Adolescent E-Cigarette Onset and Escalation: Associations With Internalizing and Externalizing Symptoms

PurposeWe sought to evaluate if internalizing symptoms (i.e., anxiety and depression) and/or externalizing symptoms (i.e., impulsivity, sensation seeking, and substance use) were risk factors for the onset of 30-day e-cigarette use and escalation in the number of days used across the following 30 months among adolescents.MethodsAdolescents (N = 1,808) from public high schools outside Philadelphia, PA, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 30 months (spring 2019, end of 11th grade).ResultsA two-part latent growth curve model of e-cigarette use revealed significant positive associations between externalizing factors, past 30-day e-cigarette use, and the number of days of e-cigarette use only at wave 1 (p values <.05). Cigarette smoking was associated with a slowing in the rate of onset of 30-day e-cigarette use across the 30-month follow-up (β = ?.24, z = ?2.41, p = .02). Depression was associated with an increased rate of escalation in the number of days of e-cigarette use across the following 30 months (β = .01, z = 2.52, p = .01), whereas anxiety was associated with a decreased rate (β = ?.72, z = ?2.36, p = .02).ConclusionsThe findings highlight two groups of adolescents at risk for e-cigarette use: adolescents whose e-cigarette use reflects a higher-risk profile with early e-cigarette onset, and adolescents who have a lower-risk profile, at least initially, with later e-cigarette use onset. The timing and content of prevention efforts should be tailored to each group.     

Dieting and Unhealthy Weight Control Behaviors During Adolescence: Associations With 10-Year Changes in Body Mass Index

Background

Dieting and unhealthy weight control behaviors are common among adolescents and questions exist regarding their long-term effect on weight status.

Objective

To examine 10-year longitudinal associations between dieting and unhealthy weight control behaviors and changes in body mass index (BMI) from adolescence to young adulthood.

Methods and Procedures

A diverse population-based sample of middle school and high school adolescents participating in Project EAT (Eating and Activity in Teens and Young Adults) was followed up for 10 years. Participants (N = 1,902) completed surveys in 1998-1999 (Project EAT-I), 2003-2004 (Project EAT-II), and 2008-2009 (Project EAT-III). Dieting and unhealthy weight control behaviors at Time 1 and Time 2 were used to predict 10-year changes in BMI at Time 3, adjusting for sociodemographic characteristics and Time 1 BMI.

Results

Dieting and unhealthy weight control behaviors at both Time 1 and Time 2 predicted greater BMI increases at Time 3 in males and females, as compared with no use of these behaviors. For example, females using unhealthy weight control behaviors at both Time 1 and Time 2 increased their BMI by 4.63 units as compared with 2.29 units in females not using these behaviors (p < .001). Associations were found in both overweight and nonoverweight respondents. Specific weight control behaviors at Time 1 that predicted larger BMI increases at Time 3 included skipping meals and reporting eating very little (females and males), use of food substitutes (males), and use of diet pills (females).

Conclusions

Findings clearly indicate that dieting and unhealthy weight control behaviors, as reported by adolescents, predict significant weight gain over time.     

Substance Use Among Women: Associations with Pregnancy, Parenting, and Race/Ethnicity

Objective To examine the association of pregnancy and parenting (0- to 2-year-old child) statuses with past 30-day use of alcohol, cigarettes and marijuana, psychotherapeutics and cocaine among American women aged 18–44, overall and by race/ethnicity. Methods Five years of data (2002–2006) from the National Survey on Drug Use and Health (NSDUH) were pooled. Binary logistic regression analyses stratified by race/ethnicity were performed to examine the relationships adjusting for age, marital status, education and family income. Results Overall, past 30-day alcohol, cigarette, marijuana, psychotherapeutic or cocaine use was substantially lower among pregnant women, particularly in their second or third trimesters, than among their parenting or non-pregnant counterparts. Logistic regression analysis suggested a strong negative association between pregnancy status and substance use, with no considerable variations in the magnitude of the relationship by race/ethnicity for most measures. The relationship between parenting status and substance use was in the same direction, but relatively weak, and not statistically significant for non-Hispanic (NH) blacks for any measures except for alcohol use. Regardless of pregnancy and parenting statuses, NH white women reported substance use at the highest rates, followed by Hispanics and NH blacks. Conclusions There is indirect evidence of postpregnancy resumption in substance use. Pregnant and parenting women, regardless of race/ethnicity, could benefit from prevention efforts focusing on cessation rather than temporary abstinence from substance use.     

