Racial discrimination and child and adolescent health in longitudinal studies: A systematic review

Racism and Health Among Aotearoa New Zealand Young People Aged 15-24 years: Analysis of Multiple National Surveys

PURPOSE

This Aotearoa New Zealand-based study addresses a gap in literature focusing on individual experiences of racism among adolescents and young adults and its links to health.

METHODS

This cross-sectional study uses data from multiple instances of the New Zealand Health Survey (2002/03, 2006/07, 2011/12, 2016/17) and General Social Survey (2008-2016) restricted to participants aged 15-24 years. Prevalence of reported experiences of racism are estimated. Meta-analytic techniques to pool data and multiple regression analyses are used to examine associations between experiences of racism and outcomes measures (mental and physical health, general health and well-being, life satisfaction, inability to access health care, and identity). The study used an ethical co-design process between university researchers and a rangatahi Māori (Māori young people) partnership group.

RESULTS

Racism was higher among Māori, Pacific, and Asian young people compared to European young people. Racism was associated with all negative health and well-being measures examined for young people, including negative mental and physical health measures (12-Item Short Form Survey, Kessler Psychological Distress Scale), lower self-rated health, negative life satisfaction, higher unmet need for primary care, and identity measures (feelings of not belonging in New Zealand, less able to express their identity).

DISCUSSION

The results of this study are concerning. Non-European young people disproportionately bear the burden of racism in Aotearoa New Zealand with a potentially substantial impact on their health and well-being. This is a breach of Indigenous (for Māori) and other international human rights and should be motivation to act to eliminate racism in all its forms.

Black and Latiné parents' perspectives on supporting their children's emotional and physical health

Informed by integrative models of cultural resilience, the purpose of this study was to (a) explore how parents are promoting their children's emotional and physical health, with a focus on race and ethnic-racial socialization strategies, and (b) identify the barriers and challenges parents are experiencing in supporting their children's health. Ethnically racially matched qualitative interviews were conducted with 33 parents (82% women, 64% Black, 36% Latiné). Results of thematic analysis revealed three overarching themes: (a) Strategies for Promoting Children's Physical and Emotional Health, (b) Challenges Promoting Children's Physical and Emotional Health, and (c) Impact of Racism on Parenting and Children's Health. Most parents believed that racism had an impact on their parenting decisions and their children's health; however, there were some differences in ethnic-racial socialization practices between Black and Latiné parents. Findings have implications for culturally relevant parenting approaches to support children's emotional and physical health.

Racial and ethnic socioenvironmental inequity and neuroimaging in psychiatry: a brief review of the past and recommendations for the future

Neuroimaging is a major tool that holds immense translational potential for understanding psychiatric disorder phenomenology and treatment. However, although epidemiological and social research highlights the many ways inequity and representativeness influences mental health, there is a lack of consideration of how such issues may impact neuroimaging features in psychiatric research. More specifically, the potential extent to which racialized inequities may affect underlying neurobiology and impact the generalizability of neural models of disorders is unclear. The present review synthesizes research focused on understanding the potential consequences of racial/ethnic inequities relevant to neuroimaging in psychiatry. We first discuss historical and contemporary drivers of inequities that persist today. We then discuss the neurobiological consequences of these inequities as revealed through current research, and note emergent research demonstrating the impact such inequities have on our ability to use neuroimaging to understand psychiatric disease. We end with a set of recommendations and practices to move the field towards more equitable approaches that will advance our abilities to develop truly generalizable neurobiological models of psychiatric disorders.

New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey

In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.

Fostering trust and understanding in social and healthcare services with migrant-origin parents: qualitative focus-group interviews of foreign-born mothers living in Finland

Migrant-origin families may have a pronounced need for psychosocial support and healthcare services, but they face barriers in using services. To ensure the timely use of services, it is important that families understand how service systems work and trust care providers. Thirty-two migrant-origin mothers living in Finland participated in five focus-group interviews and shared their wishes for social and healthcare professionals on how trust and understanding can be increased. The data were analyzed with Qualitative Content Analysis. We identified six main themes related to the use of services and professionals' behavior. These were the need for professionals to justify and explain questions, to meet each family as individuals, the importance of non-verbal communication, the need to talk about racism and discrimination, the importance of cultural sensitivity in services, and a discussion of positive aspects of life after migration and children`s strengths. To foster trust and mutual understanding in social and healthcare services, professionals should be aware of potential cultural differences in family life, while avoiding pre-conceived ideas. Misunderstandings can rise from language barriers and unclear or intimidating questions. It is important that professionals explain what they do and justify why they might inquire about a family's personal matters. Working with interpreters is necessary when professionals and parents do not share a common fluent language. Professionals should also pay attention to their non-verbal communication and to being friendly. Finally, it is important to show interest in families' experienced hardships such as racism as well as their strengths.

Racial-Ethnic Discrimination and Early Adolescents' Behavioral Problems: The Protective Role of Parental Warmth

OBJECTIVE

The purpose of the study was to investigate the association between discrimination by multiple sources (ie, teachers, students, and other adults) and early adolescents' behavioral problems (ie, internalizing, externalizing, and attention problems), also considering the protective role of parental warmth in the association.

METHOD

Cross-sectional analyses were conducted with 3,245 early adolescents of color obtained from the Adolescent Brain Cognitive Development Study (ABCD Study) at year 1 follow-up (Y1), a large and diverse sample of children (mean age = 9.48 years) in the United States. Racially-ethnically minoritized adolescents reported sources of discrimination, parental warmth, and symptoms of psychopathology. Regression with interaction terms was conducted to investigate the associations among sources of discrimination, parental warmth, and behavioral problems among racially-ethnically minority adolescents. Sensitivity analyses were conducted to examine (1) race/ethnicity and sex/gender variations; (2) whether the associations between different sources of discrimination and behavioral problems were reliably different; and (3) effects of discrimination, parental warmth, and their interplay at Y1 in predicting adolescents' behavioral problems at year 2 follow-up.

RESULTS

Early adolescents experiencing interpersonal racial-ethnic discrimination by multiple sources, including teachers, students, and other adults, reported higher levels of attention, internalizing, and externalizing problems. Parental warmth was protective for the association between interpersonal racial-ethnic discrimination and early adolescents' behavioral problems.

CONCLUSION

Experiencing interpersonal racial-ethnic discrimination from teachers, peers, and other adults is related to heightened attention, internalizing, and externalizing problems among racially-ethnically minoritized early adolescents. Parental warmth may reduce the risk of developing behavioral problems among early adolescents who experience interpersonal racial-ethnic discrimination from students, teachers, and other adults outside of school.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

Ethnic discrimination, asking for fair treatment, and poor self-rated health: a gender stratified analysis of 13,443 Korean Chinese waged workers in South Korea

BACKGROUND

In South Korea, Korean Chinese workers experience ethnic discrimination although they share physical similarities and ethnic heritage with native-born Koreans. This study aimed to examine whether perceived ethnic discrimination is associated with poor self-rated health and whether the association differs by gender among Korean Chinese waged workers in South Korea.

METHODS

We conducted a pooled cross-sectional analysis using data of 13,443 Korean Chinese waged workers from the Survey on Immigrants' Living Conditions and Labor Force conducted in 2018, 2020, and 2022. Based on perceived ethnic discrimination, asking for fair treatment, and subsequent situational improvement, respondents were classified into the following four groups: "Not experienced," "Experienced, not asked for fair treatment," "Experienced, asked for fair treatment, not improved," and "Experienced, asked for fair treatment, improved." Poor self-rated health was assessed using a single question "How is your current overall health?" We applied logistic regression to examine the association between perceived ethnic discrimination and poor self-rated health, with gender-stratified analyses.

