Behavioral health in multiracial adolescents: the role of Hispanic/Latino ethnicity

Examining identity disclosure: Racial and ethnic identity amongst Multiracial/ethnic adults in the United States

OBJECTIVES

Providing personal demographic information is routine practice in the United States, and yet, little is known about the impacts of this process. This study aims to examine the experiences and perspectives of Multiracial/ethnic adults in the United States when disclosing racial/ethnic identity.

METHODS

Seventeen semistructured interviews were conducted with adults identifying as Multiracial/ethnic. The Multiracial/ethnic identities of participants included Black or African American and White; Black or African American, American Indian or Alaska Native (AI/AN) and Hispanic or Latino; Black or African American and Hispanic or Latino; Black or African American and AI/AN; AI/AN and White and Asian, Native Hawaiian or Pacific Islander and White. Multiple participants reported identifying with multiple ethnic groups for any single broad category. Three identified as sexual minorities. Nine were Millennials; six were Gen X; one was Gen Z; one was Baby Boomer. Qualitative data were analyzed using staged hybrid inductive-deductive thematic analysis.

RESULTS

Disclosure of racial and ethnic identities presents a unique stressor for Multiracial/ethnic populations due to methods used to obtain data, perceived mismatch of identity and phenotype and exposure to prejudice. Social norms, constructs and movements impact the categories that a Multiracial/ethnic person indicates to external parties.

CONCLUSIONS

The stress and negative feelings that Multiracial/ethnic adults face when identifying their race/ethnicity underscore the broader implications of standard demographic questions on feelings of inclusivity and visibility within a population.

PATIENT OR PUBLIC CONTRIBUTION

Gathering data on individuals' racial and ethnic backgrounds is a standard practice, and yet, it can pose challenges for those who identify with multiple groups or do not see their identities reflected in the options provided. Such individuals may feel excluded or experience unfair treatment when disclosing their identity, leading to significant stress. As the frequency of this data collection increases, it is essential that the questions are posed empathetically and equitably, with a strong commitment to enhancing inclusivity throughout the process.

Mental health and Multiracial/ethnic adults in the United States: a mixed methods participatory action investigation

Introduction

Addressing gaps in the integration of justice, diversity, equity, and inclusion (J-DEI) in public health research and practice, this study investigates the mental health of Multiracial and multiethnic adults in the United States (U.S.). A rapidly growing racial/ethnic group in the U.S., Multiracial and multiethnic populations are often excluded or underrepresented in standard public health research and practice, and little is known about their mental health or associated risk and protective factors.

Methods

To investigate this knowledge gap, an electronic cross-sectional survey was conducted in two waves in 2022, pulling from various community sources, with 1,359 respondents in total. Complementing this, seventeen semi-structured interviews were performed with a subset of survey participants. Data were analyzed using a mix of statistical methods and staged hybrid inductive-deductive thematic analysis.

Results

Findings indicate over half of the participants endorsed at least one mental health concern with prevalence of anxiety, depression, post-traumatic stress disorder, and suicidal thoughts and behaviors surpassing available national estimates. Exposure to trauma, discrimination, and microaggressions were found to play a significant role in these outcomes. Conversely, strong social support and strong ethnic identity emerged as protective factors. Qualitative insights brought forward the challenges faced by individuals in navigating bias and stigma, especially in the context of mental health care. Despite these barriers, emerging themes highlighted resilience, the importance of secure identity formation, and the critical role of community and cultural support.

Conclusions

The marked prevalence of mental health concerns among Multiracial and multiethnic populations emphasizes the pressing need for tailored interventions and inclusive research methodologies. Recognizing and addressing the unique challenges faced by these communities is imperative in driving mental health equity in the U.S. The findings advocate for community-engaged practices, interdisciplinary collaborations, and the importance of addressing mental health challenges with cultural sensitivity, particularly in historically oppressed and marginalized groups. Future efforts must focus on refining these practices, ensuring that public health initiatives are genuinely inclusive and equitable.

