Journal of Adolescent Health最新文献

Purpose: In 2019, the United States raised the minimum legal age (MLA) of sales for all tobacco products from 18 to 21. Public awareness of the federal MLA of tobacco sales overall and by demographics is understudied.

Methods: A national, cross-sectional 2023 survey in which 6,098 participants aged 13-40 years responded to the question, "at which age is it legal to purchase [e-cigarettes; cigarettes; alcohol] in the United States?" Participants also reported age, sex, race/ethnicity, and prior use of each substance.

Results: Sixty-one percent, 64.6%, and 88.7% correctly identified the MLA of sales for e-cigarettes, cigarettes, and alcohol, respectively. Differences in awareness of the MLA were found by age, sex, race/ethnicity, and prior use status.

Discussion: Gaps in awareness of the MLA of tobacco sales, particularly among adolescents and adults, suggest messaging regarding the federal Tobacco 21 law is needed.

Purpose: As natural disasters become more frequent and more severe, there is a corresponding need to understand their relationship with child and adolescent mental health, and in particular, to understand exposure to multiple natural disasters. This study assesses the relationship between exposure to both single and multiple disasters and adolescent internalising and externalising behavior.

Methods: The study used five waves of a nationally representative longitudinal Australian dataset. Exposure to sudden-onset (fires, floods, storms) and slow-onset (drought) disasters was collected across five waves. Adolescent internalising and externalising behavior collected in the final three waves using the self-reported Strengths and Difficulties Questionnaire. Random effects regressions assessed sudden- and slow-onset disasters and multiple disaster exposure, controlling for geographic and socioeconomic variables.

Results: Exposure to multiple disasters was associated with adverse adolescent outcomes. Two or more sudden- and slow-onset disaster exposures in the last 12 months was related to more conduct problems. Exposure to multiple sudden-onset disasters in the current and previous waves was related to increased problems with peers. A single exposure to either sudden- or slow-onset disasters was not associated with Strengths and Difficulties Questionnaire outcomes.

Discussion: The study findings suggest that multiple exposure to disasters has a negative association with adolescent wellbeing. These findings suggest that, rather than adapting to disasters, youth exposed to multiple disasters suffer more than their peers, including peers exposed to a single disaster.

Purpose: To survey United States (U.S.) pediatric hospital websites for information about fertility preservation (FP) for transgender patients. Secondarily, to identify hospital characteristics associated with higher likelihood of publishing transgender-specific FP content on websites.

Methods: This cross-sectional study included all U.S. pediatric hospitals from Children's Hospital Association excluding specialty hospitals. From September-December 2023, 2 independent researchers surveyed websites for: geographic location, academic affiliation, religious affiliation, presence of general and transgender-specific FP information, and specialties of FP providers. Fisher's exact and Pearson's Chi-square tests were used.

Results: Of 177 websites surveyed, 41% (n = 73) published FP information, largely targeted to oncology patients (90%, n = 66). Only 8% (n = 15) of all websites mentioned FP for transgender youth. Based on website information, most fertility programs included a medical oncologist (80%, n = 53); fewer included a urologist (32%, n = 21), pediatric gynecologist (27%, n = 18) or reproductive endocrinologist (RE, 21%, n = 14). About half (n = 31) referred to affiliate REs. Presence of transgender-specific FP website content ranged from 0% to 5% in Southern divisions to 20% in New England (median = 10%). Secular (p < .001) and academic (p = .04) hospital websites were significantly more likely to include FP content.

Discussion: Our findings highlight a gap in access to FP information for transgender youth on U.S. pediatric hospital websites. Few websites identify FP teams that include an RE or pediatric gynecologist, who specialize in FP for patients with ovaries. Access to FP information is critical to transgender youth who may desire genetically related children later in life. Strategies to assure this information is widely available are needed.

Purpose: This study aimed to examine changes in mental health among adolescents by comparing data from the period following the onset of the COVID-19 pandemic with the period before the pandemic.

Methods: We estimated the annual prevalence of stress perception, depressive symptoms, and suicidal ideation among middle and high school students using data from the Korean Youth Health Behavior Survey spanning from 2015 to 2022. We then compared mental health status across 2 periods-pre-COVID-19 (2015-2019) and during COVID-19 (2020-2022)-employing an interrupted time series analysis. We adjusted for covariates, such as household economic status, residence type, self-rated health, and history of hospitalization, due to violence.

