Self-Rated Health Across Race, Ethnicity, and Immigration Status for US Adolescents and Young Adults

Social media threats and health among adolescents: evidence from the health behaviour in school-aged children study

BACKGROUND

Social media are immensely popular among adolescents. Thus, concerns have been raised about the threats adolescents encounter on social media and the possible negative health consequences, such as depressive symptoms and anxiety. This study investigated the prevalence of nine social media threats: (1) cyberbullying, (2) sexual harassment, (3) racism, (4) unauthorized distribution of sensitive material, (5) phishing attempts, (6) misinformation, (7) the sale or distribution of drugs, (8) harmful or dangerous social media challenges, (9) content causing appearance pressures. The study also investigated how individual and social factors, problematic social media use (PSMU), and online communication with strangers are associated with social media threat exposure, as well as the association between social media threats and self-rated health, depressive feelings, and anxiety symptoms.

METHODS AND FINDINGS

Nationally representative Health Behaviour in School-aged Children (HBSC) data from Finland were obtained from 2288 respondents aged 11, 13, and 15 years. Fixed effects regression models were applied. The most common threat, encountered daily and weekly, was misinformation. Regression models showed that individual and social factors, PSMU, and online communication with strangers explained adolescent exposure to social media threats in differing ways. Furthermore, certain factors (e.g., emotional intelligence, family support) were associated with encountering social media threats less frequently, whereas other factors (e.g., PSMU, online communication with strangers) were associated with more frequent encounters. Daily and weekly exposure to social media threats was systematically associated with poor self-rated health, frequent depressive feelings, and anxiety symptoms.

CONCLUSIONS

Our study highlights the need for intervention and health promotion efforts to mitigate adolescent exposure to social media threats and ensuing negative health consequences.

Self-rated health, time of residence and social determinants of health in immigrant populations: A complex relationship in groups of different origins in a Southern European region

Health of immigrant population changes with time of residence and under the effect of social determinants of health. This study analyses the health status of the immigrant population in the Basque Country according to groups of origin assessing the effect of time of residence on health in the different origin groups considering social and migration-related determinants of health. A cross-sectional study of the immigrant population in the Basque Country using the Foreign Origin Population Survey was conducted. A descriptive analysis is performed of each group of origin and Poisson models are applied. The main variable is self-rated health, and the independent variables are divided into three groups: demographic, socioeconomic and migration-related. For the study, immigrants are divided into six origin groups. Results show that the health and the effects of socioeconomic and migratory variables on health vary according to origin. Immigrants with greater economic difficulties present poorer health, though to different extents and the effects on health of educational level and perception of discrimination differ according to origin. Finally, the relation between time of residence and self-rated health varies according to origin: Colombian, Ecuadorian, Peruvian, Eastern EU and sub-Saharan immigrants living in Spain for 10 or more years report poorer health even when controlling for socioeconomic and migration-related variables, while people from the Maghreb and Asia do not. Therefore, the effects on health of time of residence, living conditions and the migratory experience differ according to migrant group, leading to the importance of analysing the health of immigrants as a heterogeneous group.

What Counteracts Problematic Social Media Use in Adolescence? A Cross-National Observational Study

PURPOSE

Social media use has increased rapidly during the past decade, raising concerns about adolescents who display problematic social media use (PSMU), as indicated by addiction-like symptoms (e.g., preoccupation, tolerance). We aimed to assess the extent to which an individual resource (health literacy), and social resources (friend support and family support), moderated the association between a range of individual characteristics (gender, age, family affluence, and depressive feelings) and PSMU; also the association between PSMU and health outcomes (self-rated health, life satisfaction, and sleep difficulties), both cross-nationally and nationally.

METHODS

Our sample included 22,226 adolescents from six European countries. We used data from the Health Behaviour in School-aged Children cross-sectional survey (2017/2018). Random-effects models and moderator analyses were applied.

RESULTS

Six moderations were found, with the resources moderating the association between individual characteristics and PSMU. One moderation emerged cross-nationally, namely that a higher level of family support was associated with a lower likelihood of PSMU, especially among adolescents who did not have frequent depressive feelings. In addition, five national moderations were identified. For example, a higher level of health literacy was associated with a lower likelihood of PSMU among Finnish girls. The resources were also found to moderate the association between PSMU and health outcomes, with two moderations emerging cross-nationally. For instance, a higher level of family support was related to higher self-rated health, especially among problematic users. In addition, nine national moderations were identified; these included a higher level of health literacy being associated with having less sleep difficulties, especially among problematic users in Germany.

DISCUSSION

In adolescence, health literacy, family support, and friend support have the potential to moderate the association between individual characteristics and PSMU, and between PSMU and health outcomes, cross-nationally and nationally. We recommend the use of universal and targeted interventions to promote individual and social resources to counteract PSMU.

