Successful schools and risky behaviors among low-income adolescents

Associations of connectedness and parental behaviors with adolescent physical activity and mental health during COVID-19: A mediation analysis using the 2021 adolescent behaviors and experiences survey

The purpose of this study was to examine the associations of connectedness and parental behaviors with adolescent physical activity (PA) and mental health during COVID-19. Participants were a representative sample of US high school students who completed the 2021 Adolescent Behaviors and Experiences Survey (ABES; N = 7705; 50.4% female). ABES was completed online during the spring of 2021 and data were analyzed during the spring of 2022. Independent variables were items asking about perceived school and virtual connectedness, parental emotional abuse, and parental monitoring. Latent variables represented both PA and mental health. Two weighted structural equation models tested the associations between connectedness, parental behaviors, and mental health mediated through PA (Model 1) and between connectedness, parental behaviors, and PA mediated through mental health (Model 2) with indirect effect confidence intervals obtained using Monte Carlo simulations. School connectedness directly associated with better mental health in Model 1 (β = 0.17, p < 0.001) and with higher PA in Model 2 (β = 0.19, p < 0.001) while virtual connectedness directly associated with higher PA in Model 2 (β = 0.08, p < 0.001). Parental emotional abuse directly associated with poorer mental health in Model 1 (β = -0.43, p < 0.001). Standardized indirect effects to better mental health mediated through higher PA were observed for school connectedness (IE = 0.017, p < 0.001) and virtual connectedness (IE = 0.007, p < 0.001) and indirect effects to lower PA mediated through poorer mental health were observed for parental emotional abuse (IE = -0.050, p < 0.001). Perceptions of school and virtual connectedness and parental emotional abuse both directly and indirectly impacted adolescent PA and mental health during the COVID-19 pandemic.

Turning Vicious Cycles Into Virtuous Ones: the Potential for Schools to Improve the Life Course

Adolescence is a critical transition period that sets the stage for adulthood and future health outcomes. Marked by key developmental milestones in brain maturation, increasing independence from parents, and greater connections to peers, adolescence is also a time of heightened risk for behavioral health problems, including substance use, violence, delinquency, and mental health issues. High school completion is a significant life course event and a powerful social determinant of health and health disparities. Jessor's Theory of Problem Behavior suggests that adolescent health behaviors and mental health problems are closely tied to poor educational outcomes and peer network formation in a reinforcing feedback loop, or vicious cycle, often leading to school failure, school disengagement, and drop-out. Schools are a novel platform through which vicious cycles can be disrupted and replaced with virtuous ones, simultaneously improving education and health. This article describes the potential for schools to transform health trajectories through interventions creating positive and supportive school climates. In addition, new models such as the Whole School Whole Community Whole Child Model promote whole child well-being, including cognitive, social, emotional, psychological, and physical development. Full-service community schools can serve as a hub coordinating and integrating all available resources to better respond to the needs of children and families. Present in every neighborhood, schools are a way to reach every school-age child and improve their health trajectories, providing an important platform for life course intervention research.

The role of primary school composition in affective decision-making: a prospective cohort study

PURPOSE

School-level characteristics are known to be associated with pupils' academic and cognitive ability but also their socioemotional development. This study examines, for the first time, whether primary school characteristics are associated with pupils' affective decision-making too.

METHODS

The sample included 3,141 children participating in the Millennium Cohort Study with available data on their school's characteristics, according to the National Pupil Database, at age 7 years. Decision-making was measured using the Cambridge Gambling Task at age 11 years. We modelled data using a series of sex-stratified linear regression analyses of decision-making (risk-taking, quality of decision-making, risk adjustment, deliberation time, and delay aversion) against four indicators of school composition (academic performance and proportions among pupils who are native speakers of English, are eligible for free school meals and have special educational needs).

RESULTS

After adjustment for individual and family-level confounding, schools with a higher average academic performance showed more delay aversion among males, and among females, higher deliberation time and lower risk-taking. Schools with proportionally more native English speakers had higher deliberation time among males. Schools with proportionally more pupils eligible for free school meals showed lower scores on quality of decision-making among males. Schools with proportionally more children with special educational needs showed better quality of decision-making among males and lower risk-taking among females.

CONCLUSION

The findings of this study can be used to target support for primary schools. Interventions aiming to support lower-achieving schools and those with less affluent intakes could help to improve boys' affective decision-making.