RESULTS

We found an association between ethnic discrimination and poor self-rated health among Korean Chinese waged workers. In the gender-stratified analysis, the "Experienced, not asked for fair treatment" group was more likely to report poor self-rated health compared to the "Not experienced" group, regardless of gender. However, gender differences were observed in the group stratified by situational improvements. For male workers, no statistically significant association was found in the "Experienced, asked for fair treatment, improved" group with poor self-rated health (odd ratios: 0.87, 95% confidence intervals: 0.30-2.53). Conversely, among female workers, a statistically significant association was observed (odd ratios: 2.63, 95% confidence intervals: 1.29-5.38).

CONCLUSIONS

This study is the first to find an association between perceived ethnic discrimination and poor self-rated health, along with gender differences in the association between situational improvements after asking for fair treatment and poor self-rated health among Korean Chinese waged workers in South Korea.

Addressing the Harms of Structural Racism on Health in Incarcerated Youth Through Improved Nutrition and Exercise Programs

Every year, hundreds of thousands of youth across the country enter the juvenile legal system. A significantly disproportionate number of them are youth of color. While youth arrests have declined over the past several decades, racial disparities have increased and persist at every stage of the system. Many youth of color enter the juvenile legal system with a history of trauma and stress that compromises their health and well-being. Arrest, prosecution, and incarceration exacerbate these poor health outcomes. This paper examines several of the health impacts of structural racism in the policing and incarceration of youth of color. The paper begins by highlighting some of the most pressing social determinants of adolescent health and then considers how youth detention and incarceration contribute to unhealthy weight, hypertension, diabetes, and cardiovascular disease through unhealthy food environments, limited physical activity, and the added stress of the incarceration setting. This paper adds to the existing literature on the harms of youth detention and advocates for harms elimination strategies grounded in a public health approach to public safety and community-based alternatives to detention. For those youth who will remain in detention, the authors offer suggestions to reduce harms and improve the health of systems-involved youth, including opportunities for research.

Racial/ethnic disparities in sleep health among adolescents in South Korea: The role of substance use behaviours

AIM

To examine the relationship between racial/ethnic disparities and substance use behaviours (alcohol and tobacco use) and their impact on the sleep health of South Korean adolescents.

DESIGN

Secondary analysis of cross-sectional study data from the 2021 Korea Youth Risk Behaviour Web-based Survey dataset.

METHODS

Given that Korean society has historically linked its racial/ethnic identity to a shared bloodline, we categorized 2644 adolescents from the Korea Youth Risk Behaviour Web-based Survey based on their racial/ethnic status, determined by their parents' birthplaces. Using multiple linear regression, we investigated whether the impact of racial/ethnic disparities on sleep health (sleep duration, debt, and timing) varies depending on substance use behaviours (alcohol and tobacco use) after controlling for age, sex, household economic status, depressed mood, suicidal ideation, perceived excessive stress, and anxiety level.

RESULTS

Despite no statistical differences in sleep health and the prevalence of substance use between racial/ethnic groups, racial/ethnic minority adolescents experienced greater sleep debt than racial/ethnic majority adolescents when consuming alcohol. Moreover, racial/ethnic minority adolescents were more likely to report psychosocial distress and had lower parental education level.

CONCLUSION

Racial/ethnic minority adolescents were more vulnerable to the detrimental effects of alcohol use on sleep health compared to racial/ethnic majority adolescents. This heightened vulnerability may be attributed to the more pronounced psychosocial challenges and the lower socioeconomic status of parents in the racial/ethnic minority group.

IMPACT

Racial/ethnic disparities are concerning in South Korea, particularly since the negative effects of substance use on sleep health are intensified among racial/ethnic minority adolescents. Nurses and other healthcare providers should recognize the importance of addressing the social disadvantages linked to racial/ethnic disparities. Beyond just advocating for the cessation of substance use, it is crucial to address these underlying issues to reduce sleep disparities among South Korean adolescents.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring adolescent-adult connections, coping, and safety among minoritized youth in neighborhoods impacted by community violence

Dyadic interviews were conducted with 32 youth ages 13-21 and their self-identified key adult supports to illuminate how adult supports help protect youth in communities impacted by high levels of violence. Interview transcripts were analyzed using thematic content analysis. Youth described choosing social interactions carefully, avoiding high-violence areas, and keeping busy with activities. Many youths discussed the necessity of minimizing contact with peers to avoid violence, resulting in isolation from friends and increased engagement with family at home. Adult supports reflected upon an intergenerational transfer of violence avoidance, safety planning, and coping strategies through sharing their own lived experiences. Dyads highlighted the need for intergenerational programming to address social isolation and build supportive social networks.

Emotional impacts of racial discrimination on caregiver-child dyads: Can mentalizing-focused parenting groups buffer against racism-related stress?

Black and Latinx caregivers face high risk for parenting stress and racism-related stress due to experiences of racial discrimination (RD). This study aimed to explore the associations between RD, parenting stress, and psychological distress in caregiver-child dyads, as well as the impact of a mentalizing-focused group intervention on caregivers' experiences of RD distress. Ethnoracially minoritized caregivers of children aged 5-17 years old participated in a non-randomized clinical trial (N = 70). They received either a 12-session mentalizing-focused group parenting intervention or treatment-as-usual in outpatient psychiatry. We assessed self-reported frequency and distress related to RD, parenting stress, and psychological distress at baseline (T1) and post-intervention (T2). Caregiver- and self-reported child psychological distress were also measured. The results showed that greater RD frequency and greater RD distress separately predicted higher overall parenting stress and parental role-related distress. Greater RD distress was linked to increased psychological distress in caregivers. Similarly, greater RD frequency and distress among caregivers were associated with higher caregiver-reported, but not self-reported, child psychological distress. No significant changes in RD distress were observed between T1 and T2 for either of the treatment groups. These findings highlight the exacerbating role of RD on parenting stress and psychological distress among ethnoracially minoritized caregivers and their children.

Proactive coping with discrimination: A mediator between ethnic-racial socialization and Latinx youth's internalizing symptoms

There is a dearth of knowledge in the coping literature on how minoritized youth cope with racism-related stressors and the predictors of effective coping responses. This two-wave study examined the direct and indirect effects of ethnic-racial socialization on depressive and anxiety symptoms via proactive coping with discrimination in a community sample of 135 Latinx adolescents (Mage  = 16, SD = 1.27; 59% female). Results indicate that cultural socialization was related to higher use of proactive coping with discrimination 6 months later, which in turn, was related to fewer depressive and anxiety symptoms. There were no direct or indirect effects between preparation for bias and mental health outcomes.

Yearly and Daily Discrimination-Related Stressors and Mexican Youth's Mental Health and Sleep: Insights From the First Wave of a Three-Wave Family Study

OBJECTIVE

Research is needed to examine discrimination-related stressors and their social and psychological shaping of mental health and sleep outcomes of Latinx youth. The background, design, and methodology of a longitudinal study of Mexican families in Indiana and the initial findings of associations between discrimination-related stressors and youth mental health and sleep outcomes are presented.