Trauma Made in America: The Consequences of Violent Victimization for Immigrant Youth in Early Adulthood

Research finds that adolescent violent victimization results in numerous lasting negative life consequences. However, the long-term impacts of victimization are understudied among immigrant youth. Using a subsample of 952 immigrants from Waves I-III of the National Longitudinal Study of Adolescent to Adult Health, regression models are specified to determine whether violent victimization in adolescence is related to negative outcomes in early adulthood (poor health, depressive symptoms, low self-esteem, suicidality, alcohol problems, drug use, property offending, and violent offending). Results indicate that victimization has no robust associations with any long-term adverse outcomes among immigrants. The findings are discussed using perspectives on immigrant resilience and highlight the need for research to further explore how immigrant youth overcome their experiences with violence.

Longitudinal associations between high school sleep characteristics and young adult health outcomes

STUDY OBJECTIVES

Short sleep duration and evening chronotype are independently associated with negative health outcomes. However, it is unclear how adolescent sleep duration and chronotype are longitudinally associated with health outcomes during early adulthood.

METHODS

Participants from the NEXT Generation Health Study (n = 2,783; 54.5% female) completed measures of sleep duration (scheduled day and unscheduled day) and chronotype in high school. Sleep duration, chronotype, general health, depressive symptoms, and psychosomatic symptoms were also assessed 4 years after high school. Latent variables estimated high school scheduled-day sleep duration, unscheduled-day sleep duration, and chronotype using the during high school measures. Two path analyses tested the prospective associations between high school sleep duration (separate models for scheduled and unscheduled days) and chronotype with 4 years after high school health outcomes as mediated by concurrent sleep duration and chronotype.

RESULTS

In the scheduled-day model, longer high school sleep duration and later chronotype were associated with longer duration and later chronotype in early adulthood. Longer high school sleep duration was directly associated with fewer psychosomatic symptoms and indirectly associated with fewer depressive and psychosomatic symptoms through longer sleep duration in early adulthood. Later chronotype in high school was indirectly associated with poorer general health, greater depressive symptoms, and greater psychosomatic symptoms in early adulthood through later chronotype.

CONCLUSIONS

Findings highlight the roles of scheduled-day sleep duration and evening chronotype in shaping health outcomes and suggest the importance of chronotype and optimal sleep habits among adolescents.

CITATION

Maultsby KD, Temmen CD, Lewin D, et al. Longitudinal associations between high school sleep characteristics and young adult health outcomes. J Clin Sleep Med. 2022;18(11):2527-2536.

Perceived stress of adolescents during the COVID-19 lockdown: Bayesian multilevel modeling of the Czech HBSC lockdown survey

Objective

Long-term isolation, including lockdowns and quarantines, may have a distressing effect on anyone experiencing it. Adolescent brain architecture is very sensitive to environmental adversities, and the mental health development of adolescents may be particularly vulnerable during the pandemic era. In order to better understand the triggers for perceived adolescent stress (PSS) during the COVID-19 lockdown, the present study aimed to assess the effects of social well-being and changes in time use during the lockdown, as well as the family COVID experience of adolescents.

Methods

The sample for this study comprised n = 3,440 adolescents (54.2% girls; mean age = 13.5 ± 1.6 years). Bayesian correlations between PSS, health and well-being variables were assessed. PSS was then modeled as an outcome variable in a series of nested Bayesian multilevel regression models.

Results

The negative impact of the COVID-19 lockdown was more apparent in girls. PSS was moderately correlated with adolescent health and well-being. The strongest predictor of higher level of PSS was frequent feeling of loneliness. On the contrary, lower level of PSS was most associated with having someone to talk to.

Conclusion

Long-term social isolation of adolescents could be harmful to their mental health. Psychological coping strategies to prevent the consequences of social isolation and development of mental health problems should be promoted on the individual, family, and even community level.

Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study

Studies of migration and health focus on a "healthy migrant effect" whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (β = 0.32; 95% CI = 0.22, 0.43) and at 1-year (β = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.

Patterns of Co-occurring Developmental Failures in Adolescence: Socioeconomic and Genetic Antecedents and Health Outcomes in Adulthood

This study investigates (1) conjoint latent classes of adolescent co-occurring developmental problems (obesity, depressive symptoms, and low educational attainment), (2) socioeconomic and genetic influences on these classes of adolescents' problem trajectories, and (3) physical health consequences of those latent classes. Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 9,107; mean age = 15.5 years; Female = 52.9 per cent) were used to identify classes of early socioeconomic adversity and conjoint trajectory groups of co-occurring developmental problems. Profiles of social antecedents, genetic endowments (polygenic scores), and physical health outcomes in young adulthood were compared across identified four conjoint trajectory risk groups (overall high-risk, overall low-risk, BMI-risk or obesity, low education-risk). The results showed that youth with overall high-risk and BMI/education-specific risk trajectory groups were more likely to be Black or Hispanic, reported more adverse socioeconomic characteristics and genetic endowment, and averaged significantly poorer physical health in young adulthood compared with youth in the overall low-risk problem trajectory group. Less pronounced differences emerged between the high-risk and problem-specific-risk groups. The findings highlight heterogeneity in adolescent co-occurring developmental problems. Adolescent heterogeneous problem co-development is associated with background socioeconomic and genetic characteristics and physical health in young adulthood.