Associations of Physical Activity, School Safety, and Non-Prescription Steroid Use in Adolescents: A Structural Equation Modeling Approach

Non-prescription steroid use can negatively impact adolescent physical and mental health and wellbeing. Determining correlates of this risk behavior is needed to help mitigate its prevalence. Two potential correlates are physical activity and school safety. The purpose of this study was to examine the associations of physical activity, school safety, and non-prescription steroid use within a sample of adolescents from the 2015-2019 US National Youth Risk Behavior Survey (YRBS). A multi-stage cluster sampling procedure yielded a representative sample of US adolescents from the 2015-2019 YRBS (n = 44,066; 49.6% female). Two latent variables indicating physical activity and unsafe schools were the independent variables. The dependent variable was a self-report of non-prescription steroid use. A weighted structural equation model examined the associations between physical activity and unsafe schools with non-prescription steroid use, controlling for age, sex, BMI %tile, race/ethnicity, and sexual minority status. The latent physical activity variable did not associate with non-prescription steroid use (β = 0.007, 95%CI: -0.01-0.02, p = 0.436); however, the unsafe schools latent variable did associate with non-prescription steroid use (β = 0.64, 95%CI: 0.59-0.69, p < 0.001). An unsafe school environment may be a determinant of non-prescription steroid use in adolescents. Physical activity behaviors did not associate with steroid use.

Psychosocial school environment and health risk behaviours of adolescents in Bulgaria: results from multilevel analysis

OBJECTIVES

The paper aims to study the relationships between psychosocial school environment and health risk behaviours (cigarette smoking, alcohol consumption, drunkenness, bullying perpetration and early start of sexual life) in a representative sample of Bulgarian adolescents.

METHODS

We apply multilevel analysis, using data from the Bulgarian 2017/2018 "Health Behaviour in School-aged Children (HBSC)" Study.

RESULTS

There is a significant variation between schools in Bulgaria in the proportions of students who smoke cigarettes, drink alcohol, get drunk and have an early start of sexual life. Lower school satisfaction is significantly associated with higher odds of smoking and drunkenness. The effect of school pressure differs for smoking and bullying perpetration. The effect of student support also differs for certain types of health risk behaviours. Higher student support is positively associated with frequent alcohol consumption and drunkenness. The relationship between teacher support and alcohol abuse is negative.

CONCLUSIONS

There is a significant association between characteristics of psychosocial school environment and Bulgarian adolescents' risk health behaviours (cigarette smoking, alcohol consumption, drunkenness, bullying perpetration). Comprehensive and effective health promotion policies in Bulgarian schools are needed in order to facilitate healthy lifestyles.

The Role of Primary School Composition in the Trajectories of Internalising and Externalising Problems across Childhood and Adolescence

There is little research on the role of school and its composition in explaining individual children’s psychological outcomes. This study examined for the first time the role of several primary-school compositional characteristics, and their interactions with individual level characteristics, in the development of two such outcomes, internalising and externalising problems, at ages 7, 11 and 14 years in 4794 children in England participating in the Millennium Cohort Study. Using hierarchical (multilevel) linear models, we found that, even after adjusting for individual and family characteristics, children in schools with higher proportions of pupils eligible for free school meals had more externalising problems. In general, children with special educational needs, lower academic performance, more distressed mothers, and those in non-intact families had more internalising and externalising problems. Our results underline the importance of targeting schools with less affluent overall intakes, but also highlight the key role of individual and family characteristics in the development of their pupils’ psychological functioning.

Assessment of Exposure to High-Performing Schools and Risk of Adolescent Substance Use: A Natural Experiment

IMPORTANCE

Although school environments are thought to influence health behaviors, experimental data assessing causality are lacking, and which aspects of school environments may be most important for adolescent health are unknown.

OBJECTIVE

To test whether exposure to high-performing schools is associated with risky adolescent health behaviors.

DESIGN, SETTING, AND PARTICIPANTS

This natural experiment used admission lotteries, which mimic random assignment, to estimate the association of school environments and adolescent health. A survey of 1270 students who applied to at least 1 of 5 high-performing public charter schools in low-income minority communities in Los Angeles, California. Schools had an academic performance ranked in the top tertile of Los Angeles County public high schools, applicants outnumbered available seats by at least 50, and an admissions lottery was used. Participants included lottery winners (intervention group [n = 694]) and lottery losers (control group [n = 576]) from the end of 8th grade and beginning of 9th grade through the end of 11th grade. Intention-to-treat (ITT) and instrumental variable techniques estimated the association of winning the lottery and attending high-performing schools with health behaviors and whether the association varied by sex. Data were collected from March 11, 2013, through February 22, 2017, and analyzed from October 1, 2017, through July 1, 2018.

