The validity of socioeconomic status measures among adolescents based on self-reported information about parents occupations, FAS and perceived SES; implication for health related quality of life studies

Analytical decisions pose moral questions

How often do we reflect on the potential moral or value implications - what is right, wrong, has value and is (in)appropriate - of seemingly trivial analytical decisions, such as how to dichotomise a variable? I argue that analytical choices relate to multifaceted and oftentimes challenging moral issues that scientists should take into deeper consideration. Here, I illustrate a variety of potential considerations about moral values, including issues like exclusion, marginalisation, autonomy, responsibility, non-maleficence in relation to various common analytical choices and practices, such as the use of thresholds for disease diagnosis or population definition, the use of composite measures in the context of clarifying effects, classification practices, decisions on variable selection, as well as decisions relating to (dis)aggregation of data. I discuss these examples in the context of reasonable theoretical or statistical reservations. I advocate for deeper engagement with the difficult moral implications of analytical decisions, and for a principled and pluralistic science, that is also a more robust science. Such a science can include diverse moral views through a coupled ethical-epistemic approach, sensitivity tests, multiverse analysis, as well as stronger commitments to participatory and mutual learning practices.

The association between aberrant salience and psychotic experiences in general population twins, and genetic vulnerability as a modifier

BACKGROUND

Previous studies assessing the hypothesis that the construct of 'aberrant salience' is associated with psychosis and psychotic symptoms showed conflicting results. For this reason, the association between measures to index aberrant salience and subclinical psychotic symptoms in a general population sample was analysed. In addition, genetic vulnerability was added to the analysis as a modifier to test the hypothesis that modification by genetic vulnerability may explain variability in the results.

METHODS

The TwinssCan project obtained data from general population twins (N = 887). CAPE (Community Assessment of Psychic Experience) scores were used to index psychotic experiences. Aberrant salience was assessed with white noise task and ambiguous situations task.

RESULTS

Measures of aberrant salience were not associated with psychotic experiences, nor was there evidence for an interaction with genetic predisposition in this association (Z = 1.08, p = 0.282).

CONCLUSIONS

Various studies including the present could not replicate the association between aberrant salience and psychotic experiences in general population samples. The conflicting findings might be explained by moderation by genetic vulnerability, but results are inconsistent. If there was evidence for a main effect or interaction, this was in the positive symptom scale only. On the other hand, the association was more robust in so-called 'ultra-high risk' patients and first episode psychosis patients. Thus, this association may represent a state-dependent association, present only at the more severe end of the psychosis spectrum.

Mediating role of physical fitness on the association between diet and health-related quality of life in adolescents

Objective

The aim of this study was to analyse whether the association between adherence to the Mediterranean diet and health-related quality of life (HRQoL) is mediated by physical fitness components (i.e., cardiorespiratory fitness, lower-limb strength, upper-limb strength and motor competence) in adolescents.

Methods

This is a cross-sectional study including mediation analyses. This study involved 181 adolescents (86 girls) aged 15.8 ± 0.3 years recruited from secondary schools and sport clubs located in Castellon (Spain). Adherence to the Mediterranean diet was evaluated using the KIDMED questionnaire. HRQoL was assessed with the KIDSCREEN-10 questionnaire. Cardiorespiratory fitness was assessed using the 20-m shuttle run test. Lower-limb strength was assessed through the standing broad jump test. Upper-limb strength was evaluated using a handgrip dynamometer. Motor competence was assessed using the 4 × 10 m shuttle run test. Mediation analyses were performed for each physical fitness component in order to assess its mediating effect on the association between adherence to the Mediterranean diet and HRQoL. Indirect effects (IE) with confidence intervals (CI) not including zero were interpreted as statistically significant.

Results

Cardiorespiratory fitness and lower-limb strength had a mediating effect on the positive association between adherence to the Mediterranean diet and HRQoL (IE = 0.11, 95 % CI = 0.01; 0.27 and IE = 0.07, 95 % CI = 0.01; 0.19). Upper-limb strength and motor competence did not act as mediators in the association between adherence to the Mediterranean diet and HRQoL (IE = 0.00, 95 % CI = -0.04; 0.07 and IE = 0.01, 95 % CI = -0.03; 0.07, respectively).

Conclusion

Our findings showed that the positive association of adherence to the Mediterranean diet on adolescents' HRQoL was mediated by physical fitness. Educational and public health strategies aiming to improve Spanish adolescents' HRQoL should focus on diet and physical fitness.

Change in clusters of lifestyle behaviours from childhood to adolescence: a longitudinal analysis

This study aimed to identify changes in clusters of lifestyle behaviours (physical activity, screen time and diet) between the ages of 7 and 14 years, and to examine socio-demographic determinants of changes. Longitudinal analyses were performed on a sample of 9339 children from the UK Millennium Cohort Study (MCS) who had complete data on behaviours of interest at age 7 (wave 4) and 14 years (wave 6). Joint Correspondence Analysis (JCA) and k-means cluster analysis were used to identify clusters of lifestyle behaviours at both time waves. Multinomial logistic regressions were used to examine the associations between socio-economic variables and changes in cluster membership. Analyses were conducted separately for boys and girls. Clusters of behaviours at age 7 and 14 years were identified as healthy, mixed or unhealthy respectively. Compared to girls, a higher proportion of boys remained in the healthier cluster over time (19.1% vs. 13.1%) or became healthier (26.4% vs. 9.36%). A higher proportion of girls changed to an unhealthier cluster (57.2% vs. 33.9%). Indicators of lower socio-economic status, such as low family income, low parental education, and not living with both parents at age 7 were associated with unhealthier changes in cluster membership. Conclusion Lifestyle behaviours cluster in children and are susceptible to change over a 7-year period, with a high proportion of boys becoming healthier and a higher proportion of girls became unhealthier. Indicators of socio-economic status appear to be important in determining changes in clusters. What is Known: • Poor lifestyle behaviours (i.e. unhealthy dietary habits, low physical activity, and sedentary behaviours) tend to cluster in children and adolescents. What is New: • Lifestyle behaviours cluster in children and are susceptible to changes between childhood and adolescence. Changes occur differently in boys and girls. Indicators of low socio-economic status are associated with unhealthier changes in behavioural clusters.

Consideration of Demographic Variables in Behavioral Interventions Pertaining to Children With Hearing Loss: A Systematic Review

PURPOSE

Equitable representation of children with hearing loss who are members of marginalized or minority groups in behavioral intervention studies enhances inclusivity in the scientific process and generalizability of results. The goal of this systematic review was to ascertain the percentage of studies conducted in the United States in the past 2 decades that reported relevant demographic variables.

METHOD

Studies were searched across eight databases and clinical trial registries in October 2022. Variations of the following search strings were used to retrieve peer-reviewed published studies and unpublished clinical trials: children, hearing loss, and intervention.

RESULTS

Thirty-nine intervention studies met the inclusion criteria. The selected studies were reviewed and coded for the following demographic variables: area and type of intervention, participant age, hearing technology data, sample size, gender, race/skin color and ethnicity, primary/home language(s), additional disabilities, parental education, family income, and parental occupation. Results revealed that many demographic variables were remarkably underreported, with parental education, family income, and parental occupation variables being the least reported data.

CONCLUSIONS

Demographic data can be an important tool for changing disparities related to intervention outcomes. This systematic review suggests that inclusive research practices should be extended to low-literacy or low-economic resources, non-White, and non-English-speaking groups. Inclusion practices coupled with sufficient sample sizes will ultimately aid in identifying hearing health disparities.

Rural-Urban Differences in HIV Sexual Risk Behaviors and HIV Service Utilization Among Adolescent Sexual Minority Males in the United States

In the United States, HIV prevalence is increasing in rural areas, specifically among rural adolescent sexual minority males (ASMM). However, it is unclear what HIV sexual risk behaviors rural ASMM engage in and what HIV preventative services they utilize. This study aimed to (1) document the lifetime HIV sexual risk behaviors and service utilization of rural ASMM and (2) compare rural-urban differences in the prevalence of HIV sexual risk behaviors and service utilization. We analyzed data collected from 1615 ASMM who participated in a baseline survey for an online HIV prevention program from April 2018 to June 2020. We compared the prevalence of lifetime HIV sexual risk behaviors and HIV healthcare utilization among rural and urban participants via descriptive statistics, chi-square tests, linear and logistic regressions, and zero-inflated Poisson regressions. These analyses indicated that rural ASMM were more likely than urban ASMM to engage in condomless sex when they had anal sex. Rural ASMM could benefit from offline and online evidence-based HIV prevention interventions, especially interventions that increase condom use.

