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Differences in Emotional and Behavioral Problems of Students over Time: A 22-Year Cross-Sectional Cohort Study. Res Child Adolesc Psychopathol 2023; 51:557-569. [PMID: 36580170 PMCID: PMC9797879 DOI: 10.1007/s10802-022-01014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
Levels of emotional and behavioral problems in children and adolescents demonstrate secular changes over time, warranting ongoing investigation. Prior studies examining secular trends in a range of such problems have been conducted in the U.S. and internationally. Research in this area generally has not fully considered the school setting. This study compared emotional and behavioral problems across two cohorts of students in the U.S. assessed over a 22-year time period as part of measurement development efforts for the Scales for Assessing Emotional Disturbance Rating Scale (SAED-RSRS; Epstein et al., 2020). Specifically, analyses drew from data collected via teacher report on matched cohorts of students for the 1998 (data collected from 1996 to 1997; n = 1,148) and 2020 (data collected from 2016 to 2018; n = 1,148) editions of the SAED-RS. After establishing measurement invariance across cohorts and testing for gender differences, structural equation modeling revealed statistically significant cohort mean differences on two of the five factors of the SAED-RS, suggesting increases over time in Inability to Learn (β = 0.09, p = .024) and Physical Symptoms and Fears (β = 0.14, p = .005) that were comparable for girls and boys. There were no statistically significant differences on the remaining factors: Relationship Problems, Inappropriate Behavior, and Unhappiness/Depression. Supplemental item-level tests revealed differences on 8 of the 39 SAED-RS items. Findings suggest increases in specific problem areas that could benefit from ongoing monitoring and targeted interventions to support contemporary students.
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The great decline in adolescent risk behaviours: Unitary trend, separate trends, or cascade? Soc Sci Med 2023; 317:115616. [PMID: 36563586 DOI: 10.1016/j.socscimed.2022.115616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk behaviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk behaviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically.
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McArdle P, Coulton S, Kaner E, Gilvarry E, Drummond C. Alcohol Misuse among English Youth, Are Harms Attributable to Alcohol or to Underlying Disinhibitory Characteristics? Alcohol Alcohol 2022; 57:372-377. [PMID: 34875694 DOI: 10.1093/alcalc/agab077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Alcohol use by young people is associated with a range of psychological and physical harms. However, similar harms are also reported with disinhibitory conditions such as conduct problems that are said to precede and predispose to alcohol misuse. We explored whether alcohol use or indicators of underlying disinhibition predict psychological and physical harms in a cohort of young people. METHODS We used data from a randomised controlled intervention trial that identified young people who consumed alcohol (n = 756), mean age = 15.6 years, attending emergency departments (EDs) in England. Disinhibition was measured by the self-report Strengths and Difficulties Questionnaire hyperactivity and conduct problem items, and alcohol-related harms by questions from the ESPAD, a major European school survey. We conducted a mediation analysis with a primary outcome of frequency of engaging in alcohol-related harms 12 months after screening in ED, exploring for the mediating influence of alcohol consumed at six months. We included age, gender, allocated group and baseline consumption as covariates and adjusted for the multi-level nature of the study, where young people were nested within EDs. RESULTS Conduct problems and to a lesser extent hyperactivity predicted harms at twelve months. This effect was not mediated by alcohol consumed at 6 months. CONCLUSIONS Among young drinkers underlying behavioural attributes predict harm independently of alcohol use. This suggests that the harms associated with alcohol use are attributable more to underlying disinhibitory characteristics than the quantity of alcohol consumed.