EXPOSURES

Schools were considered high performing if they placed in the top tercile of public high schools in LA County on 2012 state standardized tests. Most students attended that same school for 3 years (9th-11th grades).

MAIN OUTCOMES AND MEASURES

Primary self-reported outcomes were 30-day and high-risk self-reported marijuana use. Additional health outcomes included 30-day alcohol use, alcohol misuse, ever being in a fight, ever having sex, and past-year delinquency. Potential intermediate factors (time studying, truancy, school mobility, school culture, school order, teacher support for college, and proportion of substance-using peers in students' social networks) were also examined.

RESULTS

Among the 1270 participating students (52.6% female; mean [SD] age at enrollment, 14.3 [0.5] years), ITT analysis showed that the intervention group reported less marijuana misuse than the control group (mean marijuana misuse score, 0.46 vs 0.71), as well as fewer substance-using peers (9.6% vs 12.7%), more time studying (mean, 2.63 vs 2.49 hours), less truancy (84.3% vs 77.3% with no truancy), greater teacher support for college (mean scores, 7.20 vs 7.02), more orderly schools (mean order score, 7.06 vs 6.83), and less school mobility (21.4% vs 28.4%) (all P < .05). Stratified analyses suggest that among boys, intervention participants had significantly lower marijuana use (mean misuse score, 0.43 vs 0.88; difference, -0.45; 95% CI, -0.78 to -0.13) and alcohol misuse (mean misuse score, 0.52 vs 0.97; difference, -0.44; 95% CI, -0.80 to -0.09) scores compared with control participants, whereas no significant health outcomes were noted for girls.

CONCLUSIONS AND RELEVANCE

This natural experiment provides evidence that school environments can improve risky behaviors for low-income minority adolescents.

School Disciplinary Style and Adolescent Health

PURPOSE

Parenting style is strongly associated with adolescent health. However, little is known about how school disciplinary style relates to health. We categorized adolescents' perceptions of their schools as authoritative, authoritarian, permissive, or neglectful, and test whether perceived school disciplinary style is associated with health.

METHODS

We analyze data from the RISE Up study (Reducing Health Inequities Through Social and Educational Change Follow-up), comprised of baseline (eighth grade) and 2-year follow-up surveys (10th grade) from 1,159 low-income minority adolescents in Los Angeles attending 157 schools. At 10th grade, students' ratings of school support and structure were used to categorize perceived school disciplinary style as authoritative (highest tertile for support and structure), authoritarian (low support, high structure), permissive (high support, low structure), neglectful (low on both dimensions), and average (middle tertile on either dimension). Mixed effects logistic regressions controlling for sociodemographic factors, parenting style, grades, and baseline health tested whether school disciplinary style was associated with substance use, violence, bullying, and depression symptoms.

RESULTS

Risky behaviors varied by school disciplinary style. After adjusting for covariates, compared with an average school disciplinary style, a neglectful school was associated with higher odds of substance use (adjusted odds ratio [AOR] 2.3, p < .001) and bullying (AOR 1.5, p = .02), a permissive school was associated with higher odds of depression symptoms (AOR 2.1, p = .04), and an authoritative school was associated with lower odds of substance use (AOR .6, p = .049), violence (AOR .6, p = .03), and bullying (AOR .5, p = .001).

CONCLUSIONS

Structured and supportive school environments may impact the health of vulnerable adolescents.

The Role of Social-Emotional and Social Network Factors in the Relationship Between Academic Achievement and Risky Behaviors

BACKGROUND

We examined whether standardized test scores and grades are related to risky behaviors among low-income minority adolescents and whether social networks and social-emotional factors explained those relationships.

METHODS

We analyzed data from 929 high school students exposed by natural experiment to high- or low-performing academic environments in Los Angeles. We collected information on grade point average (GPA), substance use, sexual behaviors, participation in fights, and carrying a weapon from face-to-face interviews and obtained California math and English standardized test results. Logistic regression and mediation analyses were used to examine the relationship between achievement and risky behaviors.

RESULTS

Better GPA and California standardized test scores were strongly associated with lower rates of substance use, high-risk sexual behaviors, and fighting. The unadjusted relative odds of monthly binge drinking was 0.72 (95% confidence interval, 0.56-0.93) for 1 SD increase in standardized test scores and 0.46 (95% confidence interval, 0.29-0.74) for GPA of B- or higher compared with C+ or lower. Most associations disappeared after controlling for social-emotional and social network factors. Averaged across the risky behaviors, mediation analysis revealed social-emotional factors accounted for 33% of the relationship between test scores and risky behaviors and 43% of the relationship between GPA with risky behaviors. Social network characteristics accounted for 31% and 38% of the relationship between behaviors with test scores and GPA, respectively. Demographic factors, parenting, and school characteristics were less important explanatory factors.