Adolescent Polysubstance Use and Co-Occurring Weapon Carrying, Bullying Victimization, and Depressive Symptomology: Patterns and Differences in the United States

Adolescent substance use commonly co-occurs with poor mental health, bullying victimization and risky behaviors that may lead to violence. The purpose was to describe the United States (US) national prevalence of polysubstance use and co-occurring characteristics and associated demographic characteristics among youth. Middle and high school students in the 2019 CDC YRBS survey reported their demographics and current ( ≥ 1 days in the last 30 days) substances used (alcohol, cigarette, e-cigarette, cannabis); polysubstance combinations were generated. Cross-sectional weighted logistic regression estimated odds of polysubstance use and frequent use ( ≥ 6 days in the last 30 days) by weapon carrying, depressive symptoms, bullying victimization, and demographics. Mean age of the sample was 16 years, 51% were boys, 51% were non-Hispanic White. While accounting for 21% of the sample, 22-40% of Multiracial youth reported polysubstance use and frequent use. Odds of frequent polysubstance use (all combinations) were highest for weapon carrying youth.

Social and Structural Influences on Multiracial Identification and Health: a Public Health Mandate to Precisely Measure, Theorize, and Better Understand Multiracial Populations

There is a growing group of adolescents and young adults in the USA who identify as multiracial. However, very little research, especially health research, focuses on understanding multiracial identification and health and behavioral outcomes for multiracial populations in comparison to their single-race counterparts. Understanding the intersectional influences on this identification process is critical to updating the literature on racial and ethnic identity and health with more accurate identifications and categories. It is especially critical that there is an explicit focus on understanding the impact of structural racism and discrimination when studying the process of racial identification and the impact on health. This review takes an interdisciplinary approach relying on a review of multiple research literatures: the historical literature on race, racism and categorization, psychological and adolescent medicine literatures on adolescent development, the sociological literature on racial and ethnic identification, and the limited public health research beginning to disentangle multiracial health outcomes. An empirically testable conceptual framework is offered to frame the organization of this review-demonstrating the multiple spheres of influence on racial and ethnic identification and the implication for health outcomes.

Racial and ethnic differences in major depressive episode, severe role impairment, and mental health service utilization in U.S. adolescents

BACKGROUND/OBJECTIVES

This study aimed to examine racial and ethnic variations in national trends, past-year prevalence, determinants of major depressive episode (MDE), MDE-related role impairment and mental health (MH) services utilization in U.S. adolescents.

METHODS

Data was extracted from the National Survey on Drug Use and Health (NSDUH) from 2010 to 2018. A total of 137,671 nationally representative adolescents aged 12-17 were included in the study. Weighted temporal trends in the past-year prevalence of MDE, and MDE with severe role impairment were estimated both overall and by race and ethnicity. Weighted multivariate logistic regressions were conducted to assess racial/ethnic differences in determinants of MDE, MDE-related severe role impairment, and MH services utilization after adjusting for sociodemographic characteristics, family structure, substance use, activity participation, and problem-solving group engagement.

RESULTS

The prevalence of MDE and MDE with severe role impairment among U.S. adolescents has steadily increased, while MDE-related health services utilization remained low from 2010 to 2018. Racial and ethnic minority adolescents were more likely to experience an MDE, but less likely to use MH services compared to their White counterparts. Participating in school, family, community, or faith-based activities was significantly associated with lower MDE incidence. Problem-solving group engagement was associated with MH services utilization (all p-values < 0.05).

CONCLUSION

High prevalence of depression and low MH service utilization among U.S. adolescents remains a public health issue. Moreover, racial/ethnic disparities persist in MH and service utilization outcomes. Future research must investigate the burden and predictors of mental illness, and the factors influencing MH services utilization in diverse adolescent populations.

