Association between school racial/ethnic composition during adolescence and adult health

A scoping review of social determinants of health's impact on substance use disorders over the life course

BACKGROUND

Substance use is a public crisis in the U.S. Substance use can be understood as a series of events in the life course, from initiation to mortality. Social Determinants of Health (SDoH) have increasingly been recognized as essential contributors to individuals' health. This scoping review aims to examine available evidence of SDoH impact on the life course of substance use disorder (SUD).

METHODS

This study identified peer-reviewed articles that reported longitudinal studies with SDoH factors as independent variables and substance use and disorders as dependent variables from PubMed, Embase, and Web of Science. The reported associations between SDoH and substance use stages over the life course were narratively and graphically summarized.

RESULTS

Among the 50 studies identified, ten revealed parental monitoring/support and early childhood education as protective factors, while negative peer influences and neighborhood instability were risk factors of substance use initiation. Nineteen articles reported factors associated with escalation in substance use, including unemployment, neighborhood vulnerability, negative peer influence, violence/trauma, and criminal justice system (CJS) involvement. Ten articles suggested that employment, social support, urban living, and low-barrier medication treatment facilitated treatment participation, while stigma and CJS involvement had negative impact on treatment trajectory. Social support and employment could foster progress in recovery and CJS involvement and unstable housing deterred recovery. Four studies suggested that unemployment, unstable housing, CJS involvement, and lack of social support were associated with overdose and mortality.

CONCLUSIONS

This review underscores the influence of social networks and early life experiences on the life course of SUD. Future SDoH research should investigate overdose and mortality and the impact of broader upstream SDoH on SUD. Interventions addressing these social factors are needed to mitigate their detrimental effects on the trajectories of SUD over the life course.

School Segregation During Adolescence is Associated with Higher 30-Year Cardiovascular Risk of Black but not White Young Adults

Although cardiovascular disease (CVD) mortality rates are declining for American adults, a disparity remains between non-Hispanic Black and non-Hispanic White adults. Previous research has shown that residential segregation, a form of structural racism, experienced in childhood is associated with later-life racial and ethnic health disparities, including disparities in CVD and its risk factors. However, little is known about the health consequences of exposure to segregated schools, especially among those living in neighborhoods with high concentrations of minoritized people. This study used data from the In-School, Wave I, and Wave IV surveys of the National Longitudinal Study of Adolescent to Adult Health to examine a novel school measure of school racial segregation (Index of the Concentration of Extremes, ICE) as a predictor of Framingham 30-year CVD risk scores. We used General Estimating Equation models to evaluate the association between ICE, measured at Wave I, and two different 30-year CVD risk scores, measured at Wave IV, and examined whether the relationship varied by race. We observed that higher levels of school segregation were associated with a higher 30-year CVD risk among non-Hispanic Black participants while higher segregation was associated with a lower 30-year CVD risk for non-Hispanic White participants. This research suggests that exposure to segregation in the school setting may contribute to observed disparities in CVD among US adults.

School racial/ethnic composition, effect modification by caring teacher/staff presence, and mid-/late-life depressive symptoms: findings from the Study of Healthy Aging in African Americans

For Black students in the United States, attending schools with a higher proportion of White students is associated with worse mental and physical health outcomes in adolescence/early adulthood. To our knowledge, no prior studies have evaluated the association between school racial/ethnic composition from kindergarten through grade 12 and later-life mental health. In a cohort of Black adults aged ≥50 years in Northern California who retrospectively reported (2017-2020) school racial/ethnic composition for grades 1, 6, 9, and 12, we assessed the association between attending a school with mostly Black students versus not and mid-/late-life depressive symptoms (8-item Patient-Reported Outcomes Measurement Information System (PROMIS) depression score, standardized to the 2000 US adult population) using age-, sex/gender-, southern US birth-, and parental education-adjusted generalized estimating equations, and assessed effect modification by the presence of a caring teacher/staff member. Levels of later-life depressive symptoms were lower among those who attended schools with mostly Black students in grades 1 and 6 (β = -0.12 [95% CI, -0.23 to 0.00] and β = -0.11 [95% CI, -0.22 to 0.00], respectively). In grade 6, this difference was larger for students without an adult at school who cared about them (β = -0.29 [95% CI, -0.51 to -0.07] vs β = -0.04 [95% CI, -0.17 to 0.09]). Among Black Americans, experiencing early schooling with mostly Black students may have later-life mental health benefits; this protective association appears more important for students without the presence of caring teachers/staff. This article is part of a Special Collection on Mental Health.

