Determinants Of Adolescent Health Research Articles

Prediabetes Prevalence by Adverse Social Determinants of Health in Adolescents

Several clinical practice guidelines advise race- and ethnicity-based screening for youth-onset type 2 diabetes (T2D) due to a higher prevalence among American Indian and Alaska Native, Asian, Black, and Hispanic youths compared with White youths. However, rather than a biological risk, this disparity likely reflects the inequitable distribution of adverse social determinants of health (SDOH), a product of interpersonal and structural racism. To evaluate prediabetes prevalence by presence or absence of adverse SDOH in adolescents eligible for T2D screening based on weight status. This cross-sectional study and analysis used data from the 2011 to 2018 cycles of the National Health and Nutrition Examination Survey. Data were analyzed from June 1, 2023, to April 5, 2024. Participants included youths aged 12 to 18 years with body mass index (BMI) at or above the 85th percentile without known diabetes. The main outcome consisted of an elevated hemoglobin A1c (HbA1c) level greater than or equal to 5.7% (prediabetes or undiagnosed presumed T2D). Independent variables included race, ethnicity, and adverse SDOH (food insecurity, nonprivate health insurance, and household income <130% of federal poverty level). Survey-weighted logistic regression was used to adjust for confounders of age, sex, and BMI z score and to determine adjusted marginal prediabetes prevalence by race, ethnicity, and adverse SDOH. The sample included 1563 individuals representing 10 178 400 US youths aged 12 to 18 years (mean age, 15.5 [95% CI, 15.3-15.6] years; 50.5% [95% CI, 47.1%-53.9%] female; Asian, 3.0% [95% CI, 2.2%-3.9%]; Black, 14.9% [95% CI, 11.6%-19.1%]; Mexican American, 18.8% [95% CI, 15.4%-22.9%]; Other Hispanic, 8.1% [95% CI, 6.5%-10.1%]; White, 49.1% [95% CI, 43.2%-55.0%]; and >1 or other race, 6.1% [95% CI, 4.6%-8.0%]). Food insecurity (4.1% [95% CI, 0.7%-7.5%]), public insurance (5.3% [95% CI, 1.6%-9.1%]), and low income (5.7% [95% CI, 3.0%-8.3%]) were each independently associated with higher prediabetes prevalence after adjustment for race, ethnicity, and BMI z score. While Asian, Black, and Hispanic youths had higher prediabetes prevalence overall, increasing number of adverse SDOH was associated with higher prevalence among White youths (8.3% [95% CI, 4.9%-11.8%] for 3 vs 0.6% [95% CI, -0.7% to 2.0%] for 0 adverse SDOH). Adverse SDOH were associated with higher prediabetes prevalence, across and within racial and ethnic categories. Consideration of adverse SDOH may offer a more actionable alternative to race- and ethnicity-based screening to evaluate T2D risk in youth.

Psychosocial school conditions and students’ positive mental well-being

Abstract Background School is a key social determinant of adolescent health. However, earlier research on psychosocial school conditions has largely focused on their relationship with aspects of adverse health, and fewer studies have examined the links with positive health. The aim of this study was to investigate boys' and girls' experiences of school demands, teacher support, and classmate support and their associations with positive mental well-being. Methods Data were derived from the Swedish Health Behaviour in School-aged Children (HBSC) study of 2017/18, with information collected among 1,418 students in grade 9 (∼15-16 years). School demands, teacher support, and classmate support were captured by indices based on multiple items. Positive mental well-being was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMBWS). Gender-stratified linear regression analyses were performed, clustering for school class. Results Higher demands were associated with lower mental well-being (boys: b=-0.36, p &amp;lt; 0.05; girls: b=-0.65, p &amp;lt; 0.05). Conversely, mental well-being increased with greater teacher support (boys: b = 0.53, p &amp;lt; 0.05; girls: b = 0.56, p &amp;lt; 0.05) and classmate support (boys: b = 0.70, p &amp;lt; 0.05; girls: b = 0.50, p &amp;lt; 0.05). Interactions between demands and the support variables showed that at the lowest levels of teacher and of classmate support, mental well-being was low and not associated with school demands. With increasing levels of teacher and classmate support, the overall level of mental-well-being increased and revealed an inverse association between school demands and mental well-being. Conclusions The findings indicate that psychosocial school conditions are important not only for adverse health among adolescents, but also for their positive health. The study contributes with knowledge about how psychosocial conditions in school may hinder or enhance positive health among students. Key messages School demands, teacher and classmate support were associated with mental well-being among both boys and girls, although the association with demands was seen only at higher levels of support. The findings indicate that psychosocial school conditions are important not only for adverse health among adolescents, but also for their positive health.