Associations of Socioeconomic Status With Depression and Quality of Life in Patients With Hypertension: An Analysis of Data From the 2019 Community Health Survey in Korea

ObjectivesWe aimed to identify the factors related to depression and quality of life in patients with hypertension by using multilevel regression analysis.MethodsIn 2019, 229 043 participants in the Korean Community Health Survey were selected as the study group. Individual factors were identified using data from the 2019 Community Health Survey. Regional factors were identified using data from the National Statistical Office of Korea. Multilevel regression analysis was conducted to find individual and local factors affecting depression and quality of life in patients with hypertension and to determine any associated interactions.ResultsAs individual factors in patients with hypertension, women, those with lower education-levels, recipients of basic livelihood benefits, and those with poor dietary conditions showed stronger associations with depression and quality of life. As regional factors and individual-level variables in patients with hypertension, lower gross regional personal income, fewer doctors at medical institutions, and lower rates of participation in volunteer activities presented stronger associations with depression and quality of life. In addition, the associations of depression with gross regional personal income, the number of doctors at medical institutions, and dietary conditions were significantly stronger in patients with hypertension than in patients without hypertension. The associations of gender and employment status with quality of life were also significantly greater.ConclusionsPolicy interventions are needed to adjust health behaviors, prevent depression, and improve quality of life for patients with hypertension, especially for those with the risk factors identified in this study.     

Social status and health: a comparison of British civil servants in Whitehall-II with European- and African-Americans in CARDIA

Socioeconomic status (SES) is related to health in every industrialized society where it has been studied. Indicators include educational attainment, occupational status, and income. Subjective social status (SSS), a summative judgment of one's socioeconomic position across these dimensions, also appears to be associated with health status. The current study examines whether SSS has similar associations with SES indicators and with health outcomes among British civil servants (participants in the Whitehall-II study), and U.S. whites and blacks (participants in the CARDIA study). The comparisons shed light on social status in the U.S. and England and on the applicability of findings from Whitehall-II to both whites and blacks in the U.S. Parallel analyses in each group examined (1) the extent to which income, education, and occupational status determine SSS ratings, (2) the association of SSS with hypertension, depression, and global health, and (3) the extent to which adjustment for education, occupation and income individually and collectively reduce the association of SSS and health outcomes. As predicted, occupation is a more important determinant of SSS in Whitehall-II than in CARDIA; adjustment for occupation reduces the association between SSS and health outcomes more for the Whitehall-II participants -- especially males -- than for CARDIA participants. Among the latter, education and income play relatively greater roles. Socioeconomic factors do not predict SSS scores for blacks as well as they do for the other two groups. SSS is significantly related to global health and depression in all groups and to hypertension in all groups except black males. Overall, relationships of SSS and health were stronger for Whitehall-II and white CARDIA participants than for blacks in CARDIA.     

Differential effect of birthplace and length of residence on body mass index (BMI) by education, gender and race/ethnicity

Although birthplace and length of residence have been found to be associated with Body Mass Index (BMI)/obesity in the USA, their effects may not be the same across groups defined by education, gender and race/ethnicity. Using cross-sectional population based data from the 2001 California Health Interview Survey, we investigated the associations of birthplace and US length of residence with BMI, and whether the influence of birthplace-US length of residence on BMI varied by education, gender and race/ethnicity. Our sample included 37,350 adults aged 25-64 years. Self-reported weight and height were used to calculate BMI. Birthplace and length of residence were combined into a single variable divided into five levels: US-born, foreign-born living in the United States for more than 15, 10-14, 5-9, and less than 5 years. Controlling for age, gender, marital status, race/ethnicity, education, income, fruit and vegetable consumption, current smoking and alcohol use, we found that: (1) foreign-born adults had lower BMI than US-born adults; (2) among foreign-born adults, longer residence in the United States was associated with higher BMI; and (3) the effect of birthplace-length of US residence on BMI differed by education level, gender and race/ethnicity. Specifically, longer residence in the United States was associated with the greatest percent increases in BMI among the lowest educated groups than higher educated groups, among women (vs. men) and among Hispanics (vs. other racial/ethnic groups). These findings suggest that a protective effect of foreign birthplace on BMI appears to attenuate with length of residence in the United States, and also reveal that BMI/obesity trajectories associated with length of US residence vary by education, gender and race/ethnicity. Immigrant status, independently and in combination with education, gender and race/ethnicity should be considered in future obesity prevention and reduction efforts.     

