Journal of Adolescent Health最新文献

Purpose: To evaluate temporal trends and drivers of mortality among younger adults (aged 18-39), from 1999 to 2021.

Methods: Observational study using nationally representative United States mortality data from 1999 to 2021, acquired via the US Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research database. Exposure of interest was cause of death. Primary outcomes were population-level mortality rates and percent increase from 1999 to 2021. Secondary outcomes were cause-specific and subgroup-specific (sex, race, ethnicity) mortality rates and percent increases.

Results: From 1999 to 2021, US younger adults aged 18-39 experienced a 54.1% increase in annual mortality (from 113.4 deaths per 100,000 in 1999 to 174.7 deaths per 100,000 in 2021; Cochran-Armitage p < .0001). Before COVID, from 1999 to 2019, younger adults experienced a 10.8% increase in mortality, compared to a 1.5% increase among the broader US population. The top driver of increased younger adult mortality, from 1999 through 2021, was accidental poisoning and exposure to noxious substances. Mortality trends varied by demographic variables with notable increases among American Indian/Alaskan Native Americans.

Discussion: US younger adults are suffering from rising premature mortality. Resources should be calibrated to better support this generation.

Purpose: No-test medication abortion involves a teleconsultation, gestational age dating by last menstrual period (LMP), and home-use of medicines. In England and Wales, British Pregnancy Advisory Service (BPAS) and MSI Reproductive Choices UK (MSIUK) began offering no-test medication abortion to patients of all ages with pregnancies ≤69 days' gestation in April 2020. In May 2021, BPAS changed policy; adolescents aged 15 years and less could initiate care via teleconsultation but must have an in-person safeguarding assessment review (screening for harm/abuse/neglect), and an ultrasound. We assessed the impact of this change on accessibility, safeguarding, and gestational age estimation.

Methods: We compared waiting time from first contact to abortion, abortions conducted at ≤6 and ≤10 weeks' gestation, and safeguarding referrals to support organizations using routine data from BPAS or MSIUK for abortion patients aged 15 years and less over 5 months before and after BPAS' policy change. For BPAS patients postpolicy change, we determined safeguarding referral source (teleconsultation/in-person) and diagnostic accuracy of LMP and other menstrual history features versus ultrasound for determining gestational age.

Results: Between December 1, 2020 and September 30, 2021, 614 adolescents were treated. Postpolicy change, median waiting time from the first contact to abortion at BPAS significantly increased (7 vs. 11 days, p < .001) and proportion of abortions provided within 1 week of contact decreased (52.7% vs. 25.9%, p < .01). Both were stable at MSIUK (9 vs. 9 days [p = .59]; 38.2% vs. 39.2% [p = .99]). At BPAS, all indicated safeguarding referrals were identified at initial teleconsultation. Ten of 201 BPAS patients (5.0%) became ineligible for medication abortion (gestation > 69 days) while waiting for routine ultrasound; both LMP and ultrasound dating suggested eligibility (gestation ≤ 69 days) at first contact.

Discussion: Requiring in-person adolescent consultation is associated with reduced access to medication abortion without enhancing safeguarding.

Purpose: Since Crisis Pregnancy Centers (CPCs) are known to target college and university (CU) students, the purpose of this analysis was to describe the spatial proximity between CUs and CPCs in the United States by driving distance.

Methods: Using 2021 data from CPC Map and the US Department of Education's Integrated Postsecondary Education Data System survey, we generated buffer zones around each public and private not-for-profit CU based on driving distance (miles) and examined CPC locations within each buffer. We calculated distances from each CU to the nearest CPC nationally and by state. We then calculated the total number and percentage of female undergraduate students enrolled in CUs with at least one CPC within 3 miles.

Results: A total of 2,546 CPCs and 3,391 CUs were included in the analyses. Nationally, the median driving distance to the nearest CPC was 3.5 miles. In 67% of states, the minimum driving distance to the nearest CPC was less than 0.5 miles. Most (51.5%) undergraduate women were enrolled in a CU with a CPC within 3 miles. Percentages of CUs with at least one CPC within 3 driving miles were highest among private-not-for-profit institutions, CUs with higher student enrollment, doctoral degree conferring CUs, and CUs located in the West South Central and Middle Atlantic subregions.

Discussion: CPCs were located in close proximity to CUs. Efforts to increase awareness about CPCs and their risks and assist students in finding quality sources of care and information may be warranted.

Purpose: We investigated the influence of COVID-19 pandemic-related factors and cultural identification on indicators of alcohol-exposed pregnancy (AEP) risk among urban American Indian and Alaska Native (AIAN) youth ages 16-20.

Methods: Path analysis was used to evaluate associations among measures collected at baseline of the Native WYSE CHOICES, an intervention study to reduce AEP risk among urban AIAN youth. Data were collected nationally from 439 female-at-birth AIAN youth (mean age 18.1 years) residing in urban areas.