9.3 ADOLESCENT IDENTITY AND RACISM

A focus on identity and an increasing capacity for abstract and moral reasoning are hallmarks of adolescent development. Following the deaths of George Floyd and others, along with the structural inequities noted in the infection rate and deaths of minorities secondary to COVID-19, there has been a societal reckoning on the effect of racism. This has attracted constant media attention to which adolescents have been inundated, leading to increasing anxiety, depression, and vicarious trauma. This is on top of the chronic stress those of marginalized communities might have experienced from direct exposures to racism. This presentation will explore the concept of race from the developmental perspective of the adolescent. We will discuss the different levels of racism, the unique lens that the pandemic has given on its influence on the social determinants of mental health in adolescents, and the role that child and adolescent psychiatrists can play. Brandon Newsome, MD, will ground the session with clarifying terminology such as racism, antiracism, prejudice, and social determinants of health, to ensure a common language. We will highlight key issues in the current syndemic of racism and COVID-19 and the way in which it has influenced outcomes of physical, mental, and social determinants of health in adolescents. We will then showcase how these issues might present in clinical encounters with adolescents. Finally, we will discuss how child and adolescent psychiatrists converse with teens on racism, social determinants of health, and antiracism. The audience will be engaged with questions, polls, and cases. Participants will be able to: 1) meaningfully discuss the different forms of racism and understand the social determinants of health; 2) recognize stressors of the current syndemic on behavioral and social determinants of health, in particular as it relates to adolescent development; and 3) discuss unique opportunities of psychiatrists in engaging and advocating for antiracist practices when working with adolescents and their families. This presentation will highlight specific challenges that 2020 and 2021 has brought regarding concerns of racism as experienced by adolescents, especially during the COVID-19 pandemic, and unique opportunities to address this with our adolescent patients.

Aerobic fitness and the sleeping brain of adolescents-a pilot study.

Study ObjectivesAerobic fitness (AF) and sleep are major determinants of health in adolescents and impact neurocognitive and psychological development. However, little is known about the interactions between AF and sleep during the developmental transition experienced across adolescence. This study aimed to consider the relationships between AF and habitual sleep patterns and sleep neurophysiology in healthy adolescents.MethodsSubjects (mean age = 14.6 ± 2.3 years old, range 11–17, 11 females) were evaluated for AF (peak VO2 assessed by ramp-type progressive cycle ergometry in the laboratory), habitual sleep duration and efficiency (7–14 days actigraphy), and topographic patterns of spectral power in slow wave, theta, and sleep spindle frequencies in non-rapid eye movement (NREM) sleep using overnight polysomnography (PSG) with high-density electroencephalography (hdEEG, 128 channels).ResultsSignificant relationships were observed between peak VO2 and habitual bedtime (r = −0.650, p = .009) and wake-up time (r = −0.603, p = .017), with greater fitness associated with going to bed and waking up earlier. Peak VO2 significantly predicted slow oscillations (0.5–1 Hz, p = .018) and theta activity (4.5–7.5 Hz, p = .002) over anterior frontal and central derivations (p < .001 and p = .001, respectively) after adjusting for sex and pubertal development stage. Similar associations were detected for fast sleep spindle activity (13–16 Hz, p = .006), which was greater over temporo-parietal derivations.ConclusionsGreater AF was associated with a more mature pattern of topographically-specific features of sleep EEG known to support neuroplasticity and cognitive processes and which are dependent on prefrontal cortex and hippocampal function in adolescents and adults. AF was also correlated with a smaller behavioral sleep phase delay commonly seen during adolescence.