The 'freshman 15': trends and predictors in a sample of multiethnic men and women

This study focused on predictors of the ‘freshman 15’ phenomenon among university students. Participants (N = 390) included men and women who identified as African American (32%), Latino American (27%), and European American (41%). Students gained on average 3.2 lbs and 0.5 in BMI from their first through third semesters. Changes in weight and BMI did not differ by gender or racial/ethnic group. Students with lower Scholastic Aptitude Test (SAT) scores were more likely to experience the ‘freshman 15’. Results suggest that universities should work with students who may be underprepared for college in order to minimize weight gain.     

Race disparities in low birth weight in the U.S. south and the rest of the nation

There are well-documented and as yet unexplained disparities in birth outcomes by race in the USA. This paper examines the sources of disparities in low birth weight between blacks and whites in the US, by focusing on differences in disparities between two very distinct geographic areas, the Deep South and the rest of the country. Two findings from prior research drive the analyses: first, health overall is worse in the Deep South states; second, race disparities are smaller in the Deep South than in the rest of the nation. A number of potential explanations for these findings are examined using nationally representative data on approximately 8,000 children born in the US in 2001. Results suggest that, first, almost all of the increased burden of low birth weight in the Deep South states may be explained by differences in race composition and socioeconomic status between the Deep South and rest of the nation. Second, the slightly lower race disparities found in the Deep South states are being driven not by better outcomes for black mothers, but by two other factors: higher returns to socioeconomic status for black mothers and much worse outcomes for poor white mothers in the Deep South compared with the rest of the country.     

Prevalence and Correlates of Unmet Mental Health Services Need in Adolescents With Major Depressive Episode in 2019: An Analysis of National Survey on Drug Use and Health Data

PurposeMental health (MH) crises in adolescence can derail development, possibly leading to poorer health outcomes in young adulthood. According to recent estimates, approximately half of US children have unmet MH need, with increased odds when uninsured or Hispanic. The aims of this study were to update estimates of MH services need and use in the US adolescent (12– 17 years) and to reassess previously identified associations between insurance status, demographic characteristics, MH need and use, and unmet need, using data from the National Survey of Drug Use and Health (NSDUH; 2019).MethodsAdolescents aged 12–17 years were included from the NSDUH. Logistic regressions were performed to assess associations of race and insurance with outcomes of past-year major depressive episode (MDE) and unmet MH need. Adjustments were made for age, sex, and income.ResultsIndividuals of multiple races, females, and users of alcohol, marijuana, and illicit drugs had increased odds of MDE, while Black adolescents and the privately insured had decreased odds. Hispanic adolescents, people of multiple races, and users of alcohol and illicit drug had increased odds for unmet need.DiscussionWe estimate that 15.8% of all US adolescents had an MDE and that 45.8% of these adolescents with MDE went without MH care in 2019. We found very limited support for associations of race and insurance status with past-year MDE or unmet MH need, although this may be due to the small number of uninsured adolescents sampled in 2019. Longitudinal data are needed to assess severity of MH needs and appropriateness of care.     

Association of socioeconomic status with inflammation markers in black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) study

Inflammatory processes are implicated in a number of diseases for which there are known socioeconomic status (SES) disparities, including heart disease and diabetes. Growing evidence also suggests SES gradients in levels of peripheral blood markers of inflammation. However, we know little about potential gender and racial/ethnic differences in associations between SES and inflammation, despite the fact that the burden of inflammation-related diseases varies by gender and race. The present study examines SES (education and income) gradients in levels of two inflammatory biomarkers, C-reactive protein (CRP) and interleukin-6 (IL-6), in a biethnic (White and Black) sample of men and women (n = 3549, aged 37–55 years) in the USA from the CARDIA Study. Health status, behavioral and psychosocial variables that may underlie SES differences in inflammatory biomarker levels were also examined. Age-adjusted CRP and IL-6 levels were inversely associated with education level in each race/gender group except Black males. Income gradients were also observed in each race/gender group for IL-6 and in White females and males for CRP. In general, differences in CRP and IL-6 levels between low and high SES groups were reduced in magnitude and significance with the addition of health status, behavioral, and psychosocial variables, although the impact of the addition of model covariates varied across race/gender groups and different SES-inflammation models. Overall, findings indicate SES gradients in levels of inflammation burden in middle-aged White and Black males and females.     

