Journal of Adolescent Health最新文献

Purpose: Adverse childhood experiences (ACEs) increase the risk for poor adolescent mental health, yet mediational pathways that connect ACEs with mental health problems remain unaddressed. Our study investigates whether school involvement and disengagement mediate the longitudinal associations between ACEs and adolescent mental health problems.

Methods: Using data from the longitudinal Adolescent Brain Cognitive Development Study, this study included 7,558 adolescents aged 9-10 years at baseline. ACEs were a cumulative risk score of 21 adverse experiences (e.g., emotional abuse, community violence) reported by parents and youths at baseline or 1-year follow-up. School involvement and disengagement were reported by youths at two-year follow-up. Internalizing and externalizing problems were reported by parents using the Child Behavior Checklist at 3-year follow-up.

Results: A higher ACE score was associated with decreased school involvement (β = -0.08, 95% CI = [-0.10, -0.05]) and increased school disengagement (β = 0.09, 95% CI = [0.06, 0.11]) one year later, and with increased internalizing (β = 0.10, 95% CI = [0.07, 0.12]) and externalizing problems (β = 0.08, 95% CI = [0.06, 0.10]) 2 years later, adjusted for demographics and baseline mental health and school engagement levels. Decreased school involvement and increased disengagement mediated the associations between ACEs with the change in internalizing and externalizing problems over time.

Discussion: The present study highlights the roles of school involvement and disengagement in linking ACEs to worsened mental health outcomes. The findings may inform tailored school-based interventions that address mental health challenges faced by adolescents exposed to ACEs.

Purpose: Building on research suggesting that the COVID-19 pandemic may have led to an exacerbation of deteriorating trends in mental health among adolescents, this paper examined trends in adolescents' psychological and somatic complaints across 35 countries from 2010 to 2022, and tested trends in sociodemographic inequalities in these outcomes between 2018 and 2022.

Methods: Using data from 792,606 adolescents from 35 countries (51% girls; mean age = 13.5; standard deviation 1.6) across four Health Behaviour in School-aged Children surveys (2010, 2014, 2018, 2022), hierarchical multilevel models estimated cross-national trends in adolescent psychological and somatic complaints. We tested whether observed values in 2022 were in line with predicted values based on 2010-2018 linear trends. Finally, moderation effects of age, family affluence, and family structures on the outcomes were tested (2018-2022).

Results: Both girls and boys showed substantially higher levels of psychological complaints in 2022 compared with the predicted values. For somatic complaints, higher levels than predicted in 2022 were observed only in girls. Moderation analyses revealed an increase from 2018 to 2022 in age gaps and a narrowing in the socioeconomic gap for both outcomes. Also, there was a widening gap between adolescents living with 2 parents and those living in a single parent household in 2022 compared to 2018.

Discussion: Cross-national increases in adolescent psychological and somatic complaints were higher than expected in 2022, based on previous trends. Magnitudes of change varied across different sociodemographics groups, with implications for pre-existing mental health inequalities.

Purpose: Persistent self-control in the context of upward mobility in low-income adolescents, especially those of color, may have physiological costs, such as greater risks of developing cardiometabolic diseases in young adulthood. One potential mechanism linking self-control to cardiometabolic health is epigenetic age acceleration (EAA). However, little is known regarding the association between high self-control and EAA, as well as what factors may play protective roles. Therefore, we evaluated (1) the association between self-control and EAA and if this association varies by race and ethnicity, and (2) whether neighborhood collective efficacy (NCE) and school connectedness moderate the association in low-income adolescents.

Methods: This study used data from the Future of Families and Child Wellbeing Study. Participants included 772 adolescents with a household income <300% of poverty level (mean age: 15.6 years). Self-control, NCE, and school connectedness were all self-reported. EAA was assessed in saliva and estimated using Horvath, Skin and Blood, and Pediatric-Buccal-Epigenetic clocks. Multiple linear regression and PROCESS analyses were employed.

Results: Higher self-control was positively associated with EAA estimated by the skin and blood clock in low-income adolescents of color. Further, the association of higher self-control with EAA was not significant among low-income adolescents of color with higher NCE. No significant association was found among low-income White adolescents.

