About

Alexander G. Fiks, MD, MSCE, is a Professor of Pediatrics (General Pediatrics) at the Children's Hospital of Philadelphia and holds multiple roles within the University of Pennsylvania. He is a Physician in the Division of General Pediatrics at the Children's Hospital of Philadelphia and a Senior Fellow at the Leonard Davis Institute of Health Economics. Additionally, he is an Associate Scholar at the Center for Clinical Epidemiology and Biostatistics and a faculty member at PolicyLab at the Children's Hospital of Philadelphia. Dr. Fiks is also a Senior Fellow at the Penn Institute for Biomedical Informatics and a faculty member at the Center for Pharmacoepidemiology Research and Training (CPeRT) at the Perelman School of Medicine. His leadership roles include directing The Possibilities Project (Primary Care Innovation) at the Children's Hospital of Philadelphia and serving as Medical Director of The Pediatric Research Consortium (PeRC). He is a member of the Center for Health Incentives and Behavioral Economics at the Perelman School of Medicine and directs Clinical Futures, a research institute center of emphasis at the Children's Hospital of Philadelphia. Dr. Fiks's educational background includes an AB in Biology from Harvard University, a Diploma in Hispanic Studies from the University of Salamanca, Spain, an MD from Harvard University, and an MSCE in Clinical Epidemiology from the University of Pennsylvania. His research focuses on clinical epidemiology, health economics, and primary care innovation, contributing to the advancement of pediatric healthcare and health policy.

Research topics

• Medicine
• Virology
• Pathology
• Internal medicine
• Demography
• Family medicine
• Medical emergency
• Psychiatry
• Pediatrics
• Environmental health
• Gerontology

Selected publications

• Missed Opportunities for Human Papillomavirus Vaccination Before Sexual Debut Among Adolescents

  JAMA Pediatrics · 2026-03-16

  articleOpen access

  This cross-sectional study examines factors associated with missed opportunities to vaccinate adolescents for human papillomavirus before sexual debut, using survey data linked to vaccination records within a large pediatric network.

  PublisherOA PDFDOI

• Shared Decision Making Interventions for Parents of Children on the Autism Spectrum: A Systematic and Scoping Review

  Community Mental Health Journal · 2026-03-02

  articleOpen access

  Parents of children on the autism spectrum face challenging treatment-related decisions, often with limited knowledge about available options. Shared Decision Making (SDM), a process where clinicians, patients, and families collaborate to make decisions based on evidence and preferences, can assist parents in navigating these choices. However, little is known about the use of SDM interventions for autism-related parental decisions. A systematic and scoping review was conducted across four databases (PubMed, Embase, Web of Science, and PsycInfo), and grey literature in two clinical trial registries. Study selection was conducted in two phases: title and abstract screening and full-text screening. From 7,610 records identified, two studies were included from Australia and Italy, describing multicomponent SDM interventions for parents of young children (< 18 years) on the autism spectrum. Both interventions demonstrated improvements in SDM-related outcomes, including parents' knowledge of autism treatments (such as speech pathology services and Early Intensive Behavior Intervention) and parents' involvement in treatment discussions. This review reveals a critical gap in SDM intervention research for autism parental decision-making. Despite the critical role parents play in autism treatment decisions, evidence-based SDM interventions remain scarce. This finding is significant given the well-established benefits of SDM in other healthcare populations and underscores the urgent need to develop and rigorously evaluate SDM interventions tailored to autism care contexts that support parents in making informed decisions about their children's care.Systematic review registration: A protocol was registered on PROSPERO.

  PublisherOA PDFDOI

• An Electronic Health Record–Based Tobacco Treatment System for Parents in Pediatric Primary Care