Lifestyle Clusters of Diet Quality, Sleep, and Screen Time and Associations with Weight Status in Children from Madrid City: ENPIMAD Study

BACKGROUND

Childhood overweight and obesity is a global concern and has increased in Spain over the last decades. Combinations of lifestyle behaviors (i.e., diet, sleep, and sedentarism) are highly related to weight status. Therefore, this study aimed to identify lifestyle patterns among children from Madrid City, and analyze associations with the prevalence of overweight, obesity, and abdominal obesity, considering socio-economic factors.

METHODS

A cross-sectional analysis was conducted on 4545 children from the ENPIMAD study with data on diet, sleep, anthropometric, and socio-economic variables. K-means cluster analysis was used to identify lifestyle clusters, and logistic regressions were used to examine the associations between socio-economic indicators and cluster membership, and between clusters and weight status.

RESULTS

Findings show three lifestyle clusters (healthy, mixed, and unhealthy), with boys and older children more represented in the unhealthy cluster. Food insecurity and low socio-economic status were associated with unhealthier clusters in boys and girls. Children in unhealthier clusters were more likely to have obesity and abdominal obesity. However, these associations disappeared in girls after controlling for food insecurity.

CONCLUSION

These results provide insight into the combination of behaviors and socio-economic factors associated with childhood obesity that may aid in the design of future interventions.

Inequities in dietary intake and eating behaviours among adolescents in Canada

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Empathy and ethical sensitivity among intensive and critical care nurses: A path analysis

BACKGROUND

Intensive and critical care nurses need to demonstrate ethical sensitivity especially in recognizing and dealing with ethical dilemmas particularly as they often care for patients living with life-threatening conditions. Theories suggest that there is a convergence between nurses' empathy and ethical sensitivity. Evidence in the literature indicates that nurses' emotional, demographic, and work characteristics are associated with their level of empathy and ethical sensitivity.

AIM

To investigate the relationship between nurses' empathy and ethical sensitivity, considering their emotional states (depression, anxiety, and stress), demographic and work characteristics, and test an empirical model describing potential predictors of empathy (as a mediator) and ethical sensitivity using path analysis.

RESEARCH DESIGN

Using a cross-sectional design, the philosophical theory of care ethics and empathy was extended and adopted as a conceptual framework for this study and tested by path analysis.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected from 347 intensive care nurses recruited by ten educational-medical hospitals in Iran using a questionnaire between February and March 2021.

ETHICAL CONSIDERATIONS

The study was reviewed by the Ethical Advisory Board in Iran and conducted according to the Declaration of Helsinki.

FINDINGS

Study participants demonstrated a mild level of stress, anxiety, and depression, alongside a relatively high level of empathy and ethical sensitivity. Nurses with good socioeconomic status had higher empathetic behavior with patients than those with weak status. Nurses aged over 40 who had received ethics training and had higher work experience were associated with higher ethical sensitivity compared to nurses under 20 years of age. Empathy directly affected ethical sensitivity; however, anxiety had an indirect effect on ethical sensitivity through empathy. Among demographic factors, age had a positive direct effect on ethical sensitivity.

CONCLUSIONS

Less anxiety and a high level of empathy contribute to higher levels of ethical sensitivity among intensive and critical care nurses.

Effect of vicarious discrimination on race-based stress symptoms among Asian American young adults during the COVID-19 pandemic

OBJECTIVE

The COVID-19 pandemic has led to a rise in anti-Asian hate crimes in the United States. Previous work has established that experiencing racism increases one's dysfunctional anxiety and avoidance actions-key symptoms of race-based stress symptoms. However, the psychological impact of vicarious, or secondhand, discrimination (witnessing racism targeting one's own race group) remains less understood.

METHOD

We tested the hypothesis that higher reported vicarious discrimination would be associated with higher levels of race-based stress symptoms reported by Asian American young adults (n = 135) during the pandemic using a cross-sectional analysis of the COVID-19 Adult Resilience Experiences Study (CARES). Starting in April 2020, CARES assessed sociodemographic characteristics and key psychometric scales in young adults through three waves of online surveys.

RESULTS

Our multiple regression analysis showed vicarious discrimination significantly predicted race-based stress symptoms, even after controlling for direct discrimination (p < .01). This association remained significant after controlling for age, gender, subjective childhood family social status, and preexisting psychiatric disorders (p < .01). Our results demonstrate that regardless of the effect that direct discrimination might have on race-based stress symptoms, witnessing discrimination against members of one's own racial group is significantly associated with increased race-based stress symptoms (b = 2.68, p < .01). Social media was the most common source of vicarious discrimination, with one out of three participants in our sample reporting nearly daily exposure.

CONCLUSION

Providers should intentionally create a space within the therapeutic setting to discuss the effects of vicarious discrimination. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The relationship between Indonesian young people's knowledge, attitude and practice (KAP) of MyPlate with sociodemographic, body satisfaction, accessibility, and source of information

MyPlate is a 2017 campaign about Indonesian Balanced Nutrition Guidelines. Nutrition knowledge of young people plays an important role since nutritional status of young people affects offspring's health. Moreover, they are more likely to be obese later in life, particularly in urban areas. The main objective of this descriptive study was to assess the relationship between knowledge, attitude and practice (KAP) of MyPlate with sociodemographic, body satisfaction (BS), accessibility and source of information. Data were collected in a cross-sectional study involving 413 young people in Jakarta. The online questionnaire was modified from previous studies, validated by three experts, pre-tested and proven to be reliable through Cronbach's alpha value of 0.714. In this study, most participants had poor knowledge (54%), good attitude (80%), fair practice (72%), fair BS (51%) and good accessibility (70%). Chi-square analysis showed significant relationships (p-value < 0.05) of knowledge with BS, education level, major; attitude with accessibility; practice with BS and accessibility; BS with gender; accessibility with socioeconomic status; source of information with education level and major. Moreover, the biggest source of MyPlate information was this questionnaire (45%), which means they were not familiar with MyPlate before. This study verifies the necessity to intensify its promotion and improve nutritional knowledge and practice in young people.

Mental health and loneliness in Scottish schools: A multilevel analysis of data from the health behaviour in school-aged children study

BACKGROUND

Adolescent loneliness and poor mental health represent dual public health concerns. Yet, associations between loneliness and mental health, and critically, how these associations vary in school settings are less understood.

AIMS

Framed by social-ecological theory, we aimed to identify key predictors of adolescent mental health and examine school-level variation in the relationship between loneliness and mental health.

SAMPLE

Cross-sectional data on adolescents from the 2018 wave of the Health Behaviour in School-aged Children study (HBSC) in Scotland were used (N = 5286).

METHODS

Mental health was measured as a composite variable containing items assessing nervousness, irritability, sleep difficulties and feeling low. Loneliness was measured via a single item assessing how often adolescents felt 'left out'. Multilevel models were used to identify social-ecological predictors of mental health, associations with loneliness and between-school variation.

RESULTS

Loneliness, as well as demographic, social and school factors, was found to be associated with mental health. Mental health varied across schools, with the between-school difference greater among adolescents with high levels of loneliness. Additionally, the negative effect of loneliness on mental health was stronger in schools with lower average mental health scores.

CONCLUSIONS

The findings suggest that schools can play an important role in shaping adolescent mental health. Our study uniquely identifies that school-based interventions targeting mental health may be especially necessary among lonely adolescents, and programmes aimed at tackling loneliness may be more beneficial in schools with poorer mental health.

Cardiovascular risk profiles clusters among children and adolescents with disabilities

BACKGROUND

Cardiovascular diseases (CVD) are a precursor for disabilities and death worldwide. Being overweight or obese in combination with physical inactivity and smoking habits may increase the risk for CVD and other health problems such as lower limb osteoarthritis, diabetes, stroke, and various cancer types among children and adolescents. The literature emphasizes the need to follow such groups and evaluate the risk of individuals developing CVD diseases. Therefore, the current study explores the variety of cardiovascular risks in children and adolescents' profiles clusters with and without disabilities.

METHODS

Data from 42 countries including Israel, was collected with the support of the world health organization (WHO, Europe) through a questionnaire from 11-19 years old school-aged.

RESULTS

The study finding shows that children and adolescents with disabilities demonstrated a higher prevalence of overweight than those who completed the HBSC youth behavior survey. Moreover, the prevalence of tobacco smoking and alcohol use was statisticaly significantly higher among the disabled group than the non-disabled group. In addition, socioeconomic status of responders who presented a very high CVD risk was found as significantly lower than those from the first and second low risk groups.