Family Characteristics as Determinants of Mental Health in Adolescents

The family environment is considered to be a micro-ecological system with numerous risk and protective factors for mental health. The goal of this research was to determine how different functional and/or structural family characteristics affect some indicators of mental health in adolescents. A number of 1,239 adolescents (ages 15–19) participated in the research. General Data Questionnaire, Family Life Satisfaction Scale, Family Communication Scale, Positive Mental Health Scale, Anxiety, Depression and Stress Scale, and Stressful Events in the Family Checklist, were applied. The results indicated no connection between sociodemographic characteristics and self-assessed satisfaction. Adolescents with older parents were less satisfied with their family and familial communication. Gender differences in mental health were confirmed, mostly to the detriment of girls. The mother’s age and the father’s level of education significantly correlate with individual mental health. Adolescents with older mothers reported lower mental health. Adolescents with fathers of lower educational status reported higher stress and depression level. Stress within the family proved to be significant in explaining adolescents’ mental health, especially due to financial issues, and conflicts among family members. Finally, the results indicated that family communication and satisfaction, with the control of sociodemographic characteristics and stress in a family, additionally explain the significant part of the variance in adolescents’ mental health.

Proximal Social Determinants of Adolescents’ Health: The Importance of Everyday Life Circumstances

Adolescent health has a significant influence as individuals transition to adulthood and can have lifelong effects on well-being. In addition to well-established structural determinants of health such as racism and poverty, proximal determinants of adolescent health illuminate on the health effects of the daily circumstances of adolescents. Guided by the proximal determinants of adolescent health theory, we examined the association between adolescents’ self-rated health and multiple domains of proximal determinants, including family relations, peer relationships, school environment, and neighborhood environment. Using data from the Fragile Families and Child Wellbeing Study, we analyzed 3,444 adolescents who were 14 to 15 years old. Results of ordered logistic regression analyses revealed significant associations between proximal determinants and adolescents’ self-rated health even when taking into account all the domains simultaneously. This study highlights the importance of unraveling factors of multiple systems on adolescents’ health and suggests implications for their subsequent transition to adulthood.

Into the realm of social capital for adolescents: A latent profile analysis

BackgroundRecent reports of increasing prevalence of frequent health complaints and mental health problems among adolescents call for directing more attention on determinants of adolescent health. The relationship between health and social capital has gained increased attention since the early 2000’s and research at review level confirms the importance of social capital for health outcomes, despite methodological heterogeneity. The aim of this study was to identify distinct profiles of family, school and peer social capital in a nationally representative sample of adolescents and to explore health outcomes in those profiles.MethodCross-sectional data from the Swedish Health Behaviour of School-aged Children 2013/14 was used for this study. The analytical sample consisted of 7,804 adolescents aged 11-, 13- and 15-years. Items representing sense of belonging and emotional support were assessed in three contexts; family, school and among peers. Latent profile analyses (LPA) were run to determine social capital profiles. Health outcomes included frequent health complaints and life satisfaction, while socioeconomic status and genders were included as predictors.ResultsThe results show that five distinct profiles best represent the data for 11- and 15-year olds, while a four-profile model was optimal for 13-year olds. Some profiles were recurrent between age groups but unique profiles were also found. Health outcomes were significantly different between profiles depending on levels of social capital in the different contexts.ConclusionsThis study provides novel insight into how social capital co-occurs among adolescents within the contexts of family, school and peers and how this translates into differences in health outcomes. The national representativeness of the sample increases the implications of the results and contributes to meaningful insights that help explain the interactions of social capital in multiple contexts, complementing what is previously known about the relationship with adolescent health.