CONCLUSIONS

Social-emotional factors and social network characteristics were the strongest explanatory factors of the achievement-risky behavior relationship and might be important to understanding the relationship between academic achievement and risky behaviors.

Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis

Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both individual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10; OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau²=0.0, I²=0%), but not tobacco or alcohol use. A similar result was found when studies assessed as high risk of bias were excluded. Overall intervention effects were evident for illicit substance use within multiple intervention characteristic subgroups, but not tobacco and alcohol. Such results support the implementation of universal school-based interventions that address 'resilience' protective factors to reduce adolescent illicit substance use, however suggest alternate approaches are required for tobacco and alcohol use. PROSPERO registration: CRD42014004906.

What Do You Want to Be When You Grow up? Career Aspirations as a Marker for Adolescent Well-being

OBJECTIVE

"What do you want to be when you grow up?" is a simple, commonly asked question that might provide insight into adolescent well-being. Career aspirations might reflect an adolescent's sense of identity, hope for the future, and self-efficacy, all of which are critical to identifying at-risk youth and intervening on risky behaviors. However, there are no studies on whether career aspirations are associated with adolescent emotional and health behavior outcomes.

METHODS

We analyzed cross-sectional surveys of 929 ninth to 12th grade low-income minority adolescents in Los Angeles assessing career aspirations and its association with hopelessness, self-efficacy, substance use, violence, and risky sexual activity. We used Department of Labor statistics to categorize career aspirations according to amount of education required, income, and prestige. Generalized estimating equations accounted for sociodemographic characteristics, school type, academic performance, and clustering at the school level.

RESULTS

Grades, standardized test scores, and health behaviors varied according to career type. Adolescents with higher career aspirations, measured according to career-related education, income, and prestige reported less hopelessness and more self-efficacy. After adjusting for confounders, aspirations requiring high levels of education were associated with decreased odds of alcohol use, at-school substance use, and risky sexual activity, and higher prestige scores were associated with decreased odds of other drug use.

CONCLUSIONS

Career aspirations might be a marker for adolescent health and well-being. Adults might consider asking a teen what they want to be when they grow up to gain insight into their levels of hopelessness and self-efficacy and provide context for counseling on healthy behavior change.

How Urban Youth Perceive Relationships Among School Environments, Social Networks, Self-Concept, and Substance Use

OBJECTIVE

Studies suggest adolescent substance use aligns with academic and behavioral self-concept (whether teens think of themselves as good or bad students and as rule followers or rule breakers) as well as peer and adult social networks. Schools are an important context in which self-concept and social networks develop, but it remains unclear how school environments might be leveraged to promote healthy development and prevent substance use. We sought to describe how youth perceive the relationships among school environments, adolescent self-concept, social networks, and substance use.

METHODS

Semistructured interviews with 32 low-income minority youth (aged 17-22 years) who participated in a prior study, explored self-concept development, school environments, social networks, and substance use decisions. Recruitment was stratified by whether, during high school, they had healthy or unhealthy self-concept profiles and had engaged in or abstained from substance use.

RESULTS

Youth described feeling labeled by peers and teachers and how these labels became incorporated into their self-concept. Teachers who made students feel noticed (eg, by learning students' names) and had high academic expectations reinforced healthy self-concepts. Academic tracking, extracurricular activities, and school norms determined potential friendship networks, grouping students either with well-behaving or misbehaving peers. Youth described peer groups, combined with their self-concept, shaping their substance use decisions. Affirming healthy aspects of their self-concept at key risk behavior decision points helped youth avoid substance use in the face of peer pressure.

CONCLUSIONS

Youth narratives suggest school environments shape adolescent self-concept and adult and peer social networks, all of which impact substance use.

Teachers and Coaches in Adolescent Social Networks Are Associated With Healthier Self-Concept and Decreased Substance Use

BACKGROUND

Poor academic (eg, "I am a bad student") and behavioral (eg, "I am a troublemaker") self-concepts are strongly linked to adolescent substance use. Social networks likely influence self-concept. However, little is understood about the role teachers and athletic coaches play in shaping both academic and behavioral self-concepts.