The Main and Interactive Associations between Demographic Factors and Psychopathology and Treatment Utilization in Youth: A Test of Intersectionality in the ABCD Study

Demographic factors may be associated with youth psychopathology due to social-contextual factors that may also pose barriers to intervention. Further, in line with intersectionality theory, youth with multiple non-dominant identities may be most likely to experience psychopathology and face barriers to care. This study examined rates of parent-reported psychopathology and mental health treatment utilization as a function of several demographic characteristics (in isolation and in concert) in a population-based, demographically diverse sample of 11,875 9- to 10-year-old youth. Results indicated most consistently that lower SES was associated with greater rates of psychopathology and greater likelihood of treatment utilization; that Asian American youth (relative to all other racial groups) and Hispanic/Latinx (relative to non-Hispanic/Latinx) youth were less likely to have a history of psychopathology or to have utilized treatment; and that male youth had greater rates of lifetime Obsessive Compulsive Disorder (OCD) and Oppositional Defiant Disorder (ODD) and were more likely to have utilized treatment. There was more modest support for interactive effects between demographic factors on psychopathology, which are discussed. The present study provides some support for differential rates of parent-reported psychopathology and treatment utilization as a function of demographic identities in youth. Potential explanations for these differences (e.g., cultural differences in symptom presentation; underreporting of symptoms) are discussed.

Self-rated health among multiracial young adults in the United States: findings from the add health study

OBJECTIVE

The multiracial adult population is one of the fastest growing segments of the U.S. population, yet much remains to be learned about multiracial health. Considerable research finds racial/ethnic disparities in self-rated health, however subgroups within the multiracial population have not been consistently described.

DESIGN

We use data from the National Longitudinal Survey of Adolescent Health (Add Health) and multivariate logistic regression analyses to compare self-rated health of multiracial and monoracial young adults (n = 7880).

RESULTS

Overall, there were no significant differences in poor self-rated health status of multiracial adults as a single group odds ratio 0.84 (95% CI: 0.52-1.36) compared to monoracial White adults. Analyses further revealed important variations in health-status by specific subgroups and show that some multiracial subgroups may not fit existing patterns of health disparities. For instance, Asian-White multiracial adults do not fit documented patterns of health disparities and report better health than monoracial Asian and monoracial White adults.

CONCLUSION

This study illustrates that the inclusion of specific multiracial categories provides evidence to enhance understanding of the pathways that are linked to health outcomes and the implications for health disparities.

Mental health burden in a national sample of American Indian and Alaska Native adults: differences between multiple-race and single-race subgroups

PURPOSE

Research on American Indian and Alaska Native (AIAN) mental health disparities is based largely on either tribal populations or national samples of adults that do not account for multiracial AIANs, even though over 40% of AIANs identify with multiple racial groups. The present investigation extends this research by assessing mental health status in a national sample of multiracial AIAN adults relative to adults who identify exclusively as either AIAN or White.

METHODS

2012 BRFSS data were used to conduct multinomial logistic regression analyses comparing mental health outcomes among respondents who identified as either AIAN and one or more other races (AIAN-MR), AIAN-Single Race (AIAN-SR), or White-SR.

RESULTS

After demographic adjustment, the AIAN-MR group reported a higher lifetime prevalence of diagnosed depressive disorder, more days of poor mental health, and more frequent mental distress compared to both the AIAN-SR and White-SR groups. AIAN-MR individuals also had higher levels of Kessler 6 (K6) non-specific psychological distress compared to White-SR individuals but not AIAN-SR adults. Differences between AIAN-SR and White-SR adults were found in days of poor mental health, frequent mental distress, and total K6 scores.

CONCLUSIONS

These findings help gauge the magnitude of mental health disparities in the U.S. AIAN population and pinpoint AIAN subgroups for whom mental health is particularly problematic. As such, they raise concerns about restrictions that limit the identification of national survey respondents who report multiple race designations. Such restrictions will thwart efforts to understand the causal mechanisms and pathways leading to mental distress among AIAN individuals.

Initiation of Electronic Cigarette Use by Age Among Youth in the U.S

INTRODUCTION

The rapid increase in electronic cigarette (e-cigarette) smoking among U.S. youth requires data regarding the age pattern of initiation risk for effective tobacco use prevention.

