Network analysis of dimensions of childhood adversity and adolescent health risk behaviors.

BackgroundSocial media (SM) may influence adolescents’ perceived social norms and subsequent health risk behaviours, although the evidence base around this is still developing. We conducted a systematic review of the...

Maternal depression is a risk factor for adolescent depression; however, the effect of childhood exposure to maternal depression on adolescent engagement in health risk behaviors (eg, substance use, delinquency) is unclear. We examined the relationship between maternal depressive symptoms (child's age 4-15) and engagement in health risk behaviors at age 16 to 17 by using data from 2910 mother-youth pairs in a nationally representative prospective Canadian cohort. Maternal depressive trajectories were estimated through finite mixture modeling, and multiple regression analyses examined the relationship between maternal depressive symptoms and engagement in various health risk behaviors (linear regression) and age of debut of various behaviors (Cox regression). Five trajectories of maternal depressive symptoms were found: recurrent maternal symptoms, midchildhood exposure to maternal symptoms, adolescent exposure to maternal symptoms, mild maternal symptoms, and low symptoms. Adolescents exposed to maternal depressive symptoms during middle childhood were more likely to use common substances (alcohol, cigarettes, marijuana), engage in violent and nonviolent delinquent behavior, and have an earlier debut ages of cigarette, alcohol, marijuana, and hallucinogen use. The results of this study suggest that exposure to maternal depressive symptoms, particularly in middle childhood, is associated with greater and earlier engagement in health risk behaviors.

Addressing Common Risk and Protective Factors Can Prevent a Wide Range of Adolescent Risk Behaviors

Research supports the premise that greater substance use is associated with fewer sources of environmental reinforcement. However, it remains unclear whether types of environmental reinforcement (e.g., social or work) may differentially influence use. This study tested the association between types of environmental reinforcement and engagement in multiple health risk behaviors (alcohol use, binge eating, and nicotine use). Cross-sectional data were collected from a general population sample of US adults (N = 596). The Pleasant Events Schedule (PES) was used to measure sources of reinforcement. Exploratory structural equation modeling (ESEM) characterized different areas of environmental reinforcement and correlations with alcohol consumption, binge eating, and nicotine use. A four-factor structure of the PES demonstrated a conceptually cohesive model with acceptable fit and partial strict invariance. Social-related reinforcement was positively associated with alcohol consumption (β = 0.30, p < 0.001) and binge eating (β = 0.26, p < 0.001). Work/school-related reinforcement was negatively associated with binge eating (β = -0.14, p = 0.006). No areas of reinforcement were significantly associated with nicotine use (p values = 0.069 to 0.755). Social-related activities may be associated with engagement in multiple health risk behaviors (more binge eating and alcohol use), whereas work/school-related activities may be preventative against binge eating. Understanding these relationships can inform prevention efforts targeting health risk behaviors.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events occurring before age 18 years. Data on ACEs among adolescents in the United States have primarily been collected through parent report and have not included important violence-related ACEs, including physical, sexual, and emotional abuse. This report presents the first national prevalence of self-reported ACEs among U.S. high school students aged <18 years, estimates associations between ACEs and 16 health conditions and risk behaviors, and calculates population-attributable fractions of ACEs with these conditions and behaviors using cross-sectional, nationally representative 2023 Youth Risk Behavior Survey data. Exposures were lifetime prevalence of individual (emotional, physical, and sexual abuse; physical neglect; witnessed intimate partner violence; household substance use; household poor mental health; and incarcerated or detained parent or guardian) ACEs and cumulative ACEs count (zero, one, two or three, or four or more). Health conditions and risk behaviors included violence risk factors, substance use, sexual behaviors, weight and weight perceptions, mental health, and suicidal thoughts and behaviors. Bivariate analyses assessed associations between individual and cumulative ACEs and demographics. Adjusted prevalence ratios assessed associations between cumulative ACEs and health conditions and risk behaviors, accounting for demographics. Population-attributable fractions were calculated to determine the potential reduction in health conditions and risk behaviors associated with preventing ACEs. ACEs were common, with approximately three in four students (76.1%) experiencing one or more ACEs and approximately one in five students (18.5%) experiencing four or more ACEs. The most common ACEs were emotional abuse (61.5%), physical abuse (31.8%), and household poor mental health (28.4%). Students who identified as female; American Indian or Alaska Native; multiracial; or gay or lesbian, bisexual, questioning, or who describe their sexual identity in some other way experienced the highest number of ACEs. Population-attributable fractions associated with experiencing ACEs were highest for suicide attempts (89.4%), seriously considering attempting suicide (85.4%), and prescription opioid misuse (84.3%). ACEs are prevalent among students and contribute substantially to numerous health conditions and risk behaviors in adolescence. Policymakers and public health professionals can use these findings to understand the potential public health impact of ACEs prevention to reduce adolescent suicidal behaviors, substance use, sexual risk behaviors, and other negative health conditions and risk behaviors and to understand current effects of ACEs among U.S. high school students.

