Adolescent measures of family socioeconomic status: Reliability, validity, and effects on substance use behaviors in adolescence and young adulthood

Adolescent reports of subjective socioeconomic status: An adequate alternative to parent-reported objective and subjective socioeconomic status?

Socioeconomic status (SES) is associated with well-being outcomes across studies; however, there is wide variation in its measurement, particularly in adolescence. One key difference in measures of SES concerns whether participants relay objective information-for example, years of education, household income-or subjective perceptions of socioeconomic status, either with or without reference to others or society. Although parents are often considered the best source of SES information-especially objective SES-within families, interviewing parents within the context of adolescent research is costly, time-consuming, and not always feasible. Given the importance of SES for outcomes in adolescence and cumulative effects over the lifespan, we used data from adolescents (N = 702) and parents (Ns = 664-730) to examine whether adolescent reports of SES serve as reasonable proxies for parent reports of both objective and subjective SES, as well as administrative data assessing family SES and neighborhood SES. Consistent with our hypotheses, adolescents' reports of subjective SES were moderately correlated with parent reports and administrative data tapping family SES. Moreover, adolescents' reports of subjective SES predicted adolescent-reported measures of well-being, including mental health, physical health, school performance, problem behavior, and alcohol use to the same degree as or better than parent reports of both subjective and objective SES and administrative data. These findings suggest that adolescent reports of subjective SES-using two different, easily understood measures-can stand in as reasonable alternatives to parent-reported SES and administrative data.

Use of ENDS devices and modifications to vape cannabis among adolescents and young adults who also vape nicotine

BACKGROUND

Electronic nicotine delivery systems (ENDS) are the most used tobacco product among adolescents and young adults (AYAs) and are increasingly used to vape cannabis. It is unclear what vaping devices and ENDS modifications are used most frequently by AYAs who vape both nicotine and cannabis.

METHODS

AYAs (aged 14-29) reporting ENDS use in the past 30 days were recruited via Qualtrics (N = 1,011). We conducted three multivariable logistic regression models examining differences in likelihood of: 1) vaping cannabis in the past 30 days; 2) mixing cannabis and nicotine liquids; and 3) using nicotine devices to vape cannabis; based on type of vaping device used most often, controlling for age, socio-economic status, gender, race, frequency of ENDS use, and other cannabis use.

RESULTS

40 % (n = 405) of AYAs reported vaping both nicotine and cannabis in the past 30 days. AYAs who used vape pens most often were more likely to have vaped cannabis concentrates in the past 30 days compared to individuals using disposable vapes (aOR = 2.72, 95 %CI = 1.75-4.21, p < 0.001). AYAs who used open systems most often (i.e., vape pens, mods, or e-hookah) were more likely than individuals using closed systems (i.e., disposable vapes, rechargeable pods or cigalikes) to combine nicotine and cannabis e-liquids (aOR = 2.03, 95 %CI = 1.43-2.89, p < 0.001) or use a nicotine device to vape cannabis (aOR = 1.66, 95 %CI = 1.17-2.34, p = 0.005).

IMPLICATIONS

Co-use of cannabis and nicotine via similar devices, particularly vape pens and other open-systems, warrants collaborative regulatory efforts to mitigate co-use of both substances, with a particular need for increased regulation of cannabis vaping products.

Modification of Electronic Nicotine Delivery Systems Among Adolescents and Young Adults

OBJECTIVES

We assessed awareness and perceptions of, information sources about, and engagement in modifying electronic nicotine delivery systems (ENDS) among adolescents and young adults (AYAs).

METHODS

AYAs (N = 1018) endorsing past-month ENDS use completed a survey on awareness and use of the following modifications: (1) refilling rechargeable cartridges/pods or (2) disposable pods, (3) rewicking or (4) recharging disposable pods, (5) modifying nicotine e-liquids (eg, changing propylene glycol/vegetable glycerin, nicotine), (6) combining nicotine and cannabis for simultaneous vaping, and (7) putting cannabis in ENDS designed for nicotine vaping. Logistic regression assessed how sources of information (eg, friends, social media, nonsocial media Web sites, vape shops) about and perceptions of ENDS modifications associated with ENDS modifications.