Likelihood of Lung Cancer Screening by Poor Health Status and Race and Ethnicity in US Adults, 2017 to 2020

Importance

Lung cancer screening (LCS) via low-dose chest computed tomography can prevent mortality through surgical resection of early-stage cancers, but it is unknown whether poor health is associated with screening. Though LCS may be associated with better outcomes for non-Hispanic Black individuals, it is unknown whether racial or ethnic disparities exist in LCS use.

Objective

To determine whether health status is associated with LCS and whether racial or ethnic disparities are associated with LCS independently of health status.

Design, Setting, and Participants

This cross-sectional, population-based study of community-dwelling US adults used data from Behavioral Risk Factor Surveillance System annual surveys, 2017 to 2020. Participants were aged 55 to 79 years, with a less than 30 pack-year smoking history, and were current smokers or those who quit within 15 years. Data were analyzed from August to November 2021.

Exposures

Self-reported health status and race and ethnicity.

Main Outcomes and Measures

Self-reported LCS in the last 12 months.

Results

Of 14 550 individuals (7802 men [55.5%]; 7527 [55.0%] aged 65-79 years [percentages are weighted]), representing 3.68 million US residents, 17.0% (95% CI, 15.1%-18.9%) reported undergoing LCS. The prevalence of LCS was lower among non-Hispanic Black than non-Hispanic White individuals but not to a significant degree (12.0% [95% CI, 4.3%-19.7%] vs 17.5% [95% CI, 15.6%-19.5%]; P = .57). Health status was associated with LCS: 468 individuals in poor health vs 96 individuals in excellent health reported LCS (25.2% [95% CI, 20.6%-29.9%] vs 7.6% [95% CI, 5.0%-10.3%]; P < .001), and those with difficulty climbing stairs were more likely to report LCS than those without this functional limitation. Adjusting for sociodemographic factors, functional status, and comorbidities, self-rated health status remained associated with LCS (adjusted odds ratio, 1.19 per each 1-step decline in health; 95% CI, 1.03-1.38), and non-Hispanic Black individuals were 53% less likely to report LCS than non-Hispanic White individuals (adjusted odds ratio, 0.47; 95% CI, 0.24-0.90). Results were robust in sensitivity analyses in which health was alternatively quantified as number of comorbidities.

Conclusions and Relevance

LCS in the US is more common among those who may be less likely to benefit from screening because of poor underlying health. Furthermore, racial or ethnic disparities were evident after accounting for health status, with non-Hispanic Black individuals nearly half as likely as non-Hispanic White individuals to report LCS despite the potential for greater benefit of screening this population.

Downward income mobility among individuals with poor initial health is linked with higher cardiometabolic risk

The effects of socioeconomic position (SEP) across life course accumulate and produce visible health inequalities between different socioeconomic groups. Yet, it is not well-understood how the experience of intergenerational income mobility between origin and destination SEP, per se, affects health outcomes. We use data from the National Longitudinal Study of Adolescent to Adult Health collected in the United States with the outcome measure of cardiometabolic risk (CMR) constructed from data on LDL Cholesterol, Glucose MG/DL, C-reactive protein, systolic and diastolic blood pressure, and resting heart rate. Intergenerational income mobility is estimated as the difference between Waves 1 and 5 income quintiles. Diagonal reference models are used to test if intergenerational income mobility, net of origin and destination income quintile effects, is associated with CMR. We find that individuals in the lowest and the highest income quintiles have, respectively, the highest and the lowest CMR; both origin and destination income quintiles are equally important; there are no significant overall income mobility effects for different gender and race/ethnicity groups, but downward income mobility has negative health implications for individuals with poor initial health. We conclude that downward income mobility can increase inequalities in CMR in the United States by worsening the health of those who had poor health before their mobility experiences.

Impact of experienced HIV stigma on health is mediated by internalized stigma and depression: results from the people living with HIV stigma index in Ontario

Background

Experiences of HIV stigma remain prevalent across Canada, causing significant stress and negatively affecting the health and wellbeing of people living with HIV. While studies have consistently demonstrated that stigma negatively impacts health, there has been limited research on the mechanisms behind these effects. This study aims to identify which dimensions of stigma have significant relationships with self-rated health and examine the mechanisms by which those types of stigma impact self-rated health.