Results: We analyzed data from 472,385 adolescents (242,819 boys and 230,016 girls). Stress perception, depressive symptoms, and suicidal ideation showed an increasing trend during the pre-COVID-19 period, followed by a decrease in the first year of the pandemic and an increasing trend in the second and third years. Boys experienced a faster increase in stress and depressive symptoms during the second and third years of the pandemic compared with the pre-COVID-19 period, whereas girls showed trends similar to those observed before the pandemic. Middle school students experienced a more rapid increase in these indicators than high school students during the second and third years.

Discussion: Adolescents' mental health initially improved in the first year of COVID-19 but worsened during the second and third years of the pandemic. This suggests a need for intervention policies and programs to support adolescent mental health.

Purpose: The objective of this study was to evaluate the effect of message frames (gain vs. loss) and sources (formal expert: a health-care professional vs. informal expert: an individual who successfully quit vaping) on the persuasiveness of TikTok videos among youth who currently use e-cigarettes. Additionally, the study examined how emotional responses and perceived message effectiveness (PME) mediate the framing effect on youth intention to quit vaping.

Methods: A 2 (gain frame vs. loss frame) × 2 (formal expert vs. informal expert) factorial design experiment was conducted with 378 youth aged 13 to 18 who currently use e-cigarettes. The study measured participant's emotional responses, PME of the messages, and intention to quit vaping after the video exposure.

Results: Messages from a formal expert resulted in stronger intention to quit vaping compared to messages from an informal expert. Gain-framed messages were associated with higher PME when delivered by an informal expert, whereas loss-framed messages showed stronger effects on PME from a formal expert. Positive emotional responses and increased PME mediated the relationship between gain-framed messages and youth intention to quit vaping.

Discussion: TikTok could serve as an effective tool for formal experts to promote vaping cessation among youth who use e-cigarettes. Additionally, the findings suggest that gain frames may be more influential than loss frames in promoting vaping cessation among youth, by eliciting positive emotional responses from the audience. The differential impact of message frames depending on source type indicates a nuanced interaction between content and messenger.

Purpose: Research indicates that loneliness and emotional and behavioral problems increase the risk of suicidal ideation in adolescents, but less is known about the distinct contributions of these problems. This study aimed to distinguish the pathways through which loneliness, internalizing problems, and externalizing problems contribute to suicidal ideation in Chinese adolescents.

Methods: We did a longitudinal mediation analysis with data collected at 3 time points (2021.05, 2021.10, and 2022.05) from 28 Taizhou high schools. Loneliness and suicidal ideation were assessed using the UCLA 3-Item Loneliness Scale and one suicide item from the Children's Depression Inventory, respectively. The Strength and Difficulties Questionnaire assessed internalizing (emotional and peer problems) and externalizing problems (conduct and hyperactivity problems). Structural equation modeling was used to construct complete longitudinal path models.

Results: Using data from 2,190 adolescents in junior and senior high schools, we found that loneliness, internalizing problems, and externalizing problems separately contributed to subsequent higher levels of suicidal ideation. Most notably, loneliness predicted worse subsequent internalizing problems (β = 0.279, p < .001) and externalizing problems (β = 0.159, p < .001), which in turn predicted more severe suicidal ideation (β = 0.019, p < .001; β = 0.018, p < .001). Loneliness also partially mediated the association between internalizing or externalizing problems and suicidal ideation.

Discussion: Loneliness, internalizing problems, and externalizing problems were strongly intertwined with suicidal ideation in adolescents. Public health initiatives could reduce loneliness and emotional and behavioral problems by implementing multifaceted interventions, thereby breaking the vicious circle and protecting against the development of suicidal ideation.

Purpose: Youth in the United States are experiencing mental health concerns at an unprecedented level. Child Psychiatry Access Programs offer an innovative approach to close the gap between the need for care and insufficient mental health workforce. This study examined whether primary care provider consultation with a Child Psychiatry Access Program, Michigan Clinical Consultation & Care (MC3), was associated with greater access to treatment for adolescents with moderate to severe depression symptoms.

