Firearm access and adolescent health: Safety in numbers?

Access to firearms and perceived unsafe school environments are associated with negative adolescent health outcomes. Whether widespread acceptance of firearms alters these associations, however, is unknown. To address this literature gap, we examined whether peer acceptance of firearms moderates associations between personal firearm access and health outcomes. In 2018-2019, we analyzed Wave I of the National Longitudinal Study of Adolescent to Adult Health (collected 1994-1995) to assess personal firearm access and school-level percentage of firearm access, using weighted multilevel analyses with interactions to determine associations among personal access, school-level percentage of access, and adolescent depression, suicidality, general health, and perceived school safety. Models controlled for age, sex, race, region, urbanicity, family structure, parental income and education level, school type, school size, and school quality. Results showed that personal firearm access was associated with depression (OR 1.20 p = 0.03), suicidal ideation (OR 1.73, p < 0.001), and perceiving school as unsafe (OR 1.59, p < 0.001). A higher school-level percentage of access, however, was associated with lower rather than higher odds of perceiving school as unsafe (OR 0.83, p = 0.003). With interaction terms included, the association between personal access and suicidal ideation was weaker when school-level access was more common. Similarly, the association between school-level access and poor general health was negative among students with personal access but positive among students with no access. These findings suggest firearm access is a complex social phenomenon. In a low-access environment, personal firearm access may signify a high-risk physical and mental state. In schools where access is common, however, personal access may signify social belonging, possibly mitigating some potential negative health effects. Although evidence that firearm access is harmful remains clear, local norms may have a substantial moderating impact

Gender stigma awareness is associated with adolescent risky health behaviors.

ObjectivesAlthough racial stigma in school is associated with adolescent risky health behaviors, there are no studies investigating how gender stigma relates to adolescent risky health behaviors among low-income, minority youth. We sought to determine whether gender stigma awareness is associated with adolescent risky health behaviors (delinquency, fighting, and substance use) and whether this association is mediated by school disengagement (low perceived teacher support, low school engagement, cutting classes, and breaking school rules) among low-income, minority students.MethodsWe analyzed cross-sectional survey data, collected from 2017 to 2019, from 412 high school students. Multi-level logistic regressions tested whether gender stigma awareness was associated with delinquency, fighting, and substance use, controlling for covariates, baseline behaviors, and clustering within schools. Mediation analyses tested whether school disengagement (low school engagement, perceived teacher support, cutting class, and breaking school rules) mediated these associations. Secondary analyses explored whether associations differed for male versus female, high-performing versus low-performing, and Latinx versus non-Latinx students.ResultsIn this predominantly Latinx (83%) sample, gender stigma awareness was associated with delinquency (AOR = 1.48, P< 0.001) and fighting (AOR = 1.15, P< 0.001). School engagement, perceived teacher support, breaking school rules, and cutting classes mediated 42.7% of the association between gender stigma awareness and delinquency and 65.42% of the association between gender stigma awareness and fighting. Gender stigma awareness was also associated with substance use for low-performing (AOR = 1.68, P = 0.003) and non-Latinx adolescents (AOR = 3.80, P = 0.03). School disengagement did not mediate the association between gender stigma awareness and substance use for non-Latinx students but mediated 50% of this association for low-performing students.ConclusionsGender stigma awareness is associated with adolescent risky health behaviors. A decreased sense of acceptance in the school community and increased school misbehavior may mediate these associations. School environments that value and accept all students may better support adolescent health

School‐Based Health Center Utilization During COVID‐19 Pandemic‐Related School Closures

BackgroundLittle is known regarding utilization of school-based health centers (SBHCs) during prolonged school closures, such as those that occurred during the COVID-19 pandemic. We sought to compare SBHC utilization before and after pandemic-related school closures across a network of SBHCs affiliated with a large Southern Californian urban school district.MethodsWe conducted a secondary analysis of encounter data extracted from electronic health records from 12 SBHCs that remained open despite school closures, including patient demographics and diagnostic and billing codes. We used the Clinical Classifications Software Refined to group encounters for common primary care conditions. Utilization before and during pandemic-related school closures was compared using logistic regression with cluster-robust standard errors to account for clustering within clinics, after adjusting for month of encounter.ResultsDuring the pandemic, study SBHCs conducted 52,530 encounters and maintained ∼4040 encounters/month. The frequency of encounters for annual preventative health exams increased for school-aged patients but decreased for other age groups while the frequency of encounters for mental health problems increased for all age groups.Implications for school health policy, practice, and equityDespite pandemic-related school closures, SBHCs appeared play a critical role in providing primary care to vulnerable communities.ConclusionsSBHCs may hold value beyond their co-location with academic instruction

Adolescent Feelings on COVID-19 Distance Learning Support: Associations With Mental Health, Social-Emotional Health, Substance Use, and Delinquency