CONCLUSION

This led to the conclusion that children and adolescents with disability were at a higher risk of developing CVDs than their non-disabled peers. In addition, intervention programs tailored to the needs of adolescents with disability should consider lifestyle habit change and promoting healthy living thus improving their quality of life as well as reducing their risk of being exposed to severe CVD diseases.

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

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

The bidirectional longitudinal association between health-related quality of life and academic performance in adolescents: DADOS study

PURPOSE

Although previous evidence has suggested a relationship between health-related quality of life (HRQoL) and academic performance, the directionality of this association is understudied and remains to be clarified. Thus, the primary objective of this study was to explore the bidirectional association between HRQoL and academic performance in adolescents between two timepoints with a 24-month interval. A secondary aim was to analyze whether this association varies between boys and girls.

METHODS

This is a bidirectional longitudinal analysis with 257 adolescents (13.9 ± 0.3 years at baseline) from the DADOS study. HRQoL was measured using the KIDSCREEN-10 questionnaire. Academic performance was assessed through academic grades and the Spanish version of the Science Research Associates Test of Educational Ability.

RESULTS

Cross-lagged analyses revealed that HRQoL at baseline was not associated with academic performance 24 months later, while all the academic grades and the overall score of academic abilities at baseline were positively associated with HRQoL at follow-up in adolescents. Results of the stratified analyses by sex were largely similar. Specifically, in girls, math, language, physical education, and grade point average at baseline were positively associated with HRQoL 24 months later, while in boys, all the academic grades indicators (except physical education), numeric ability, and the overall score of academic abilities at baseline were positively associated with HRQoL at follow-up.

CONCLUSION

These findings suggest that academic performance in early adolescence may predict HRQoL 24 months later. Health and education professionals could benefit from collaborating to achieve both improved academic performance and HRQoL in youth.

Individual and combined impact of physical fitness on health-related quality of life during adolescence: DADOS Study

The purpose of the present study was to investigate the individual and combined impact of physical fitness components at baseline on health-related quality of life (HRQoL) at 24-month follow-up in adolescents. This longitudinal research included 199 adolescents (13.9±0.3 years at baseline) from the DADOS study. Cardiorespiratory fitness was assessed using the 20-m shuttle run test. Muscular strength was assessed using the standing broad jump test. Motor competence was assessed using the 4 × 10-m shuttle run test. A physical fitness z-score was calculated as the mean of the z-scores values of each fitness test. A fitness index ranging from 0 to 3 was created according to the number of physical fitness components in which participants achieved high levels according to normative values. HRQoL was evaluated by the KIDSCREEN-10 questionnaire. Linear regression analyses showed that cardiorespiratory fitness, muscular strength, and the physical fitness z-score at baseline were individually associated with HRQoL at follow-up (β ranging from 0.123 to 0.183; all p < 0.05). Moreover, logistic regression analysis revealed that adolescents with a fitness index ≥1 at baseline were more likely to achieve high HRQoL at 24-month follow-up, compared with their peers with an index of 0 (OR ranging from 3.554 to 9.087; all p < 0.05). Our results revealed an individual and cumulative positive impact of physical fitness at baseline on HRQoL at 24-month follow-up. These findings underline the key role of promoting the enhancement of overall physical fitness components in order to improve adolescents' health and well-being.Highlights Adolescents with high levels of cardiorespiratory fitness, muscular strength and motor competence will benefit from a greater physical and mental well-being over the time.The more physical fitness components with optimal levels, the greater likelihood of reaching better HRQoL over the time.Public health authorities should focus on the promotion of multiple physical fitness components to increase adolescent's likelihood of achieving greater HRQoL over the time.

Nonusage Attrition of Adolescents in an mHealth Promotion Intervention and the Role of Socioeconomic Status: Secondary Analysis of a 2-Arm Cluster-Controlled Trial

Background

Mobile health (mHealth) interventions may help adolescents adopt healthy lifestyles. However, attrition in these interventions is high. Overall, there is a lack of research on nonusage attrition in adolescents, particularly regarding the role of socioeconomic status (SES).

Objective

The aim of this study was to focus on the role of SES in the following three research questions (RQs): When do adolescents stop using an mHealth intervention (RQ1)? Why do they report nonusage attrition (RQ2)? Which intervention components (ie, self-regulation component, narrative, and chatbot) prevent nonusage attrition among adolescents (RQ3)?

Methods

A total of 186 Flemish adolescents (aged 12-15 years) participated in a 12-week mHealth program. Log data were monitored to measure nonusage attrition and usage duration for the 3 intervention components. A web-based questionnaire was administered to assess reasons for attrition. A survival analysis was conducted to estimate the time to attrition and determine whether this differed according to SES (RQ1). Descriptive statistics were performed to map the attrition reasons, and Fisher exact tests were used to determine if these reasons differed depending on the educational track (RQ2). Mixed effects Cox proportional hazard regression models were used to estimate the associations between the use duration of the 3 components during the first week and attrition. An interaction term was added to the regression models to determine whether associations differed by the educational track (RQ3).

Results

After 12 weeks, 95.7% (178/186) of the participants stopped using the app. 30.1% (56/186) of the adolescents only opened the app on the installation day, and 44.1% (82/186) stopped using the app in the first week. Attrition at any given time during the intervention period was higher for adolescents from the nonacademic educational track compared with those from the academic track. The other SES indicators (family affluence and perceived financial situation) did not explain attrition. The most common reasons for nonusage attrition among participants were perceiving that the app did not lead to behavior change, not liking the app, thinking that they already had a sufficiently healthy lifestyle, using other apps, and not being motivated by the environment. Attrition reasons did not differ depending on the educational track. More time spent in the self-regulation and narrative components during the first week was associated with lower attrition, whereas chatbot use duration was not associated with attrition rates. No moderating effects of SES were observed in the latter association.

Conclusions

Nonusage attrition was high, especially among adolescents in the nonacademic educational track. The reported reasons for attrition were diverse, with no statistical differences according to the educational level. The duration of the use of the self-regulation and narrative components during the first week may prevent attrition for both educational tracks.

Trial Registration

ClinicalTrials.gov NCT04719858; http://clinicaltrials.gov/ct2/show/NCT04719858

Associations between socioeconomic position and young people's physical activity and sedentary behaviour in the UK: a scoping review

OBJECTIVE

To examine the evidence on the associations between socioeconomic position and young people's physical activity and sedentary behaviours in the UK.

DESIGN

Scoping review.

DATA SOURCES

PubMed, SCOPUS and Web of Science databases were searched for articles published up to and including January 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Observational studies in children and adolescents (aged 5-18 years) from the UK that had assessed associations between at least one indicator of socioeconomic position and at least one outcome of physical activity and/or sedentary behaviour.

DATA EXTRACTION AND SYNTHESIS

Data were extracted by one reviewer and 20% were double checked. Indicators of socioeconomic position were tabulated with domains of physical activity and sedentary behaviour.

RESULTS

Fifty-seven publications were included in the review; 37 publications from 19 studies (k=23) of children and 21 publications from 15 studies (k=23) of adolescents. Most studies were cross-sectional. 63% of studies of children, and 40% of studies of adolescents assessed Index of Multiple Deprivation. Eighteen studies measured physical activity in children, 13 measured sedentary behaviour. Eleven studies of adolescents included a measure of physical activity, 10 included a measure of sedentary behaviour. Among children and adolescents, the association between socioeconomic position and measures of either physical activity or sedentary behaviour was highly variable depending on the measure of both socioeconomic position used and the behavioural outcome, with the exception of higher family affluence which was consistently associated with higher reported physical activity among adolescents.

CONCLUSION

Physical activity and sedentary behaviours of children and adolescents in the UK are complex and influenced by multiple indicators of socioeconomic position that are, in most cases, different across age stages, outcomes examined and measurement tools. Greater consistency in the use and measures of socioeconomic position as well as outcomes of behaviour are required for robust country-specific meta-analyses.