How long-term changes in neighborhood and school racial composition shape children's behavior problems

Relatively few neighborhood-focused studies explicitly model the relationship between neighborhood change- i.e., racial change within a neighborhood-and individual mental health, instead focusing on the current composition of the neighborhood or on the outcomes of individuals that switch neighborhood contexts via moves. Further, while neighborhoods and schools are interconnected, researchers tend to focus on only one of these contexts in their work. Combining family and student data from the Panel Study of Income Dynamics (PSID) with multiple waves of neighborhood and school administrative data, our study extends current scholarship in this area by explicitly focusing on the relationship between exposure to neighborhood and school racial change-i.e., change occurring within the neighborhood or school in the prior decade-and the behavior problems of current students. We further analyze how associations vary: 1) by student race; 2) between newcomers to the neighborhood and those that lived in the neighborhood as it underwent demographic change; 3) and in neighborhoods with higher proportions of same-race residents. Our findings suggest that the relationship between local neighborhood contexts and the behavioral problems of children is nuanced and depends on the racial trajectories-change or stability-of neighborhoods, schools, and the interaction of both. Compared to longer-term residents, White newcomers tended to have more behavioral problems across racially changing and stable neighborhoods alike, regardless of the racial trajectories observed in the local school. Our results align with past work documenting the protective effect of same-race peers for Black children. Conversely, we find White students exhibit greater behavioral problems in settings with very high proportions of same-race peers, particularly in neighborhoods and schools that are simultaneously becoming increasingly racially isolated.

School Segregation and Health Across Racial Groups: A Life Course Study

PURPOSE

Contemporary school racial segregation is a manifestation of structural racism shown to harm Black children's health. Yet, evidence on its long-term impacts throughout life, as well as effects among children of other racial backgrounds, is sparse.

METHODS

Data on Black and White children were drawn from the National Longitudinal Study of Adolescent to Adult Health. Using multilevel models, we estimated associations between district-level school segregation and measures of short-term and long-term health, including self-reported outcomes and biomarkers. Models were run separately for Black and White children, adjusting for individual- and district-level covariates. We further carried out subgroup analyses by school racial composition (i.e., majority White vs. majority non-White schools).

RESULTS

School segregation was associated with worsened short- and long-term risk factors of chronic disease among both Black and White students in terms of exercise and body mass index, but only in majority non-White schools. Moreover, Black students in these schools demonstrated less adolescent drinking and smoking with increased racial segregation and better self-reported health in young adulthood.

DISCUSSION

Our findings suggest that segregated majority non-White schools may be targets of systemic disinvestment and may therefore lack sufficient resources for physical education or nutrition. Improvements in some outcomes among Black children may reflect peer influence (i.e., Black adolescents generally drink less than White adolescents), reduced exposure to interpersonal racism from White peers, or positive health fostered by feelings of belonging in Black community. Ensuring all students go to schools with the resources they need to thrive may have positive spillovers for population health.

Individual and regional differences in the effects of school racial segregation on Black students' health

Background

School racial segregation in the US has risen steadily since the 1990s, propelled by Supreme Court decisions rolling back the legacy of Brown v. Board. Quasi-experimental research has shown this resegregation harms Black students' health. However, whether individual or family characteristics (e.g., higher family incomes) are protective against segregation's health harms-or whether segregation is more damaging in regions of the US with fewer public sector investments-remains unclear. We leverage the quasi-random timing of school districts being released from Brown-era integration plans to examine heterogeneity in the association between resegregation and Black students' health.