METHOD

Initiating wave 1 of a 3-wave (yearly) longitudinal study, investigators surveyed an ethnically homogeneous sample of 344 Mexican-origin adolescents (ages 12-15) and their primary caregivers, assessing risks and protective factors for mental health and sleep outcomes. Youth also completed a one-time 21-day daily diary after wave 1. Self-reported measures of youth mental health, sleep, and discrimination across wave 1 and the daily diary were evaluated to compare the cross-sectional (wave 1) and daily associations between discrimination and youth mental health and sleep outcomes.

RESULTS

Of youth, 88.1% reported at least one incident of lifetime discrimination. Almost one-third had elevated depressive symptoms, 44.5% had probable generalized anxiety disorder, and 50.9% had poor sleep quality. Between-youth correlations at wave 1 and in the daily diary were consistent in that perceived racial discrimination was positively correlated with worse mental health and poorer sleep quality. Smaller within-youth correlations were observed in the daily diary, but there was striking variability in the effect of discrimination across youth.

CONCLUSION

The present results illustrate the powerful methods of combining yearly and daily time data to investigate how and for whom discrimination-related stressors lead to adverse outcomes.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

CLINICAL TRIAL REGISTRATION INFORMATION

Seguimos Avanzando - Latino Youth Coping With Discrimination; https://clinicaltrials.gov/; NCT04875208.

Racial Discrimination and Interpersonal Violence in Asian American Adolescents During the COVID-19 Pandemic

PURPOSE

Racial discrimination targeting Asians in the United States has increased sharply since the COVID-19 pandemic. Despite a well-established link with mental/physical health outcomes, little is known about how racial discrimination relates to interpersonal violence, particularly in adolescents. To address this gap in knowledge, we examined cross-sectional and longitudinal (1-year follow-up) associations between racial discrimination and interpersonal violence perpetration and victimization in Asian American adolescents in a large US city.

METHODS

Data from Waves 3 (2020) and 4 (2021) of a randomized clinical trial of a school-based violence prevention program were examined. We limited our sample to participants who identified as Asian American (n = 344; 48.3% female; Meanage = 14.6 years at Wave 3).

RESULTS

At Wave 3, 26.5% of the adolescents reported experiencing some form of racial discrimination, including 18.3% experiencing verbal harassment due to race and 16.0% reporting inequitable treatment due to race. Relative to their nonvictimized counterparts, adolescents who experienced racial discrimination were more likely to report being a victim of bullying and teen dating violence cross-sectionally and being a bullying victim longitudinally. Moreover, those who experienced racial discrimination reported more bullying and teen dating violence perpetration concurrently, as well as more dating violence perpetration 1 year later.

DISCUSSION

In the understudied population of Asian American adolescents, we found that experiencing racial discrimination contributes to both interpersonal violence victimization and perpetration. Youth violence prevention could include strategies addressing racial discrimination.

Everyday discrimination, co-ethnic social support and mood changes in young adult immigrants in Germany-Evidence from an ecological momentary assessment study

Objective

In the context of international migration flows, Germany is the second largest receiving country of migrants in the world. The aim of this study is to investigate the momentary mood effects of discrimination experiences for young adult immigrants and which social resources can buffer negative effects. A distinction is made between the importance of inter and intra-ethnic interaction partners in processing stressors.

Method

Using an ecological momentary assessment design, first-generation migrants in Germany who had recently migrated from Poland, Turkey or Syria were interviewed three times a day over seven days in June 2021 (N individuals = 976; N observations = 11,470). The timing of the short surveys was chosen at random using a signal contingent sampling method. Participants reported their momentary mood and instances of discrimination, along with information on social support perception and interaction partners during the preceding hour in the context of their everyday lives. Hybrid mixed-effects regression models were estimated and the research questions were tested with three-way interactions.

Results

The results indicate that perceived social support only moderately buffers the negative effect of everyday discrimination experiences on mood. A positive main effect on mood is observed for situational variations in perceived social support as well as for support from interaction partners.

Conclusion

The findings illustrate that being embedded in supportive relationships is important in everyday life, regardless of the occurrence of stressors. Furthermore, the study suggests that the level of perceived support is more important for first-generation migrants than the ethnic origin of the support provider.

Racism-Related Experiences and Traumatic Stress Symptoms in Ethnoracially Minoritized Youth: A Systematic Review and Meta-Analysis

OBJECTIVE

Despite growing evidence demonstrating the association between racial and ethnic discrimination and traumatic stress symptoms in adult populations, the research among youth remains sparse. Drawing upon race-based traumatic stress models, and following the PRISMA-2020 guidelines, this systematic review and meta-analysis aimed to identify the state of the empirical evidence in the association between racism-related experiences and traumatic stress symptoms in ethnoracially minoritized youth.

METHOD

Scientific databases were searched to identify articles with ethnoracially minoritized youth participants under age 18 years old that examined the association between racial and/or ethnic discrimination and traumatic stress symptoms.

RESULTS

A total of 18 articles comprising 16 studies (N = 4,825 participants) met inclusion criteria. Studies were largely cross-sectional, used nonrandom sampling strategies, focused on Black and Latinx youth, and were conducted in the United States. Furthermore, most studies were theoretically grounded and operationalized racism-related experiences as frequency of direct, personal, everyday discrimination. Few studies examined other dimensions of racism-related experiences. The meta-analysis demonstrated a significant positive association with a medium effect size, rpooled = .356, 95% confidence interval [CI] = 0.27, 0.44, between racism-related experiences and traumatic stress symptoms. No evidence of moderation by age, sex/gender, race/ethnicity, country, or recruitment setting was detected.

CONCLUSION

Racism-related experiences may confer risk for traumatic stress symptoms in ethnoracially minoritized youth. Attending to racism-related experiences is critical to improve the cultural responsiveness of trauma-informed services.

Elevated mortality among the second-generation (children of migrants) in Europe: what is going wrong? A review

INTRODUCTION

The 'second-generation' (i.e. the children of migrants) represent one of the fastest growing subpopulations of the child and young adult populations in Europe today. The research so far appears to indicate that their mortality risk is elevated relative to people with non-migrant backgrounds.

SOURCES OF DATA

Peer-reviewed publications.

AREAS OF AGREEMENT

Second-generation status is a clear marker of elevated mortality risk in Europe in early life (including stillbirth, perinatal, neonatal and infant mortality) and adulthood, particularly if the parent(s) were born outside of Europe. Socioeconomic inequality plays an important, albeit rarely defining, role in these elevated risks.

AREAS OF CONTROVERSY

It remains unclear what causes-of-death are driving these elevated mortality risks. The exact influence of (non-socioeconomic) explanatory factors (e.g. health care, racism & discrimination, and factors related to integration) on the elevated mortality risks of the second-generation also remains unclear.

GROWING POINTS

The second-generation will continue to grow and diversify in Europe; we must intervene to address these inequalities now.

AREAS TIMELY FOR DEVELOPING RESEARCH

Place more emphasis on the complexity of migration background, specific causes-of-death, and understanding the roles of explanatory factors beyond socioeconomic background.

Current evidence and opportunities in child and adolescent public mental health: a research review

BACKGROUND

A public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents.

METHODS

This research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions.

RESULTS

In our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school-based interventions) have demonstrated small-to-modest positive effects. Few, however, have achieved sustained mental health improvements.

CONCLUSIONS

There is an opportunity to re-think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population-level impacts of interventions, complemented by measurement that embraces complexity through more in-depth characterisation, or 'phenotyping', of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.