Background Despite the high incidences of health risk behaviors (HRBs) in sub-Saharan Africa, studies on the contextual determinants of HRBs across countries are generally lacking, concentrated on isolated countries and often focus solely on specific health behaviors. Thus, this study investigated the environmental and social correlates of HRBs in West Africa. Methods Data was from post-2015 Demographic and Health Surveys in three West African countries of Benin, Mali and Nigeria. A composite outcome variable of health risk behaviors (HRBs) was derived from variables of tobacco smoking, intimate partner violence, overweight/obesity and risky sexual behaviors. The contextual variables were normalized difference vegetation index, precipitation, maximum and minimum temperatures, region of residence and population Density. Data analysis involved descriptive statistics, chi square test, geographical mapping, and multilevel logistic regression. Results The engagement in HRBs varied from 42.65% in Nigeria to 42.88% in Benin and 51.06% in Mali as there are spatial variations in the engagement in HRBs within different regions of these countries. There also existed significant variations in HRBs regarding age, education, employment status, wealth index, household size, place of residence, and region of residence in the three countries. In the contextual models of environmental and social factors, population density significantly increased odds of HRBs in the three countries, maximum temperature significantly increased odds of HRBs in Benin and Mali, while precipitation significantly increased odds of HRBs in Nigeria and Mali. Other factors which significantly increased odds of HRBs across the three countries were increase in age, wealth index, households with 9+ persons, and regions of residence. Conclusions These findings suggest that among other things, changes in lifestyles regarding the different HRBs should be emphasized in specific contextual situations Key messages • There are variations in engagement in health risk behaviours across the countries. • Cliamte variables influence engagement in health risk behaviours.

Background Health risk behaviours such as tobacco smoking, alcohol consumption, drug misuse, unhealthy diet and unprotected sexual intercourse are global health issues, often initiated in adolescence. There is contrasting evidence on the association between health risk behaviours and socioeconomic position in adolescence and young adulthood, with little qualitative evidence to illuminate the relationship. The aim of the study was to examine to what extent young people perceive health risk behaviours to shape socioeconomic inequalities while transitioning into adulthood. Methods We undertook a nested qualitative study within The Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort using semi-structured interviews of 25 young adults aged 26–28 years. A grounded theory approach was adopted. Theoretical sampling was conducted based on participants’ early life socioeconomic background and engagement in health risk behaviours when they were adolescents. Data collection and analysis were undertaken iteratively to aid constant comparison. Results Categories of peer influence, family influence, ‘drive to succeed’ and personal responsibility were identified. These data underline the importance of family and peers in relation to both health risk behaviours and socioeconomic life chances as young people transition into adulthood. Engaging in some level of health risk behaviour allowed young people to gain experiences and bond with peers but avoiding certain behaviours helped construct their identity and self-security. Some participants adopted a moralistic or neoliberal perspective in labelling peers who engaged in certain risk behaviours, such as drug use, as irresponsible or immature. Adolescent alcohol use was seen as normative during adolescence and therefore less tied to socioeconomic position. Many participants saw the individualised concept of ‘drive to succeed’ as pivotal for the transition to adulthood, claiming the possessing this quality made it possible to achieve in education or employment regardless of upbringing or structural factors. The study highlighted class stigma, with some young people from low socioeconomic backgrounds avoiding health risk behaviours such as tobacco smoking or hazardous alcohol consumption as a strategy to evade further stigmatisation. Conclusion While individual agency was highlighted by many participants, family support was recognised as essential for navigating adolescence in relation to health behaviours and socioeconomic life trajectories. Class stigma related to health risk behaviours was either experienced or witnessed by young people throughout their adolescence. Therefore, while quantitative data suggest that youth from low SES backgrounds engage in more health risk behaviours, public health interventions should adopt measures to avoid further stigmatising these young people.