Trends in material and non-material inequalities in adolescent health and health behaviours: A 12-year study in 23 European countries

Information on trends in adolescent health inequalities is scarce but the available evidence suggests that inequalities are increasing. Prior studies describe associations between material resources of socioeconomic status (SES) and health, while information on non-material SES resources and inequalities in health behaviours is lacking. To improve current understandings of evolutions in adolescent health inequalities, we examined how material and non-material SES resources were associated with changes in selected health outcomes (life satisfaction, physical and psychological symptoms) and health behaviours (physical activity, screen time, breakfast, fruit, vegetables, sweets and soft drinks consumption and alcohol and tobacco use) over a 12-year period. Repeated cross-sectional data came from the 2002, 2006, 2010 and 2014 waves of the Health Behaviour in School-aged Children (HBSC) survey from 23 European countries (n = 480,386). Measures of family affluence and occupational social class were used as indicators of material and non-material SES resources respectively. Regression-based slope indices of inequality indicated that absolute material and non-material inequalities remained stable from 2002 to 2014 in all health outcomes, except for life satisfaction for which a decrease in material inequalities was found between the highest and lowest affluence group (0.81 to 0.68 difference; p < 0.001). In terms of health behaviours, material inequalities decreased in screen time between highest and lowest affluence groups (0.53 to 0.34 h/day difference; p < 0.001), fruit (odds ratio [OR] 1.89 to 1.72 lower odds; p = 0.0088) and soft drinks consumption (OR 1.36 to 1.13 lower odds; p < 0.001) and remained stable in all others. Non-material inequalities increased in all health behaviours (except for sweets consumption) between highest and lowest occupational social class groups: physical activity (0.16 to 0.24 h/day difference; p = 0.0071), screen time (-0.41 to -0.58 h/day difference; p < 0.001), breakfast (0.21 to 0.51 day/week difference; p < 0.001), fruit (OR 1.23 to 1.48 higher odds; p < 0.001), vegetables (OR 1.39 to 1.74 higher odds; p < 0.001) and soft drinks consumption (OR 0.59 to 0.43 lower odds; p < 0.001) and alcohol (OR 0.99 to 0.85 lower odds; p = 0.0420) and tobacco use (OR 0.71 to 0.59 lower odds; p = 0.0183). In summary, non-material inequalities in most health behaviours increased, whereas material inequalities in adolescent health and health behaviours remain stable or decreased. Policies and interventions may consider non-material SES components as these can help in reducing future health inequalities.

Stress Mediates the Association Between Pain and Alcohol Use in College Students

Background

Alcohol use in young adults is highly prevalent and associated with numerous consequences, including academic difficulties and motor vehicle accidents. Pain is one factor that has been increasingly shown to be associated with higher rates of alcohol consumption and riskier patterns of drinking among undergraduate students. Although pain has traditionally been viewed as a lesser concern for young adults, current research demonstrates that pain may be more prevalent in younger populations than originally thought. However, little is known about how common psychosocial factors, such as stress and subjective social status (SSS), influence the association between pain and alcohol consumption in college students.

Objective

The study's goal was to examine the effect of stress and SSS on the relationship between pain and alcohol consumption.

Participants and Methods

Participants (N = 445, 39.3% women, Mage = 22.98) were 18- to 25-year-old college students who completed an online questionnaire.

Results

Pain was significantly associated with total weekly alcohol consumption (r(445) = .22, p < 0.001); this association was significantly mediated by stress (b = 0.15, SE = 0.04, 95% CI = [.07,0.23]). SSS was significantly positively associated with alcohol consumption (r(445) = .22, p < 0.001) but was not found to significantly moderate the relationship between stress and alcohol use.

Conclusion

Results suggest that efforts to reduce college student alcohol use should include assessment of pain and stress given their association with alcohol consumption. Further, findings suggest that future studies are warranted to prospectively examine pain as an antecedent for alcohol use and to examine the utility of incorporating stress management techniques in pain-focused interventions to indirectly target alcohol use.

Material Hardship and Association With Sexual Risk Behavior Among Adolescent Sexual Minority Males in 3 US Cities-National HIV Behavioral Surveillance-Young Men Who Have Sex With Men, 2015

INTRODUCTION

Adolescent sexual minority males (ASMMs) are disproportionately affected by HIV relative to other youth within the United States. Social determinants of health have been explored among this population; however, economic determinants, such as material hardship, remain understudied. We examined the relationship between material hardship and sexual behavior among ASMMs aged 13-18 years residing in 3 US cities using 2015 data from CDC's National HIV Behavioral Surveillance among Young Men Who Have Sex with Men.

METHODS

Young men ages 13-18 years residing in 3 US cities were recruited through venue-based, respondent-driven, or Facebook sampling. We estimated adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for condomless anal intercourse (CAI) with a male sex partner in the past 12 months and with having 4 or more male sex partners in the past 12 months.

RESULTS

Of 547 ASMMs, 27% reported experiencing material hardship in the past 12 months. After adjusting for demographics, household characteristics, and city, ASMMs who experienced material hardship were more likely to report CAI with a male partner in the past 12 months (aPR: 1.55, 95% CI: 1.25 to 1.93) and to have had 4 or more male sex partners in the past 12 months (aPR: 1.44, 95% CI: 1.08 to 1.91).

DISCUSSION

More than a quarter of ASMMs experienced material hardship that was associated with increased sexual risk behavior among ASMMs. Incorporating services that address all unmet needs is important to consider for HIV prevention efforts for ASMMs.

Alcohol and Cannabis Use Milestones in Diverse Urban Adolescents: Associations with Demographics, Parental Rule Setting, Sibling and Peer Deviancy, and Outcome Expectancies

Objective: Alcohol and cannabis use progression milestones in adolescence (such as ages at first use, first intoxication and at onset of regular use) may inform the development of alcohol and cannabis use disorders. Although parent, sibling, and peer behavior and alcohol-related cognitions have been shown to be associated with alcohol milestone attainment, findings have been mixed; further, those factors' associations with cannabis use milestones are unknown. This study examined whether progression through such milestones differed as a function of perceived peer/sibling deviancy, parental rule-setting, and substance use outcome expectancies in a racially diverse adolescent sample.Methods: Data were drawn from a two-wave longitudinal health survey study of 9-11^th graders (n = 355 for the current analyses; M_age=15.94 [SD = 1.07]; 44% male; 43% Black; 22% White; 18% Asian; 17% Multiracial; 10% Hispanic/Latinx ethnicity) at an urban high school. A series of logistic and proportional hazards regressions examined associations of peer/sibling deviancy, parental rule-setting, and outcome expectancies with age and attainment of alcohol/cannabis use milestones.Results: For both alcohol and cannabis, greater peer deviancy and positive expectancies were associated with higher odds of milestone attainment, while negative expectancies were associated with slower progression through milestones. For cannabis, but not alcohol, greater perceived sibling deviancy was positively associated with milestone attainment, while negative expectancies were associated with lower odds of milestone attainment.Conclusions: Perceived deviant behavior by peers and siblings, in addition to adolescents' expectancies for either alcohol or cannabis use, is associated with attainment and progression through key adolescent substance use milestones.

Does the family affluence scale reflect actual parental earned income, level of education and occupational status? A validation study using register data in Sweden

AIM

To examine the external validity of the Family Affluence Scale (FAS) among adolescents in Sweden by using register data for parental earned income, level of education and occupational status.

METHODS

Data from the baseline (2015-2019) of the Study of Adolescence Resilience and Stress (STARS), comprising 2283 13-year-olds in the region of Västra Götaland, were used. The FAS III consists of six items: unshared bedroom, car ownership, computer/tablet ownership, dishwasher, number of bathrooms and number of holidays abroad. Register data regarding earned income, educational level and occupational status from Statistics Sweden (2014-2018) were linked to adolescents. In total, survey data were available for 2280 adolescents, and register data were available for 2258 mothers and 2204 fathers.

RESULTS

Total parental earned income was moderately correlated with adolescents' scoring on FAS (0.31 < r < 0.48, p < 0.001), depending on examination year. The low FAS group mainly comprised low-income households, and the high FAS group mainly comprised high-income households. Correlations between mothers' and fathers' educational level and adolescents' scoring on FAS were low (r = 0.19 and r = 0.21, respectively, p < 0.001). FAS was higher among adolescents whose parents were working, but the correlation between parents' occupational status and FAS was low (r = 0.22, p < 0.001).

CONCLUSIONS

The FAS can mainly identify low- and high-income households in Sweden. It may be used as an alternative measure of parental earned income in studies using self-reported socioeconomic status among adolescents.

Participation after childhood stroke: Is there a relationship with lesion size, motor function and manual ability?

BACKGROUND

Childhood arterial ischemic stroke (AIS) is associated with significant morbidity with up to 50% of affected children developing hemiparesis. Hemiparesis is assumed to influence participation within the peer group, but it is unclear to what extent its severity affects participation in different areas of social life.