Methods

We recruited 724 participants to complete the People Living with HIV Stigma Index in Ontario, designed by people living with HIV to measure nuanced changes in stigma and discrimination. The present study utilizes data from externally validated measures of stigma and health risks that were included in the survey. First, we conducted multiple regression analyses to examine which variables had a significant impact on self-rated health. Results from the multiple regression guided the mediation analysis. A parallel mediation model was created with enacted stigma as the antecedent, internalized stigma and depression as the mediators, and self-rated health as the outcome.

Results

In the multiple regression analysis, internalized stigma (coefficient = −0.20, p < 0.01) and depression (coefficient = −0.07, p < 0.01) were both significant and independent predictors of health. Mediation analyses demonstrated that the relationship between enacted stigma and self-rated health is mediated in parallel by both internalized stigma [coefficient = −0.08, se = 0.03, 95% CI (−0.14, −0.02)] and depression [coefficient = −0.16, se = 0.03, 95% CI (−0.22, −0.11)].

Conclusions

We developed a mediation model to explain how HIV-related stigma negatively impacts health. We found that that enacted stigma, or experiences of prejudice or discrimination, can lead to internalized stigma, or internalization of negative thoughts regarding one’s HIV status and/or increased depressive symptoms which then may lead to worse overall health. Highlighting the importance of internalized stigma and depression has the potential to shape the development of targeted intervention strategies aimed at reducing the burden of stigma and improving the health and wellbeing of people living with HIV.

Recently-Arrived Afghan Refugee Parents' Perspectives About Parenting, Education and Pediatric Medical and Mental Health Care Services

Refugee children are at risk for mental/behavioral health problems but may not receive timely diagnosis or care. Parental experiences and perspectives about resources in the US may help guide interventions to improve mental/behavioral health care. In a community-academic partnership, we performed a qualitative study of recently-arrived Afghan refugee parents, using in-depth, semi-structured interviews to characterize experiences with parenting, education, and health care services. A four-person coding team identified, described, and refined themes. We interviewed 19 parents from ten families, with a median residence in the US of 24 months. Four themes emerged; parents described: (1) shifting focus as safety needs changed, (2) acculturation stress, (3) adjustment to an emerging US support system, and (4) appreciation of an engaged health care system. Health and educational providers' appreciation for the process of acculturation among newly-arrived refugee Afghan families may facilitate screening, diagnostic, and intervention strategies to improve care.

Determinants of self-perceived oral health in adolescents: A cross-sectional study

BACKGROUND

Self-perceived oral health (SPOH) is a summary of multiple determinants related to oral health and has been suggested for use in clinical practice as a health assessment tool.

AIM

To analyse determinants of SPOH among adolescents.

DESIGN

In 2018, we selected 1742 participants from eight high schools in Olinda/PE, Brazil, using a multistage stratified cluster sample. The main survey item of SPOH was 'How would you rate your oral health'. Determinants of were queried with a questionnaire and a clinical examination: socio-demographic variables, exposure to family violence, somatic symptoms, and orofacial and general health factors. Pearson's chi-square test and logistic regressions evaluated associations between determinants and SPOH.

RESULTS

Very poor SPOH had a prevalence of 8.7%. Nearly half (43.5%) rated their oral health as 'fair'. Very poor SPOH was associated with poor self-perceived general health (OR = 2.60), anterior open bite (OR = 2.24), not cohabiting with one or both parents (OR = 2.40), caries experience (OR = 1.93), dental pain (OR = 1.91), and temporomandibular disorders (OR = 1.77).

CONCLUSION

Very poor self-perceived oral health indicates life stress and associates with poor oral conditions. Assessments should be used to explore individual treatment needs and abilities to comply with recommendations.

Undoing resilience: immigrant status and poor health following incarceration

BACKGROUND

In the United States, foreign-born persons often have better health outcomes than their native-born peers, despite exposure to adversity. Nevertheless, it is unclear whether this pattern extends to the consequences of life events, such as incarceration, that separate immigrants from their supportive networks and increase exposure to adversity. Accordingly, using four waves of data from the National Longitudinal Study of Adolescent to Adult Health, hierarchical generalized linear models were used to examine within-individual changes in self-rated health following first incarceration (N = 31,202 person-waves).

RESULTS

The results showed that incarceration was associated with modest health declines that were similar in magnitude for immigrant and native-born persons. Supplemental analyses revealed that these effects did not vary by immigrant race or ethnicity, or by age at immigration. The only exception was for immigrants from low- and middle-income countries, who were marginally less likely to experience health declines following incarceration.