Background Daily life of higher education students across the world changed profoundly in 2020 with the implementation of governmental and institutional measures to control the COVID-19 pandemic. We investigated mental wellbeing and engagement in health risk behaviours (HRB) in German university students at the start of the COVID-19 pandemic. Methods Data stem from the COVID-19 International Student Wellbeing Study (C19 ISWS). The web-based survey was conducted in May 2020 at four German universities. HRBs included tobacco and cannabis use, alcohol consumption, and engagement in physical activity. All HRBs were assessed retrospectively and at the time of data collection. Mental wellbeing was assessed using the 8-item Center for Epidemiologic Studies-Depression Scale (CES-D 8). We conducted multinomial regression analyses to investigate factors associated with changes in HRBs and latent transition analysis to identify substance use profiles. Results 5021 students completed the survey (69% female; mean age 24.4 years, SD = 5.1). The mean score for depressive symptoms was 9.25 (SD = 0.67, range 0-24). Sixty-one percent of students reported consuming alcohol, 46% binge drinking, 44% inactivity, 19% smoking and 11% cannabis use. While smoking and cannabis use remained unchanged during the COVID-19 pandemic, 24% reported a decrease in binge drinking. Changes to physical activity were frequently reported, with 31% reporting an increase and 19% reporting a decrease in vigorous physical activity. Higher depressive symptoms were found to be associated with changes in HRBs. Five substance use behaviour profiles were identified, which remained fairly unchanged. Conclusions Engagement in HRBs remains at high level during the COVID-19 pandemic among German students. Depressive symptoms were found to be associated with changes in HRBs. Efforts to promote student health and wellbeing are needed in times of the COVID-19 pandemic and thereafter to prevent longer-term consequences.

Engagement in risk behaviours may pose a significant threat to health if involvement spans multiple behaviours. The asset model suggests that contextual aspects of young people's lives, such as factors related to family, school and community, serve as a protective function against health risk behaviours. A risk-taking index was created from the English health behaviour in school-aged children study on 15 years olds, substance use and sexual activity. Using a multinomial regression, potential asset variables relating to school, family, peers, community and family affluence were tested for their association with levels of risk behaviours. Sense of neighbourhood belonging, strong school belonging and parental involvement in decision-making about leisure time were related to lower engagement in health risk behaviours. A weaker sense of family belonging was associated with increased risk behaviours if connectedness with teachers was also low. Factors related to school and community played a greater role in adolescent participation in health-related risk behaviours than family-related factors, including family affluence. Feelings of safety and belonging in the out-of-home settings of adolescents were positively associated with reduced risk behaviours, and indicate the importance of the wider community alongside parents and school as protective assets for health.