METHODS

Thirteen children (mean age 9y6m) with AIS (6 without hemiparesis, 7 with hemiparesis) and 21 controls (mean age 9y8m) participated. We scored hemiparesis severity with hand strength asymmetry (pinch and grip strength), measured with a dynamometer. We assessed manual ability (ABILHAND-Kids), socioeconomic status (Family Affluence Scale) and participation (Participation and Environment Measure - Children and Youth). From structural MRI, we measured lesion size. We investigated differences in participation and its relationship with hemiparesis severity using non-parametric partial correlations (controlling for lesion size, manual ability, and socioeconomic status), interpreted as absent (r < 0.25), weak (r = 0.25-0.50), moderate (r = 0.50-0.75) or strong (r > 0.75). Analyses were performed in jamovi 1.6.3.

RESULTS

Children with AIS (with or without hemiparesis) showed reduced participation frequency at school (p < 0.001), whilst participation at home and in the community resembled that of their peers. Severity of hemiparesis was moderately related to frequency and involvement at home and to involvement and desire for change in the community, although unrelated to school participation.

CONCLUSION

Reduced participation in school life requires close attention in the follow-up of children with AIS - regardless of the severity of hemiparesis. Participation at home and in the community is related to hemiparesis severity and may be improved with participation-focused motor intervention strategies.

The interplay of familial warmth and LGBTQ+ specific family rejection on LGBTQ+ adolescents' self-esteem

INTRODUCTION

Our study sought to assess the interplay of family dynamics, namely familial warmth and LGBTQ+ specific rejection, and its association to self-esteem in a non-probabilistic sample of LGBTQ+ adolescents in the United States.

METHODS

Stratified by (1) cisgender and (2) transgender and non-binary LGBTQ+ adolescents (N = 8774), we tested multivariable regression analyses to assess the association between familial warmth and LGBTQ+ specific family rejection, adjusted for sociodemographic characteristics. We then conducted a sub-analysis with LGBTQ+ adolescents who reported being out to any family member about their LGBTQ+ identity; specifically, we tested a series of multivariable regression models to assess whether levels of LGBTQ+ specific family rejection attenuated the association between familial warmth and self-esteem.

RESULTS

Full sample models indicated a positive association between familial warmth and self-esteem. Findings from our sub-analysis indicated that familial warmth remained positively linked to self-esteem and family rejection was negatively associated with self-esteem. Family rejection was a statistically significant moderator, attenuating the association between familial warmth and self-esteem. With respect to being out about one's sexual orientation, these findings were robust across gender stratification groups.

CONCLUSIONS

Families of origin serve as sources of stress and resilience for LGBTQ+ adolescents. Our findings contribute support to arguments that familial warmth and LGBTQ+ specific rejection are not mutually-exclusive experiences among LGBTQ+ adolescents. We provide recommendations for multilevel interventions to leverage activities that support positive family dynamics and self-esteem among LGBTQ+ adolescents.

Structural Inequity and Pregnancy Desires in Emerging Adulthood

Public health discourses often claim that delaying pregnancy is associated with social and economic benefits. Yet research suggests that, for young people, structural inequity is most influential in future outcomes, regardless of childbearing. We conducted in-depth interviews with 50 young women (ages 18-24) and their male partners (n = 100) and investigated the influence of structural inequity on pregnancy desires and plans. Three themes emerged, stratified by social advantage. In the "Things Will Be Different Later" theme, socially advantaged participants envisioned that their future lives would surely be different due to achievement of educational, professional, and economic goals; thus, their pregnancy plans aligned with their desires, often reflected in use of highly effective contraception. In the "I Don't Have Everything I Need" theme, participants expressed delaying desired pregnancies (primarily through condom use) until they could contend with structural barriers. Their pregnancy plans, shifted by way of structural inequity, were not aligned with their desires. Under the "I'll Never Have Everything I Need" theme, socially disadvantaged participants expressed significant doubt about ever realizing ideal circumstances for pregnancy preparedness; as pregnancy prevention was not salient, these participants used condoms or no contraception. This analysis indicates that structural inequities constrain reproductive self-determination in emerging adulthood, creating a chasm between desired and actual childbearing that was reflected in contraceptive decision-making. Public health narratives emphasizing the importance of pregnancy prevention for socially disadvantaged groups without addressing the manifestation of structural inequity in their lives perpetuate reproductive oppression vis-à-vis emphasis on contraceptive use to ensure future economic success.

Social Inequalities in Breakfast Consumption among Adolescents in Spain: The DESKcohort Project

Breakfast has a critical role in energy balance and dietary regulation. Consequently, it is considered an important component of a healthy diet, especially in adolescence, when there are great opportunities to consolidate habits and establish future patterns of healthiness in adulthood. Socioeconomic position (SEP) causes inequalities that are reflected in health behaviors, physical activity, mental health, and diet. Therefore, we conducted a cross-sectional study using data from the 2019-2020 DESKcohort project (Spain) to explore the relationships between breakfast and sociodemographic characteristics, health-related behaviors, and school performance of 7319 adolescents. Our findings showed that the prevalence of skipping breakfast every day was 19.4% in girls and 13.7% in boys and was related to students' SEP. The risk of skipping breakfast was 30% higher in girls from the most disadvantaged SEP, in comparison to those in the most advanced SEP (prevalence ratio (PR) = 1.30; 95% confidence interval (CI) = 1.11-1.54). Also, boys from the most disadvantaged SEP showed 28% higher risk of skipping breakfast than those in the most advanced SEP (PR = 1.28; 95% CI = 1.04-1.59). In conclusion, future public policies should be adapted considering a SEP and gender perspective to avoid increasing nutritional and health inequalities.

Brain cortical and subcortical morphology in adolescents with depression and a history of suicide attempt

BACKGROUND

Suicidal behaviours are a major source of mortality and morbidity among adolescents. Given the maturational changes that occur in cortical and subcortical structures during adolescence, we tested whether atypical brain structural measurements were associated with a history of suicide attempt.

METHODS

We assessed 3 groups of adolescents (n = 92; 79% female, mean age 15.9 years, range 11.6-18.1 years): patients with a depressive disorder and a history of suicide attempt (n = 28); patient controls, who had a depressive disorder but no history of suicide attempt (n = 34); and healthy controls (n = 30). We derived regional cortical thickness and surface area, and subcortical volumes, from T1-weighted anatomic MRI scans acquired at 3 T.

RESULTS

We found significant group differences in surface area in the prefrontal, temporal and parietal regions, as well as in the volume of several subcortical nuclei (pFDR ≤ 0.05), but not in cortical thickness. Post hoc analyses indicated that morphological alterations primarily differentiated patients with a history of suicide attempt from healthy controls, but not from patient controls. However, patients with a history of suicide attempt exhibited positive correlations between age and cortical thickness in the temporal cortices and right insula, and between age and right putamen volume (i.e., thicker regional cortex and larger subcortical volumes with age). These correlations were negative in both patient controls and healthy controls (i.e., thinner regional cortex and smaller subcortical volumes).

LIMITATIONS

Sample sizes, cross-sectional findings and psychiatric heterogeneity were limitations of this study.

CONCLUSION

Macroscopic structural differences in several brain regions differentiated adolescents with a history of suicide attempt from healthy controls, but not from patient controls. However, adolescents with a history of suicide attempt may present with atypical maturation of specific cortical and subcortical regions that might contribute to the risk of suicidal behaviour.

Impacts on Children and Adolescents' Lifestyle, Social Support and Their Association with Negative Impacts of the COVID-19 Pandemic

The impacts of the COVID-19 pandemic on physical and mental health-related behaviors among children and adolescents are likely to be profound and long-lasting. This study aimed to investigate the changes in lifestyle and social support and their associations with negative impacts due to the pandemic. A classroom survey using stratified random sampling and structured questionnaire was conducted among Hong Kong primary and secondary school students. The paper-and-pen survey, administered by well-trained research assistants, was completed by 2863 participants aged 9-17 years old (M = 12.6, SD = 1.3) at a brief school reopening six months after the outbreak of the COVID-19 pandemic. About 48% and 37% of the participants stated that they paid increased attention to physical and mental health, respectively. About 20% to 40% stated that they found more support from their friends and family members; only a small percentage reported decreased social support. Around 25% to 50% spent more time to rest, relax, and exercise. The aforementioned changes varied among genders, education groups, and socio-economic status. In general, higher perceived vulnerability, feeling more stressed, apprehensive, and helpless were associated with more reported positive lifestyle changes, including more social/family support, increased mental health awareness, and a positive lifestyle. These positive changes serve as important cushions against the negative impacts of COVID-19.

Lifestyle habits and depressive symptoms in Norwegian adolescents: a national cross-sectional study

Background

This study’s purpose was to examine the association between a broad range of lifestyle habits and depressive symptoms in Norwegian adolescents.