  PEDIATRICS · 2026-03-17

  article

  BACKGROUND: Parental smoking is a leading source of secondhand smoke exposure for children, increasing risks of respiratory illness and future smoking. Cessation treatment delivery for parents remains rare in pediatrics. This study evaluates the population-level impact of an automated tobacco treatment system integrated into the electronic health record (EHR) in pediatric primary care. METHODS: We conducted a retrospective observational study of parents whose children received care at 12 pediatric practices in a cluster-randomized trial (June 2021-August 2024). Six practices implemented an automated EHR-linked parent tobacco treatment system (screening, motivational messaging, automatic treatment connection including nicotine replacement therapy, SmokefreeTXT, and quitline referral through a previsit questionnaire); 6 implemented screening only. This analysis included all parents who completed questionnaires during routine care, excluding parents enrolled in the trial. We analyzed self-reported cessation rates among parents who reported smoking during the study period. RESULTS: Among 55 567 parents with follow-up data (49 595 mothers; 5972 fathers), smoking rates were 4.3% vs 5.5% for mothers and 6.5% vs 8.3% for fathers receiving care with vs without the system. Among mothers who reported smoking during the study, cessation rates were significantly higher for those receiving care with the system (37.4% vs 33.5%, P = .044), representing a 3.9% improvement. Among fathers who smoked, there was no difference in cessation rates (29.6% vs 29.6%). CONCLUSIONS: An automated tobacco treatment system was associated with significantly increased maternal smoking cessation in pediatric settings while showing no effect for fathers. This scalable approach could enhance pediatric preventive care by reducing household tobacco use.

  PublisherDOI

• Extreme Temperatures and Missed Pediatric Preventive Care Visits

  JAMA Network Open · 2026-04-27

  articleOpen accessSenior author

  Importance: Missed pediatric preventive care visits can delay essential developmental screenings, immunizations, and management of chronic conditions, adversely impacting child health. Understanding the relationship between extreme temperatures and missed preventive care is essential for developing adaptive strategies to maintain care access amid increasing climate variability. Objective: To assess the association of extreme temperatures with rates of missed pediatric preventive care visits and evaluate differences by patient age, insurance, and neighborhood socioeconomic status (SES). Design, Setting, and Participants: This cross-sectional time-series study used electronic health record data of patients aged younger than 19 years with scheduled preventive care visits at 32 primary care practices in the Children's Hospital of Philadelphia primary care network in Pennsylvania and New Jersey from January 1, 2009, to December 31, 2023. Statistical analyses were completed between March and October 2025. Exposure: Daily maximum temperature (°F), derived from the National Oceanic and Atmospheric Administration's weather stations and averaged at the county level for each practice. Main Outcome and Measures: Daily rate of missed preventive care visits (the proportion of scheduled visits resulting in same-day cancellation or no-show). Generalized linear quasi-Poisson models estimated associations of daily maximum temperature (in °F) with daily rate of missed preventive care visits overall and stratified by age, insurance, and neighborhood SES. Associations were evaluated separately for warm (May-October) and cold (November-April) months. Heterogeneity across strata was evaluated using the Cochran Q test. Results: Among 504 428 patients, 51% were male, 36% had public insurance, and 27% were from very low SES neighborhoods. Mean (SD) patient age was 6.0 (5.7) years. Among 4 137 542 scheduled preventive care visits, 13% were missed. Each 1 °F decrease below a maximum daily temperature of 41.5 °F in cold months and 1 °F increase above 88.0 °F in warm months was associated with a higher rate of missed visits (rate ratios, 1.01 [95% CI, 1.01-1.01] and 1.01 [95% CI, 1.00-1.01], respectively). Significant heterogeneity in missed visits across age, payer, and neighborhood SES was observed in cold months, with higher rates of missed visits among patients with commercial vs public or other types of insurance (RR, 1.02; 95% CI, 1.02-1.02) as well as among younger patients and those from high SES neighborhoods. Conclusions and Relevance: In this cross-sectional study, extreme outdoor temperatures were associated with increased rates of missed pediatric preventive care visits, with heterogeneity across age, payer, and neighborhood SES during cold months. The findings suggest proactive scheduling strategies and alternative care delivery models should be assessed to maintain access to essential pediatric preventive care services during temperature extremes.

  PublisherOA PDFDOI

• Generative Artificial Intelligence: Implications for Families and Pediatricians

  PEDIATRICS · 2026-03-04 · 1 citations

  article

  Generative artificial intelligence (AI) technologies, capable of producing original text, images, audio, and video, are increasingly embedded in children's learning, play, and daily life. Pediatric clinicians and parents face the challenge of guiding children toward safe and constructive engagement with these rapidly evolving tools. This state-of-the-art review synthesizes current knowledge regarding opportunities, risks, and best practices related to children's interactions with generative AI. Developmental considerations are emphasized because the impact of AI varies across early childhood, middle childhood, and adolescence. We highlight potential benefits, including personalized learning, creative expression, and enhanced communication, while also discussing risks such as misinformation, privacy threats, and false perceptions of AI as a friend or caregiver. Evidence-based strategies are proposed to promote AI literacy, critical thinking, and safe integration of AI into pediatric care and education.

