Journal of Adolescent Health最新文献

Purpose: Family acceptance is a crucial protective factor for transgender and gender diverse (TGD) youth well-being. Few studies examine how families react to gender transitions by youth. This study aimed to examine whether families react differently when youth report different gender identities or when youth report gender-nonconforming expressions.

Methods: Data from 92 TGD youth from a community-based sample participated in up to 4 waves of surveys, 9 months apart (2012-2015). Three gender identity trajectories were identified: (1) youth who consistently identified as TGD (consistent TGD); (2) youth who were initially cisgender (CIS) but later identified as TGD (CIS→TGD); and (3) youth who identified as TGD but later identified as CIS (TGD→CIS). Patterns of family acceptance over time were analyzed using hierarchical linear modeling, including within-person (time-varying) and between-person associations.

Results: Youth who reported consistent TGD identities reported less family acceptance at baseline, and stable and low family acceptance across time; youth who initially identified as CIS and later as TGD reported a pattern of decreasing family acceptance (b = -0.41, p = .004). Current gender nonconformity (but not gender nonconformity in childhood) was associated with lower family acceptance (between-person level: b = -0.22, p = .005; within-person level: b = -0.12, p = .058).

Discussion: In a community-based sample of gender-diverse youth, family acceptance corresponds to gender identity and current gender expression (rather than gender expression earlier in childhood). Interventions should help families of TGD youth, particularly of those whose gender expression is nonconforming, understand gender-diverse identities.

Purpose: Weight stigma is a common experience for adolescents at high weight statuses. Prior research regarding experiences of weight stigma in adolescence has been in primarily homogenous samples. The present study sought to characterize weight stigma experiences and internalization in adolescents from low-income backgrounds. This was done by reporting on teen's experiences of weight stigma in daily life and in conversations with health-care professionals, and examining the effect of internalization of this stigma.

Methods: This study is a secondary analysis of semi-structured qualitative interviews conducted with adolescents with high weight from low-income backgrounds who had been referred to weight management, as well as their caregivers. Data was analyzed using applied thematic analysis.

Results: Fifty-five participants (29 adolescents and 26 caregivers) from low-income backgrounds participated in semi-structured interviews. Given the broader focus of the primary study, weight stigma was not a focus of interviews. However, almost all participants identified weight stigma and bias as influencing their lives and medical care. Identified themes included the following: (1) difficulty identifying preferences regarding weight-related terminology; (2) commonality of experienced weight stigma; and (3) significant effect of internalized weight bias on adolescent daily living.

Discussion: Overall, the present study identified nearly ubiquitous experiences of weight stigma for a sample of youth from low-income backgrounds living in larger bodies. This highlights the pervasive presence of weight stigma and bias throughout adolescents' lives, including in health-care settings. These findings are particularly stark, given that weight stigma was not a topic within the interview guide.

Purpose: Research has rarely examined biobehavioral factors in mitigating substance use (SU) risks associated with discrimination among racially and ethnically minoritized youth. This study investigated sleep duration as a potential moderator of the association between multiple forms of discrimination based on race and ethnicity, sexual orientation, and weight (i.e., multiple discrimination) and subsequent SU intention in this population.

Methods: Data were drawn from a national, longitudinal sample of racially and ethnically minoritized early adolescents (N = 3,495, M_age = 11.52 years) participating in the Adolescent Brain Cognitive Development Study. Multiple discrimination was assessed through aggregated youth reports at 1-year follow-up (Y1) and 2-year follow-up (Y2). Sleep duration was assessed at Y2 via self-reports in the full sample and actigraphy over 3 weeks in a subsample (N = 1,404). Youth reported SU intention at Y2 and 3-year follow-up (Y3). Relevant sociodemographic and psychosocial covariates were included.

Results: Path analyses showed that more exposure to multiple discrimination was associated with greater subsequent SU intention, controlling for prior SU intention levels. However, this association was only significant among adolescents with shorter sleep duration on weekdays, not among those who slept longer (above 9.6 hours based on self-reports or 7.5 hours based on actigraphy) on weekdays. Actigraphy sleep duration mean and variability also exhibited nuanced linkages with subsequent SU intention.

Discussion: Findings highlighted sleep duration as a promising lever of change for preventative interventions aiming to curb SU among racially and ethnically minoritized youth in early development.

The purpose of this systematic review is to assess evidence for an association between opioid misuse and suicide-related outcomes among youth and young adults (aged 12-30 years). A Boolean search strategy of eligible publications from January 1990 to June 2024 identified 2,696 independent citations. An additional 10 were identified through reference screening. A total of 55 publications met the inclusion criteria. Twelve studies used administrative data and 43 were based on observational data. Risk of bias was assessed qualitatively by domain. Nearly all (98%) studies using observational data found an association between opioid misuse and at least one suicide-related outcome (e.g., suicidal ideation, suicide plan, suicide attempt). Administrative data studies had higher risk of bias compared with observational studies, typically due to higher confounding bias. Reporting bias was moderate to high across all studies in the review. Our review provides clear evidence of the association between opioid misuse and suicide-related outcomes among youth and young adults. However, we highlight a need for longitudinal research on the directionality of the association and potential mechanisms.