Methods: A retrospective chart review was conducted of primary care visits between 2017 and 2021 for adolescent patients with first-time positive scores on the Patient Health Questionnaire-9. Descriptive statistics and logistic regression were used to examine if patients whose primary care provider used MC3 psychiatric consultations had improved access to depression treatment compared to those who did not.

Results: Four hundred seventy nine patients reported Patient Health Questionnaire-9 scores indicating moderate to severe depression symptoms. Compared to non-MC3 consult patients (n = 409), MC3 consult patients (n = 70) had higher odds of being prescribed antidepressant medications (odds ratio [OR], 2.16; 95% confidence interval [CI] [1.11-4.22], p = .05), 4 times higher odds of having a primary care follow-up visit to monitor depression symptoms (OR, 4.56, 95% CI [2.56-8.14], p < .001), and higher odds of accessing mental health therapy (OR, 2.14; 95% CI [1.13-4.05], p = .05).

Discussion: Use of MC3 consultations was associated with increased utilization of evidence-based depression treatments including medication, therapy, and follow-up care. Greater adoption of models such as MC3 may increase the capacity for addressing mental health needs in children.

Purpose: Adolescent mothers face heightened economic and social vulnerabilities, which can place them at increased risk of intimate partner violence (IPV), prepandemic, and during COVID-19. However, few studies examine this population, and even less disaggregate findings by HIV status.

Methods: We analyzed data from 834 South African adolescent mothers, 35% living with HIV (LHIV), who reported on physical, psychological, and sexual IPV exposure at two interviews: 2018-2019 (prepandemic) and 2021-2022 (during COVID-19). We estimated lifetime prevalence of IPV, disaggregating by HIV status. We used inverse weighted probability multivariate mixed-effects logistic regression to examine changes in IPV between the two periods and if changes in IPV differed by HIV status.

Results: A quarter of adolescent mothers had experienced any IPV during COVID-19, quadruple prepandemic levels (24.7% vs. 6.0%). The increase was driven by surges in physical (+15.7%) and psychological (+11.2%) IPV. In both periods, psychosocial and physical IPV were the most prevalent forms and the most common combination among those who had experienced multiple forms of IPV. Exposure to any IPV was significantly more prevalent among those LHIV compared to those without HIV, prepandemic (9.5% vs. 4.1%, p = .026) and during COVID-19 (31.8% vs. 20.6%, p < .001). Adjusted models revealed an 18.2% significant increase in the average predicted probability of reporting IPV during COVID-19 compared to prepandemic, with no differential effect by HIV status.

Discussion: Adolescent mothers experienced a significantly higher burden of IPV during COVID-19 than prepandemic, with those LHIV experiencing the highest level. Initiatives to reduce IPV need to reach adolescent mothers, particularly those living with HIV.

Purpose: Youth who are Not in Education, Employment, or Training (NEET) are at risk for numerous long-term occupational, social, and mental health-related sequelae. The aim of the present study was to investigate mediated pathways from early life risk factors to NEET status in early adulthood, with a particular focus on the role of the family environment during adolescence.

Methods: Participants were 6,403 respondents from the National Longitudinal Survey of Children and Youth, who were aged 10-11 years in cycles 1 (1994-1995) to 4 (2000-2001). Parents reported on indicators of early life adversity as well as parent-child conflict at age 12-13. Adolescents reported on their mental health and behaviour at age 14-15. NEET status was assessed at age 24 using tax information from the linked T1 Family File. Indirect pathways from childhood exposures, through adolescent factors, to NEET status in young adulthood were assessed via mediation analysis.

Results: At age 10/11, living with a single parent, low household income, stressful life events, and having a parent with a chronic condition were associated with greater likelihood of being NEET at age 24; parents' social support was negatively associated with NEET. These associations were mediated through parental depression at age 10/11, parent-child conflict at age 12/13, and adolescent mental health and behaviour at age 14/15.

Discussion: Our results add to a large body of literature linking family stressors, parental depression, parent-child interaction, and adolescent behaviour symptoms, suggesting a chain of influence through these factors toward young adult marginalization from the labour market.