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Affiliation(s)
- Paul McArdle
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, NE3 3XT, Newcastle upon Tyne, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, Kent CT2 7NF, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, NE2 4AX, Newcastle-upon-Tyne, UK
| | - Eilish Gilvarry
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, NE3 3XT, Newcastle upon Tyne, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 de Crespigny Park, London SE5 8AF, UK
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Ball J, Crossin R, Boden J, Crengle S, Edwards R. Long-term trends in adolescent alcohol, tobacco and cannabis use and emerging substance use issues in Aotearoa New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2060266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jude Ball
- Department of Public Health, University of Otago, Wellington
| | - Rose Crossin
- Department of Population Health, University of Otago, Christchurch
| | - Joseph Boden
- Department of Psychological Medicine, University of Otago, Christchurch
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington
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Sharma A, Mitchell SG, Nordeck CD, Schwartz RP, Dusek K, O'Grady KE, Gryczynski J. Sexually Transmitted Infection Testing After Brief Intervention for Risk Behaviors in School-Based Health Centers. J Adolesc Health 2022; 70:577-583. [PMID: 35078735 DOI: 10.1016/j.jadohealth.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The initiation and escalation of substance use and sex behaviors is prevalent during adolescence. School-based health centers (SBHCs) are well-equipped to provide interventions for risky behaviors and offer sexually transmitted infection (STI) testing services. This study examined receipt of STI testing following brief intervention (BI) among sexually active adolescents. METHODS This is a secondary analysis of data from a randomized trial comparing computer versus nurse practitioner-delivered BI approaches among adolescents (ages 14-18) with risky alcohol and/or cannabis use at two SBHCs within two urban high schools. Associations were examined among receipt of STI testing and participant characteristics, BI format, site, and frequency of substance use/sexual behaviors. RESULTS Among sexually active participants (N = 254), 64.2% received STI testing at their SBHC within 6 months of receiving a BI. Participants receiving nurse practitioner-delivered BI had higher odds of getting STI testing than participants receiving computer-delivered BI (adjusted odds ratio 2.51, 95% confidence interval 1.41-4.47, p = .002). Other variables associated with STI testing in multivariable logistic regression included female sex (p = .001), being in a serious relationship (p = .018), and SBHC site (p < .001). Frequency of substance use and sexual risk behaviors were not independently associated with receipt of STI testing services. CONCLUSION Sexually active adolescents who received in-person BI from a nurse practitioner were more likely to get STI testing than adolescents who received BI via computer. Nurse practitioners working in SBHCs can successfully engage adolescents in additional sexual health services subsequent to BI for risky behaviors.
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Affiliation(s)
| | | | - Courtney D Nordeck
- Friends Research Institute, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, Maryland
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Ball J, Zhang J, Stanley J, Waa A, Gurram N, Edwards R. Has increasing internet use due to smartphone uptake contributed to the decline in adolescent smoking? Drug Alcohol Rev 2021; 41:365-376. [PMID: 34487593 DOI: 10.1111/dar.13378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The emergence of low-cost smartphone technology has coincided with major declines in adolescent smoking and other risk behaviours. This study explores the relationship between internet use and smoking in adolescents and investigates whether rising internet use contributed to the decline in smoking between 2012 and 2018. METHODS Data were drawn from a nationally representative New Zealand survey of students aged 14-15 (N = 11 299), conducted biennially between 2012 and 2018. We used logistic regression to explore the association between internet use and smoking and test whether increasing time on the internet was associated with declining adolescent smoking over the study period. RESULTS The proportion of students spending 5+ hours per day online increased from 15% to 35%. Heavy internet use was not a protective factor for smoking at the individual level. In 2016/2018, some types of past week internet use were associated with decreased risk of smoking (e.g. doing schoolwork, finding out about news), some were associated with increased risk (e.g. social media use) and others appeared to have no association with smoking (e.g. gaming, online shopping). The relative risk of smoking was lower in 2018 relative to 2012 (relative risk 0.68, 95% confidence interval 0.51, 0.90, after adjustment for demographic factors). Adding internet use to the model did not help to account for smoking decline. DISCUSSION AND CONCLUSIONS We found no evidence that increasing time spent on the internet during the 2012-2018 period (during which smartphones became ubiquitous) contributed to the decline in adolescent smoking.
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Affiliation(s)
- Jude Ball
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jane Zhang
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrew Waa
- Eru Pōmare Māori Health Research Centre, University of Otago, Wellington, New Zealand
| | - Niveditha Gurram
- Te Hiringa Hauora/Health Promotion Agency, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
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Borodovsky JT, Krueger RF, Agrawal A, Elbanna B, de Looze M, Grucza RA. U.S. Trends in Adolescent Substance Use and Conduct Problems and Their Relation to Trends in Unstructured In-Person Socializing With Peers. J Adolesc Health 2021; 69:432-439. [PMID: 33814281 PMCID: PMC8403622 DOI: 10.1016/j.jadohealth.2020.12.144] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/24/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE This study examined whether national trends in unstructured in-person socializing with peers (i.e., socializing without goals or supervision) among adolescents could help explain recent declines in adolescent risk behaviors (e.g., substance use, fighting, theft). METHODS The sample contained of 44,842 U.S. 12th-grade students (aged 17-18 years) from the Monitoring the Future survey (years 1999-2017). Analyses examined (1) prevalence trends, (2) latent factor structure of risk behaviors and unstructured in-person socializing, and (3) whether trends in the unstructured in-person socializing factor accounted for the relationship between time (i.e., survey year) and the risk behavior factor. RESULTS Adolescent risk behaviors and unstructured in-person socializing declined by approximately 30% in the U.S., and both formed coherent latent factors. After adjusting for sociodemographics, declines in unstructured in-person socializing accounted for approximately 86% of declines in risk behaviors. CONCLUSIONS The prevalence of risk behaviors and unstructured in-person socializing behaviors declined among U.S. 12th graders from 1999 to 2017. It is unknown whether such effects are directly causal and/or influenced by unmeasured variables. However, the results provide evidence that national declines in unstructured in-person socializing are a likely component of the explanation for national declines in adolescent risk behaviors.
