The intersection of neighborhood and race in urban adolescent health risk behaviors

Neighborhood Violence Exposure and Alcohol and Tobacco Use Initiation Among Ethnic Minority Adolescents

Background/Objectives: Although the extant literature has recognized the importance of neighborhood contexts for adolescent alcohol and tobacco use, less is known about the effects of exposure to neighborhood violence on the prevalence and timing of initiation across gender and race/ethnic groups. Methods: This secondary analysis of administrative and survey data from a natural experiment in Denver examines the influence of neighborhood contexts on the health and well-being of 1100 Latino/a and African American adolescents. Cox Proportional Hazard models were used to (1) estimate the effects of exposure to neighborhood violence on the prevalence and timing of adolescent alcohol and tobacco use initiation; (2) examine gender and race/ethnic variations in alcohol and tobacco use initiation after controlling for adolescent, caregiver, household, and other neighborhood characteristics; and (3) test for threshold effects. Results: Prevalence rates among all adolescents were 12.9% for alcohol use initiation and 13.7% for tobacco use initiation but were 14.6% and 17.3%, respectively, among adolescents exposed to higher levels of neighborhood violence. The average age of initiation was 16.1 and 15.6 years for alcohol and tobacco use, respectively, but 2-8 months earlier for adolescents exposed to higher levels of neighborhood violence. Heightened exposure to neighborhood violence increased the hazards of alcohol use initiation by 32% for all adolescents and 38% for adolescent males. The hazards of tobacco use initiation were 1.3 to 1.5 times higher for male, Latino/a, and African American adolescents. Exposure to neighborhood violence suggests threshold effects of diminishing returns on adolescent tobacco use initiation. Conclusions: Findings underscore the need to examine gender and race/ethnic group differences in adolescent alcohol and tobacco initiation, the multiple pathways to such use, and interventions aimed at reducing neighborhood violence.

Responsible research in health disparities using the Adolescent Brain Cognitive DevelopmentSM (ABCD) study

PURPOSE

The Adolescent Brain Cognitive DevelopmentSM (ABCD) Study is the largest longitudinal study on brain development and adolescent health in the United States. The study includes a sociodemographically diverse cohort of nearly 12,000 youth born 2005-2009, with an open science model of making data rapidly available to the scientific community. The ABCD Study® data has been used in over 1100 peer-reviewed publications since its first data release in 2018. The dataset contains a broad scope and comprehensive set of measures of youths' behavioral, health, and brain outcomes, as well as extensive contextual and environmental measures that map onto the social determinants of health (SDOH). Understanding the impact of SDOH on the developmental trajectories of youth will help to address early lifecourse health inequities that lead to disparities later in life. However, the open science model and extensive use of ABCD data highlight the need for guidance on appropriate, responsible, and equitable use of the data.

DESIGN METHODS

Our conceptual framework integrates the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework with strength-based and data equity perspectives. We use this framework to articulate best practices and methods for investigations that aim to identify the multilevel pathways by which structural and systemic inequities impact adolescent health trajectories.

RESULTS

Using our conceptual model, we provide recommendations for equitable health disparities research using ABCD Study data. We identify over fifty ABCD measures that can encompass SDOH across five levels of influence: individual, interpersonal, school, community, and societal. We expand the societal level to acknowledge structural discrimination as the root cause of systemic and structural inequities resulting in health disparities among marginalized youth. We apply the methodological recommendations in an example data analysis using a multi-level approach that integrates strength-based and data equity perspectives to elucidate pathways by which social and structural inequities may influence cognitive decision making in youth. We conclude with recommendations for strengthening the utility of ABCD data for health disparities research now and in the future.

CONCLUSION

Adolescence is a critical period of development with subsequent ramifications for health outcomes across the lifespan. Thus, understanding SDOH among diverse youth can inform prevention interventions before the emergence of health disparities in adulthood.

Alcohol use in multiracial American youth compared with monoracial youth: A meta-analysis

BACKGROUND AND AIMS

Although multiracial people comprise the fastest growing population in the United States, multiracial youth are nearly invisible in alcohol research. This meta-analysis synthesized the youth alcohol literature to estimate the magnitude of difference in alcohol use as a function of multiracial status.