Discussion: The results suggest that supportive resources like neighborhood collective efficacy could mitigate adverse associations of high self-control with health in low-income adolescents of color.

Purpose: To examine the implementation and effectiveness of a contraception care intervention for adolescents hospitalized with psychiatric disorders.

Methods: This prospective, observational, hybrid type 2 effectiveness-implementation study examined the effectiveness of the Contraception Care at the Behavioral Health Pavilion (CC@BHP) intervention in 4 inpatient psychiatric units at a quaternary children's hospital. A multifaceted implementation blueprint guided implementation. CC@BHP is a clinical pathway intervention designed to increase access to contraceptive counseling and initiation during hospitalization. Eligible patients were assigned female at birth, at least 14 years old, and admitted to one of four units between December 2021 and February 2023. Implementation outcomes were provider adoption (documentation of assessing interest in contraception care) and intervention reach (order placed for contraception consultation). Intervention effectiveness outcomes assessed downstream health service access, including patient receipt of contraception consultation and contraceptive prescription/initiation.

Results: Across 1,461 visits, the mean patient age was 15.9 years and 63.4% were White. Forty percent (n = 586) of visits included at least one intervention component. Overall, healthcare providers adopted CC@BHP in 29.0% (n = 424) of visits and ordered contraception consultations in 19.1% (n = 279) of visits (reach). Adolescents received contraception consultations in 16.7% (n = 244) of visits and 116 patients (7.9%) initiated a contraceptive (effectiveness). Later study waves demonstrated greater adoption and reach.

Discussion: Implementation improved over time and CC@BHP delivered contraceptive counseling and initiation, including implants and intrauterine devices, in a large quaternary hospital to interested adolescents. Inpatient psychiatry admissions offer a timely opportunity to address reproductive health needs of adolescents.

Purpose: This study aimed to shed light on the mental health of a unique group of medically transitioning transgender adolescents: those who had made a binary social transition during childhood and who, in general, had not experienced substantial gender-incongruent puberty.

Methods: Study participants were part of a broader longitudinal study comprising 3 groups: transgender youth, their cisgender siblings, and unrelated cisgender peers. Using multilevel models, we compared self-reported and parent-reported levels of anxiety and depressive symptoms among transgender youth at 3 stages: before youth had begun puberty blockers; after they had begun blockers; and after they had begun hormone therapy. We also compared age-based mental health trajectories in transgender and cisgender youth.

Results: In this sample of transgender youth who sought and received gender-affirming medical care, participants experienced stable and relatively low levels of psychological distress across stages of medical transition and across time. There was one exception: transgender girls showed increased, followed by decreased, parent-reported depressive symptoms over time. In contrast, cisgender girls showed increases in internalizing symptomatology (with the exception of parent-reported anxiety) as they got older, and cisgender boys showed decreased self-reported anxiety and increased, followed by decreased, parent-reported depressive symptoms. By mid-adolescence, levels of anxiety and depressive symptoms among transgender girls and transgender boys generally fell between those of cisgender girls and cisgender boys.

Discussion: Results demonstrate that transgender youth who are socially and medically supported in their gender identity can experience stable and positive mental health throughout the notoriously challenging developmental period of adolescence.

Purpose: To study how COVID-19 stress-related factors and changes in psychosocial resources during the pandemic contributed to changes in mental health symptoms among first-year college students during the pandemic.

Methods: Using data on 339 first-year students (ages 18-20) at a large public university in North Carolina, we evaluated changes in anxiety and depression symptoms from before to early and later stages of the COVID-19 pandemic. Additionally, we estimated longitudinal associations of chronic stress, COVID-19 stress/stressors and psychosocial resources with anxiety and depression symptoms using a first-difference model.

Results: We found that mental health symptoms increased significantly 4 months into the pandemic. Eighteen months into the pandemic, depression symptoms had returned to prepandemic levels, but anxiety symptoms had not. Chronic stress, social isolation, and distanced learning were significant risk factors; resilience was significantly protective. Results varied by the presence/absence of moderate-severe anxiety/depression symptoms prepandemic.