RESULTS

Refilling (69.0% heard, 40.1% tried) and recharging the battery (66.4% heard, 35.8% tried) of disposable pods were most common. Friends (64.4%) and social media (46.7%) were the most common sources of information. Notable significant associations between information sources and modifications were: 1. nonsocial media Web sites and vape shops with rewicking and recharging disposable devices and modifying nicotine e-liquid; 2. nonsocial media Web sites with refilling rechargeable cartridges/pods and disposable pods; and 3. social media with recharging disposable devices and mixing nicotine and cannabis liquids. Perceptions of reduced harm and "coolness" were associated with various modifications.

DISCUSSION

AYAs are aware of and modify ENDS for purposes unintended by manufacturers. ENDS policies should consider unintended ENDS use to safeguard public health. Prevention efforts should communicate about the potential harms of ENDS modifications.

Effectiveness of interventions to reduce social inequalities of weight status in adolescents: A systematic review and meta-analysis

Many interventions are implemented in the public health context to overcome social inequalities of weight status in adolescents, but their effectiveness is challenged. This study aimed to examine the effectiveness of these interventions with a systematic review and meta-analysis. We systematically searched for reports of randomized control trials and quasi-experimental studies aiming to reduce social inequalities of weight status in adolescents in five electronic databases. The primary outcomes were social inequalities in weight-related outcomes (body mass index [BMI], BMI z score, waist circumference, percent body fat, prevalence of overweight/obesity). Interventions were effective when they reduced social inequalities in at least one weight-related outcome. Meta-analyses involved using random-effects models. The review included 38 publications (33 studies) with interventions mostly targeting disadvantaged adolescents (n = 29 studies), showing effectiveness in half of the studies (n = 19/33, 57.6%). The meta-analysis (27 studies) revealed that targeted interventions significantly reduced BMI z score (β = -0.04 [95% CI -0.08, -0.01]), BMI (β = -0.32 [-0.47, -0.18]), and waist circumference (β = -0.84 [-1.48, -0.21]) but not percent body fat (β = -0.27 [-0.71, 0.17]) or prevalence of overweight/obesity (odds ratio = 1.06 [0.85, 1.31]). This review shows moderate effectiveness of interventions targeting disadvantaged adolescents to reduce social inequalities of weight status. High-quality research with better implementation to reach their full potential is required to strengthen their effectiveness.

Inequities in dietary intake and eating behaviours among adolescents in Canada

OBJECTIVE

To provide contemporary evidence of how dietary intake and eating behaviours vary by social positions among adolescents.

METHODS

We used survey data collected during the 2020-2021 school year from 52,138 students attending 133 secondary schools in Alberta, British Columbia, Ontario, and Quebec, Canada. Multiple regression models tested whether self-reported indicators of dietary intake and eating behaviours differed by gender, race/ethnicity, and socioeconomic status (SES).

RESULTS

Females were more likely than males to skip breakfast, restrict eating, and consume fruit, vegetables, and fast food on more days. Gender-diverse/"prefer not to say" students were more likely to restrict eating than males and the least likely to consume breakfast and drink water daily, and fruits and vegetables regularly. Black and Latin American students were more likely to restrict eating and consume purchased snacks and fast food, and less likely to drink water daily than white and Asian adolescents. Daily breakfast consumption was most likely among Latin American students. Black students were the least likely to report eating breakfast daily and fruits and vegetables regularly. Lower SES was associated with lower odds of eating breakfast and drinking water daily and regular fruit and vegetable consumption, and higher odds of restrictive eating and purchased snack consumption. Fast food consumption had a u-shaped association with SES.