Results: Identification with Native American culture and heritage was significantly and positively associated with self-efficacy to abstain from alcohol (β = 0.178; p < .001), and, indirectly, significantly and negatively associated with the risk of AEP (β = -0.046; p = .001). Alternatively, distress about the pandemic's consequences for Native American communities and experiencing economic impacts exacerbated by the COVID-19 pandemic were significantly and negatively associated with self-efficacy to abstain from alcohol (respectively: β = -0.165, p < .01; β = -0.126, p < .01) and, indirectly, significantly and positively associated with risk of AEP (respectively: β = 0.043, p < .01; β = 0.033, p < .05).

Discussion: Results underscore the protective role that connectedness to Native American culture and heritage plays directly and indirectly in AEP risk potential. Conversely, the experience of economic barriers and distress over loss of Native American population and culture are direct and indirect risk factors for potential AEP risk. Development of future AEP interventions for urban AIAN young adults should consider Native American cultural identification, historical trauma, and economic impacts in program design and implementation.

Purpose: Social media present opportunities to intervene on harmful rape myth beliefs among adolescents and young adults, such as through digital bystander intervention.

Methods: We conducted a digital experiment to examine young peoples' willingness to intervene on rape myth comments in a simulated social media environment. Participants were adolescents and young adults (n = 712) aged 18-25 years (M = 22.14, SD = 1.92). Participants randomly viewed social media posts with the following: (1) rape myth comments, (2) rape myth comments with bystander intervention comments, or (3) control condition with only neutral comments. Participants then reported willingness to intervene, gender stereotype agreement, alcohol rape myth acceptance, and perceived normativity of bystander behavior.

Results: Rape myth comments (with or without bystander comments) led to greater willingness to intervene among participants. Alcohol rape myth acceptance, perceived normativity of bystander behavior, and gender (women vs. men) were all significant moderators of this relationship. Participants susceptible to alcohol rape myths and those who were men were less willing to intervene in the rape myth and rape myth + bystander conditions. Participants who perceived bystander behavior to be less normal were more willing to intervene in the rape myth-only condition.

Discussion: This study explored attitudes of young people exposed to harmful rape myth comments on social media. Future studies should continue this work, especially pursuing ways to reduce undesirable moderation effects of alcohol rape myths and gender.

The United States Advisory Committee on Immunization Practices recommends routine vaccination against meningococcal serogroups A, C, W, and Y for all aged 11-12 years (with a booster dose for age 16 years) and vaccination against meningococcal serogroup B (MenB) for ages 16-23 years under shared clinical decision-making (SCDM). Considering the Advisory Committee on Immunization Practices' ongoing revision of the adolescent meningococcal vaccine schedule, it is important to capture the perspectives of key stakeholders (adolescents and young adults, parents, and health-care providers) in order to understand barriers to meningococcal vaccination. We conducted a targeted literature search and narrative review of survey-based studies to consolidate available evidence on knowledge, attitudes, and practices among these stakeholders since the MenB recommendation in 2015. Our study identified persistent knowledge gaps regarding invasive meningococcal disease (IMD) risks, MenB, and SCDM among patients, parents, and health-care providers, suggesting that SCDM may not be consistently taking place. Simplifying the meningococcal vaccination schedule may more broadly protect United States adolescents and young adults against IMD and should be accompanied by efforts to increase knowledge and awareness among patients and parents regarding IMD and MenB.

Purpose: E-cigarette use among adolescents and young adults (AYAs) remains prevalent in the United States and is linked with combustible tobacco product use. This study examines sociodemographic differences (i.e., sex, age, sexual identity, transgender identity, race, ethnicity, and income) in transitions from e-cigarette use to other forms of tobacco use among AYAs from 2014 to 2023.

Methods: AYAs aged 14-25 years from the nationally representative Population Assessment of Tobacco and Health study waves 2-7 (2014/15-2022/23) were used to examine transitions in e-cigarette and combustible tobacco use over 1-to-2-year periods (n = 7,523). Using multinomial logistic regression models, we examined associations of sociodemographic characteristics and wave with e-cigarette and combustible tobacco transitions.

Results: Maintaining e-cigarette use only (21.2% in 2014/15-49.2% in 2022/23) and transitioning from e-cigarette and combustible use (i.e., dual use) to e-cigarettes only (7.6% in 2014/15-29.7% in 2022/23) increased over time. Simultaneously, transitioning from e-cigarettes to dual use (18.2% in 2014/15-17.9% in 2022/23) and maintaining dual use remained steady. Bisexual individuals were more likely to transition from e-cigarette use only to dual use (adjusted relative risk ratio = 2.07; 95% confidence interval = 1.44, 2.99) and maintain dual use (adjusted relative risk ratio = 2.01; 95% confidence interval = 1.43, 2.84), compared to heterosexual individuals. Female, Hispanic, and Black individuals were less likely to transition to dual use or maintain dual use compared to male, non-Hispanic, and White individuals, respectively.