PurposeSchool social support is associated with improved adolescent wellbeing. However, positive school relationships were potentially disrupted when schools transitioned to distance learning in 2020 to mitigate the spread of COVID-19. This study investigated associations among perceived distance learning school support, mental health, social-emotional wellbeing, substance use, and delinquency among low-income, public high school students.MethodsWe analyzed longitudinal survey data, collected between June 2020 and June 2021, from 372 students attending five large urban public high schools. Mixed-effects regression models examined associations among changes in distance learning support and changes in mental health, social-emotional wellbeing, substance use, and delinquency, controlling for time, social-demographics, and baseline health.ResultsIn this predominantly Latinx (83%) sample, within-person increases in perceived distance learning support were associated with improved mental health, increased grit, increased self-efficacy, and decreased stress. Between-person differences in distance learning support indicated that students reporting greater support had improved mental and social-emotional outcomes. Although there were no within-person associations among distance learning support and hopelessness or delinquency, students with greater distance learning support (between-person) had lower levels of hopelessness and lower odds of engaging in any delinquent behavior. There were no associations between distance learning support and 30-day substance use.DiscussionSchool social support, even without students physically on campus, may be critical to adolescent health behaviors and social-emotional outcomes

How Does Incarcerating Young People Affect Their Adult Health Outcomes?

BACKGROUND AND OBJECTIVES: Despite the widespread epidemic of mass incarceration in the US, relatively little literature exists examining the longitudinal relationship between youth incarceration and adult health outcomes. We sought to quantify the association of youth incarceration with subsequent adult health outcomes. METHODS: We analyzed data from 14 344 adult participants in the National Longitudinal Study of Adolescent to Adult Health. We used weighted multivariate logistic regressions to investigate the relationship between cumulative incarceration duration (none, <1 month, 1–12 months, and >1 year) before Wave IV (ages 24–34 years) and subsequent adult health outcomes (general health, functional limitations, depressive symptoms, and suicidal thoughts). Models controlled for Wave I (grades 7–12) baseline health, sociodemographics, and covariates associated with incarceration and health. RESULTS: A total of 14.0% of adults reported being incarcerated between Waves I and IV. Of these, 50.3% reported a cumulative incarceration duration of <1 month, 34.8% reported 1 to 12 months, and 15.0% reported >1 year. Compared with no incarceration, incarceration duration of < 1 month predicted subsequent adult depressive symptoms (odds ratio [OR] = 1.41; 95% confidence interval [CI], 1.11–1.80; P = .005). A duration of 1 to 12 months predicted worse subsequent adult general health (OR = 1.48; 95% CI, 1.12–1.96; P = .007). A duration of >1 year predicted subsequent adult functional limitations (OR = 2.92; 95% CI, 1.51–5.64; P = .002), adult depressive symptoms (OR = 4.18; 95% CI, 2.48–7.06; P < .001), and adult suicidal thoughts (OR = 2.34; 95% CI, 1.09–5.01; P = .029). CONCLUSIONS: Cumulative incarceration duration during adolescence and early adulthood is independently associated with worse physical and mental health later in adulthood. Potential mechanisms merit exploration

How Does Incarcerating Young People Affect Their Adult Health Outcomes?

Background and objectivesDespite the widespread epidemic of mass incarceration in the US, relatively little literature exists examining the longitudinal relationship between youth incarceration and adult health outcomes. We sought to quantify the association of youth incarceration with subsequent adult health outcomes.MethodsWe analyzed data from 14 344 adult participants in the National Longitudinal Study of Adolescent to Adult Health. We used weighted multivariate logistic regressions to investigate the relationship between cumulative incarceration duration (none, &lt;1 month, 1-12 months, and &gt;1 year) before Wave IV (ages 24-34 years) and subsequent adult health outcomes (general health, functional limitations, depressive symptoms, and suicidal thoughts). Models controlled for Wave I (grades 7-12) baseline health, sociodemographics, and covariates associated with incarceration and health.ResultsA total of 14.0% of adults reported being incarcerated between Waves I and IV. Of these, 50.3% reported a cumulative incarceration duration of &lt;1 month, 34.8% reported 1 to 12 months, and 15.0% reported &gt;1 year. Compared with no incarceration, incarceration duration of &lt; 1 month predicted subsequent adult depressive symptoms (odds ratio [OR] = 1.41; 95% confidence interval [CI], 1.11-1.80; P = .005). A duration of 1 to 12 months predicted worse subsequent adult general health (OR = 1.48; 95% CI, 1.12-1.96; P = .007). A duration of &gt;1 year predicted subsequent adult functional limitations (OR = 2.92; 95% CI, 1.51-5.64; P = .002), adult depressive symptoms (OR = 4.18; 95% CI, 2.48-7.06; P &lt; .001), and adult suicidal thoughts (OR = 2.34; 95% CI, 1.09-5.01; P = .029).ConclusionsCumulative incarceration duration during adolescence and early adulthood is independently associated with worse physical and mental health later in adulthood. Potential mechanisms merit exploration

Long-term health implications of school quality.