CONCLUSION

Results emphasize gender, racial/ethnic, and socioeconomic inequities in the diets and eating behaviours of adolescents. There is a critical need to address the structural factors contributing to inequities and prevent the consequences of dietary disparities.

Inequitable Changes in School Connectedness During the Ongoing COVID-19 Pandemic in a Cohort of Canadian Adolescents

BACKGROUND

We examined whether subgroups of adolescents experienced disparate changes in school connectedness-a robust predictor of multiple health outcomes-from before the COVID-19 pandemic to the first full school year following pandemic onset.

METHODS

We used 2 waves of prospective survey data from 7178 students attending 41 Canadian secondary schools that participated during the 2019-2020 (T1; pre-COVID-19 onset) and 2020-2021 (T2; ongoing pandemic) school years. Fixed effects analyses tested differences in school connectedness changes by gender, race, bullying victimization, socioeconomic position, and school learning mode.

RESULTS

Relatively greater declines in school connectedness were reported by students that identified as females, were bullied, perceived their family to be less financially comfortable than their classmates, and attended schools in lower income areas. Marginally greater school connectedness declines resulted among students attending schools that were fully online at T2 than those at schools using a blended model.

CONCLUSION

Results point to disparate school connectedness declines during the pandemic, which may exacerbate pre-existing health inequities by gender and socioeconomic position, and among bullied youth.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Effective strategies to improve school climates for equity denied groups are critical for pandemic recovery and preparedness for future related events.

Factors Associated with Substance Use Disorder among High-Need Adolescents and Young Adults in North Carolina

Background

Prevalence of substance use disorders (SUD) is high among adolescents and young adults (AYAs) with complex medical needs. Little is known about risk factors for SUD in this population.

Methods

This retrospective cohort study used electronic health record data from a large academic hospital system (2015-2019) to identify adolescents (aged 10-17) and young adults (aged 18-27) with intellectual/developmental disorders, psychiatric conditions, or complex medical conditions. Logistic regression was used to identify demographic, clinical, and neighborhood-level risk factors associated with SUD in this population.

Results

A total of 149 adolescents and 536 young adults had a SUD diagnosis (6.7% and 20.6%, respectively). Among adolescents, notable risk factors for SUD included age (adjusted odds ratio [aOR] = 1.42, 95% confidence interval [CI] = [1.31, 1.54]), Hispanic ethnicity (aOR = 2.10, 95% CI = [1.10, 3.99]), additional psychoactive medication classes (aOR = 1.27, 95% CI = [1.11, 1.46]), and living in a "high" child opportunity index (COI) (aOR = 2.06, 95% CI [1.02, 4.14]) or a "very high" COI (aOR = 3.04, 95% CI [1.56,5.95]) area. Among young adults, notable risk factors included being male (aOR = 2.41, 95% CI [1.91, 3.05]), being Black (aOR = 1.64, 95% CI [1.28, 2.09]), and additional non-psychoactive (aOR = 1.07, 95% CI [1.03, 1.11]) or psychoactive medication classes (aOR = 1.17, 95% CI [1.07, 1.28]).

Limitations

These descriptive analyses are limited to one large academic hospital system in North Carolina and may not be representative of all high-need AYAs in the state.

Conclusions

Several demographic, clinical, and neighborhood risk factors are associated with SUD in high-need AYAs.

The relationship between time spent on social media and adolescent alcohol use: a longitudinal analysis of the UK Millennium Cohort Study

BACKGROUND

To estimate the effect of social media use in 14 year olds on risk of and inequalities in alcohol use and binge drinking at 17 years.

METHODS

Using the UK-representative Millennium Cohort Study, the relationship between time spent on social media (assessed using questionnaires [n = 8987] and time-use-diaries [n = 2520]) with frequency of alcohol use in the past month and binge drinking was estimated using adjusted odds ratios (AORs) or adjusted relative risk ratios (ARRRs). Associations within low and high parental education groups were compared to examine effect modification. Analyses accounted for pre-specified confounders, baseline outcome measures (to address reverse causality), sample design, attrition and item-missingness (through multiple imputation).