Discussion: Findings identify important sociodemographic groups at greater risk of transitions to combustible tobacco use that warrant attention in future research and prevention strategies to reduce health disparities.

Purpose: Using nationally representative surveys with internet-using children aged 12-17 across 13 countries in Eastern and Southern Africa and Southeast Asia, the study aimed to examine attitudinal factors associated with sexting-related risk perception and analyze the extent to which risk perception is correlated with sexting behavior.

Methods: Multivariate linear regression with risk perception as the outcome variable was conducted. Slopes were plotted per country, with risk perception and sexting (having shared naked pictures or videos of self online in the past year) as the outcome, to examine the relationship between risk perception and sexting behavior across countries.

Results: More risk-averse attitudes were consistently positively associated with risk perception in almost all countries. Plotted slopes of risk perception and sexting, in turn, showed that higher risk perception was associated with reduced sexting, with similar directionality across all countries. However, the levels varied, e.g., in Thailand and Cambodia, risk perception had a similar effect on sexting (same slope) but at substantially different levels: those who sext in Thailand still have higher concerns (risk perception = 4) than those who do not sext in Cambodia (risk perception = 3).

Discussion: The finding that less restrictive attitudes and lower risk perception were correlated with sexting aligns with literature in the field, although the range of risk perception thresholds associated with sexting was noteworthy. The study provides some support for the importance of developing tailored approaches that take into consideration the psychological as well as contextual factors affecting sexting, as opposed to one-size-fits-all methods.

Purpose: Sexual minority women and gender diverse youth in the United States experience disparities in sexual and reproductive health. We evaluated whether sexual partner type, identity, and attraction were associated with healthcare disclosure, and whether healthcare disclosure was associated with sexual and reproductive healthcare receipt in a sample of sexual minority and gender diverse youth aged 18-24 years assigned female at birth.

Methods: 103 youth assigned female at birth completed a behavioral health survey. Data were analyzed to determine whether healthcare disclosure was associated with receipt of the human papillomavirus (HPV) vaccine, human immunodeficiency virus (HIV) testing, contraception method, and long-acting reversible contraception. We examined whether sexual partner type, identity, and attraction were associated with healthcare disclosure.

Results: Over half of the 103 participants self-identified as Black (78%) and had at least one female partner (55%); 14.6% identified as gender diverse. 51.5% received an HPV vaccine, 52.4% were HIV tested in the last year, 38.8% received any contraception method, and 19.4% received long-acting reversible contraception. The majority (63.1%) of youth reported healthcare disclosure. Healthcare disclosure was associated with sexual and reproductive healthcare receipt. Participants who had only male partners, identified as heterosexual or were unsure of their sexual identity were less likely to disclose their sexual orientation and receive HIV and HPV services.

Discussion: Reducing barriers to healthcare disclosure and care receipt will be critical to overcoming sexual and reproductive health disparities for all youth.

Purpose: This study investigated mental health outcomes among young adults who experienced direct police contact - including unfair or aggressive policing - in the past year.

Methods: Data came from 2019 participants enrolled in the nationally representative 2021 Transition to Adulthood Supplement of the Panel Study of Income Dynamics. Descriptive analyses provided population-based prevalence estimates of police contact measures (including being stopped unfairly, being frisked or searched, and officer verbal or physical aggression) in the overall sample and stratified by key sociodemographic factors. Linear regression models quantified associations between police contact and mental health domains (i.e., psychological distress, depressive symptoms, anxiety symptoms, and well-being), adjusting for sociodemographic factors and participants' history of arrest.

Results: Males, lesbian, gay, or bisexual individuals, and those with lower levels of education reported the highest prevalence of frequent police contact (i.e., ≥2 times in a 12-month period). When considering aggressive policing, stark racial disparities emerged, with Black young adults exhibiting the highest prevalence. Net of covariates, more frequent police contact was associated with poorer mental health, with comparable effect estimates observed across all outcome domains. When considering unfair and aggressive policing, experiencing an unfair stop was the most strongly and consistently associated with higher levels of psychological distress (β = 0.44, 95% confidence interval [CI] = 0.00, 0.88), depression (β = 0.48, 95% CI = 0.15, 0.81), and anxiety (β = 0.53, 95% CI = 0.17, 0.90).

Discussion: Our findings underscore the need to implement policies and procedures that curtail frequent, unfair, and aggressive policing and surveillance of U.S. young adults - especially in minoritized and underresourced communities.