Purpose: We hypothesized that extended exposure to the COVID-19 pandemic and government lockdown was associated with increased depression and anxiety symptoms among South African adolescents and a sense of school belonging mediated these relationships. We also hypothesized that poor mental health or school belonging impacted alcohol consumption.

Methods: Embedded in the Asenze Cohort Study, data were collected from adolescents between 2019 and 2021. The Patient Health Questionnaire, General Anxiety Disorder questionnaire and Psychological Sense of School Membership scale were used to measure depression, anxiety, and school belonging, respectively. Alcohol consumption was a cumulative score of the total number of days alcohol was consumed in the previous 30 days. Lockdown exposure was the number of months participants were exposed to lockdown conditions. Structural equation modeling was used to assess the relationship between the outcome variables.

Results: Among 866 adolescents included in the analysis, approximately 20% met the symptom criteria for moderate or severe depression or anxiety. The mean school belonging score was high (23; SD = 5.79) and alcohol consumption low. Lockdown exposure was not directly or indirectly associated with depression or anxiety symptoms. A greater sense of school belonging reduced both depression and anxiety symptoms.

Discussion: This study contradicts previous studies and suggests that lockdown was not associated with poor mental health in this cohort of adolescents. School belonging was high despite school closures and associated with lower depression and anxiety. Research around school belonging and how it can be promoted to better support isolated students is recommended.

Purpose: Existing literature has provided limited and inconsistent findings regarding disparities in mental health and mental health care utilization among racial and ethnic subgroups of sexual and gender minority adolescents (SGMA). This study aimed to investigate racial and ethnic disparities in mental health and care utilization among SGMA.

Methods: Data from a large national sample of SGMA who participated in the 2022 Lesbian, Gay, Bisexual, Transgender and Queer National Teen Survey (N = 9,691) were analyzed. Symptoms of depression and anxiety were assessed using the patient health questionnaire-4. Mental health care utilization was classified as follow: (1) received; (2) wished for but not received (indicating unmet mental health care needs); and (3) neither wished for nor received.

Results: Compared to White SGMA, Black/African American SGMA were less likely to report anxiety symptoms (adjusted prevalence ratio = 0.89, 95% confidence intervals [CIs] = 0.82-0.97). No significant racial and ethnic differences in depression symptoms were observed among SGMA. Regarding mental health care utilization, Asian or Asian American (adjusted relative risk ratio [ARRR] = 2.07, 95% CIs = 1.62-2.64), Black/African American (ARRR = 1.80, 95% CIs = 1.41-2.28), and Hispanic/Latino SGMA (ARRR = 1.32, 95% CIs = 1.16-1.51) were more likely to report unmet mental health care needs than White SGMA.

Discussion: Despite the lack of major and consistent racial and ethnic differences in anxiety and depression symptoms documented in our sample, Asian or Asian American, Black/African American, and Hispanic/Latino SGMA were more likely to report unmet mental health care needs than their White counterparts. This finding highlights the need to address barriers to mental health care for racially and ethnically minoritized SGMA.

Purpose: Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth are at high suicide risk. Family/peer connectedness may be protective factors; few studies assess social connectedness within cisgender lesbian, gay, bisexual, and queer (cis-LGBQ) and transgender and gender-diverse (TGD) samples. This study aims to identify associations between family/peer connectedness and suicidal thoughts/behaviors (STBs) among cisgender-LGBQ and TGD youth to better inform suicide prevention strategies.

Methods: This study utilized data from LGBTQ youth aged 12-17 in the Emergency Department Screen for Teens at Risk for Suicide study. Youth completed measures for STBs (Ask Suicide-Screening Questions and Columbia Suicide Severity Rating Scale) and family/peer connectedness ("low," "moderate," and "high"). Logistic regression analyses examined associations between family/peer connectedness and STBs in cis-LGBQ and TGD youth.

Results: 53.2% (607/1,140) of cis-LGBQ and 69.7% (99/142) of TGD youth self-reported STBs. For cis-LGBQ youth, the odds of reporting STBs increased when comparing low/moderate versus high family connectedness (p < .001, adjOR = 9.8[6.8-14.2]; p < .001, adjOR = 3.5[2.7-4.7]) and low versus moderate (p < .001, adjOR = 2.8[1.9-4.0]). Regarding cis-LGBQ peer connectedness, the odds of reporting STBs increased when comparing low/moderate versus high (p < .01, adjOR = 1.8[1.2-2.7]; p < .05, adjOR = 1.5[1.1-2.1]), not low versus moderate (p = .4). For TGD youth, the odds of reporting STBs significantly increased when comparing low/moderate versus high family connectedness (p < .001, adjOR = 9.8[3.7-28.2]; p < .001, adjOR = 7.7[2.8-22.8]), not when comparing low versus moderate (p = .7). Peer connectedness levels had no significant associations with TGD youths' STB rates (p = .2, p = .3, p = .8).

Discussion: LGBTQ, especially TGD youth, are at elevated suicide risk. High levels of family connectedness may especially help mitigate suicide risk in TGD youth. Future research should replicate findings in larger TGD samples and adapt LGBTQ-specific, family-based emergency department interventions.