Shift-and-persist coping and health among rural African American adolescents

This study examines whether shift-and-persist coping, a coping strategy defined by accepting challenges and remaining hopeful for the future, is associated with psychosocial and physical health and/or moderates the effects of contextual stress (i.e., racial discrimination, financial strain) on health among African American adolescents living in the rural Southeastern United States. Participants (N = 299, 56% boys, Mage  = 12.91) completed measures of shift-and-persist coping, contextual stress, and psychosocial and physical health. Shift-and-persist coping was generally associated with better health but did not buffer the effects of contextual stress. Results suggest that shift-and-persist coping may serve as a source of resilience among African American adolescents living in a context where many experience heightened contextual stress.

Discrimination and school outcomes in first nation youth: The role of positive psychological characteristics

INTRODUCTION

Positive psychological characteristics have been found to be associated with discrimination and school outcomes separately; however, no work has examined these associations together or in North American Indigenous (NAI) populations. NAI adolescents experience high rates of racial discrimination. Because discrimination has a detrimental impact on academic outcomes it is critical to identify factors that could buffer this impact. The purpose of this study was to examine the indirect effect of racial discrimination on three distinct school outcomes (i.e., attitudes toward school, grades, and educational attainment goals) through the pathway of three positive psychological characteristics (i.e., satisfaction with life, subjective happiness, and self-compassion).

METHODS

First Nation adolescents living on a rural reserve in Eastern Canada (N = 106, Mage  = 14.6 years, 50.0% female) completed a pencil-and-paper survey in Spring 2017 as part of a larger community-based participatory research study.

RESULTS

In the model examining school attitudes, indirect effects through subjective happiness (b = -0.21, 95% confidence interval (CI): [-0.53, -0.03]) and self-compassion (b = -0.19, 95% CI: [-0.39, -0.04]), but not satisfaction with life, were significant. In the model examining grades, only the specific indirect effect through subjective happiness was significant (b = -0.27, 95% CI: [-0.59 -0.07]). Similarly, in the model examining school goals, only the indirect effect through subjective happiness was significant (b = -0.40, 95% CI: [-0.94, -0.08]). The direct effects of discrimination on school attitudes (b = 0.02, 95% CI: [-0.52, 0.56]), grades (b = 0.16, 95% CI: [-0.39, 0.71]), and school goals (b = -0.03, 95% CI: [-0.90, 0.84]) were not significant after controlling for positive psychological characteristics.

DISCUSSION

Schools should foster positive emotions to enhance academic outcomes, especially for NAI youth who are more likely to experience racial discrimination.

Family-Centered Prevention to Reduce Discrimination-Related Depressive Symptoms Among Black Adolescents: Secondary Analysis of a Randomized Clinical Trial

Importance

Racial discrimination undermines the mental health of Black adolescents. Preventive interventions that can attenuate the effects of exposure to racial discrimination are needed.

Objective

To investigate whether participation in the Strong African American Families (SAAF) program moderates Black adolescents' depressive symptoms associated with experience of racial discrimination.

Design, Setting, and Participants

This secondary analysis used data from a community-based randomized clinical trial of SAAF (SAAF vs no treatment control). Participants were followed up at 10, 22, and 34 months after the baseline assessment. Assessment staff were blind to participant condition. Participants in this trial lived in 7 rural counties in Georgia. SAAF was delivered at local community centers. Eligible families had a child aged 11 to 12 years who self-identified as African American or Black. The joint influence of random assignment to SAAF and exposure to racial discrimination was investigated. Data were analyzed from September 2022 to March 2023.

Intervention

SAAF is a 7-session (14 hours) family skills training intervention that occurs over 7 weeks. Small groups of caregivers and their adolescents participate in a structured curriculum targeting effective parenting behavior, adolescent self-regulation, and Black pride.

Main Outcomes and Measures

The main outcome was adolescent-reported depressive symptoms, assessed at 34 months via the 20-item Center for Epidemiologic Studies Depression Scale for Children.

Results

Of 825 families screened randomly from public school lists, 472 adolescents (mean [SD] age, 11.6 years; 240 [50.8%] female) were enrolled and randomized to SAAF (252 participants) or a no treatment control (220 participants). Exposure to racial discrimination at age 13 years was associated with increased depressive symptoms at age 14 years (β = 0.23; 95% CI, 0.13 to 0.34; P < .001). Interaction analyses indicated that the experimental condition significantly moderated the association of racial discrimination with depressive symptoms: (β = -0.27; 95% CI, -0.47 to -0.08; P = .005). Probing the interaction with simple slopes at ±SD revealed that for the control group, racial discrimination was significantly associated with depressive symptoms (β = 0.39; 95% CI, 0.23 to 0.54; P < .001), while for the SAAF group, there was no association between racial discrimination and depressive symptoms (β = 0.12; P = .09).

Conclusions and Relevance

This randomized clinical trial found that the SAAF intervention reduced the incidence of racism-associated mental health symptoms among Black adolescents. SAAF is recommended for dissemination to health care practitioners working with rural Black adolescents.

Trial Registration

ClinicalTrials.gov Identifier: NCT03590132.

A window of opportunity: Adverse childhood experiences and time alone with a provider in the United States

BACKGROUND

To date, there is limited literature on the relationship between Adverse Childhood Experiences (ACEs) and the quality of health care provider encounters. This is key, as people with a history of ACEs have a greater burden of illness.

METHODS

This study uses data from the 2020-2021 National Survey of Children's Health to examine relationships between ACEs and (1) spending less than ten minutes with a health care provider, and (2) spending time alone with a health care provider.

RESULTS

In general, our results suggested most ACEs were associated with higher odds of a provider spending <10 min with a child during their last preventative care visit, while ACEs were inconsistently related to spending time alone with a provider. Each additional ACE was found to be associated with higher odds of both outcomes.

CONCLUSIONS

This work emphasizes the importance of ACEs screening in a health care setting and may set the groundwork for future research investigating mechanisms within these associations. Given the established link between health care quality and patient-provider trust, and health outcomes, intervention work is needed to develop healthcare practices that may encourage the length and quality of health care provider visits.

Racial/ethnic discrimination and suicide-related risk in a treatment-seeking group of ethnoracially minoritized adolescents

INTRODUCTION AND AIMS

Despite growing evidence demonstrating the negative mental health effects of racism-related experiences, racial/ethnic discrimination is seldom examined in youth suicide risk. The present study tested the association between racial/ethnic discrimination and well-supported correlates of suicide-related risk including emotion reactivity and dysregulation, and severity of psychiatric symptoms in a sample of ethnoracially minoritized adolescents receiving outpatient psychiatric services.

METHODS

Participants were adolescents (N = 46; 80.4% female; 65.2% Latinx) who ranged in age from 13-20 years old (M=15.42; SD=1.83) recruited from a child outpatient psychiatry clinic in a low-resourced community in Northeast US. Youth completed a clinical interview and a battery of surveys.

RESULTS

Findings from separate linear regression models show that increases in frequency of racial/ethnic discrimination were associated with increases in severity of suicidal ideation (SI), independent of emotion reactivity and dysregulation, and symptoms of PTSD and depression. Discriminatory experiences involving personal insults, witnessing family being discriminated, and school-based contexts were uniquely associated with SI.

DISCUSSION AND CONCLUSION

Preliminary findings support the association between racial/ethnic discrimination and increased severity of suicide-related risk in ethnoracially minoritized adolescents. Accounting for racial/ethnic discrimination may improve the cultural responsiveness of youth suicide prevention strategies within outpatient psychiatric care.