Methods

This study was based on national, self-reported, cross-sectional data from the Ungdata Surveys, conducted in 2017–2019. The target group comprised 244,250 adolescents (ages 13–19). Binominal logistic regression was used to analyse the association between lifestyle habits (physical activity, social media use, gaming, dietary habits, smoking, smokeless tobacco, alcohol intoxication) and depressive symptoms. The outcome measure was defined as a high level of depressive symptoms (≥80th percentile). Separate analyses were performed for boys and girls, and all models were adjusted for perceived family economy, parental higher education and age.

Results

The odds of having depressive symptoms were significantly lower among those who reported being physically active at least 3 times per week (OR; boys: 0.81, girls: 0.83), used social media ≤3 h per day (OR; boys: 0.65, girls: 0.70), engaged in gaming ≤3 h per day (OR; boys: 0.72, girls: 0.77), were non-smokers (OR; boys: 0.74, girls: 0.72) and had not experienced alcohol intoxication during the previous 12 months (OR; boys: 0.66, girls: 0.67). Furthermore, the results indicated a significant inverse association between depressive symptoms and high consumption of a range of healthy food items and low consumption of unhealthy food and beverages among girls. Similar tendencies were found among boys (OR; 0.77–0.91). Finally, higher adherence to healthy lifestyle habits was associated significantly with lower odds of having depressive symptoms among both genders (OR; boys: 0.40, girls: 0.52).

Conclusions

A healthier lifestyle was associated with lower odds of having depressive symptoms. Additional research is needed to confirm a possible causal relationship.

Subjective health complaints in early adolescence reflect stress: A study among adolescents in Western Sweden

Aims: Mental health problems are common among Swedish adolescents and are sometimes referred to as 'stress-related'. The overall aim of this study is to do an analysis of subjective health complaints (SHCs) and perceived general stress among adolescents in Sweden, both their prevalence and association, by gender, migration background, family structure and socioeconomic conditions. Methods: Data from the baseline (comprising 2283 adolescents aged 13) of the STudy of Adolescence Resilience and Stress (STARS) study in Västra Götaland in Sweden were used. SHCs were measured by the Psychosomatic Problems Scale (PSP-scale) and self-reported stress was measured by Cohen's Perceived Stress Scale (PSS-10). Socioeconomic conditions were measured with the Family Affluence Scale (FAS) and the MacArthur Scale of Subjective Social Status (SSS). Statistical analyses included Student's t-tests and ANOVAs of means, linear and logistic regression analyses and Pearson's correlations. Results: Social inequalities in both SHCs and self-reported stress were found; levels were higher among girls, adolescents living with one parent or in families with less favourable socioeconomic conditions. Self-reported stress and SHCs were found to be strongly correlated (r=0.70). Correlations with self-reported stress were stronger for psychological complaints (r=0.71) than for somatic complaints (r=0.52). Correlations did not vary with socioeconomic conditions of the family. Conclusions: SHCs do reflect general stress among adolescents, and it is appropriate to address the complaints as 'stress-related'. Measures to improve adolescents' mental health by reducing levels of SHCs should pay special attention to stressors in adolescents' daily lives and strengthening adolescent's coping resources and strategies.

The Sequential Mediating Effects of Dietary Behavior and Perceived Stress on the Relationship between Subjective Socioeconomic Status and Multicultural Adolescent Health

Studies have examined the impact of social determinants of health on the health behaviors and health statuses of ethnic minority adolescents. This study examines the subjective health of this population by examining the direct effects of multicultural adolescents’ subjective socioeconomic status (SES) and the sequential mediating effects of their dietary behaviors and perceived stress. We utilized secondary data of 500 middle school students from multicultural families who participated in the 15th Korean Youth Health Behavior Survey, 2019. Information about SES, perceived stress, subjective health status, and dietary behavior (measured by the breakfast intake frequency during the prior week) were utilized. For the relationship between the SES and the subjective health status, we confirmed the sequential mediating effects of breakfast frequency and perceived stress using SPSS 25.0 and PROCESS macro with bootstrapping. The results showed that SES had a direct effect on subjective health status and indirectly influenced subjective health status through the sequential mediating effect of breakfast frequency and perceived stress. However, SES had no direct effects on perceived stress. These findings emphasize that broadening the community-health lens to consider the upstream factor of SES when preparing health promotion interventions is essential to achieving health equity for vulnerable populations.

Contraceptive provision in Oregon school-based health centers: Method type trends and the role of Title X

OBJECTIVE

We describe provision of contraception to adolescents at Oregon school-based health centers (SBHCs). We examine trends over time, by race/ethnicity, and by Title X clinic status and test whether these factors are associated with provision of long-acting reversible contraception (LARC; intrauterine devices/IUDs and implants).

STUDY DESIGN

We conducted a retrospective cohort study of 33 SBHCs participating in a shared electronic health record 2012-2016. We identified 20,339 contraception provision visits to 5,934 adolescent females ages 14-19 using diagnosis and procedure codes. We used logistic regression to evaluate the association of clinic Title X status, race/ethnicity, and year with receipt of LARC, controlling for individual-, clinic-, and residence-level factors. We calculated adjusted probabilities.

RESULTS

Provision of IUDs and implants increased at Oregon SBHCs between 2012 and 2016. IUD provision increased almost 5-fold, (from 0.9% to 4.4% of contraception provision visits), and implants increased approximately 6.5-fold (from 1.1% to 7.2%). More adolescent contraception provision visits occurred at Title X SBHCs, which had greater than twice the adjusted probability of providing LARCs than non-Title X SBHCs (4.4% versus 1.7%). After adjusting for adolescent-, clinic-, and residence-level covariates, non-white adolescents had lower probabilities of receiving LARC methods than white adolescents.

CONCLUSIONS

SBHCs play an important role in providing access to contraceptive services to adolescents in Oregon. Access to IUDs and implants is increasing over time in SBHCs, particularly those that participate in the Title X program.

IMPLICATIONS

Adolescents have expanding access to IUDs and implants in SBHCs over time in Oregon. Participation in the Title X program can help further increase access to effective contraception in SBHCs.

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

Socioeconomic status (SES) is a robust predictor of health disparities in adolescence and early adulthood, yet obtaining accurate and reliable measurements of family SES from younger participants remains a challenge. We evaluated the reliability and validity of a subjective SES measure, i.e., perceived family financial security (PFS), which assesses adolescents' perceptions of whether their family has enough money to meet their needs. We also examined the predictive associations of PFS and parental education (adolescent reports) with alcohol, marijuana, and tobacco use during adolescence and young adulthood. Longitudinal data were obtained from 593 parent-child dyads in the Pacific Northwest region of the United States, who were assessed eight times between 2005 and 2014. Present analyses included data from four annual assessments conducted when the participating children were adolescents (age range = 10.25-16.33 years) and a final follow-up in young adulthood (age range = 20-23.42 years). PFS had good test-retest reliability and convergent validity with other parent and adolescent reported SES measures. Adolescent-reported PFS significantly predicted tobacco use frequency in young adulthood, whereas adolescent-reported parental education predicted alcohol use frequency. PFS was not a significant predictor of alcohol or marijuana use. Findings suggest that PFS can be a psychometrically sound measure to assess a unique dimension of SES in adolescent samples, with differential predictive associations among substance use outcomes in young adulthood compared to more traditional measures like parental education. Future research should evaluate the psychometric properties and utility of PFS as a complementary SES measure.

Caries Prevalence and Severity for 12-Year-Old Children in Latvia

Objectives

To study caries prevalence/severity in 12-year-old children in Latvia and potential risk indicators.

Methods

A cross-sectional oral-health national survey of 12-year-old children was conducted in 2016. A nationally representative stratified-cluster probabilistic sample of 2,138 pupils in 92 schools was selected. Children were examined by seven calibrated examiners (kappa inter-examiner, intra-examiner scores of 0.71–0.77, 0.81–0.97, respectively) at school. Enamel-non-cavitated decay (D₁), enamel cavitation (D₃), dentine cavitation (D₅), missing (M) or filled (F) status at the tooth (T)/surface (S) levels were evaluated, and decayed, missing, and filled (DMF) index scores for severity, along with the Significant Caries Index (SiC), were calculated. An associated caries factor questionnaire was completed by participants.

Results

The prevalence of caries was 98.5% for D₁MFT, 79.7% for D₃MFT, and 71.9% for D₅MFT. The means (standard deviations) for severity were 9.2 (5.3) for D₁MFT, 3.3 (3.0) for D₃MFT, and 2.4 (2.4) for D₅MFT, and 5.6 (2.1) for the SiC. Indicators associated with a lower risk of caries (D5MFT) were irregular dental visits (prevalence odds ratio POR = 0.45, 95% confidence interval (CI): 0.36, 0.56) and irregular use of mouthwashes (POR = 0.73, 95% CI: 0.60, 0.89).