Longitudinal Correlates of Health Risk Behaviors in Children and Adolescents with Type 2 Diabetes

Objective To explore the status of adolescents' health risk behaviors, relationship between cognitive ability and health risk behaviors, and provide an empirical reference for reducing the occurrence and early prevention of health risk behaviors among adolescents. Methods Samples were extracted by hierarchical, multi-stage, probability and scale proportional (PPS) methods. There were 112 schools randomly selected from 28 county-level regions (county, district, city), and 19 487 students were investigated by baseline survey, a follow-up study was conducted among 8 636 students during 2014-2015. Descriptive statistical methods of using 2 test and t test, and logistic multivariate regression analysis were used to analyze the relationship between cognitive abilities and healthy risk behaviors. Results The reported rate of a healthy risk behavior was 20.77%, and the incidence of more than one type of health risk behavior was 16.03%. The student’s cognitive ability standardized score was (0.33±0. 82). The average score of cognitive ability of adolescents with healthy risk behavior was 0.14, which was lower than the average score of cognitive ability of adolescents without healthy risk behaviors (0.43). Boys, having rural household registeration, non-residential schools, and parents with low education levels adolescents were more likely to be involved in health behavior risks. There was a significant correlation between adolescent cognitive ability and healthy risk behavior ( OR = 0.67, P <0.01). Conclusion The current status of adolescent health risk behaviors is worrying. The cognitive ability has a significant impact on health risk behaviors. It is recommended to use the cognitive ability of adolescents as a starting point to prevent and reduce the occurrence of adolescent health risk behaviors. 【摘要】目的 探究青少年健康危险行为现状及其与认知能力的关系，为减少青少年健康危险行为的发生及早期预 防提供实证参考。 方法 采用分层次、多阶段、概率与规模成比例（PPS)的方法，从全国28个县级单位（县、区、市）随机抽 取112所学校，2013—2014学年基线调査19 487名学生，2014—2015学年追踪调査8 636名初中学生。运用妒检验、《检 验的描述性统计方法，以及Logistic多因素回归分析认知能力与健康危险行为的关系。 结果 学生存在1种健康危险行为 的报告率为20.77%，1种以上的健康危险行为报告率为16.03%。学生认知能力标准化得分为（0.33±0.82)分。有健康危 险行为的青少年认知能力标准化得分均分为0.14分，没有健康危险行为青少年的得分为0.43分。男性、农村户口、非住 校、父母受教育程度低的青少年更容易发生健康危险行为。Logistic回归分析显示，青少年认知能力与其健康危险行为的 相关有统计学意义（ OR = 0.67， P <0.01)。 结论 青少年健康危险行为现状堪忧，认知能力对健康危险行为的影响显著。建 议以青少年的认知能力为出发点，预防和减少青少年健康危险行为的发生。

Recent attachment research suggests that children with avoidant attachment often underreport their psychological distress compared to their physiologic indicators of distress (neuroendocrine reactivity, startle response, event-related potentials). This pattern of behavior (referred to as psychobiological divergence) may confer risk for suboptimal coping behaviors, including substance use, sexual risk-taking, and non-suicidal self-injury (NSSI), because individuals who are not aware of or cannot express their emotional needs may engage in maladaptive strategies to regulate their emotions. In the current pilot study (N = 45 youth), we investigate whether psychobiological divergence of neuroendocrine and self-reported reactivity in middle childhood prospectively predicts health risk behaviors (HRBs) in adolescence. The results revealed that divergence was significantly associated with adolescents’ substance use and non-suicidal self-injury (NSSI), but not with their sexual behavior. Among adolescents currently reporting low levels of attachment security, divergence was associated with greater self-reported NSSI. Our results provide initial evidence that psychobiological divergence confers risk for substance use and NSSI in combination with current relational distress. We discuss the implications of our findings for adolescent development and clinical risk.