CONCLUSIONS

In general, incarceration appears to be similarly health damaging for immigrants and non-immigrants. These findings raise important questions about how incarceration is linked to health declines for foreign- and native-born populations and emphasize the importance of access to healthcare for individuals released from correctional facilities. More research is needed, however, to further examine the cumulative impacts of incarceration on immigrants' health across the life course, and to assess a broader spectrum of health outcomes.

Experiences of health service literacy and access amongst Australian young adults from migrant backgrounds

ISSUE ADDRESSED

We currently know very little about the attitudes of young adult Australians from migrant backgrounds towards health service utilisation. This qualitative study aimed to explore their experiences of accessing health services and identify barriers and facilitators to health service utilisation.

METHODS

Semi-structured interviews were conducted with young people aged between 18-24 and living in Greater Western Sydney. Interview questions focused on facilitators and barriers to health service access. NVivo 11 was used to facilitate thematic analysis of the interviews.

RESULTS

Twenty-five young adults between 18-24 years from migrant backgrounds participated. Twenty semi-structured individual interviews and one group interview with five participants were conducted. Analysis identified themes relating to health literacy, cultural factors and quality of care and showed the importance of families, the education system and service outreach in facilitating access.

CONCLUSIONS

Findings indicate that more effective delivery of health services information in education, positive engagement between service-providers and service-users, and age-appropriate, culturally considerate health promotion strategies are needed to overcome barriers to health services accessibility. SO WHAT?: The results show the importance of families and communities, the education system and health service outreach in facilitating health service access for young people from migrant backgrounds. The paper highlights the need for more effective health promotion strategies targeting this group, their families and communities. To increase access, health promotion practitioners need to actively reach out to families and young people from migrant backgrounds through education and community-relevant forums.

Material hardship, perceived stress, and health in early adulthood

Purpose

We examined the associations between material hardship and health outcomes in early adulthood and the extent to which these associations are mediated by perceived stress.

Methods

We used wave I and IV of the National Longitudinal Study of Adolescent Health, a nationally representative survey of young adults aged 18–34 years old (n = 13,313). Multivariate logistic regression and decomposition methods were used to evaluate the associations between types and depth of material hardship (food, bill-paying, and health resource hardship), health outcomes (self-rated health, depression, sleep problems, and suicidal thoughts) in early adulthood, and the extent to which these associations were mediated by perceived stress.

Results

The adjusted odds of fair or poor health status, depression, sleep problems, and suicidal thoughts were higher among individuals with material hardship than counterparts without. A considerable proportion of the association between material hardship and health outcomes was attributable to perceived stress.

Conclusions

Material hardship is associated with adverse health outcomes in early adulthood, and these relationships are robust after accounting for various sociodemographic characteristics and family background. Perceived stress accounted for a sizable portion of the effects of material hardship on health.

Public Health Implications

Efforts to promote health equity in young adults should focus on material hardship and associated stressful conditions.

Self-Rated Health in Migrant and Non-Migrant Women before, during and after Pregnancy: A Population-Based Study of 0.5 Million Pregnancies from the Swedish Pregnancy Register

Self-rated health is a strong health marker. Migrants have been suggested to have poorer self-rated health than non-migrants (i.e., native-born). However, little is known about whether there are disparities in self-reported health in relation to pregnancy. Therefore, the aim of the current study was to examine the odds of poor self-rated health before, during and after pregnancy in migrant women as compared to women born in Sweden. We utilized population-based data from the Swedish Pregnancy Register containing 0.5 million women born in Sweden (i.e., non-migrant women) and migrant women between 2010 and 2018. Self-rated health was reported on a 5-point scale (from very poor to very good). Very poor and poor health were categorized as poor self-rated health. Logistic regression was utilized to calculate odds ratios (ORs) that were unadjusted and adjusted for covariates (age, parity, educational attainment and body mass index). The results demonstrate disparities in self-rated health across birth regions. In comparison to women born in Sweden, women born in Latin America and the Caribbean, South Asia as well as North Africa and the Middle East had consistently higher odds of poor self-rated health before, during and after pregnancy (ORs ranging from 1.14 to 1.96 in both unadjusted and adjusted models). Although women born in Sub-Saharan Africa did have comparable self-rated health as to women born in Sweden before pregnancy, after accounting for covariates, they had lower odds of poor self-rated health during and after pregnancy (ORs: 0.71 and 0.80 respectively). Therefore, additional measures and support may be needed to tackle disparities in health between migrant and non-migrant women before, during and after pregnancy.

Connectedness as a protective factor in immigrant youth: results from the Health Behaviours in School-aged Children (HBSC) Italian study

OBJECTIVES

The aim of this work was to study whether and to what extent selected connectedness variables (perceived family, peer, and school support) are protective factors against low life satisfaction and high health complaints in immigrant youth with different ethnic backgrounds, while also taking into account the effect of socioeconomic status (SES).