Conclusions

We found a high caries prevalence and severity in 12 year-old children in Latvia. Although the WHO target for 2010 (D₅MFT ≤ 3) is met, the values for caries prevalence (D₅MFT > 0 = 71.9%) and severity (D₅MFT = 2.5) in 12-year-old Latvian children are higher than the European averages (D₅MFT > 0 = 52%, D₅MFT = 1.1).

Cumulative socio-economic disadvantage and traumatic dental injuries during adolescence

BACKGROUND/AIM

Studies on the association between socio-economic circumstances and traumatic dental injuries (TDIs) are cross-sectional and inconclusive. The aim of this study was to investigate the association between cumulative socio-economic disadvantage and TDIs among adolescents.

METHOD

Data from 668 participants in the East London Adolescents Community Health Survey (RELACHS) were analysed. Family socio-economic indicators (parental employment, car ownership and eligibility for free school meals) were collected when participants were in grades 7 (11-12 years), 9 (13-14 years) and 11 (15-16 years). The number of periods (RELACHS waves) adolescents lived in socio-economic disadvantage was counted for each socio-economic measure, ranging from 0 (never in disadvantage) to 3 (always in disadvantage). Adolescents were dentally examined for TDIs at age 15-16 years. The association between each measure of cumulative socio-economic disadvantage and TDIs was tested in logistic regression models adjusting for demographic factors.

RESULTS

Significant positive linear trends in the prevalence of TDIs were observed by the number of periods of parental unemployment and being without a family car, but not by eligibility for free school meals. Adolescents whose parents were always unemployed had 2.06 (95% CI: 1.12-3.80) greater odds of having TDIs than those whose parents were never unemployed. Similarly, adolescents from families that never owned a car had 2.17 (95% CI: 1.26-3.74) greater odds of having TDIs than those that always had a family car.

CONCLUSION

Cumulative socio-economic disadvantage during adolescence was associated with greater odds of having TDIs.

Health-related quality of life in adolescents: individual and combined impact of health-related behaviors (DADOS study)

PURPOSE

To investigate the individual and combined effect of physical activity, adherence to the Mediterranean diet, sleep quality, sleep duration, and screen time on health-related quality of life (HRQoL) in adolescents.

METHODS

This is a cross-sectional analysis with 262 adolescents (13.9 ± 0.3 years) from DADOS (Deporte, ADOlescencia y Salud) study. Physical activity was assessed with a wrist-worn GENEActiv triaxial accelerometer. Adherence to the Mediterranean diet was evaluated by the KIDMED questionnaire. Sleep patterns were self-reported through the Spanish version of Pittsburgh Sleep Quality Index questionnaire. Screen time was assessed through the HELENA sedentary behavior questionnaire. HRQoL was measured using the KIDSCREEN-10 questionnaire. Scores were categorized into low and high using a normative cut-off used to identify factors associated with being in a high HRQoL group. A healthy lifestyle index was created including positive scores for each individual behavior, and five categories of achievement were established (0, 1, 2, 3, ≥ 4).

RESULTS

Sleep patterns and screen time revealed a significant individual relationship with HRQoL (p < 0.05). Adolescents achieving ≥ 3 positive health-related behaviors showed higher HRQoL levels compared to those fulfilling none (p < 0.05). Logistic regression analysis revealed an increased likelihood of high HRQoL according to the number of positive health-related behaviors achieved (p < 0.05).

CONCLUSIONS

Our results reveal higher levels of HRQoL in those adolescents achieving ≥ 3 health-related behaviors compared to their peers achieving none. Moreover, our findings show a cumulative effect of health-related behaviors on HRQoL. These findings underline the key role of promoting a healthy lifestyle in order to improve adolescents' health and well-being.

Personality and impulsivity as predictors of tobacco use among emerging adults: A latent class analysis

The tobacco industry markets their products toward emerging adults (18-29), with the goal of increasing use among this age group. To inform prevention efforts, researchers are investigating how specific demographic and psychological traits may predict tobacco initiation and continuation. Participants were 578 incoming university freshmen from the Appalachian region. Participants provided information on demographics, personality traits, impulsivity characteristics, lifetime use of cigarettes and electronic cigarettes (ECIGs), and current use of cigarettes, ECIGs, small cigars/cigarillos, large cigars, smokeless tobacco, and waterpipe. Latent class analysis identified tobacco-use classes and regressions identified psychological predictors of class membership. Participants were Nonusers, Experimenters, and Polytobacco Users. Lower agreeableness and conscientiousness as well as higher extraversion and neuroticism were associated with being Experimenters or Polytobacco Users. Lower impulsivity was associated with being Nonusers. Distinct types of emerging adults belong to each tobacco use class, suggesting that individual differences be incorporated in prevention efforts.

Physical inactivity, non-participation in sports and socioeconomic status: a large population-based study among Norwegian adolescents

Background

Physical activity in adolescence is found to promote both immediate and long-term health, as well as school- and work performance. Previous studies suggest that parental socioeconomic status (SES) may influence the level of activity, although the results are inconsistent. The objective of this study was to examine the overall level of low physical activity/sports participation and the associations with parental SES and adolescent school program in a population-based study of older adolescents.

Methods

The youth@hordalandy study, a large population-based study in Hordaland county, Norway, conducted in 2012, included 10,257 adolescents aged 16–19 years (53% girls). Physical activity was examined by self-reported overall activity, and participation in organized team- and individual sports. Predictor variables were parental SES measured by youth self-reports of family economic well-being, parental education and work affiliation and self-reported current high school program (vocational versus general studies). Age, ethnicity, and family structure were included as covariates.

Results

Girls who reported lower parental education had small, but significant higher risk for physical inactivity and non-participation in individual sports compared with their counterparts who reported higher family education (RRs ranging from 1.04 to 1.12, p < 0.01). There were some, but inconsistent, evidence of an increased risk for physical inactivity and non-participation in sports among those (and particularly boys) with lower family economic well-being. Parental work status was largely unrelated with physical inactivity/non-participation in sports. Adolescents in vocational studies had a small but significantly increased risk of physical inactivity and non-participation in sports compared with individuals in general studies (RRs ranging from 1.03 to 1.05, all p < 0.05).

Conclusions

We found some evidence of a social gradient for lower physical inactivity and non-participation in sports for adolescents. Although effect sizes were small, vocational studies was the most robust correlate for physical inactivity/non-participation in sports among the SES-variables, while the corresponding associations with parental education and family economic well-being differed by gender.

How do socioeconomic status relate to social relationships among adolescents: a school-based study in East China

Background

A great number of studies have concentrated on the influence of socioeconomic status with health outcomes, but little on how socioeconomic status affects social relationship in adolescents’ families, peers and schools. This study aimed to clarify more detailed information on the connection between social relationships and different dimensions of socioeconomic status.

Methods

A school-based cross-sectional study was performed by 13–18 adolescents enrolled in East China from September, 2018 to May, 2019, which recruited 6902 students from junior and senior high schools and used the stratified random sampling method. Parent-child relationship (cohesion, expressiveness, conflict), peer relationship (interpersonal relationship, communication and interaction, social emotion) and student-teacher relationship (intimacy, support, satisfaction, conflict) were investigated. Besides, objective socioeconomic status (parental education and occupation, assessed by the adolescent) and subjective socioeconomic status (self-evaluation of family social class) were measured. More detailed information was used to clarify the link between social relationships and different dimensions of socioeconomic status.

Results

All five indicators of socioeconomic status were slightly positively correlated with the quality of social relationships (r ranged from 0.036 to 0.189, all p < 0.001), except that maternal education was not correlated with the conflict dimension of parent-child relationship. Standardized regression coefficients indicated that paternal education (β = 0.08) and occupation (β = 0.07) were the predictors of parent-child relationship. And peer relationship model revealed that the corresponding effect size was slightly stronger for subjective socioeconomic status (β = 0.10), whereas the maternal education had a slightly stronger correlation with student-teacher relationship (β = 0.07) relative to other indicators.

Conclusions

Adolescents with lower socioeconomic status had poorer social relationships compared to those with higher socioeconomic status. These findings have important public health implications for health policy makers to make sound decisions on resources allocation and services planning in improving adolescents’ social relationships and promoting health outcomes.