State-Level Anti-Immigrant Sentiment and Policies and Health Risks in US Latino Children

BACKGROUND

Although systemic inequities, broadly defined, are associated with health disparities in adults, there is a dearth of research linking contextual measures of exclusionary policies or prejudicial attitudes to health impairments in children, particularly among Latino populations. In this study, we examined a composite measure of systemic inequities in relation to the cooccurrence of multiple health problems in Latino children in the United States.

METHODS

Participants included 17 855 Latino children aged 3 to 17 years from the National Survey of Children's Health (2016-2020). We measured state-level systemic inequities using a factor score that combined an index of exclusionary state policies toward immigrants and aggregated survey data on prejudicial attitudes toward immigrants and Latino individuals. Caregivers reported on 3 categories of child health problems: common health difficulties in the past year, current chronic physical health conditions, and current mental health conditions. For each category, we constructed a variable reflecting 0, 1, or 2 or more conditions.

RESULTS

In models adjusted for sociodemographic covariates, interpersonal discrimination, and state-level income inequality, systemic inequities were associated with 1.13 times the odds of a chronic physical health condition (95% confidence interval: 1.02-1.25) and 1.24 times the odds of 2 or more mental health conditions (95% confidence interval: 1.06-1.45).

CONCLUSIONS

Latino children residing in states with higher levels of systemic inequity are more likely to experience mental health or chronic physical health conditions relative to those in states with lower levels of systemic inequity.

Ethnic Discrimination and Self-rated Health among Hispanic Emerging Adults: Examining the Moderating Effects of Self-esteem and Resilience

Exposure to ethnic discrimination has been conceptualized as a sociocultural stressor that is associated with lower self-rated health. However, this association remains understudied among Hispanics and less is known about constructs that may mitigate the effects of ethnic discrimination on self-rated health. Accordingly, this study aimed to (a) examine the association between ethnic discrimination and self-rated health among Hispanic emerging adults (ages 18-25), and (b) examine the extent to which self-esteem and resilience may moderate this association. A convenience sample of 200 Hispanic emerging adults from Arizona (n=99) and Florida (n=101) was recruited to complete a cross-sectional survey. Data were analyzed using hierarchical multiple regression and moderation analyses. Results indicate that higher ethnic discrimination was associated with lower self-rated health. Moderation analyses indicated that self-esteem functioned as a moderator that weakened the association between ethnic discrimination and self-rated health; however, resilience did not function similarly as a moderator. This study adds to the limited literature on ethnic discrimination and self-rated health among Hispanics and highlights that psychological factors, such as enhancing self-esteem, may help buffer the adverse effects of ethnic discrimination on health outcomes.

Racial discrimination, self-efficacy, and oral health behaviours in adolescents

To examine the mediation effect of discrimination on the association of self-efficacy and oral health behaviours among adolescents. A cross sectional study of adolescents aged 12 to 18 years who were recruited from the University outpatient dental clinic were asked to complete a questionnaire consisting of: demographics (12 items), oral health behaviours (7 items), general self-efficacy (10 items) and self-efficacy for self-care (SESS, 15 items). Perceived discrimination was assessed if the adolescent had ever been treated unfairly based on their race. Perceived discrimination was assessed if the adolescent had ever been treated unfairly based on their race. Using pathway analyses, the relationship between oral health behaviours, self-efficacy, and discrimination was explored. Mediation and hierarchal logistic regression analyses were conducted. Of 252 participants, mean (SD) age was 14 (1.8) years old. 60% were female, 81% were born in Canada, 56% identified themselves as White, and 20% perceived discrimination. Mean score of all task-specific self-efficacies were significantly different within respective oral health behaviour categories (P-value <0.001). Of demographics, age and ethnicity (White) were significantly associated with discrimination (OR = 1.25: 95% CI; 1.06-1.48 and OR = 0.29: 95% CI; 0.15-0.55, respectively). Perceived discrimination was positively associated with higher sugar consumption and mediate the association between diet self-efficacy and adolescent's dietary behaviour. Significant mediation effect of perceived discrimination on the association of diet specific self-efficacy and diet oral health behaviour was observed. Oral health behaviours were self-reported which may have influenced the results.

Association of Racial Discrimination With Adiposity in Children and Adolescents

Importance

Childhood obesity is a major public health issue and is disproportionately prevalent among children from minority racial and ethnic groups. Personally mediated racism (commonly referred to as racial discrimination) is a known stressor that has been linked to higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in adults, but little is known about the association of racial discrimination and childhood and adolescent adiposity.

Objective

To assess the prospective association between self-reported experiences of racial discrimination and adiposity (BMI and waist circumference) in a large sample of children and adolescents in the Adolescent Brain Cognitive Development (ABCD) study.

Design, Setting, and Participants

This cohort study used complete data from the ABCD study (2017 to 2019), involving a total of 6463 participants. The ABCD study recruited a diverse sample of youths from across the US, with rural, urban, and mountain regions. Data were analyzed from January 12 to May 17, 2023.

Exposure

The child-reported Perceived Discrimination Scale was used to quantify racial discrimination, reflecting participants' perceptions of being treated unfairly by others or unaccepted by society based on their race or ethnicity.

Main Outcomes and Measures

Weight, height, and waist circumference were measured by trained research assistants. BMI z scores were computed by applying the US Centers for Disease Control and Prevention's age and sex-specific reference standards for children and adolescents. Waist circumference (inches) was quantified as the mean of 3 consecutive measures. Measurements were taken from time 1 (ie, 2017 to 2019) and time 2 (ie, 2018 to 2020).

Results

Of the 6463 respondents with complete data, 3090 (47.8%) were female, and the mean (SD) age was 9.95 (0.62) years. Greater racial discrimination exposure at time 1 was associated with higher BMI z score in both unadjusted (β, 0.05; 95% CI, 0.02-0.08) and adjusted regression models (β, 0.04; 95% CI, 0.01-0.08). Discrimination at time 1 was associated with higher waist circumference in unadjusted (β, 0.35; 95% CI, 0.15-0.54) and adjusted (β, 0.24; 95% CI, 0.04-0.44) models.

Conclusions and Relevance

In this cohort study of children and adolescents, racial discrimination was positively associated with adiposity, quantified by BMI z score and waist circumference. Interventions to reduce exposure to racial discrimination in early life may help reduce the risk of excess weight gain across throughout life.

"The Fight is Two Times as Hard": A Qualitative Examination of a Violence Syndemic Among Young Black Sexual Minority Men

Young Black men who have sex with men (YBMSM) are disproportionately impacted by violence, including violence rooted in anti-Black racism, sexual identity bullying, and neighborhood violence rooted in structural racism and inequities. These multiple forms of violence are frequently co-occurring and interactive creating syndemic conditions that can negatively impact HIV care. This qualitative study is based on in-depth interviews with 31 YBMSM, aged 16-30 years, living with HIV in Chicago, IL, to examine how violence has impacted their lives. Using thematic analysis, we identified five themes that reflect how YBMSM experience violence at the intersection of racism, homonegativity, socioeconomic status, and HIV status: (a) the experience of intersectional violence; (b) long histories of violence contributed to hypervigilance, lack of safety, and lack of trust; (c) making meaning of violence and the importance of strength; (d) normalizing violence for survival; and (e) the cyclical nature of violence. Our study highlights how multiple forms of violence can accumulate across an individual's life and contribute to social and contextual situations that further contribute to violence and negatively impact mental health and HIV care.

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States

OBJECTIVE

Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample.

METHODS

Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents.

RESULTS

About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use.

CONCLUSION

Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.

