Generation Health Study Research Articles

Individual and social-environmental factors among young drivers informing decisions to ride with an impaired driver and drive impaired: A sequential mixed methods assessment

Objective To contextually examine facilitators of young driver decisions to ride with an impaired driver (RWI) or drive while impaired (DWI). Methods Data were from the NIH’s NEXT Generation Health Study (NEXT), a 7-year longitudinal nationally representative study with a U.S. probability cohort of 10th graders starting in 2009–2010. Using a multistage sequential explanatory mixed methods approach, we conducted latent class analysis (n = 2,783) to identify RWI/DWI trajectories from adolescence to young adulthood (Stage-1). We then conducted in-depth qualitative interviews with purposively sampled young adults (N = 105, 26.30 ± 0.43 y/o) from four identified RWI/DWI trajectory classes (Stage-2): 31 Abstainers (consistently low probability), 33 Escalators (low-to-high probability), 14 Decliners (high-to-low probability), and 27 Persisters (consistently high probability). In Stage-2, the qualitative interview guide was informed by Stage-1 findings and Ecodevelopmental Theory. Using directed content analysis, we applied inductive and deductive theory-grounded codes to interview transcripts. With data immersion, reflexivity, and team dialogue, we derived themes from the code, “Facilitators of RWI and/or DWI”. Demographics and validated measures of resiliency, health-related quality of life, Timeline Follow Back for alcohol and marijuana, and recent engagement in RWI/DWI were collected during the interviews. Results Based on the interview transcripts, five themes emerged around RWI/DWI facilitators during and after high school: (1) beliefs about alcohol/drug effects; (2) trust of others; (3) trust of self; (4) parental disapproval; and (5) transportation factors. Participants who RWI confidently placed their trust in their assessment of the driver’s impairment and their own in the context of close relationships. Those who DWI described desire to maintain simple/easy vehicle access while avoiding tickets/towing. The joint display of the quantitative and qualitative data is presented. Conclusions Notable misperceptions exist about how alcohol/drugs impact driving in the RWI/DWI context, particularly regarding the subtle signs of impairment. Youth commonly relied on their own assessment of impairment before driving themselves or riding with a potentially impaired driver, sometimes to avoid parental disapproval. Some engage in RWI/DWI to avoid discord with parents. DWI may relate to needing easy/immediate vehicle access. Pragmatic remedy considerations could include educating youth and young drivers about impairment, enhancing safe public transportation, and expanding ride-share programing.

Shared and distinct parental influences on teen impaired driving in rural and suburban contexts: A mixed methods study of young drivers

ObjectiveTo explore shared and distinct parental influences on rural and suburban adolescents’ riding with an impaired driver (RWI) and driving while impaired (DWI) behaviors during high school. MethodsParticipants in the NEXT Generation Health Study (NEXT) were classified into four RWI/DWI trajectory classes (i.e., Abstainer, Escalator, Decliner, Persister) which described patterns of RWI/DWI from high school to emerging adulthood. A follow-up, in-depth, qualitative interview was conducted with a purposeful selection of participants from each trajectory class between March and September 2020. Guided by Ecodevelopmental Theory, the interview included questions which explored parent-teen influences on driving and RWI/DWI. ResultsImposition of a curfew was a shared parental influence in rural and suburban contexts. Unique to the rural context, parent modeling of RWI/DWI was described as normative and occurring since childhood. ConclusionsPrevention interventions targeting parent RWI/DWI may reduce their children’s risk for RWI/DWI among rural adolescents.