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Affiliation(s)
- Jacob T Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire.
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri
| | - Basant Elbanna
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri
| | - Margaretha de Looze
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Richard A Grucza
- Departments of Family and Community Medicine and Health and Clinical Outcomes Research, Saint Louis University, Saint Louis, Missouri
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Willoughby T, Heffer T, Good M, Magnacca C. Is adolescence a time of heightened risk taking? An overview of types of risk-taking behaviors across age groups. DEVELOPMENTAL REVIEW 2021. [DOI: 10.1016/j.dr.2021.100980] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Li X, Borodovsky JT, Kasson EM, Fentem A, Cavazos-Rehg PA. An analysis of within-subject and population level risk related to substance use and mental health outcomes among adolescents in the PATH study. Drug Alcohol Depend 2021; 218:108385. [PMID: 33168340 DOI: 10.1016/j.drugalcdep.2020.108385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The objective of this study was to understand how adolescent substance use patterns may lead to negative mental health outcomes. METHODS Data from adolescents (12-17 years old at baseline, Wave 1) who participated in the first 3 waves of the Population Assessment of Health and Tobacco (PATH) study were used. Self-reported data on past 30-day substance use and internalizing/externalizing problems were used to conduct within-subject (fixed-effects model) and population-averaged (GEE model) analyses. RESULTS In both within-subject and between-subject analyses, the use of other illicit drugs (e.g., opioids, cocaine, prescription drugs for non-medical use) was positively associated with internalizing problems (within-subject estimate, AOR: 1.65, 95 % CI = 1.36-2.01; between-subject estimate, AOR: 1.53, 95 % CI = 1.32-1.78) and alcohol use was positively associated with externalizing problems (within-subject estimate, AOR: 1.66, 95 % CI = 1.43-1.93; between-subject estimate, AOR: 1.67, 95 % CI = 1.48-1.89). Additionally, within-subject analysis suggested that alcohol, marijuana, and other illicit drugs were associated with increased odds of comorbid internalizing and externalizing problems (ranging from marijuana, AOR: 1.18, - alcohol, AOR: 1.58). DISCUSSION Using within-subject and between-subject comparisons, this study demonstrated associations between adolescent substance use and internalizing and externalizing problems. Results suggest not only the need for individual level assessment and early intervention, but also the development and implementation of public health policy aimed at preventing or mitigating the negative effects of substance use in adolescence to promote improved mental health outcomes for this at-risk group.
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Affiliation(s)
- Xiao Li
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, United States
| | - Jacob T Borodovsky
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, United States
| | - Erin M Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, United States
| | - Andrea Fentem
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, United States
| | - Patricia A Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, United States.
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Haraldsson J, Pingel R, Nordgren L, Tindberg Y, Kristiansson P. Understanding adolescent males' poor mental health and health-compromising behaviours: A factor analysis model on Swedish school-based data. Scand J Public Health 2020; 50:232-244. [PMID: 33323059 PMCID: PMC8873304 DOI: 10.1177/1403494820974555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: The aim was to develop a factor model of the clustering of poor mental-health symptoms and health-compromising behaviours (HCBs) in adolescent males. Methods: The study was based on two cross-sectional school-based Swedish surveys in 2011 (response rate 80%, N=2823) and 2014 (response rate 85%, N=2358), both of which comprised questionnaires from males aged 15–16 and 17–18 years. A factor model was developed by exploratory factor analysis on the 2011 survey and validated by confirmatory factor analysis on the 2014 survey. Results: Four aspects of poor mental health and HCBs emerged in the exploratory factor analysis: (a) deviancy as a tendency to substance use and delinquency, (b) unsafety as an inclination towards feelings of unsafety in different environments, (c) gloominess as a tendency towards pessimism and feeling unwell and (d) pain as an inclination to experience physical pain. The model was validated with good model fit. Age did not affect the model structure, but older adolescent males were more influenced by deviancy and gloominess and less by unsafety compared to their younger peers. Conclusions: Separating symptoms of poor mental health and HCBs into four areas – deviancy, unsafety, gloominess and pain – brings new perspectives to the understanding of adolescent males’ health. To the best of our knowledge, our factor model is the first to include unsafety and pain in this context. Whenever a comprehensive approach to the health of adolescent males is needed in the clinic or in the field of public health, this factor model may provide guidance.