Healthy and Equitable Interpersonal Relationships, Health Inequalities and Socio-Educational Interventions: A Conceptual Framework for Action

BACKGROUND

Interpersonal relationships undoubtedly have a bidirectional connection with the health of individuals and communities. Relational models based on equity contribute to well-being, while asymmetrical relationships based on hierarchies and differences of power negatively impact mental, physical, and social health.

METHODS

A conceptual framework for understanding the determinants of interpersonal relational models was developed.

RESULTS

Structural determinants were identified as the combined action of systems of oppression, the socio-historical context that normalizes violence, and social stratification and segregation, consequences which included inequitable access to power, resources, and opportunities. Intermediate determinants include individual, psychosocial, behavioral, and community aspects. Structural and intermediate determinants impact health and health inequalities through multiple relational patterns that are simultaneously established and sustained by individuals and communities. The health impact of inequitable relational patterns includes: Reduced self-esteem; anxiety, stress, and depression; acceptance of violence; physical and sexual harm; suicide; and murder.

CONCLUSIONS

This conceptual framework allows for the modification of relational models by influencing structural and intermediate determinants. Six areas of intervention have been identified: educative policies, school governance, physical and symbolic space, school curriculum, school-community relations, and socio-educative interventions to promote healthy and equitable relationships. Healthy and equitable relationships are associated with improved subjective well-being, health status and protection from violence. Socio-educational interventions that consider the elements of this conceptual framework may be effective in promoting healthy and equitable relational models.

Racial Discrimination in Late Adolescence and Mental Health Outcomes Among Participants in the Panel Study of Income Dynamics

PURPOSE

To assess whether racial discrimination experienced at ages 18-21 years is associated with psychological distress and well-being, and investigate potential moderators of this relationship.

METHODS

We used panel data collected from 2005 to 2017 from 661 participants in the Transition into Adulthood Supplement of the Panel Study of Income Dynamics. The Everyday Discrimination Scale measured racial discrimination. The Kessler six and Mental Health Continuum Short Form assessed psychological distress and well-being, respectively. Generalized linear mixed modeling was used to model outcomes and test potential moderating variables.

RESULTS

Approximately 25% of participants experienced high levels of racial discrimination. In analyses of panel data, these participants had significantly worse psychological distress (odds ratio = 6.04, 95% confidence interval: 3.41, 8.67) and lower levels of emotional well-being (odds ratio = 4.61, 95% confidence interval: 1.87, 7.36) compared to those who did not. Race and ethnicity moderated the relationship.

DISCUSSION

Exposure to racial discrimination in late adolescence was associated with worse mental health outcomes. This study has important implications for interventions addressing the need for mental health support that is critical for adolescents who experience racial discrimination.

Embedded racism: Inequitable niche construction as a neglected evolutionary process affecting health

Racial health disparities are a pervasive feature of modern experience and structural racism is increasingly recognized as a public health crisis. Yet evolutionary medicine has not adequately addressed the racialization of health and disease, particularly the systematic embedding of social biases in biological processes leading to disparate health outcomes delineated by socially defined race. In contrast to the sheer dominance of medical publications which still assume genetic 'race' and omit mention of its social construction, we present an alternative biological framework of racialized health. We explore the unifying evolutionary-ecological principle of niche construction as it offers critical insights on internal and external biological and behavioral feedback processes environments at every level of the organization. We Integrate insights of niche construction theory in the context of human evolutionary and social history and phenotype-genotype modification, exposing the extent to which racism is an evolutionary mismatch underlying inequitable disparities in disease. We then apply ecological models of niche exclusion and exploitation to institutional and interpersonal racial constructions of population and individual health and demonstrate how discriminatory processes of health and harm apply to evolutionarily relevant disease classes and life-history processes in which socially defined race is poorly understood and evaluated. Ultimately, we call for evolutionary and biomedical scholars to recognize the salience of racism as a pathogenic process biasing health outcomes studied across disciplines and to redress the neglect of focus on research and application related to this crucial issue.

COVID-19 Racism and Chinese American Families' Mental Health: A Comparison between 2020 and 2021

This study compared rates of multiple forms of COVID-19 racism-related discrimination experiences, fear/worries, and their associations with mental health indices among Chinese American parents and youth between 2020 and 2021. Chinese American parents of 4- to 18-year-old children and a subsample of their 10- to 18-year-old adolescents completed surveys in 2020 and 2021. A high percentage of Chinese American parents and their children continued to experience or witness anti-Chinese/Asian racism both online and in person in 2021. Parents and youth experienced less vicarious discrimination in person but more direct discrimination (both online and in person) and reported poorer mental health in 2021 than in 2020. Associations with mental health were stronger in 2021 than in 2020 for parents' and/or youth's vicarious discrimination experiences, perceptions of Sinophobia, and government-related worries, but weaker only for parents' direct discrimination experiences. The spillover effect from parents' vicarious discrimination experiences and Sinophobia perceptions to all youth mental health indices were stronger in 2021 than in 2020. Chinese American families experienced high rates of racial discrimination across multiple dimensions, and the detrimental impacts on their mental health were still salient in the second year of the pandemic. Vicarious and collective racism may have even stronger negative impacts on mental health and well-being later in the pandemic. Decreasing health disparities for Chinese Americans and other communities of color requires extensive, long-term national efforts to eliminate structural aspects of racism.

Racial Discrimination Experiences and Friendship Network Dynamics Among Black and Latinx Youth

Despite a robust volume of evidence documenting adverse effects of racial discrimination experiences on adolescent adjustment outcomes, relatively little is known about the relational consequences of racial discrimination experiences for adolescent friendship networks. To address this gap, this study examines how racial discrimination experiences shape and are shaped by friendship network dynamics in early and middle adolescence. The current study's goals were to explicate whether relational consequences of racial discrimination experiences for friendship network selection differed between interracial and intraracial friendships among Black and Latinx youth, and how these adolescents were influenced by their friends' racial discrimination experiences. Longitudinal social network analysis was used among a sample of predominantly Latinx and Black middle school students from the southwestern U.S. (n = 1034; 50.1% boys, Mage = 12.1, 13.8% White, 18.6% Black, 53.1% Latinx, 14.4% Other race and multiracial). The results showed that Black and Latinx youth preferred intraracial friends. Above and beyond that, Black youth were more likely to have intraracial friendships when the focal individual reported lower levels of general racial discrimination experiences and higher levels of adult-perpetrated racial discrimination experiences. Black and Latinx adolescents reported increases in general racial discrimination experiences over time, as a function of their friends reporting higher levels of racial discrimination (e.g., peer influence). These findings advance developmental research by showing that racial discrimination experiences are consequential for friendship network dynamics by increasing the likelihood of intraracial friend selection among Black youth and through peer influence processes.

Racial/Ethnic Differences in Biological Aging and Their Life Course Socioeconomic Determinants: The 2016 Health and Retirement Study

Objectives: This study examined differences in accelerated biological aging among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites in the United States and assessed whether including life course socioeconomic conditions attenuated observed racial/ethnic differences. Methods: Data came from the Venous Blood Collection Subsample of the Health and Retirement Study. We used a comprehensive summary measure of biological age (BA-22). We determined whether key lifetime socioeconomic conditions contributed to racial/ethnic differences in biological aging. Results: Findings indicated that non-Hispanic Blacks and Hispanics have accelerated aging, and non-Hispanic Whites have decelerated aging. Racial/ethnic differences were strongly tied to educational attainment. We also observed a significant difference by birthplace for Hispanics. US-born Hispanics had accelerated biological aging, whereas foreign-born Hispanics did not. In age-stratified analyses, these racial/ethnic differences were found for adults aged 56-74, but not for adults aged 75+. Conclusions: These findings provide insight into biological differences underlying racial/ethnic disparities in health.