METHODS

Data from the 2014 National Youth Tobacco Survey (N=20,680, aged 11-19 years, 50.6% male) were analyzed using survival analysis in 2016 to quantify the likelihood of e-cigarette use initiation by age, overall and by gender and racial/ethnic groups.

RESULTS

The estimated mean age of e-cigarette initiation was 17.50 (95% CI=17.47, 17.52) years. The estimated hazards of e-cigarette use initiation were 0 up to age 6 years, increased slowly from age 7 to 11 years, and continued with an accelerated increase up to age 17 years before it slowed down. There were significant gender (male > female) and racial/ethnicity (from high to low: multiracial, white, Hispanic, African, and Asian) differences in the age pattern.

CONCLUSIONS

E-cigarette smoking is initiated as young as age 7 years. Different from conventional cigarette smoking with peak initiation risk at age 14-15 years, the likelihood of initiating e-cigarette smoking continues to increase up to age 18 years. The unique age pattern and significant gender and racial/ethnic differences provide useful data to support further research to strengthen tobacco use prevention in the U.S.

Cigarette-smoking trajectories of monoracial and biracial Blacks: Testing the intermediate hypothesis

Research on the cigarette-smoking patterns of biracial adolescents and young adults is severely limited. In this study, we tested the intermediate biracial substance-use hypothesis, which suggests that the prevalence of substance use among biracial individuals falls intermediate to their monoracial counterparts. We examined cigarette-smoking trajectories of a de-aggregated sample of biracial Black adolescents and young adults. We used longitudinal data from the National Longitudinal Study of Adolescent and Adult Health (Add Health; Harris et al., 2009). Our sample (N = 9,421) included 4 monoracial groups (Black, White, Hispanic, and American Indian [AI]) and 3 biracial groups (Black-AI, Black-Hispanic, and Black-White). Study hypotheses were tested using latent growth-curve modeling. We found some support for the intermediate biracial substance-use hypothesis for 2 of 3 biracial groups (Black-American Indian, Black-Hispanic) and 2 of 4 cigarette-use outcomes (lifetime cigarette use, number of cigarettes smoked during past month for regular smokers). The cigarette-use trajectories of biracial Blacks were significantly different from only 1 corresponding monoracial group. Black-AIs and Black Hispanics engage in lifetime cigarette use at comparable rates to monoracial Blacks. Black-Hispanic regular smokers' rate of cigarette smoking is comparable to the higher rates of Hispanics and not to the lower rates of Blacks. Knowledge of the origins, developmental course, and consequences of tobacco use among the biracial population may lead to effective intervention programs and policies for this group. (PsycINFO Database Record

Smoking Trajectories Among Monoracial and Biracial Black Adolescents and Young Adults

INTRODUCTION

Cigarette smoking trajectories were assessed among monorace Blacks, Black-American Indians, Black-Asians, Black-Hispanics, and Black-Whites.

METHOD

We used a subsample of nationally representative data obtained from the National Longitudinal Study of Adolescent Health (Add Health). The sample consisted of adolescents who were in Grades 7 - 12 in 1994, and followed across four waves of data collection into adulthood. Wave 4 data were collected in 2007-2008 when most respondents were between 24 and 32 years old. Respondents could report more than one race/ethnicity. Poisson regression was used to analyze the data.

RESULTS

We found distinct smoking trajectories among monorace and biracial/ethnic Blacks, with all groups eventually equaling or surpassing trajectories of Whites. The age of cross-over varied by gender for some subgroups, with Black-American Indian males catching up earlier than Black-American Indian females. Black-White females smoked on more days than monorace Black females until age 26 and also smoked more than Black-White males between ages 11 and 29 years. Black-Hispanic males smoked on more days than Black-Hispanic females from ages 11 to 14. The results of the interaction tests also indicated different smoking trajectories across SES levels among White, Black, and Black-White respondents.