RESULTS

Questionnaire-reported time spent on social media was associated with increased risk of alcohol use and binge drinking in a dose-response manner. Compared to 1-< 30 min/day social media users, 30 min-<1 h/day users were more likely to report alcohol use ≥6 times/month (ARRR 1.62 [95% confidence interval 1.20 to 2.20]) and binge drinking (AOR 1.51 [1.22 to 1.87]), as were 1-<2 h/day users (ARRR 2.61 [1.90 to 3.58]; AOR 2.06 [1.69 to 2.52]) and ≥2 h/day users (ARRR 4.80 [3.65 to 6.32]; AOR 3.07 [2.54 to 3.70]). Social media measured by time-use-diary was associated with higher risks, although not always demonstrating a dose-response relationship. The effect of social media use (vs no-use) on binge drinking was larger in the higher (vs lower) parental education groups. Analyses repeated in complete case samples, and with adjustment for baseline outcome measures revealed consistent findings.

CONCLUSIONS

Findings suggest social media use may increase risk of alcohol use and binge drinking. Regulatory action protecting adolescents from harmful alcohol-related social media content is necessary.

Predictors of Youth Accessibility for a Mobile Phone-Based Life Skills Training Program for Addiction Prevention

BACKGROUND

Digital interventions are an emerging and promising avenue for addiction prevention and mental health promotion, but their reach and use are often limited, and little is known about the factors associated with youth accessibility. SmartCoach is a life skills training program for addiction prevention where adolescents are proactively invited for program participation in secondary school classes. The mobile phone-based program provides individualized coaching for a period of 4 months and addresses self-management skills, social skills, and substance use resistance skills. This study examined sociodemographic and other predictors of program participation and program use.

METHODS

A total of 476 adolescents in 28 secondary and upper secondary school classes in the German-speaking part of Switzerland were proactively invited for participation in the SmartCoach program. Using generalized linear mixed models (GLMMs), we examined predictors of both program participation and program use at the individual and school class levels.

RESULTS

In total, 315 (66.2%) of the present 476 adolescents gave their active consent and provided the necessary information to be included in the program. None of the individual sociodemographic characteristics significantly predicted program participation, however, the participation rate was significantly higher in upper secondary school classes (84%) than secondary school classes (59%). The mean number of interactions with the program was 15.9, i.e., participants took part in almost half of the 34 possible interactions with the SmartCoach program. None of the baseline characteristics on the level of the school class significantly predicted program use. On the level of the individual, the univariate models showed that, compared to the reference category of 14-year-old students, program use was significantly lower for students who were 16 or older. Furthermore, participants with a migration background or an origin from a non-German-speaking country showed significantly lower program use. Finally, students with a medium level of perceived stress showed higher program use compared to those with a low level of stress. Within the final multivariate model for program use, only the variable "origin from a non-German-speaking country" remained significant.

CONCLUSIONS

SmartCoach is an attractive offer for young people, in which two out of three young people who are invited in the classroom to participate do so. Among the program participants, the use of the program is acceptable, with an average of almost half of the content being worked on. There is potential for improvement in terms of recruitment, especially in school classes with a lower level of education. The most important starting point for improving program use lies in taking greater account of needs and wishes of students with non-German-speaking countries of origin.