Older adults consistently report a lower likelihood of engaging in health and safety risks (e.g., substance use, not wearing seatbelts) than younger adults. However, the mechanisms that explain this age difference are not clear. Greater dispositional mindfulness is associated with lower engagement in health risk behaviors, and older adults tend to score higher in dispositional mindfulness than younger adults. Thus, we tested whether older adults’ greater dispositional mindfulness helped to explain their lesser health and safety risk-taking propensity. Two community-dwelling samples of younger (25–36 years) and older (60+ years) adults completed self-report measures of dispositional mindfulness and health and safety risk-taking propensity. In Study 1, older adults reported greater dispositional mindfulness and a lower likelihood to engage in health and safety risk behaviors than younger adults. Greater dispositional mindfulness was associated with lesser health and safety risk-taking propensity. Importantly, older adults’ greater dispositional mindfulness partially accounted for their lesser health and safety risk-taking propensity. These findings were replicated in Study 2, and an alternative mechanism (i.e., perceived health) was ruled out. The results suggest that age-related decreases in health and safety risk behaviors may be statistically explained, in part, by dispositional mindfulness. The current research has implications for behavioral interventions intended to increase preventative health behaviors and decrease health risk behaviors.

Background Facets of decision‐making and risk‐taking are implicated in adolescent health risk behaviors; however, whether they may lead to adolescent engagement in substance use, gambling, and self‐harm is unknown. Methods We used the Millennium Cohort Study to test whether a task‐based measure of decision‐making and risk‐taking predicts engagement in adolescent health risk behaviors. Participants were born in the United Kingdom (2000–2002) and surveyed in‐home at ages 14 ( n = 10,531) and 17 ( n = 8417). A computerized task‐based measure of decision‐making and risk‐taking for reward (Cambridge Gambling Task) measured impulsivity, quality of decision‐making, risk adjustment, and risk‐taking (exposures) at age 14. Several health risk behaviors (outcomes) were self‐reported at 14/17 years: cigarette use, electronic cigarette/vaping use, drinking, cannabis use, other illegal drug use (e.g., ecstasy), gambling, and self‐harm. We conducted adjusted multinomial and logistic regression models. Results Computerized task‐based measures of greater impulsivity and risk‐taking were most consistently associated with self‐reported health risk behaviors at 14 and 17 years. Better quality of decision‐making and risk adjustment were inconsistently associated with health outcomes at age 14; however, better risk adjustment was related to a reduced likelihood of all levels of cigarette and e‐cigarette/vaping use (e.g., occasionally/regularly) when compared to nonusers. At age 14, risk‐taking was associated with every self‐reported health risk behavior (e.g., substance use, gambling) except for self‐harm. In prospective models, relationships were attenuated, but risk‐taking predicted new onset engagement in all forms of substance use except alcohol consumption and self‐harm. Risk‐taking was most strongly associated with other drug use (age 14: odds ratio (OR) = 11.26, 95% CI: 1.48, 86.01) and predictive of former vaping use (age 17: OR = 4.10, 95% CI: 1.43, 11.76). Conclusion Risky betting on a computerized risk‐taking task appears highly indicative of substance use and recent gambling at age 14 and predictive of new onset substance use and gambling 3 years later (age 17) for both sexes, but not self‐harm.

The impact of neighborhoods on adolescent engagement in health-risk behaviors (HRBs), such as substance use and sexual activity, has been well documented in high-income countries; however, evidence from low and middle-income country settings is limited, particularly in sub-Saharan African (SSA) countries. Neighborhoods and communities in SSA continue to experience urbanization, epidemiologic transition, and the simultaneous presence of large populations living in rurality and urbanicity. This is a dynamic context for exploring adolescent health challenges. This review seeks to identify and summarize existing literature that investigates adolescent engagement in HRBs when compared across rural and urban neighborhoods across SSA. We performed searches using three electronic databases, targeted grey literature searches and scanned reference lists of included studies. Following dual-screening, our search yielded 23 relevant studies that met all inclusion criteria. These were categorized into six broad themes including studies on: (1) sexual risk taking, (2) injury-related, (3) violence, (4) eating and/or exercise-related, (5) substance use, and (6) personal hygiene. We found that neighborhood factors relating to accessibility and availability of health information and care impacted adolescent engagement in HRBs in rural and urban areas. Urbanization of areas of SSA plays a role in differences in engagement in HRBs between rural and urban dwelling adolescents.