  PublisherDOI

• Primary Care Telemedicine vs In-Person Antibiotic Prescribing for Pediatric Respiratory Tract Infections

  JAMA Network Open · 2026-05-01

  articleOpen accessSenior author

  Importance: Acute respiratory tract infections (ARTIs) are among the most common reasons for pediatric primary care visits and antibiotic receipt. Telemedicine outside of primary care settings has been associated with overuse of antibiotics for ARTIs in children. The quality of telemedicine when integrated within primary care for children is not clear. Objective: To compare antibiotic management during primary care visits conducted through telemedicine vs in-person. Design, Setting, and Participants: This retrospective, cross-sectional study analyzed visits for ARTIs in children younger than 18 years between January 1 and December 31, 2023, at 694 US primary care practices (including community health organizations, independent pediatric practices, and practice networks affiliated with large health systems). Analyses were performed between October 1, 2024, and February 12, 2026. Exposure: Primary care telemedicine vs primary care in-person index visits. Main outcomes and measures: The primary outcomes were percentage of index visits with antibiotics prescribed and percentage with antibiotic management concordant with guidelines for visit diagnosis. Secondary outcomes included index visit diagnosis, follow-up visits within 14 days, and antibiotic prescription within 14 days. Weighted analyses were conducted using a propensity score model to estimate the probability of an ARTI index visit being conducted via telemedicine and estimated the average treatment effect associated with telemedicine. Results: This study included 438 148 in-person and 11 482 telemedicine index ARTI visits at primary care practices by 302 817 children (mean [SD] age: 6.6 [4.7] years; 51.4% male). Antibiotic prescription occurred during 46.8% (95% CI, 45.1%-48.4%) of primary care in-person visits vs 34.6% (95% CI, 27.0%-42.3%) of primary care telemedicine visits in the propensity score-weighted model, with a difference of -12.1 (95% CI, -19.3 to -5.0) percentage points. Antibiotic management was guideline concordant for 86.2% (95% CI, 85.1%-87.3%) of primary care in-person visits vs 85.5% (95% CI, 80.5%-90.4%) of primary care telemedicine visits, with a difference of -0.7 (95% CI, -5.3 to 3.8) percentage points. The proportion of follow-up visits and antibiotic prescription within 14 days after initial visit did not vary significantly by index visit modality. Conclusions and Relevance: In this cross-sectional study of primary care practices caring for children, telemedicine integrated within primary care was associated with judicious antibiotic prescribing without increased follow-up visits or subsequent antibiotics prescribed. Supporting primary care practices in offering telemedicine for acute concerns may be a strategy to limit unnecessary antibiotic receipt.

  PublisherDOI

• Association of Stress and Neighborhood Social Context With Actigraphy-Measured and Self-Reported Adolescent Sleep Outcomes

  Journal of Adolescent Health · 2026-05-01

  articleOpen access

  PURPOSE: Chronic stress and unfavorable neighborhood environments may increase adolescents' risk for poor sleep. Few studies have examined whether neighborhood social environments moderate associations of adolescents' perceptions of stress with actigraphy-measured and self-reported sleep outcomes. METHODS: In a cross-sectional study of adolescents aged 15-18 (n = 163) years, perceived stress (10-item Perceived Stress Scale) and perceived neighborhood collective efficacy and safety were assessed via survey. Over 14 days, actigraphy measured nightly sleep duration and timing, while ecological momentary assessment (EMA) measured daily stress, self-reported sleep problems, and sleep environment disruptions. Multivariable mixed effects regression estimated associations of stress and neighborhood social factors with nightly sleep patterns and self-reported sleep outcomes, while multivariable linear regression estimated associations with sleep variability (intraindividual standard deviation of each sleep measure). RESULTS: Higher 10-item Perceived Stress Scale scores and daily EMA-reported stress were associated with more variable sleep duration, onset, and offset timing, and higher and more variable sleep problem scores. Daily EMA-reported stress was also associated with earlier sleep timing. Higher neighborhood collective efficacy was associated with less variable sleep duration and timing, and lower and less variable sleep problem scores. Neighborhood collective efficacy and safety moderated associations between stress and several sleep outcomes (e.g., stronger associations between stress and sleep variability were present among adolescents with low neighborhood safety or collective efficacy). DISCUSSION: Lower perceived stress and higher neighborhood collective efficacy were associated with less variable sleep patterns and lower sleep problem scores. Results suggest positive neighborhood social environments may moderate the relationship of stress with adolescent sleep variability.