Social inequalities and the early provision and dispersal of COVID-19 vaccinations in the United States: A population trends study

BackgroundIn December 2020 the U.S. began a massive COVID-19 vaccination campaign, an action that researchers felt could catalyze inequalities in COVID-19 vaccination utilization. While vaccines have the potential to be accessible regardless of social status, the objective of this study was to examine how and when socioeconomic status (SES) and racial/ethnic inequalities would emerge in vaccination distribution.MethodsPopulation vaccination rates reported at the county level by the Centers for Disease Control and Prevention across 46 states on 3/30/2021. Correlates included SES, the share of the population who were Black, Hispanic, Female, or aged ≥65 years, and urbanicity (thousands of residents per square mile). Multivariable-adjusted analyses relied on zero-inflated negative binomial regression to estimate the odds of providing any vaccine, and vaccination rate ratios (aVRR) comparing the distribution rate for vaccinations across the U.S.ResultsAcross the U.S., 16.3 % of adults and 37.9 % of adults aged 65 and older were vaccinated in lower SES counties, while 20.45 % of all adults and 48.15 % of adults aged 65 and older were vaccinated in higher SES counties. Inequalities emerged after 41 days, when < 2 % of Americans were vaccinated. Multivariable-adjusted analyses revealed that higher SES was associated with improved vaccination distribution (aVRR = 1.127, [1.100–1.155], p < 1E−06), while increases in the percent reporting Black or Hispanic race/ethnicity was associated with lower vaccination distribution (aVRR = 0.998, [0.996–0.999], p = 1.03E−04).ConclusionsSocial inequalities in COVID-19 vaccines reflect an inefficient and inequitable distribution of these technologies. Future efforts to improve health should recognize the central role of social factors in impacting vaccine delivery.     

Social and Emotional Adjustment Following Early Pregnancy in Young Australian Women: A Comparison of Those Who Terminate,Miscarry, or Complete Pregnancy

PurposeTo compare social and emotional adjustment including educational attainment and substance use in women who had a child, pregnancy termination, or miscarriage by young adulthood.MethodsData were from a population-based longitudinal study of the health and well-being of 1,943 young Australians (Victorian Adolescent Health Cohort Study) followed from 15 to 24 years of age. The sample was restricted to female participants and based on pregnancies reported by age 24 years. Analyses were adjusted for early teenage depressive symptoms, cigarette smoking, alcohol use, cannabis use, and parent socioeconomic context.ResultsA total of 208 pregnancies (in 170 women) were reported from a sample of 824 young women by 24 years of age. Compared with those who had never been pregnant, those who had a child had lower tertiary education completion and a higher risk of nicotine dependence; those who terminated a pregnancy were more commonly single and had a higher risk of smoking and alcohol use as well as nicotine and alcohol dependence; and those who had a miscarriage had a higher risk of depressive symptomatology and binge drinking as well as nicotine and cannabis dependence.ConclusionsYoung women who have been pregnant by their mid-twenties report a range of difficulties in social and emotional adjustment that vary across the different pregnancy outcomes. Broad-based psychosocial health care is essential not only for young women whose pregnancies proceed to live birth, but also for those whose pregnancies end with miscarriage or induced abortion.     

Neighborhood differences in patterns of syringe access,use, and discard among injection drug users: Implications for HIV outreach and prevention education

The article presents results from the Syringe Access, Use, and Discard: Context in AIDS Risk research project comparing two neighborhoods by (1) socioeconomic and demographic characteristics; (2) patterns of syringe access, use, and discard; and (3) encounters with a local human immunodeficiency viruslacquired immunodeficiency syndrome (HIV/AIDS) outreach project targeted to injection drug users (IDUs). The results show that IDUs in more economically advantaged neighborhoods were more likely to acquire syringes from a single source (rather than multiple sources), more likely to inject alone in their own residence (rather than public injection locales), and more likely to dispose of syringes in private garbage cans rather alleys or dumpsters. These results are further associated with the likelihood of encountering street outreach workers, with IDUs in more affluent neighborboods much less likely to have any such contacts. Based on the different patterns of access, use, and discard evident in each neighborhood, the results indicate that different and more carefully tailored local outreach and prevention strategies are urgently needed. An earlier version of this article was presented at the Annual Meeting of the American Public Health Association, Atlanta, Georgia, October 21–25, 2001.     