Discussion: Mental health symptoms for first-year college students were at already high levels prepandemic and have not improved 18 months into the pandemic. Colleges may help address this growing mental health crisis through bolstering social connectedness and resilience.

Purpose: Limiting time with friends (LTWF), a facet of parental monitoring, may be protective for newly incident adolescent alcohol, tobacco cigarette, and cannabis use.

Methods: We extended epidemiological evidence based on estimates from nationally representative samples of US adolescents aged 12-17 years, across 18 years of independent samples of the National Survey on Drug Use and Health (2002-2019). We estimated the prevalence of always LTWF, and odds ratios examining incident alcohol, tobacco cigarette, and cannabis use by LTWF within age and cohort.

Results: The prevalence of always LTWF decreased with older age within study year and cohort. The odds of alcohol initiation were lower among youth reporting their parents were always LTWF. The odds of tobacco cigarette and cannabis initiation were lower among younger youth reporting their parents were always LTWF.

Discussion: Future research is needed to fully understand the influence of LTWF on incident substance use, particularly for older adolescents.

Purpose: Teen economic abuse (TEA) is an understudied form of adolescent relationship abuse with limited measures available to assess prevalence. The purpose of this article is to assess the underlying dimensions of survey items (developed with youth) to refine measurement of and validate the structures comprising TEA and examine differences in prevalence of TEA perpetration (Prp) and victimization (Vct) by demographic characteristics.

Methods: This cross-sectional, online survey was conducted between July and September 2021. Youth ages 13-19 who read English and reside in the United States were eligible to complete this study. Recruitment occurred through a national violence prevention listserv with an emphasis on reaching organizations serving youth who are unhoused, juvenile justice and child welfare-system involved, identifying as sexual or gender minorities, or from communities of color. Based on exploratory and confirmatory factor analysis, negative binomial regression models were run to assess associations of demographic characteristics, with levels of TEA Vct and Prp.

Results: Adolescents who identify as White reported significantly more types of TEA exposures than their American Indian or Alaskan Native (adjusted incident rate ratios = 1.3; 95% CI = [1.1, 1.4]), Hispanic Latino (1.2 [1.1, 1.4]), and Multiracial peers (2.4 [1.8, 3.1]). Gender diverse adolescents (1.14 [1, 1.3]) and cisgender females (1.08 [1, 1.2]) had significantly more types of TEA exposures than cisgender males. Those with past-year physical or sexual violence in dating relationships reported more types of TEA exposures (4.1 [3.8, 4.4]) than those who had not experienced such violence. Adolescents with exposure to foster care or homelessness had more types of TEA (1.3 [1.2, 1.4]) than those without such experiences.

Discussion: Healthcare providers serving youth should be aware of how economic abuse manifests in adolescent relationships when providing support and resources for youth, especially those who are system-involved or experiencing housing instability. Findings also highlight the need for education about TEA and economic justice in violence prevention programs.

Purpose: Structural racism and racial discrimination may increase adverse sexual health outcomes in Black adolescent girls. However, the influence of racism on sexual health has not been well-described in qualitative studies. The purpose of this study was to explore definitions of structural racism and determine how experiences of racial discrimination impact sexual health and decision-making in a sample of adolescent Black girls.

Methods: Black girls aged 13-19 years were recruited from an ongoing longitudinal study. Virtual focus groups and individual interviews were facilitated, inquiring about understandings of structural racism, experiences with discrimination, and factors that influence sexual health decision-making and healthcare-seeking. Transcripts were professionally transcribed and coded by two independent, blinded team members. Thematic content analysis was used to identify emergent themes.

Results: Four themes emerged as follows: (1) slavery and medical racism in the United States impact the sexual and reproductive health (SRH) choices of Black girls; (2) stereotypes and oversexualization of Black girls are considered a barrier to SRH education; (3) adults serve as both barriers and facilitators to SRH and resource utilization; and (4) Black girls often seek information from friends or social media outlets to make SRH decisions.

Discussion: Reproductive health education for Black girls should integrate historical influences of systemic oppression. Practitioners should include reproductive justice to build trust in clinical and community spaces. Engaging caregivers in health education may reduce barriers for youth to engage in care.