Methods & findings

We took an instrumental variables approach, using the timing of integration order releases as an instrument for school segregation and analyzing a pre-specified list of theoretically-motivated modifiers in the Panel Study of Income Dynamics. In sensitivity analyses, we fit OLS models that directly adjusted for relevant covariates. Results suggest resegregation may have been particularly harmful in the South, where districts resegregated more quickly after order releases. We find little evidence that the effects of school segregation differed across family income, gender, or age.

Conclusion

The end of court-ordered integration threatens the health of Black communities-especially in the US South. Modestly higher incomes do not appear protective against school segregation's harms. Research using larger samples and alternative measures of school segregation-e.g., between districts, instead of within districts-may further our understanding of segregation's health effects, especially in Northern states.

Explaining Physical Health Disparities and Inequalities Over the First Half of the Life Course: An Integrative Review of Add Health Studies

This integrative review of research utilizing the National Longitudinal Study of Adolescent to Adult Health draws on previous research detailing pathways linking early socioeconomic adversity in childhood and adolescence (Wave 1 in 1995 and prior) to physical health outcomes in young adulthood (Wave 5 in 2015). Health outcomes considered included specific diseases, disease risk, and morbidity as prospectively measured by parent-reported and self-reported health outcomes as well as clinical biomarkers. A heuristic research framework was developed from the comprehensive review focused on 4 study designs and identifying total associations, physiological pathways, stress pathways, and resources pathways linking early socioeconomic adversity to physical health outcomes for young adults, as well as potential modifiers of these pathways. The appropriateness of different analytical strategies used in these research studies including approaches for analysis of change in health are discussed. Taken together, review findings suggest the merit of an integrated perspective taking a long view over early life course to explain cumulative physical health risk over the first half of the life course by assessing multiple pathways simultaneously. Looking forward, the review findings also emphasize the need for the investigation of the continuity and change in these pathways over the second half of the life course.

An Illustrative Review of Substance Use-Specific Insights From the National Longitudinal Study of Adolescent to Adult Health

PURPOSE

The purpose of this illustrative, thematic review was to demonstrate the utility of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) for substance use research and to describe substance use-specific insights gained from Add Health research over the past 2 decades.

METHODS

We searched multiple electronic databases (PubMed, PsycInfo, and Web of Science) and selected an illustrative sample of 40 articles that used Add Health data and longitudinally examined a measure of alcohol, marijuana, or illicit drug use or prescription drug misuse as the exposure or outcome in association with diverse domains of additional factors assessed (social, emotional, behavioral, contextual, biological, and genetic).

RESULTS

Included articles identified several key associations between substance use behaviors and additional factors from a wide range of domains. For example, results from several studies indicated that experiences of sexual violence, adolescent dating violence, and intimate partner violence are associated with an increased likelihood of later prescription opioid misuse, heavy drinking, and marijuana use, with some differences by biological gender and race/ethnicity. Results from other studies showed that bidirectional associations between substance use and mental health differ by specific type of substance and mental health condition.

DISCUSSION

Existing research using Add Health data has provided valuable insights regarding substance use by leveraging the study's longitudinal design, the prospective nature of data collection, the breadth and depth of substance use questions assessed from adolescence to adulthood, the size and diversity of the cohort, and the wide range of additional factors measured over time.

High School Composition and Health Outcomes in Adulthood: A Cohort Study

BACKGROUND

A multitude of empirical evidence documents links between education and health, but this focuses primarily on educational attainment and not on characteristics of the school setting. Little is known about the extent to which aggregate characteristics of the school setting, such as student body demographics, are associated with adult health outcomes.

METHODS

We use the U.S. nationally representative National Longitudinal Survey of Youth 1979 cohort to statistically assess the association between two different measures of high school student composition (socioeconomic composition, racial/ethnic composition) and two different health outcomes at age 40 (self-rated health and obesity).

RESULTS

After adjusting for confounders, high school socioeconomic composition, but not racial/ethnic composition, was weakly associated with both obesity and worse self-rated health at age 40. However, after adding adult educational attainment to the model, only the association between high school socioeconomic composition and obesity remained statistically significant.

CONCLUSIONS

Future research should explore possible mechanisms and also if findings are similar across other populations and in other school contexts. These results suggest that education policies that seek to break the link between socioeconomic composition and negative outcomes remain important but may have few spillover effects onto health.