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Affiliation(s)
- Johanna Haraldsson
- Department of Public Health and Caring Sciences, Uppsala University, Sweden.,Centre for Clinical Research, Sörmland/Uppsala University, Sweden
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Sweden
| | - Lena Nordgren
- Department of Public Health and Caring Sciences, Uppsala University, Sweden.,Centre for Clinical Research, Sörmland/Uppsala University, Sweden
| | - Ylva Tindberg
- Centre for Clinical Research, Sörmland/Uppsala University, Sweden.,Department of Women's and Children's Health, Uppsala University, Sweden
| | - Per Kristiansson
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
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Korpics J, Stillerman A, Hinami K, Dharmapuri S, Feinglass J. Declining health risk exposure among Chicago public high school students: Trends from the Youth Risk Behavior Survey 1997-2017. Prev Med Rep 2020; 20:101161. [PMID: 32904066 PMCID: PMC7452138 DOI: 10.1016/j.pmedr.2020.101161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/27/2020] [Accepted: 07/04/2020] [Indexed: 12/28/2022] Open
Abstract
There have been improvements nationally in teenagers' self-reported health risk since the 1990s. This study provides an overview of trends in substance use, sexual health, violence and victimization, and suicide risk among Chicago Public High School (CPS) students over a 20-year period. We compared responses to 29 identically worded items from the 1997, 2007, and 2017 Chicago Youth Risk Behavior Survey (YRBS) in the four domains. We show changes in responses across individual items, mean changes across the four domains, and change in the proportion of students with highest risk exposure (≥10 affirmative responses). Analyses control for CPS students' grade, sex, and race/ethnicity. Reductions in substance use, sexual health risk, and violence and victimization (30, 40% and 40% in the mean number of affirmative responses, respectively) were observed. Suicide risk showed an initial improvement from 1997 to 2007, only to worsen by 2017 and show little difference from 1997. There was an approximate 70% decrease in the likelihood of being in the high multiple risk category (≥10 affirmative responses) in 2017 compared to 1997 (OR 0.33; CI 0.22-0.49). In alignment with national trends, our study documents significant improvement in Chicago public high school students' long-term health risk exposure over the 20-year study period, with the notable exception of suicide risk. This study emphasizes the need to invest in strategies both inside and outside of the classroom to mitigate the effect of adversity and promote protective factors, which are at the root of academic success and overall wellbeing.
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Affiliation(s)
- Jacqueline Korpics
- Cook County Health and Northwestern Feinberg School of Medicine, 1950 W Polk St, Chicago, IL 60612, United States
| | - Audrey Stillerman
- Office of Community Engagement and Neighborhood Health Partnerships, University of Illinois at Chicago, 818 S. Wolcott Ave, Chicago, IL 60612, United States
| | - Keiki Hinami
- Collaborative Research Unit, Cook County Health, 1950 W Polk St, Chicago, IL 60612, United States
| | - Sadhana Dharmapuri
- Division of Adolescent Medicine, Cook County Health, 1950 W Polk St, Chicago, IL 60612, United States
| | - Joseph Feinglass
- Division of General Internal Medicine, Northwestern University, 750 N Lakeshore Dr. 10th Floor, Chicago IL 60611, United States
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Grucza RA, Bello-Kottenstette JK, Mintz CM, Borodovsky JT. The changing landscape of alcohol use disorder and problem drinking in the USA: implications for primary care. Fam Pract 2020; 37:870-872. [PMID: 32634209 PMCID: PMC7699309 DOI: 10.1093/fampra/cmaa066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Richard A Grucza
- Department of Family and Community Medicine, St. Louis, MO, USA.,Center for Health Outcomes Research, Saint Louis University, St. Louis, MO, USA
| | | | - Carrie M Mintz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob T Borodovsky
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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