Socioeconomic inequalities and the equity impact of population-level interventions for adolescent health: an overview of systematic reviews

OBJECTIVES

Despite robust evidence on health inequalities in adulthood, less attention has been paid to inequalities in adolescence. The aim of this overview was to examine systematic review (SR) evidence on the equity impact of population-level interventions intended to improve health, happiness and wellbeing for adolescents.

STUDY DESIGN

An overview (review of systematic reviews).

METHODS

Eleven electronic databases were systematically searched to identify SRs of population-level interventions for adolescent health. A secondary data analysis of socioeconomic inequality was conducted to identify whether SRs reported on primary studies in terms of disadvantage, by measures of socioeconomic status (SES) and by differential effects.

RESULTS

35,310 review titles were screened; 566 full texts were retrieved and 140 SRs met the predefined selection criteria. Differential intervention effects were considered in 42/140 (30%) SRs, 18/140 (13%) reported primary studies using an SES measure and 16/140 (11%) explicitly reported differential effects. 15/140 SRs (11%) explicitly focused on socioeconomic inequalities; of these 4/15 reported differential intervention effects in more detail, 7/15 concluded there was insufficient primary evidence to identify the impact of interventions on socioeconomic inequalities and 4/15 planned to examine differential effects by SES, but this was not reported further.

CONCLUSIONS

Our overview identifies that there is limited SR evidence on the equity impact of population-level interventions for adolescent health. Strengthening the evidence on whether interventions narrow or widen inequalities for adolescents must be a priority for public health research.

A trial protocol for the effectiveness of digital interventions for preventing depression in adolescents: The Future Proofing Study

BACKGROUND

Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years. Despite advances in treatment, there has been limited progress in addressing the burden at a population level. Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression. Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs. Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes. The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression.

METHODS

A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted. In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator. The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia. At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition. Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline. Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models.

DISCUSSION

This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale. Results from this trial will provide much-needed insight into the feasibility of this approach. They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123. Registered on 31 May 2019. Clinical Trial Notification Scheme (CTN), CT-2019-CTN-02110-1-v1. Registered on 30 June 2019.

Does Life Satisfaction Mediate the Association between Socioeconomic Status and Excessive Internet Use?

Excessive Internet use is becoming a rapidly increasing problem in today’s society. Our aim was to assess the association between socioeconomic status (SES) of the family and excessive Internet use (EIU), and whether life satisfaction mediates this association. We analyzed data from a representative sample of 2844 Slovak adolescents (mean age 14.34, 50.5% boys) from the 2014 Health Behavior in School aged Children (HBSC) study, based on self-report questionnaires. We assessed the association of SES, measured by several indicators, such as perceived family wealth, parental education, and (un)employment, and adolescent EIU using linear regression, adding life satisfaction as a mediator. Adolescents whose father was unemployed and whose perceived family wealth was low tended to score higher on EIU. Neither gender nor age affected this relationship. Life satisfaction mediated a part of the association between SES and EIU in the case of low perceived family wealth and father’s (un)employment. Adolescents with a low SES are more likely to become excessive Internet users, and life satisfaction mediates this association. Prevention of EIU among adolescents should be targeted at those with low SES, with life satisfaction being the topic to address.

Adolescent Socioeconomic Status and Mental Health Inequalities in the Netherlands, 2001-2017

Even in wealthy countries there are substantial socioeconomic inequalities in adolescent mental health. Socioeconomic status (SES) indicators-parental SES, adolescent subjective SES and adolescent educational level-are negatively associated with adolescent mental health problems, but little is known about the interplay between these SES indicators and whether associations have changed over time. Using data from the Dutch Health Behaviour in School-Aged Children (HBSC) studies (n = 27,020) between 2001 and 2017, we examined associations between three SES indicators and six indicators of adolescent mental health problems. Linear regressions revealed that adolescent subjective SES and adolescent educational level were independently negatively associated with adolescent mental health problems and positively associated with adolescent life satisfaction, but parental SES had negligible independent associations with adolescent mental health problems and life satisfaction. However, when interactions between SES indicators were considered, high adolescent subjective SES was shown to buffer the negative association between parental SES and adolescent mental health problems and the positive association between parental SES and life satisfaction. Despite societal changes between 2001 and 2017, socioeconomic inequalities in adolescent mental health were stable during this period. Findings suggest that all three SES indicators-parental SES, adolescent subjective SES and adolescent educational level-are important for studying socioeconomic inequalities in adolescent mental health.

Economic Circumstances in Childhood and Subsequent Substance Use in Adolescence - A Latent Class Analysis: The youth@hordaland Study

The aim of the present study was to investigate the association between longitudinal registry-based data on family income during childhood and self-reported substance use in adolescence, including potential alcohol- or drug problems. Data from the Norwegian population-based youth@hordaland-survey was employed, and the analyzed included n = 8,983 adolescents aged 16–19 years. This information was linked to registry-based information about childhood family income for seven consecutive years prior to adolescents’ participation in the youth@hordaland-survey. Latent class analyses (LCA) were used to examine associations between patterns of family economic circumstances in childhood and subsequent substance use in adolescence. Based on the LCA, we identified four distinct patterns of family economic circumstances: a ‘never poor’ (89.3%) group, followed by two groups characterized by moving in (3.0%) or out (4.6%) of poverty, and a final ‘chronically poor’ (3.1%) group. Several findings were of interest: the chronically poor reported less daily snus use, fewer had tried alcohol, were less likely to report frequent intoxication, and less prone to have potential alcohol- or drug-related problems compared to all other groups. They were also less likely to have tried any illicit drug compared to those moving in or out of poverty. Finally, the chronically poor reported more daily smoking than the never poor group, but less daily smoking than the moving out of poverty group. The never poor group was less likely to have tried any illicit drugs compared to the groups moving into or out of poverty, and less likely to smoke daily compared to the moving out of poverty group. In other words, the present study somewhat surprisingly suggested lower substance use among the chronically poor adolescents compared to other adolescents on several of the measures of substance use.

Trends in socioeconomic differences in daily smoking among 15-year-old Danes 1991–2014

Aim: To examine trends in socioeconomic differences in daily smoking among 15-year-old Danes between 1991–2014, using occupational social class as indicator of socioeconomic status. Methods: The study included 15-year-olds participating in seven Danish Health Behaviour in School-aged Children studies between 1991–2014, n = 8,641. The analyses focused on absolute socioeconomic differences (prevalence difference between low and high occupational social class) and relative socioeconomic differences communicated by odds ratio for daily smoking. Results: The prevalence of daily smoking declined from 18.6% in 1991 to 4.5% in 2014. Across all surveys, the prevalence was 8.9% in high, 12.8% in middle and 16.5% in low occupational social classes ( p < 0.0001). The absolute socioeconomic differences increased from 1991 to 2006 and declined thereafter. Across all survey years, the odds ratio (95% confidence interval) for daily smoking was 1.40 (1.19–1.65) in middle and 1.90 (1.56-2.32) in low versus high occupational social classes. The statistical interaction between occupational social class and survey year was significant ( p = 0.0404), suggesting increasing relative socioeconomic differences from 1991 to 2014. Conclusions: There was a substantial decline in daily smoking among 15-year-olds between 1991–2014 in all occupational social class groups. The prevalence of daily smoking was highest in the low occupational social class during the entire period. The absolute socioeconomic differences in daily smoking increased between 1991–2006 and declined thereafter. The relative socioeconomic differences increased over 1991–2014. Studies of change in socioeconomic differences over time should address both absolute and relative socioeconomic differences as they may result in different conclusions and because important improvement in prevalence patterns may be disguised by exclusive focus on changes in relative socioeconomic differences.

The Longitudinal Association between Perceived Powerlessness and Sexual Risk Behaviors among Urban Youth: Mediating and Moderating Effects

A distal psychosocial factor, perceived powerlessness, has been found to predict various sexual risk behaviors among youth, yet no studies have assessed mediators or moderators in this relationship. Using a demographically diverse, longitudinal sample of urban youth (N = 257), this study assessed whether the need for sexual validation mediates the relationship between perceived powerlessness and sexual risk behaviors and to assess whether this mediated pathway is moderated by socioeconomic status and gender. The mean age of the participants was 21 years old (range: 15-24) and the majority of the sample identified as Black (65%) and female (62%). The results of structural equation modeling showed that the need for sexual validation mediated perceived powerlessness and condomless sex at last sex among Black youth. The need for sexual validation mediated perceived powerlessness and concurrent sexual partnerships among White youth and depended on levels of socioeconomic status. Sexual risk behavior interventions should provide youth with increased opportunities that encourage feelings of validation from other personal achievements in addition to sex while simultaneously addressing the structural conditions that drive young people to feel powerless.