Longitudinal perspectives of riding with a cannabis-impaired driver

ObjectiveTo explore decisions and perceptions of engaging in riding with a cannabis-impaired driver (RWI) during high school and young adulthood to build context around RWI-cannabis events. MethodsParticipants were sampled from the NEXT Generation Health Study (NEXT), a 7-year national cohort study of adolescent health behaviors. Four RWI and driving while impaired (DWI) trajectories classes (i.e., Abstainer, Escalator, Decliner, Persister) were previously derived.A theoretical model based on ecological systems theory guidedin-depth semi-structured interviews to includecomplex, social-developmental and environmental multi-level factors affectingpersonal experiences with RWI-cannabis during high school, after high school, and during young adulthood. Participants (n = 105) were purposively selected from each trajectory class for follow-up, in-depth, qualitative interviews. All interviews were conducted via Zoom between March and September 2020. ResultsTwo unique themes emerged as facilitators of RWI-cannabis: “Driving Context” and “Trust in Driver”. “Legal Concerns” and “Concerns with Safety Emerge with Age” were themes that described deterrents to RWI-cannabis. ConclusionsCurrent data suggest that youth RWI-cannabis occurs during daytime hours and while driving to everyday activities. Youth report legal concerns as a potential deterrent to RWI-cannabis in high school and concerns for safety emerge in young adulthood. The multifaceted nature of RWI-cannabis among young drivers identifies potential complexities for programming designed to reduce RWI/DWI-cannabis.

Do adolescent trajectories of riding with an impaired driver and driving impaired predict similar behaviors in early adulthood?

BackgroundA recent study shows four trajectories of riding with an impaired driver (RWI) and driving while impaired (DWI) from adolescence to emerging adulthood. We examined prospective associations of adolescent RWI/DWI trajectory class with early adulthood RWI/DWI behavior. MethodsData were from the NEXT Generation Health Study (NEXT), a nationally representative longitudinal study (N = 2783) beginning with a 10th-grade cohort completing 7 annual assessment waves (W1–W7) between 2010 and 2016 and a later follow-up mixed methods study. Four RWI and DWI trajectories derived from a recently published latent class analysis study (RWI (last 12 months); DWI (last 30 days) dichotomized as ≥ once vs. none) were used: Abstainer, Escalator, Decliner, and Persister. In the follow-up examination, a purposive subsample (N = 105, 26.3 ± 0.5 y/o, Female 50.5%) of NEXT participants were selected by trajectory (31 Abstainers, 33 Escalators, 14 Decliners, and 27 Persisters) for in-depth interviews 4 years after NEXT. In interviews, self-reported RWI events (number of times) related to alcohol (Alc-RWI) or marijuana (MJ-RWI) use in the last 12 months, and DWI events (number of times) related to alcohol (Alc-DWI) & marijuana (MJ-DWI) use in January 2020 (pre-COVID pandemic) were collected using structured surveys. General linear models were used to examine associations of adolescents’ RWI/DWI trajectories with early adulthood RWI/DWI behavior, controlling for sex, health status, education attainment, and work hours. ResultsThe mean number (SD) of Alc-RWI and MJ-RWI events reported by Escalators (3.83(2.48), 2.43(2.77)) and Persisters (3.83(2.43), 3.57(2.54)) were higher (p≤0.05) than Abstainers (0.82(1.42), 0.77(2.04)) and Decliners (1.81 (2.69), 1.38 (2.04)). Similarly, Escalators (1.61 (2.28), 1.88(2.69)) and Persisters (1.96(2.08), 1.93(2.48)) reported more Alc-DWI and MJ-DWI events than Abstainers (0.18 (0.53), 0.42(1.38)) and Decliners (0.00 (0.00), 0.08(0.28)). Linear regression models indicated membership in Escalator and Persister classes compared to Abstainer class was associated (p≤0.01) with higher engagement in RWI/DWI in early adulthood. ConclusionAdolescents with escalating and persistent high RWI/DWI may continue these health risking behaviors into their mid-twenties. Decliners during the transition maintained low RWI/DWI into their mid-twenties. Taken together, these findings suggest that earlier reduction may have long-term effects. Our findings can be used to inform the precision tailoring of prevention efforts aimed at effectively reducing alcohol/drug impairment crash injuries and related deaths among those in early adulthood.