Socio-economic Determinants of Adolescent Health in Russia

The article presents the results of a comprehensive study of the socio-economic determinants of the health of Russian adolescents, performed using quantitative and qualitative methods. The quantitative analysis was carried out on the basis of the data of the Russian Monitoring of the Economic Situation and Health conducted by the Higher School of Economics for 2010-2016 (19th- 25th waves) using the logistic regression apparatus. Qualitative data are obtained by conducting 39 semi-structured interviews with adolescents aged 14-17 living in the Republic of Udmurtia and the Moscow Region in two stages: in 2010 and 2013. Within the framework of the study, the complex of socio-cultural determinants of health is separately singled out for the first time and its significance is shown for the health of Russian teenagers. The definition of the most significant socio-economic determinants of adolescent health enabled developing a series of recommendations in the area of public health promotion policy.

How often parents make decisions with their children is associated with obesity

BackgroundEvidence supports that better parental involvement and communication are related to reduced obesity in children. Parent-child collaborative decision-making is associated with lower BMI among children; while child-unilateral and parent-unilateral decision-making are associated with overweight children. However, little is known about associations between joint decision-making and obesity among Hispanic youth. The purpose of this analysis was to determine the relationship between parent-child decision making and obesity in a sample of predominantly Hispanic adolescents.MethodsData from two studies focused on risk for type II diabetes were analyzed. A total of 298 adolescents 10–14 years of age and their parent/legal guardian were included. Parents completed questionnaires related to psychosocial, family functioning, and environmental factors. Multiple logistic regression was used to determine the association between obesity (≥ 95th percentile for age and gender), the dependent variable, and how often the parent felt they made decisions together with their child (rarely/never, sometimes, usually, always), the primary independent variable. Covariates included gender, age, ethnicity, total family income, and days participated in a physical activity for at least 20 min. ORs and 95% CIs were calculated.ResultsAdolescent participants were predominantly Hispanic n = 233 (78.2%), and approximately half n = 150 (50.3%) were female. In multivariate analyses, adolescents who rarely/never made decisions together with their family had significantly higher odds (OR = 3.50; 95% CI [1.25–9.83]) of being obese than those who always did. No association was observed between either those who sometimes make decisions together or those who usually did and those that always did.ConclusionsParents and children not making decisions together, an essential aspect of parent-child communication, is associated with increased childhood obesity. The results of our study contribute to evidence of parental involvement in decision-making as an important determinant of adolescent health. Further studies should explore temporal relationships between parenting or communication style and obesity.

Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes

ObjectiveTo examine the relationship between the social determinants of health and markers of early renal injury in adolescent patients with type 1 diabetes (T1D).Study designRenal outcomes included estimated glomerular filtration rate (eGFR) and albumin–creatinine excretion ratio (ACR). Differences in urinary and serum inflammatory markers also were assessed in relation to social determinants of health. Regression analysis was used to evaluate the association between the Ontario Marginalization Index (ON-Marg) as a measure of the social determinants of health, patient characteristics, ACR, eGFR, and renal filtration status (hyperfiltration vs normofiltration).ResultsParticipants with T1D (n = 199) with a mean age of 14.4 ± 1.7 years and diabetes duration of 7.2 ± 3.1 years were studied. Mean eGFR was 122.0 ± 19.4 mL/min/1.73 m2. Increasing marginalization was positively associated with eGFR (P < .0001) but not with ACR (P = .605). Greater marginalization was associated with greater median levels of urinary interleukin (IL)-2, IL-12 (p40), macrophage-derived chemokine, monocyte chemoattractant protein-3, and tumor necrosis factor-β and serum IL-2. ON-Marg was significantly associated with eGFR after we controlled for age, sex, body mass index z score, ethnicity, serum glucose, and hemoglobin A1c in linear regression. A similar association between hyperfiltration and ON-Marg score was observed in multivariable logistic regression.ConclusionIncreasing marginalization is significantly associated with both eGFR and hyperfiltration in adolescents with T1D and is associated with significant changes in urinary inflammatory biomarkers. These findings highlight a potentially important interaction between social and biological determinants of health in adolescents with T1D.