METHODS

A representative sample of 47,799 students (15% immigrants, among whom 4980 were from non-Western countries) aged 11, 13, and 15 years were recruited from schools throughout Italy within the framework of the Italian 2013/2014 Health Behaviour in School-aged Children study. Bayesian network analyses were used to assess the association between connectedness variables, and low life satisfaction and high health complaints.

RESULTS

The connectedness variables family and school support were strong protective factors against both low life satisfaction and high health complaints (99% probability of relative risk < 1 in all subgroup comparisons). This protective role was still present when subgroups with high SES were compared. Peer support also showed a protective effect, though it was weaker.

CONCLUSIONS

Our results show that, among immigrant youth, perceived high support can act as a moderator on the effect of environmental stressors. In line with international guidelines, these results confirm that public health professionals should create school interventions that foster a culture of inclusiveness, promote a supportive school environment, and engage families of immigrant youth.

Chronic sleep disturbance, not chronic sleep deprivation, is associated with self-rated health in adolescents

Improving our understanding of the cumulative effects of persistent sleep problems on adolescent health has been identified as an important area of research. This prospective study aimed to ascertain prospectively gender-specific associations between quantity and quality of sleep and self-reported health. Data from a cohort of 3104 adolescents (13-18 y) with repeated measures of sleep deprivation and sleep disturbance (2011 fall, 2012 spring, 2012 fall), and self-reported health (SRH) (2011 fall, 2012 fall) were analysed with multivariable logistic regression models adjusted for confounders. The results of the regression models indicated that cumulative exposure to sleep disturbance was monotonically associated with SRH in both genders, however cumulative sleep deprivation was not associated with self-reported health among young people. Young women reporting chronic exposure to sleep disturbance had over twice the odds of reporting sub-optimal health at follow-up (OR 2.18 [CI95: 1.13, 4.22]), compared to those with no history. Similar results were found in chronically sleep disturbed young men (OR 2.41 [1.05, 5.51]). These findings suggest that chronic exposure to impaired quality of sleep, such as difficulty falling or staying asleep, is related to adolescent self-reported health and thus may be an important determinant of young people's wellbeing.

The association between self-rated health and underlying biomarker levels is modified by age, gender, and household income: Evidence from Understanding Society - The UK Household Longitudinal Study

The goal of this study was to evaluate how self-rated health (SRH) and objective measures of health (biomarkers) are associated, and if this association varies by gender, age, and socioeconomic position (measured by household income). Data come from the UK Household Longitudinal Study nurse visit (2010–2012), including a representative sample of adults in Great Britain (N = 15 687 maximum sample). SRH was assessed by the question “In general, would you say your health is excellent, very good, good, fair, or poor?” and dichotomized into good or poor. Indices were created for four biomarker categories based on the aspects of health they are likely to reflect, including visible weigh-related, fitness, fatigue, and disease risk biomarkers. Logistic regression models were run with SRH as the outcome and each biomarker index as a predictor, adjusting by gender, age, and income. Further, interaction terms between each biomarker index and gender, age, and income (independently) were added to test for effect modification. All biomarker indices were associated with SRH in expected directions, with the fitness index most strongly predicting SRH. Gender, age, or income modified the associations between SRH and all biomarker indices to different extents. The association between the visible weight-related biomarker index (including body mass/fat variables) and SRH was stronger for women than men and for those in higher income groups than lower income groups. Income also modified the association between SRH and the fitness biomarker index, whereas age modified the association between SRH and the fatigue biomarker index. When using SRH to investigate health inequalities, researchers and policy makers should be clear that different social groups may systematically consider different dimensions of health when reporting their SRH.

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The association between self-rated global health and underlying objective health as measured by biomarkers varies by type of biomarker, age, sex and socioeconomic status.

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Biomarkers that measure different aspects of fitness most strongly predicting self-rated health.

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The association between the visible biomarkers (including body mass/fat variables) and self-rated health was stronger for women than men and for those in higher income groups than lower income groups.

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Income also modified the association between self-rated health and biomarkers of disease, with a stronger association for higher income groups.

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When rating own health individuals from different social groups may systematically consider different dimensions of health.

