Family- and neighborhood-level environmental associations with physical health conditions in 9- and 10-year-olds

Intersections of Structural State-Level Racism and Neighborhood Deprivation on Nutrition and Obesity for Black Adolescents

PURPOSE

Black adolescents in the United States face disproportionate poor nutrition and obesity risk due to racism. Intersections of larger structural contexts that pose differential access to Black adolescents' health resources, such as state-level racism and neighborhood-level disadvantage, may govern these risks. The purpose of this correlational study was to examine the associations between state-level racism, neighborhood disadvantage, and their intersection with nutrition and obesity for Black adolescents in a longitudinal study.

METHODS

Publicly available administrative data measuring state-level racism was linked to 2 waves (collected 2016-2018) of individual-level demographic, health, and neighborhood data from 1,530 Black adolescents (Mage at baseline = 9.46; 47.70% female) from the Adolescent Brain and Cognitive Development Study. Neighborhood deprivation scores were calculated from American Community Survey data. Caregivers reported adolescents' nutrition and demographics. Adolescent waist circumference and height and weight (converted to body mass index) were measured.

RESULTS

Residing in a state higher in racism was associated with greater body mass index for adolescents 1 year later (B = 0.29, p = .001), and residing in a neighborhood higher in area deprivation was associated with worse nutrition 1 year later (B = -0.02, p = .001).

DISCUSSION

Both state-level racism and neighborhood disadvantage exert separate negative influences on health outcomes. Targeting separate state- and neighborhood-level social policies for obesity and nutrition risk may be crucial to bolster the health of Black adolescents.

Anxiety and Depression Symptoms, Adverse Childhood Experiences, and Persistent/Recurrent Pain Across Early Adolescence

OBJECTIVE

To determine whether anxiety and depression symptoms are mechanisms through which adverse childhood experiences (ACEs) contribute toward persistent/recurrent pain (PRP) across early adolescence.

METHODS

This study described the direct and indirect (ie, mediated) effects of ACEs on PRP across early adolescence, using 4 years of Adolescent Brain Cognitive Development Study data. Annual pain frequency, anxiety, and depression symptoms were measured using the Child Behavior Checklist, and youth with pain for ≥3 of the 4-year study period were classified with PRP. Early (up to age 9-10 years; reported at baseline) and recent (at age 10-11 years; reported at year 1) ACE exposures were derived from parent and youth completed surveys. Structural equation modeling estimated the direct and indirect associations among early and recent ACEs, pain outcomes, and anxiety/depression symptoms reported in the year(s) in between.

RESULTS

Among 7951 youth, 2540 (31.9%) were classified with PRP. Higher levels of early ACE exposure were associated with an increased probability of having PRP (adj. β 0.65 [95% confidence interval {CI} 0.07, 1.22). Early ACEs also had indirect effects on PRP via higher interim anxiety (adj. β 5.36 [95% CI 3.45, 7.26]) and depression symptoms (adj. β 4.57 [95% CI 3.01, 6.13]). Early and recent ACE exposures predicted higher pain frequency scores in subsequent years, with mixed results regarding the role of anxiety and depression in the relationships between ACEs and pain frequency scores.

CONCLUSIONS

Anxiety and depression symptoms are potentially important interventional targets to lower the risk for PRP among youth exposed to ACEs.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.