Race,place and AIDS: The role of socioeconomic context on racial disparities in treatment and survival in San Francisco

Prior evidence suggests that the health and longevity benefits of antiretroviral therapy (ART) for persons living with AIDS (PLWAs) have not been equally distributed across racial/ethnic groups in the United States. Notably, black PLWAs tend to fare worse than their counterparts. We examine the role of neighborhood socioeconomic context on racial/ethnic differences in AIDS treatment and survival in San Francisco. The study population encompassed 4211 San Francisco residents diagnosed with AIDS between 1996 and 2001. Vital status was reported through 2006. Census data were used to define neighborhood-level indicators of income, housing, demographics, employment and education. Cox proportional hazards models were employed in multivariate analyses of survival times. Compared to whites, blacks had a significant 1.4 greater mortality hazard ratio (HR), which decreased after accounting for ART initiation. PLWAs in the lowest socioeconomic neighborhoods had a significant HR of 1.4 relative to those in higher socioeconomic neighborhoods, independent of race/ethnicity. The neighborhood association decreased after accounting for ART initiation. Path analysis was used to explore causal pathways to ART initiation. Racial/ethnic differences in neighborhood residence accounted for 19–22% of the 1.6–1.8 black–white relative odds ratio (ROR) and 14–15% of the 1.3–1.4 Latino–white ROR for delayed or no treatment. Our findings illuminate the independent and synergistic contributions of race and place on treatment disparities and highlight the need for future studies and interventions to address treatment initiation as well as neighborhood effects on treatment differences.     

Association of Socioeconomic Status, Problem Behaviors, and Disordered Eating in Mexican Adolescents: Results of the Mexican National Health and Nutrition Survey 2006

Purpose

To explore the association of socioeconomic status (SES) with disordered eating behaviors (DEB) in Mexican adolescents, and the coexistence of DEB and other problem behaviors.

Methods

Information about adolescents (10–19 years) was retrieved from the Mexican National Health and Nutrition Survey 2006 database. Associations were evaluated through ordinal regression.

Results

Higher SES was associated with DEB (odds ratio [OR]: 2.05, 95% confidence interval [CI]: 1.52–2.75). Use of tobacco (OR: 2.10, 95% CI: 1.58–2.81), alcohol (OR: 2.03, 95% CI: 1.51–2.56), and suicide intent (OR: 5.13, 95% CI: 3.46–7.60) were associated with DEB.

Conclusion

DEB were more frequent among adolescents from higher SES households. The lack of association between SES and DEB reported by other studies might be because of the lack of variability in samples. The association of DEB and other problem behaviors highlights the importance of an integral approach to teenagers' mental health.     

A framework for the systematic consideration of ethics,equity, feasibility,and acceptability in vaccine program recommendations

For the successful implementation of population-level recommendations, it is critical to consider the full spectrum of public health science, including clinical and programmatic factors. Current frameworks may identify various factors that should be examined when making evidence-informed vaccine-related recommendations. However, while most immunization guidelines systematically assess clinical factors, such as efficacy and safety of vaccines, there is no published framework outlining how to systematically assess programmatic factors, such as the ethics, equity, feasibility, and acceptability of recommendations. We have addressed this gap with the development of the EEFA (Ethics, Equity Feasibility, Acceptability) Framework, supported by evidence-informed tools, including Ethics Integrated Filters, Equity Matrix, Feasibility Matrix, and an Acceptability Matrix. The Framework and tools are based on five years of environmental scans, systematic reviews and surveys, and refined by expert and stakeholder consultations and feedback. For each programmatic factor, the EEFA Framework summarizes the minimum threshold for consideration and when further in-depth analysis may be required, which aspects of the factor should be considered, how to assess the factor using the supporting evidence-informed tools, and who should be consulted to complete the assessment. Research, particularly in the fields of vaccine acceptability and equity, has validated the utility and comprehensiveness of the tools. The Framework has been successfully used in Canada for clear, timely, transparent vaccine guidance with positive stakeholder feedback on its comprehensiveness, relevance and appropriateness. Applying the EEFA Framework allows for the systematic consideration of the spectrum of public health science without a delay in recommendations, complementing existing decision-making frameworks. This Framework will therefore be useful for advisory groups worldwide to integrate critical factors that could impact the successful and timely implementation of comprehensive, transparent recommendations, and will further the global objective of developing practical and evidence-informed immunization policies.