GFAP and NfL may represent early signs of exposure, but lack of association with heading exposure warrants further investigation. These results highlight the need for large, multiyear studies to inform health policy.

Public housing residents face elevated environmental health risks, yet indoor air quality in these settings remains underexamined. To evaluate indoor air quality in public housing 5 years after implementation of the federal smoke-free housing policy and compare it with outdoor air quality in the same regions. A 1-year cohort study of indoor air quality (particulate matter &#x2264;2.5 &#x3bc;m in diameter [PM2.5]) across 12 multifamily public housing communities in southeastern Virgina for individuals 65 years and older or persons with disability in cities with the highest rated outdoor air quality. Indoor PM2.5 was continuously measured using 117 air quality monitors in shared common spaces and hallways of buildings. Outdoor data were obtained from 3 nearby Environmental Protection Agency (EPA) monitoring stations. Data were collected from January 1 to December 31, 2023. Federal smoke-free housing policy implemented in 2018 aimed at reducing indoor pollution from tobacco smoke. Daily PM2.5 concentrations indoors and outdoors classified using EPA-defined risk categories. A repeated-measures linear mixed model was used to assess daily concentration differences over the 1-year study timeframe. In this study of 12 public housing communities, indoor PM2.5 levels were significantly higher than outdoor levels (mean indoor PM2.5, 23.33 &#x3bc;g/m3; 95% CI, 21.85-24.81 &#x3bc;g/m3; mean outdoor PM2.5, 8.42 &#x3bc;g/m3; 95% CI, 5.49-11.35 &#x3bc;g/m3; P&#x2009;<&#x2009;.001), with 95% of daily indoor readings in the moderate (PM2.5, 9.1-35.4 &#x3bc;g/m3) or worse EPA risk categories, while 69% of outdoor readings were classified as good (PM2.5, 0-9 &#x3bc;g/m3). Results of this study suggest that, despite a strong outdoor air quality rating and a smoke-free housing policy, indoor air quality in public housing remains poor. The findings underscore the need for strong, multifaceted interventions to reduce indoor pollution and promote environmental health equity.