Weight perception and perceived attractiveness associated with self-rated health in young adults

Self-rated health (SRH) is a widely used and valid marker of overall health and wellbeing and demographic differences in SRH are well-established. To date, few studies have examined how multiple components of body image shape young adults' SRH. The purpose of this study was to investigate the contributions of weight perception and perceived attractiveness on SRH among young adults. Data were from Wave IV (2007-2008) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and young women and men ages 24-34 were analyzed (n = 7044 women, n = 6594 men) in April 2018. All analyses were weighted and stratified by gender. Design-based F test and ordinal multinomial logistic regression were used. For both genders, relative to Whites, Hispanic, Black, and Asian young adults reported poorer health; women and men with higher education and income reported better health. Independent of measured body mass index (BMI), young adults who thought they were underweight or overweight reported poorer health relative to those who thought their weight was normal. Both young women and young men who thought they were more attractive also reported better health. This study demonstrates that weight status, perceived weight status, and perceived attractiveness independently impact SRH for both young men and women controlling for race/ethnicity, nativity status, marital status, education, income, and number of health conditions.

Dark and sick, light and healthy: black women's complexion-based health disparities

Objective: Although research on skin tone inequalities suggest that darker-skinned Black women should experience worse health outcomes than lighter-skinned women, findings have been mixed. The present study investigates the possibility that the manner that stress and health are measured (i.e. global versus count measures) may explain the conflicting findings. Design: Black American women of different skin tones were investigated in two cross-sectional samples: the National Longitudinal Study of Adolescent to Adult Health (N = 571) and the Detroit Area Study (N = 290). Women's skin tone health disparities were examined using both objective (i.e. directly measured) or count measures (i.e. number of diagnosed chronic health conditions) as well as a global measure of health (i.e. self-rated health - SRH). Additionally, in the Detroit Area Study (DAS), disparities in stress exposure were examined using count and global measures. Results: Skin tone did not predict global measures of health (i.e. SRH) in both samples. In contrast, skin tone predicted objective and count measures of health in both samples, and the disparities between dark- and light-skinned women were starker among higher SES populations. Furthermore, DAS analyses of stress measures indicated that skin tone did not predict a global measure of stress but significantly predicted a count measure of stress (i.e. life events) since dark-skinned women reported worse outcomes. Conclusions: Health disparities research will benefit from accounting for Black women's skin tones as an important social determinant of health. Additionally, use of subjective measurements of health (e.g. SRH) may conceal within-race health disparities across complexions as well as obscure the magnitude of disparities across race.

Do racial and ethnic disparities in health care use vary with health?

OBJECTIVE

To determine the relationship between health status and the magnitude of black-white and Hispanic-white disparities in the likelihood of having any office-based or hospital outpatient department visits, as well as number of visits.

DATA SOURCE

2010-2014 Medical Expenditure Panel Survey.

STUDY DESIGN

The probability of having a visit is modeled using a Probit model, and the number of visits using a negative binomial model. We use a nonlinear rank-and-replace method to adjust minority health status to be comparable to that of whites, and predict utilization at different levels of health by fixing an indicator of health status. We compare estimated differences in predicted utilization across racial/ethnic groups for each level of health status to map out the relationship between the racial/ethnic disparity and health status, also stratifying by health insurance coverage.

EXTRACTION METHODS

We subset to nonelderly adults.

PRINCIPAL FINDINGS

We find that Hispanic-white differences in the probability of having an office-based or hospital outpatient department were widest among adults in excellent health (27 percentage points, 95% CI: [23, 31]) and narrowest when reporting poor or fair health (15 p.p. [13, 17]). Black-white and Hispanic-white differences in the number of visits were wider for adults who report poor or fair health (5.3 visits [4.0, 6.6] and 5.7 [4.3, 7.0], respectively) compared to excellent health (1.7 [1.2, 2.1] and 1.5 [1.1, 2.0], respectively) among adults who are full-year privately insured.

CONCLUSIONS

The magnitudes of racial/ethnic disparities vary with level of health.

Perceived well-being in adolescent immigrants: it matters where they come from

OBJECTIVES

The aim of this work was to explore whether adolescent immigrants have worse or better perceived well-being, and whether this perception varies by ethnic background or between first- and second-generation immigrants, when compared with adolescents from the host population.

METHODS

A representative sample of 47,799 students (13.4% immigrants) aged 11, 13, and 15 years were recruited throughout all Italian regions within the framework of the Italian 2013/2014 Health Behaviour in School-aged Children study.

RESULTS

Adolescent immigrants from Eastern European and non-Western/non-European countries had a higher occurrence of health complaints and the highest risk of reporting low life satisfaction, which increased among the second generation. The risk of reporting bullying behaviours and physical fights was higher in first-generation immigrants and decreased in the second generation, independent of ethnic background.

CONCLUSIONS

Italian welfare immigration policies do not seem to offer the same opportunities to all adolescent immigrant groups, which leads to differing effects on their well-being. To tackle these inequalities, Italy should increase its investment in education through early prevention initiatives, e.g. providing support in intercultural education and proper training to school teachers and staff.