ObjectiveIndividual academic achievement is a well-known predictor of adult health, and addressing education inequities may be critical to reducing health disparities. Disparities in school quality are well documented. However, we lack nationally representative studies evaluating the impact of school quality on adult health. We aim to determine whether high school quality predicts adult health outcomes after controlling for baseline health, socio-demographics and individual academic achievement.MethodsWe analyzed data from 7037 adolescents who attended one of 77 high schools in the Unites States and were followed into adulthood from the National Longitudinal Study of Adolescent to Adult Health. Selected school-level quality measures-average daily attendance, school promotion rate, parental involvement, and teacher experience-were validated based on ability to predict high school graduation and college attendance. Individual adult health outcomes included self-rated health, diagnosis of depression, and having a measured BMI in the obese range.ResultsLogistic regressions controlling for socio-demographics, baseline health, health insurance, and individual academic performance demonstrated that school quality significantly predicted all health outcomes. As hypothesized, attending a school with lower average daily attendance predicted lower self-rated health (Adjusted Odds Ratio (AOR) 1.59, p&nbsp;=&nbsp;0.003) and higher odds of depression diagnosis (AOR 1.35, p&nbsp;=&nbsp;0.03); and attending a school with higher parent involvement predicted lower odds of obesity (AOR 0.69, p&nbsp;=&nbsp;0.001). However, attending a school with higher promotion rate also predicted lower self-rated health (AOR1.20, p&nbsp;&lt;&nbsp;0.001).ConclusionsHigh school quality may be an important, but complex, social determinant of health. These findings highlight the potential inter-dependence of education and health policy

Measurement and Identification of Parenting Behaviors Associated with Social-Emotional Outcomes in Children

OBJECTIVE: The objective of this study is to examine parenting styles (observed parent-child interactions via the Two-Bag Task) associated with young children’s socio-emotional outcomes, comparing children from Mexican-American and African-American families to children from their white counterparts. METHODS: The Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) data were used to examine six global parenting styles with socio-emotional outcomes at 48-months of age while controlling for both time-independent and time-depending socio-demographic, maternal mental health, and child characteristics. Data was stratified by race and ethnicity, and weighted longitudinal linear regressions models were estimated using STATA/Xtmixed. RESULTS: The six global parenting scores from the Two-Bag Task measures differed across White, African-American, and Mexican-American groups of parents. White parents on average scored higher on parenting styles related to sensitivity, positive regard, and cognitive stimulation, while Mexican-American and African-American parents scored lower. These parenting styles were associated with both approach to learning and social competence outcomes among White children, but were nearly non-existent for Mexican-American and African-American children, when adjusting for covariates. CONCLUSION: Our results highlight the need to critically evaluate measures of parenting behaviors used in research studies with racially and ethnically diverse families. Examining the comprehensive psychometric properties and cultural appropriateness of parenting measures for diverse families is important in order to optimally support child development for non-White children. Furthermore, a critical lens is important in order to mitigate the perpetuation of inaccurate research findings for Mexican-American and African-American children

Measurement and Identification of Parenting Behaviors Associated with Social-Emotional Outcomes in Children: The Racial and Cultural Appropriateness of a Commonly Used Parenting Measure.

ObjectiveThe objective of this study was to examine parenting styles (observed parent-child interactions via the Two-Bag Task) associated with young children's socioemotional outcomes, comparing children from Mexican-American and African American families with children from their White counterparts.MethodsThe Early Childhood Longitudinal Study Birth Cohort data were used to examine 6 global parenting styles with socioemotional outcomes at 48 months of age while controlling for both time-independent and time-depending sociodemographic, maternal mental health, and child characteristics. Data were stratified by race and ethnicity, and weighted longitudinal linear regressions models were estimated using STATA/Xtmixed.ResultsThe 6 global parenting scores from the Two-Bag Task measures differed across White, African American, and Mexican-American groups of parents. White parents on average scored higher on parenting styles related to sensitivity, positive regard, and cognitive stimulation, whereas Mexican-American and African American parents scored lower. These parenting styles were associated with both approach to learning and social competence outcomes among White children but were nearly nonexistent for Mexican-American and African American children when adjusting for covariates.ConclusionOur results highlight the need to critically evaluate measures of parenting behaviors used in research studies with racially and ethnically diverse families. Examining the comprehensive psychometric properties and cultural appropriateness of parenting measures for diverse families is important to optimally support child development for non-White children. Furthermore, a critical lens is important to mitigate the perpetuation of inaccurate research findings for Mexican-American and African American children