  PublisherOA PDFDOI

• Parent-focused behavioural interventions for the prevention of early childhood obesity (TOPCHILD): a systematic review and individual participant data meta-analysis

  The Lancet · 2025-09-01 · 7 citations

  reviewOpen access
  PublisherOA PDFDOI

• Feasibility, Acceptability, and Fidelity of the Take Steps HIV Prevention Intervention

  Journal of Adolescent Health · 2025-02-07

  articleOpen access
  PublisherOA PDFDOI

• Family partnerships to support equity and cultural humility in pediatric intervention research

  Journal of Pediatric Psychology · 2025-05-20

  articleOpen access

  OBJECTIVE: Family partnerships in community-engaged research (CEnR) can promote family-centered, equitable interventions. This paper describes the process (meeting frequency, content) of a collaborative research family partnership and related methodological modifications to support equity and cultural humility during a multi-phase project adapting and evaluating an early childhood sleep intervention (Sleep Well!) for families of primarily lower socioeconomic status (SES) backgrounds in urban (large, metropolitan) primary care. METHODS: The Children's Hospital of Philadelphia Research Family Partners Program consulted on initial project development. Research family partners collaborated to modify intervention content, delivery methods, and research procedures in an open-pilot (NCT04046341) and randomized controlled trial (NCT04473222). We reviewed family partners meeting agendas, presentations, and minutes to identify meeting frequency, content, and resulting project modifications and to generate related themes. Family partners also provided recommendations for researchers, including for those without existing institutional CEnR resources. RESULTS: Ten 60-120-min meetings with 4-6 family partners occurred over 4 years. Themes representing the partnership process and project modifications included enhancing flexibility, centering cultural humility, and incorporating contextual factors (coronavirus pandemic, police violence, racism). These factors were especially relevant as project participants were primarily Black mothers and/or of lower-SES backgrounds. Family partner recommendations highlighted the need for collaborative, meaningful, and communicative relationships in pediatric intervention research. CONCLUSIONS: The extent of recommended project modifications highlights the importance of family partnerships to support equity and cultural humility in pediatric psychology research and practice. Findings also underscore the need for representation of racial and ethnic minoritized scholars and families in this work.

  PublisherOA PDFDOI

Recent grants

• National Center for Pediatric Practice Based Research & Learning

  NIH · $599k · 2012–2018

• NIH Grant K23HD059919

  NIH · $631k · 2015

• NIH Grant R18HS022689

  NIH · $488k · 2015

• Improving HPV Vaccination Delivery in Pediatric Primary Care: The STOP-HPV Trial

  NIH · $3.1M · 2017–2024

• Flu2Text: A Multi-Site Study assessing an Intervention for 2nd Dose of Influenza Vaccine

  NIH · $2.4M · 2016–2022

Frequent coauthors

• Robert W. Grundmeier

  Children's Hospital of Philadelphia

  164 shared

• Stephanie L. Mayne

  University of Pennsylvania

  107 shared

• Maryland Baltimore

  AtlantiCare

  93 shared

• Ron Keren

  Children's Hospital of Philadelphia

  92 shared

• Brian P. Jenssen

  University of Pennsylvania

  87 shared

• Dimitri Christakis

  University of Washington

  82 shared

• Maria Trent

  Johns Hopkins University

  78 shared

• Shawn J. Rangel

  Boston Children's Hospital

  78 shared

Education

• B.A., Biology

  Harvard University

  1992

• Other, Hispanic Studies

  University of Salamanca, Spain

  1993

• M.D., Medicine

  Harvard University

  1997

• M.S., Clinical Epidemiology

  University of Pennsylvania

  2007