CONCLUSION

Significant heterogeneity was observed regarding smoking trajectories between monoracel and biracial/ethnic Blacks. Knowledge of cigarette smoking patterns among monorace and biracial/ethnic Black youth and young adults extends our understanding of the etiology of tobacco use and may inform interventions.

Familial factors related to suicidal ideation of Latina adolescents in the United States

The purpose of this study was to examine whether a Latina adolescent's perception of mother connectedness, father connectedness, parental caring, autonomy granting from parents, and parental interest in their child's school life predicts suicidal ideation above and beyond known risk factors of adolescent depression and acculturation. Using the National Longitudinal Study of Adolescent Health (Add Health) Wave 1, 2 secondary logistic regression data analyses were conducted on a sample of 345 Latina adolescents. Results of correlational analyses indicated that perceived mother connectedness, father connectedness, parental caring, and academic interest were positively related; depression and nativity were negatively related to reports of suicidal ideation. Additionally, in a model with adolescents who reported having both a mother and father figure present in their life, depression and academic interest were significant predictors of suicidal ideation. In a second model, which included all Latinas regardless of the presence of both parents, depression, nativity, perceived academic interest, and caring were significant predictors. Implications are discussed for suicide prevention and intervention with Latina adolescents.

The relationship of alcohol use and physical activity from an ecologic perspective

PURPOSE

To determine the predictors of alcohol use (AU) and their relationship to physical activity (PA) among adolescents and to examine differences among groups using an ecologic model.

DESIGN AND METHODS

Cross sectional secondary analysis of 11,432 adolescents (51% 8th and 49% 10th graders).

RESULTS

Attitude, perception of risk, and academic performance were the strongest predictors of AU. PA did not moderate, but it had a positive influence on AU in 10th graders. Differences were observed among groups.

PRACTICE IMPLICATIONS

Nurses can address individual and school factors in an effort to decrease AU and guide nurses in creating an individualized plan.

Suicide and related health risk behaviours among school learners in South Africa: results from the 2002 and 2008 national youth risk behaviour surveys

BACKGROUND

Attempted and completed suicide constitute a major public health problem among young people world-wide, including South Africa (SA). Suicide attempt and completed suicide increase during the adolescent period. One in 5 adolescents considers attempting suicide, but statistics are frequently unreliable.

METHODS

Data for this study were derived from the 2002 and 2008 South African Youth Risk Behaviour Surveys (YRBS). The study population comprised grades 8, 9, 10 and 11 students in governmental schools in the nine provinces of SA (N = 10,699 in 2002 and 10,270 in 2008). Key outcome measures were suicide ideation and suicide attempts.

RESULTS

Of the total sample, 18% of the students in 2002 and 19% in 2008 reported to have seriously considered and/or made a plan to commit suicide during the past six months (Suicide ideation), whereas 18.5% of students in 2002 and 21.8% in 2008 reported that they had attempted suicide at least 1 time during the past six months. On both suicide measures girls have higher prevalence scores than boys, and older school learners score higher than younger learners. In addition, 32% of the learners reported feelings of sadness or hopelessness. These feelings contributed significantly to the explanation of suicide ideation and suicide attempt next to being the victim or actor in violent acts and illegal substance use.

CONCLUSION

The prevalence of suicide ideation and suicide attempts among South African adolescents is high and seems to be influenced by a wide spectrum of factors at the demographic, psychological and behavioural level. Hence, more research is needed to determine the behavioural and psychological determinants of suicide among youngsters in order to develop comprehensive intervention strategies for suicide prevention and care.

The most critical unresolved issues associated with race, ethnicity, culture, and substance use

This paper discusses the limitations of previous research on race, ethnicity, culture, and substance use. The study offers the following recommendations for future research in this area: (1) move beyond simple comparisons of mutually exclusive groups, (2) focus on the meaning of an ethnic label to the individual, (3) consider the complex interactions between an individual's cultural identity and the cultural context, (4) understand and acknowledge the researcher's inherent biases, and (5) translate research findings into practice and policy change.