Adolescent immigrants, the impact of gender on health status

Background

: Although studies have described the 'healthy immigrant effect' in adults, far fewer have examined the 'healthy immigrant effect' for adolescents living in immigrant families. Those few studies that did, noted conflicting results, and also differed on whether gender confounds the results. : This cross-sectional study was informed by the community-based participatory research (CBPR) approach in which researchers obtained the expertise and guidance on instrument design and study implementation. Data collection of self-administered surveys was completed between May 2015 and December 2015 on adolescents. Comparisons were made among six groups based on gender and immigrant status. : Of the total sample ( n = 618), more than a third were first or second generation immigrant adolescents ( n = 239). Comparisons among six groups, categorized by gender and immigrant status (i.e. first generation immigrants, second generation immigrants, native born), indicated many differences. However, when the differences were taken into account using logistic regression models, excellent health status was least likely to be reported by second generation immigrant males (versus native born adolescent females) ( P < 0.01), even after adjusting for the independent associations found for psychological symptoms ( P < 0.0001), not smoking ( P < 0.05) and having normal BMI ( P < 0.05). : This study demonstrates the relative disadvantage of second generation immigrant boys, but not first generation boys or first and second generation immigrant girls relative to their native counterparts. Reasons for the gap may be differences in support services and/or parental expectations; however further studies are needed to confirm these possibilities.

Variability in self-rated health trajectories from adolescence to young adulthood by demographic factors

Self-rated health (SRH) is a robust measure of general health status and an indicator of where and when to target disease prevention efforts-especially in adolescent populations when clinical endpoints are rare. This study's purpose was to model SRH trajectories from ages 13 to 31 and identify whether and when differences between demographic groups emerge. We employed a conditional latent growth model of SRH in December 2016 using a nationally representative sample of 11,512 adolescents from the National Longitudinal Study of Adolescent to Adult Health data collected in 1994-2008. The average SRH trajectory is curvilinear: SRH increases until age 21 and then decreases. This trajectory contains significant between-individual variability in the intercept and linear slope. Males and self-identified non-Hispanic Blacks had higher SRH at age 13 but experienced steeper linear declines than their demographic counterparts. Individuals who grew up in households without two parents and whose parents did not graduate college had consistently lower SRH compared to those living in households with two parents and whose parents graduated college. Self-rated health is not stable over the span of early adolescence to young adulthood; demographic factors account for differences in individual variability around the starting point and overtime changes in SRH. Because these differences are apparent as early as age 13years, prevention efforts targeting demographic-based disparities should occur early in life.

Body mass index and self-rated health in East Asian countries: Comparison among South Korea, China, Japan, and Taiwan

There have been conflicting findings regarding the relationship between body mass index (BMI) and self-rated health (SRH) worldwide. The purpose of this study was to examine the association between BMI and SRH by comparing its relationship in four East Asian countries: South Korea, China, Japan, and Taiwan. Using data from the East Asian Social Survey, the relationship between weight status and SRH status was investigated and compared between four countries, China, Japan, South Korea, and Taiwan. An ordinal logit regression model was estimated for each country, and the results were compared. We found that the relationship between weight status and SRH status differed across the four countries. In China, people who were overweight reported better SRH scores than those of normal weight, whereas in Japan, obese and severely obese people reported poor scores. In contrast, South Koreans who were underweight, obese, or severely obese reported poor ratings of health status than those of normal weight. In Taiwan, however, no differences in respondents' weight status were found across SRH scores. There were notable differences in the relationship between BMI and SRH status in four East Asian countries. Individual countries should consider these relationships when designing and implementing obesity intervention programs.

An education gradient in health, a health gradient in education, or a confounded gradient in both?

There is a positive gradient associating educational attainment with health, yet the explanation for this gradient is not clear. Does higher education improve health (causation)? Do the healthy become highly educated (selection)? Or do good health and high educational attainment both result from advantages established early in the life course (confounding)? This study evaluates these competing explanations by tracking changes in educational attainment and Self-rated Health (SRH) from age 15 to age 31 in the National Longitudinal Study of Youth, 1997 cohort. Ordinal logistic regression confirms that high-SRH adolescents are more likely to become highly educated. This is partly because adolescent SRH is associated with early advantages including adolescents' academic performance, college plans, and family background (confounding); however, net of these confounders adolescent SRH still predicts adult educational attainment (selection). Fixed-effects longitudinal regression shows that educational attainment has little causal effect on SRH at age 31. Completion of a high school diploma or associate's degree has no effect on SRH, while completion of a bachelor's or graduate degree have effects that, though significant, are quite small (less than 0.1 points on a 5-point scale). While it is possible that educational attainment would have greater effect on health at older ages, at age 31 what we see is a health gradient in education, shaped primarily by selection and confounding rather than by a causal effect of education on health.