A comprehensive examination of discrimination and the impact on health in young adults

Research has begun to clarify links between discrimination and health, but important gaps remain. A more complete understanding may arise from data on both frequency of discrimination as well as the various forms of discrimination. Using unique Panel Study of Income Dynamics (PSID) Transition to Adulthood Supplement (TAS) data on a representative sample of young adults from the 2017 and 2019 waves, we consider frequency and forms of discrimination separately and in tandem. Using generalized estimating equations panel models, we find that the association between discrimination and health is more pronounced when the frequency of, and the number of reasons for, discriminatory experiences are considered together. For example, relative to experiencing no discrimination, perceiving frequent discrimination and for three or more reasons results in nearly three times higher odds of poor/fair self-rated health and 1.25 points lower on the languishing/flourishing scale. The impact of perceived discrimination on health is likely underestimated if frequency and rationale are not considered as a holistic experience.

Neighborhood Racial and Economic Privilege and Timing of Pubertal Onset in Girls

PURPOSE

Early puberty is associated with adverse health outcomes over the life course, and Black and Hispanic girls experience puberty earlier than girls of other racial/ethnic backgrounds. Neighborhood racial and economic privilege may contribute to these disparities by conferring differential exposure to mechanisms (e.g., stress, obesity, endocrine disruptors) underlying early puberty. We examined associations between neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), and age at pubic hair onset (pubarche) and breast development onset (thelarche) in a large multiethnic cohort.

METHODS

A cohort of 46,299 girls born 2005-2011 at Kaiser Permanente Northern California medical facilities were followed until 2021. Pubertal development was assessed routinely by pediatricians using the Sexual Maturity Rating scale. ICE quintiles for race/ethnicity, income, and income + race/ethnicity were calculated using American Community Survey 2010 5-year estimates and linked to census tract at birth. We fit multilevel Weibull regression models accommodating left, right, and interval censoring for all analyses.

RESULTS

ICE measures were monotonically associated with pubertal onset, with the strongest associations observed for ICE-race/ethnicity. Adjusting for maternal education, age at delivery, and parity, girls from the least versus most privileged ICE-race/ethnicity quintiles were at increased risk for earlier pubarche (hazard ratio: 1.30, 95% confidence interval: 1.21, 1.38) and thelarche (hazard ratio: 1.45, 95% confidence interval: 1.36, 1.54). These associations remained significant after adjusting for girls' race/ethnicity and childhood body mass index. Additionally, adjustment for ICE partially attenuated Black-White and Hispanic-White disparities in pubertal onset.

DISCUSSION

Neighborhood privilege may contribute to pubertal timing and related disparities.

The role of discrimination and adverse childhood experiences in disordered eating

BACKGROUND

In clinical research, there has been a call to move beyond individual psychosocial factors towards identifying cultural and social factors that inform mental health. Similar calls have been made in the eating disorders (ED) field underscoring the need to understand larger sociocultural influences on EDs. Discrimination is a social stressor that may influence mental health in similar ways to traumatic or adverse childhood experiences (ACEs). Given the high rates of EDs and discrimination among marginalized groups, it is vital to understand the role of discrimination and ACEs as predictors of ED symptoms in these populations. The aim of this study is to examine how perceived discrimination predicts ED pathology when statistically adjusting for gender, race, and ACEs.

METHODS

The diverse study sample consisted of 331 undergraduate students from a longitudinal cohort study (ages 18-24; 66% female; 35% White/non-Hispanic). Participants completed measures of everyday discrimination, ACEs, and ED pathology.

RESULTS

Following adjustment for multiple statistical comparisons, the frequency of daily discrimination predicted all ED symptoms above and beyond history of ACEs. In follow-up analyses, number of reasons for discrimination predicted cognitive restraint and purging. Differences in ED symptomatology were found based on the reason for discrimination, gender, and race. Specifically, those who experienced weight discrimination endorsed higher scores on all ED symptoms, and those experiencing gender discrimination endorsed higher body dissatisfaction, cognitive restraint, and restriction. People of color endorsed higher restriction, while female participants endorsed higher scores on all ED symptom with the exception of cognitive restraint.

CONCLUSION

Discrimination is a salient risk factor for ED symptoms even when accounting for individuals' history of ACEs. Future research should utilize an intersectional approach to examine how perceived discrimination affects ED pathology over time. (Word count: 234).

The impact of anti-Asian racism on routine activities and mental health among Korean American older adults and their caregivers

Introduction

Reported anti-Asian discrimination has been on the rise since the COVID-19 pandemic. Nevertheless, limited research addresses the health impact of perceived anti-Asian racism on Asian Americans, especially among older adults, during COVID-19. To address the gap, we examined how the novel coronavirus pandemic affected Korean American older adults, one of the largest Asian subgroups. Specifically, this study addressed the magnitude of racism or discrimination related to the pandemic and impact of anti-Asian racism on negative mental health symptoms among Korean American older adults and their caregivers.

Methods

We used survey data collected from 175 Korean American older adults with probable dementia and their primary caregivers (female = 62%, mean age = 71 years) who went through eligibility screening for an ongoing randomized controlled trial involving dyads in the Baltimore-Washington and the New York Metropolitan areas (ClinicalTrials.gov Identifier: NCT03909347).

Results

Nearly a quarter of the survey sample reported they were fearful for their safety due to anti-Asian racism related to the pandemic. Additionally, 47% of the respondents indicated changes to routine activities due to anti-Asian racism or discrimination related to COVID-19. The most common changes included avoiding walking alone or physical activities outside, followed by avoiding public transportation or leaving the house to go to any public places such as grocery stores, churches, or schools, not carrying out usual social activities, and avoiding going to health care appointments. Multinomial logistic regression revealed that people who reported changes to routine activities were at least five times more likely (adjusted odds ratio = 5.017, 95% confidence interval = 1.503, 16.748) to report negative mental health symptoms than those who did not. Being fearful for their own safety was not associated with experiencing negative mental health symptoms in the survey sample.

Discussion

Study findings indicate that the increased reporting of anti-Asian racism during the COVID-19 pandemic has substantially affected Korean American older adults and their caregivers. The mechanism by which changes to routine activities is related to negative mental health symptoms is unclear, future research is needed to elucidate this pathway. Furthermore, our findings highlight the importance of identifying multi-level strategies to raise awareness of and to mitigate the reported surge of racism.

Classmates' Discrimination Experiences and Adolescent Depressive Symptoms: Evidence From Random Assignment of Students to Classrooms in South Korea

PURPOSE

The purpose of this study is to examine the association between classmates' discrimination experiences and an individual student's depressive symptoms. A set of social-psychological and behavioral variables were considered as potential mechanisms underlying this association.

METHODS

The data came from the Gyeonggi Education Panel Study of seventh graders in South Korea. This study leveraged quasi-experimental variation generated from random assignment of students to classes within schools to address the endogenous school selection problem and account for the unobserved school-level confounders. To formally test for mediation, Sobel tests were conducted and peer attachment, school satisfaction, smoking, and drinking were explored as mechanism variables.

RESULTS

An increase in classmates' discrimination experiences was positively associated with an individual student's depressive symptoms. This association remained statistically significant even after adjusting for personal discrimination experience, a myriad of individual- and class-level covariates, as well as school fixed effects (b = 0.325, p < .05). Classmates' discrimination experiences were also associated with a decline in peer attachment and school satisfaction (b = -0.386, p < .01 and b = -0.399, p < .05, respectively). These psychosocial factors explained about one-third of the association between classmates' discrimination experiences and individual students' depressive symptoms.