DESIGN AND MEASUREMENTS

Empirical studies reporting multiracial and monoracial comparisons in youth (aged 10-24 years) alcohol use were identified through a systematic literature search. A random-effects meta-analysis was conducted using 85 effect sizes extracted from 16 studies assessing life-time, past-year, past-month and binge alcohol use.

SETTING AND PARTICIPANTS

A total of n=1 555 635 youth were assessed in the United States.

FINDINGS

Multiracial youth are suggested to be more likely to endorse life-time alcohol use than Asian youth [number of studies (k) = 3; odds ratio (OR) = 1.81, 95% confidence interval (CI) = 1.01, 3.24; p = 0.04], with significant between-study heterogeneity (Q = 8.42; p < 0.001; I2  = 76%) in effect size comparisons. Multiracial youth are suggested to be more likely to endorse past-month alcohol use than Black (k = 6; OR = 1.54, 95% CI = 1.38, 1.71; p < 0.001) and Asian (k = 4; OR = 2.09, 95% CI = 1.52, 2.88; p < 0.001) youth, but less likely than White (k = 6; OR = 0.87, 95% CI = 0.84, 0.91; p < 0.001) youth, with significant between-study heterogeneity for Black youth (Q = 11.94; p = 0.03; I2  = 58%) in effect size comparisons. Lastly, multiracial youth are suggested to be more likely to endorse binge alcohol use than Black (k = 4; OR = 1.98, 95% CI = 1.62, 2.44; p < 0.001) and Asian (k = 4; OR = 2.82, 95% CI = 2.28, 3.48; p < 0.001) youth, but less likely than White (k = 5; OR = 0.75, 95% CI = 0.70, 0.81; p < 0.001) and American Indian/Alaska Native (k = 3; OR = 0.78, 95% CI = 0.71, 0.85; p < 0.001) youth, with significant between-study heterogeneity among Black (Q = 23.99; p < 0.001; I2  = 87%) and Asian (Q = 17.76; p < 0.001; I2  = 83%) youth in effect size comparisons.

CONCLUSIONS

In the United States, multiracial youth report distinct alcohol use patterns compared with monoracial youth and may be at elevated alcohol use risk compared with Black and Asian youth.

Cumulative Health Vulnerabilities Among Adolescents by Age and Neighborhood Opportunity

BACKGROUND AND OBJECTIVES

Early detection of health vulnerabilities in adolescents is integral to promoting healthy behaviors into adulthood. Our objective was to quantify the prevalence of health vulnerabilities among adolescents and examine differences by age and neighborhood opportunity.

METHODS

In a cross-sectional analysis of electronic health record data for adolescents aged 13 to 18 years with preventive visits in a large pediatric primary care network between September 2021 and September 2022, we examined 5 health vulnerabilities: Tobacco use, substance use, firearm access, condomless intercourse, and depressive symptoms. Health vulnerabilities were assessed via self-reported adolescent health questionnaire and the validated Patient Health Questionnaire-Modified. Prevalence of health vulnerabilities were calculated alone and in combination, and compared by age and by quintile of neighborhood Child Opportunity Index (COI) score. Multivariable logistic regression estimated associations of neighborhood COI with reporting ≥2 health vulnerabilities.

RESULTS

Among 40 197 adolescents (57.7% aged 13-15 years, 66.3% living in "high"/"very high" COI neighborhoods), 29.7% reported at least 1 health vulnerability and 7.9% reported ≥2 vulnerabilities. Cumulative health vulnerabilities were more prevalent among older adolescents and adolescents from lower opportunity neighborhoods. In adjusted models, lower COI was associated with 65% higher odds of having ≥2 vulnerabilities (odds ratio 1.65, 95% confidence interval 1.43-1.91) compared with adolescents from the highest COI quintile.

CONCLUSIONS

Understanding the relationship between health vulnerabilities and neighborhood opportunities among adolescents may allow pediatric primary care providers and health systems to offer more tailored community support services and transdiagnostic specialized care navigation to address the health needs of teens with multiple vulnerabilities.