Ethnic differences in risk factors for suicide among American high school students, 2009: the vulnerability of multiracial and Pacific Islander adolescents

This study compared self-reported risk factors for suicide among American high school students in the last decade. Data from the 1999-2009 Youth Risk Behavior Surveys was analyzed by 8 self-reported ethnicity groups across 6 suicide-related items: depression, suicide ideation, suicide planning, suicide attempts, and suicide attempts requiring medical attention). Native Hawaiian/Pacific Islander adolescents had the higher prevalence of risk factors for suicide. Multiracial adolescents were also at high risk for suicide-related behaviors, with a risk comparable to American Indian/Alaska Native adolescents. Overall, Native Hawaiian/Pacific Islander, multiracial, and American Indian/Alaska Native adolescents reported a significantly higher risk for suicide-related behaviors compared to their Asian, Black, Hispanic, and White peers. The ethnic disparities in risk factors for suicide dictate a need to understand the vulnerability of the Pacific Islander, American Indian, and growing multiracial adolescent populations, in an effort to develop and implement suicide prevention strategies.

Measurement of ethnic background in cross-national school surveys: agreement between students' and parents' responses

PURPOSE

Indicators such as country of birth and language spoken at home have been used as proxy measures for ethnic background, but the validity of these indicators in surveys among school children remains unclear. This study aimed at comparing item response and student-parent agreement on four questions about country of birth and language spoken at home in three European countries.

METHODS

We analyzed data from the Health Behaviour in School-aged Children (HBSC) Child-Parent Validation Study 2005, including 486 matched student-parent pairs from Denmark, Hungary, and Scotland. Selected items from the internationally standardized HBSC questionnaire were completed by 11-year-old students and their parents. We examined item response and student-parent agreement on the four HBSC Ethnic Background Indicators: the student's country of birth, mother's country of birth, father's country of birth, and language usually spoken at home.

RESULTS

All item response rates were high for both students (>92%) and parents (>96%). The percent student-parent agreement was high on all four items (>97%). The strength of agreement ranged from good to excellent for all items indicated by the kappa value (between .60 and 1.00). Results were robust across countries.

CONCLUSIONS

Our findings suggest that students as young as 11 years are able to provide valid responses to four simple questions about country of birth and language spoken at home. The four HBSC Ethnic Background Indicators can be useful in epidemiologic studies on identification of subgroups that may receive unequal prevention services or in assessment of how risk factors, symptoms, and diseases may differ by ethnic background among school children.

A Cross-National Comparison of Adolescent Alcohol and Drug Use Behaviors: U. S. Hispanics and Youth in the Dominican Republic

The prevalence of substance use behaviors during adolescence is an important concern in the United States and internationally. Of particular importance to the U.S. is our ability to compare prevalence estimates and trends with those of neighboring countries, particularly those that feed our immigrant population and have a circulatory migration pattern with us. One of the fastest-growing Hispanic groups is Dominicans, who are also a young group, with a third of Dominicans in the United States under age 18. However, cross-national comparisons of the substance use rates of youth in the U. S. and the Dominican Republic have not been done. Our study represents, to our knowledge, the first such comparison. We conducted a secondary data analysis comparing data from the U.S. Center for Disease Control and Prevention's (CDC) 1997 Youth Risk Behavior Survey (YRBS), a biennial survey in the U.S., to data from a survey conducted by the Ministry of Education of the Dominican Republic in 1997. The Dominican Republic survey used a similar sampling methodology and the Spanish version of the YRBS, piloted and modified to ensure linguistic and cultural appropriateness. Youth in the United States in general, and U.S. Hispanic youth in particular, consistently reported higher lifetime and recent use of alcohol, marijuana, and cocaine than youth in the Dominican Republic. Our study supports other cross-national comparisons that have found rates of substance use for youth in Latin America lower than those for youth in the United States. Cross-national comparisons of this nature help each individual country inform its social policies around prevention. They may also allow us to examine the impact of immigration, acculturation, and return migration processes on adolescent substance use in both countries.