METHODS

We analyzed cross-sectional surveys of 929 9th-12th grade low-income minority adolescents in Los Angeles assessing self-concept, social networks, and 30-day use of alcohol, marijuana and other drugs. We performed generalized estimating equations, accounting for clustering at the school level and controlling for family and peer influences and contextual factors. We also tested whether self-concept-mediated associations between relationships with teachers or coaches and 30-day substance use.

RESULTS

More perceived teacher support was associated with lower odds of marijuana and other drug use and better academic and behavioral self-concepts. Behavioral self-concept mediated the associations between teacher support and substance use.

CONCLUSIONS

By facilitating relationships with adults and improving teachers' capacity to build supportive environments, schools may positively shape how adolescents see themselves, which might help reduce adolescent substance use.

Profiles of Kindergarten Classroom and Elementary School Contexts: Associations with the First-Grade Outcomes of Children Transitioning from Head Start

Poor quality classroom and school contexts may impede the academic and behavioral adjustment of low-income students when they transition into kindergarten. Several studies have examined the impact of teacher-student interactions on student progress, whereas others have explored the impact of school-level adversity (e.g., student poverty, school achievement levels). Expanding on prior findings, this study used latent profile analysis to characterize kindergarten contexts in terms of both classroom teacher-student interaction quality and school-level adversity. Following 164 children longitudinally and accounting for functioning in Head Start prior to kindergarten entry, associations between kindergarten context profiles and first grade outcomes revealed that children who experienced dual-risk contexts in kindergarten (classrooms with poor quality teacher-student interactions in schools with high levels of adversity) demonstrated the greatest aggression and social difficulties in first grade. Associations between kindergarten context profiles and first grade academic outcomes were less clear.

Grit: A Potential Protective Factor Against Substance Use and Other Risk Behaviors Among Latino Adolescents

OBJECTIVE

Grit, defined as "working strenuously toward challenges, maintaining effort and interest over years despite failure, adversity, and plateaus in progress," is strongly associated with academic achievement and life success and may also be associated with health outcomes and behaviors. We examined predictors of grit, and the association between grit and health behaviors among at-risk Latino adolescents.

METHODS

We analyzed baseline survey data collected in 2013-2014 from a sample of 1270 9th graders in low-income neighborhoods of Los Angeles. We examined factors associated with grit and whether grit is associated with substance use and delinquent behaviors, controlling for adolescent and parent sociodemographic factors.

RESULTS

In a sample of mostly Latino adolescents (89.5%), compared to those with low grit, those with high grit had significantly lower odds of alcohol use in the last 30 days (odds ratio 0.30, P < .001), marijuana use (odds ratio 0.21, P < .05), and fighting (odds ratio 0.58, P < .05). Involvement in delinquent behavior was also lower (β = -0.71, P < .001). Factors associated with more grit included authoritative parenting style, parental employment, and high self-efficacy scores.

CONCLUSIONS

Grit may be an important candidate protective factor against substance use and other risk behaviors among Latino adolescents.

Chaos, Hubbub, and Order Scale and Health Risk Behaviors in Adolescents in Los Angeles

OBJECTIVE

To determine the relationship between household chaos and substance use, sexual activity, and violence-related risk behaviors in adolescents.

STUDY DESIGN

We analyzed cross-sectional data among 929 high-school students in Los Angeles who completed a 90-minute interview that assessed health behaviors and household chaos with the 14-question Chaos, Hubbub, and Order Scale (CHAOS). Using the generalized estimating equation and adjusting for personal, parental, and family covariates, we examined associations of CHAOS score with substance use, sexual activity, and violent behavior outcome variables. We also examined the role of depression and school engagement as mediators.

RESULTS

Mean (SD) age of the 929 students was 16.4 (1.3) years, 516 (55%) were female, and 780 (84%) were Latino. After adjustment, compared with students with CHAOS score 0, those students with the greatest scores (5-14) had ORs of 3.1 (95% CI 1.1-8.7) for smoking, 2.6 (95% CI 1.6-4.4) for drinking, 6.1 (95% CI 1.8-21) for substance use at school, and 1.9 (95% CI 1.1-3.3) for fighting in the past 12 months. Associations between CHAOS score and sexual risk and other violent behaviors were not significant. Depression and school engagement attenuated the associations.

CONCLUSIONS

In this group of adolescents, greatest CHAOS score was associated with increased odds of risky health behaviors, with depression and school engagement as potential mediators. In the future, CHAOS score could be measured to assess risk for such behaviors or be a target for intervention to reduce chances of engaging in these behaviors.