How School and Home Contexts Impact the School Adjustment of Adolescents from Different Ethnic and SES Backgrounds During COVID-19 School Closures

Many schools worldwide closed to contain the spread of the COVID-19 virus. However, the consequences of school closures for the school adjustment of adolescents from different ethnic and SES backgrounds remain unclear. This study examined how school adjustment changed before, during, and after school closure across adolescents from different ethnic and SES backgrounds; and which factors in home and school contexts served as resources. Early adolescents (N = 124, M_age = 12.86, 58.8% boys) from different ethnic and SES backgrounds were repeatedly assessed 1 week before (March 2020), during (June 2020), and 1 year after (February 2021) the first school closure in Belgium. The results revealed that school closure augmented ethnicity- and SES-based inequalities in school adjustment. Moreover, factors in the school context-and not the home context-served as resources. Specifically, the quality of online instruction and teacher-pupil relationships buffered against reduced school adjustment during school closure, particularly among youth from ethnic minority and lower SES backgrounds. The findings corroborate unequal school adjustment consequences of school closures, but also highlight the role of teachers to buffer against them. The study design, hypotheses, and analyses were preregistered in the following link: https://osf.io/6ygcu/?view_only=c77cfb46028447bdb7844cd2c76237aa .

Associations of parent-adolescent closeness with P3 amplitude, frontal theta, and binge drinking among offspring with high risk for alcohol use disorder

BACKGROUND

Parents impact their offspring's brain development, neurocognitive function, risk, and resilience for alcohol use disorder (AUD) via both genetic and socio-environmental factors. Individuals with AUD and their unaffected children manifest low parietal P3 amplitude and low frontal theta (FT) power, reflecting heritable neurocognitive deficits associated with AUD. Likewise, children who experience poor parenting tend to have atypical brain development and greater rates of alcohol problems. Conversely, positive parenting can be protective and critical for normative development of self-regulation, neurocognitive functioning and the neurobiological systems subserving them. Yet, the role of positive parenting in resiliency toward AUD is understudied and its association with neurocognitive functioning and behavioral vulnerability to AUD among high-risk offspring is less known. Using data from the Collaborative Study on the Genetics of Alcoholism prospective cohort (N = 1256, mean age [SD] = 19.25 [1.88]), we investigated the associations of closeness with mother and father during adolescence with offspring P3 amplitude, FT power, and binge drinking among high-risk offspring.

METHODS

Self-reported closeness with mother and father between ages 12 and 17 and binge drinking were assessed using the Semi-Structured Assessment for the Genetics of Alcoholism. P3 amplitude and FT power were assessed in response to target stimuli using a Visual Oddball Task.

RESULTS

Multivariate multiple regression analyses showed that closeness with father was associated with larger P3 amplitude (p = 0.002) and higher FT power (p = 0.01). Closeness with mother was associated with less binge drinking (p = 0.003). Among male offspring, closeness with father was associated with larger P3 amplitude, but among female offspring, closeness with mother was associated with less binge drinking. These associations remained statistically significant with father's and mothers' AUD symptoms, socioeconomic status, and offspring impulsivity in the model.

CONCLUSIONS

Among high-risk offspring, closeness with parents during adolescence may promote resilience for developing AUD and related neurocognitive deficits albeit with important sex differences.

Adolescents' Perceptions of Harmfulness of Tobacco and Tobacco-like Products in Finland

During the recent years, new tobacco and tobacco-like products, e.g., e-cigarettes, have emerged on the market. Adolescents often underestimate health risks in general, including those concerning tobacco. Little is known of adolescents' perceptions of health risks of the newer products. Our paper compares adolescents' perceptions of harmfulness of cigarettes, e-cigarettes, snus, water pipes, and nicotine in Finland, a country with a long history of strict tobacco control policy. Online surveys to nationally representative samples of 12-18-year-olds were conducted in 2017 and 2019, with 7578 answering the surveys. Only 3% of boys and 2% of girls did not agree that cigarettes are harmful to health. The percentages were slightly higher for snus (6% and 3%, respectively) and nicotine (12%, 8%) but much higher for e-cigarettes (30%, 22%) and water pipes (36%, 38%). Those who used the product, whose parents were smokers or had lower education, and whose school performance was lower, less often agreed with the harmful health effects of the products. Our results showed that adolescents understood the harmfulness of older tobacco products better than the harmfulness of the newer ones. Our results also showed the need to strengthen health education and fix adolescents' misperceptions of the health effects of the newer products.