DISCUSSION

The findings of this study suggest that exposure to peer-level discrimination experience leads to friend detachment and school dissatisfaction, which in turn increases an individual student's depressive symptoms. This study reaffirms the importance of fostering a more cohesive and nondiscriminatory school environment to promote adolescents' psychological health and well-being.

Culturally sensitive prevention programs for substance use among adolescents of color: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis aims to synthesize the efficacy of culturally sensitive prevention programs for substance use outcomes among U.S. adolescents of color (aged 11 to 18 years old) and explore whether the intervention effects vary by participant and intervention characteristics. Eight electronic databases and grey literature were searched for eligible randomized controlled trials through September 2022. Robust variance estimation in meta-regression was used to synthesize treatment effect size estimates and to conduct moderator analysis. After screening, 30 unique studies were included. The average treatment effect size across all substance use outcomes (including 221 effect sizes) was Hedges's g = -0.20, 95% CI = [-0.24, -0.16]. The synthesized effect sizes were statistically significant across types of substances (alcohol, cigarette, marijuana, illicit and other drugs, and unspecified substance use), racial/ethnic groups (Hispanic, Black, and Native American), and different follow-ups (0-12 months, >12 months). Very few studies reported substance use consequences as outcomes and the synthesized effect size was non-significant. Meta-regression findings suggest that the intervention effects may vary based on the type of substance. This meta-analysis found supportive evidence of culturally sensitive prevention programs' efficacy in preventing or reducing substance use among Black, Hispanic, and Native American adolescents. More substance use prevention efforts and evidence is needed for Asian American, Pacific Islander, and multiracial adolescents.

Systematic Review: The Association Between Race-Related Stress and Trauma and Emotion Dysregulation in Youth of Color

OBJECTIVE

This systematic review aims to summarize the current state of knowledge on the relations between race-related stress and trauma (RST) and emotion dysregulation, synthesize empirical research examining these associations in youth of color, and discuss clinical implications.

METHOD

We searched PubMed, ProQuest PsycInfo, and Web of Science for relevant articles on June 24, 2021. Eligible studies were empirical studies in peer-reviewed journals or from gray literature. They included a sample of participants (5-24 years of age) from racial and ethnic minority backgrounds and at least 1 measure of RST and emotion dysregulation. We evaluated target studies using the Quality Assessment for Diverse Studies and extracted information on associations between RST and emotion dysregulation, as well as mediators and moderators.

RESULTS

Ultimately, 29 studies (78,173 participants) met inclusion criteria. A total of 28 studies were correlational, 16 were cross-sectional, and 12 were longitudinal. Greater RST was linked to greater emotion dysregulation in 78% of observed associations. Remaining associations were not significant. Relationships were mediated by types of coping, biological factors, and identity factors. RST was also related to several wellbeing outcomes through its relations with emotion dysregulation.

CONCLUSION

Results consistently demonstrated that greater exposure to RST is related to greater emotion dysregulation and decreased wellbeing in youth of color. These findings suggest that clinicians should incorporate the role of RST in case conceptualizations and treatment plans for this population. Future research should use multidimensional measures of RST and include experimental studies to examine the causal relationship between RST and emotion dysregulation.

The Hospitalized Adolescent

This clinical report provides pediatricians evidence-based information on the developmentally appropriate, comprehensive clinical care for hospitalized adolescents. Included in this report are opportunities and challenges facing pediatricians when caring for specific hospitalized adolescent populations. The companion policy statement, “The Hospitalized Adolescent,” includes detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital setting and design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.

Intersectional microaggressions, depressive symptoms, and the role of LGBTQ-specific parental support in a sample of Latinx sexual and gender minority youth

INTRODUCTION

Latinx and sexual and gender minority (SGM) youth experience higher incidents of racism, cissexism, and heterosexism in the forms of overt discrimination and microaggressions. These experiences could in part explain increased negative mental health outcomes, such as depressive symptoms. Evidence points to the possibility that LGBTQ-specific parental support buffers the effects of intersectional microaggressions on depressive symptoms among Latinx SGM youth.

METHODS

In a sample of 1292 Latinx SGM youth (ages 13-17), we assessed: a) the association between LGBTQ-specific parental support and depressive symptoms, b) the associations between three forms of intersectional microaggressions and depressive symptoms, and c) whether parental LGBTQ-specific parental support moderated the relationship between three forms of intersectional microaggressions and depressive symptoms. Main effect and moderation analyses examined interactions between LGBTQ-specific parental support with each of the three forms of intersectional microaggressions on depressive symptoms.

RESULTS

We found that Latinx transgender youth experienced higher intersectional microaggressions compared to their cisgender counterparts and that Latinx SGM youth who reported lower LGBTQ-specific parental support experienced higher depressive symptoms. We also identified a significant interaction between intersectional microaggressions and LGBTQ-specific parental support, suggesting that parental support was more protective at low rather than high levels of intersectional microaggressions.

CONCLUSIONS

Findings suggest a need for future work examining culturally appropriate approaches to foster a supportive parent-child relationship among Latinx SGM youth and their parental figures.

The mental health of Asian American adolescents and young adults amid the rise of anti-Asian racism

Objectives

We describe the perceptions and experiences of anti-Asian racism and violence and depression severity prior to and during the COVID-19 pandemic among a sample of Asian American (AA) adolescents and young adults.

Methods

We used data from the Young Asian American Health Survey (YAAHS), an online-recruited sample of AA adolescents (ages 13-17) and young adults (ages 18-29 years) conducted during May 2021 to March 2022. We presented descriptive statistics examining the univariate distribution and bivariate relationships of depression severity, sociodemographic characteristics, and experiences and perceptions of anti-Asian violence.

Results

Our sample (n = 176) comprised AA adolescents and young adults from 17 Asian ethnicities. A quarter said that the frequency and/or severity of their personal experiences of anti-Asian harassment had increased since the pandemic started. 76% indicated feeling less safe now than before the pandemic. Two-thirds reported that their depressive symptoms have increased since the pandemic started. Participants who reported feeling less safe now than before the pandemic were more likely to report increased personal experiences with anti-Asian harassment and increased depression severity since the pandemic started than those who reported feeling as safe or safer before the pandemic (p < 0.01 for both).

Discussion

Findings illustrate AA adolescent and young adults are experiencing multiple health and social crises stemming from increased anti-Asian racism during the COVID-19 pandemic. We urge policymakers to strengthen data systems that connect racial discrimination and mental health and to institute prevention measures and anti-racist mental health services that are age- and culturally-appropriate for AA adolescent and young adults.

Engaging White parents to address their White children's racial biases in the Black-White context

Multiple studies (n = 1065 parents, 625 females, 437 males, 3 nonbinary, 99.06% White; n = 80, 5 to 7-year-old children, 35 girls, 45 boys, 87.50% White; data collection September 2017-January 2021) investigated White U.S. parents' thinking about White children's Black-White racial biases. In Studies 1-3, parents reported that their own and other children would not express racial biases. When predicting children's social preferences for Black and White children (Study 2), parents underestimated their own and other children's racial biases. Reading an article about the nature, prevalence, and consequences of White children's racial biases (Study 3) increased parents' awareness of, concern about, and motivation to address children's biases (relative to a control condition). The findings have implications for engaging White parents to address their children's racial biases.