Association of Adolescents' Body Mass Index Classification With Preventive Clinical Care Receipt

PurposeTo examine differences in screening and advising for modifiable risk behaviors during well-visits based on adolescents' body mass index categories. MethodsRetrospective analyses were conducted with the National Institute of Health's NEXT Generation Health Study data, a nationally representative cohort of 10th graders. In wave 1 (2010), adolescents were classified as being underweight (<4.99th percentile), normal-weight (5-84.99th percentile), overweight (85–94.99th percentile), or with obesity (≥95th percentile) based on the body mass index categories described by the Centers for Disease Control and Prevention. In wave 2 (2011), adolescents were asked by their provider about smoking, alcohol use, use of other drugs, sexual activity, nutrition, and exercise, and whether they were advised about risks associated with these behaviors. ResultsThe sample consisted of 1,639 eligible participants as follows: 57.8% females, 63.3% 16-year-olds, 47.8% non-Hispanic Whites, 41.5% living in the South, 75.4% with health insurance, and 29.8% with low family affluence. Screening rates for overweight compared to normal-weight males were 51% reduced for smoking, 46% for alcohol use, 47% for other drug use, 57% for nutrition, and 47% for exercise. Screening rates were 40% reduced for other drug use for males with obesity, and 89% reduced for alcohol use for underweight males compared to normal-weight males. Advice receipt for females with obesity compared to normal-weight females was 90% increased for nutrition and 78% increased for exercise. DiscussionOverweight male adolescents reported being less likely to be screened across almost all preventive service topics representing missed opportunities for care delivery.

Adolescent Substance Use Patterns and Risk for Suicidal Thoughts and Behaviors in Young Adulthood.

There is strong evidence that substance use is a risk factor for suicidality. Prior studies have focused on the suicide risk associated with using individual substances, even though substance users often use more than one substance. This study investigates the association between patterns of adolescent substance use and suicidality in young adulthood. Participants were U.S. adolescents (n = 2,111, 58.9% female, mean age = 16.31 years) from the NEXT Generation Health Study, which followed tenth graders for 7 years (2009/2010-2016) and collected data via yearly surveys. Longitudinal latent class analysis was used to identify high school patterns of substance use, and logistic regression was used to relate these patterns to risk of suicidality in young adulthood. We identified two groups of adolescents: "non-/infrequent users" (71%) and "multiple substance users" (29%). Multiple substance users had higher odds of making a suicide plan or attempt in young adulthood (odds ratio [OR] = 2.41, 95% CI [1.05, 5.53]), but not suicidal ideation (OR = 1.55, 95% CI [0.80, 2.99]), than non-/infrequent users, adjusting for sociodemographic factors and depressive symptoms. Multiple substance users with suicidal ideation were not more likely to progress to a later plan or attempt (OR = 1.41, 95% CI [0.41, 4.84]) than non-/infrequent users. Adolescents who use substances in high school are at higher risk for making a suicide plan or attempt in young adulthood. Early identification of these adolescents may help inform interventions to mitigate risk for suicidal behaviors in young adulthood.

A Nationally Representative Study of Sexual Orientation and High-Risk Drinking From Adolescence to Young Adulthood

PurposeTo determine whether peer drunkenness, parental knowledge about their adolescent's whereabouts and behaviors, and depressive symptoms contribute to sexual orientation disparities in high-risk drinking behaviors; if they do, they would be potential intervention targets. MethodsLongitudinal survey data from 2,051 adolescents who participated in the NEXT Generation Health Study were analyzed. Latent growth curve and longitudinal path analyses were used to test for indirect effects linking sexual orientation in 11th grade (3.4% males and 8.4% females were sexual minorities) to past 30-day heavy episodic drinking (HED) over 6 years and past year high-intensity binge drinking at 4 years after high school. ResultsSexual minority males were not more likely to engage in high-risk drinking than heterosexual males. In contrast, sexual minority females were more likely than heterosexual females to engage in HED when they were in 11th grade (Odds Ratio = 2.83, 95% confidence interval = 1.43, 5.61), in part because of lower parental knowledge. Sexual minority females also had higher depressive symptoms during the transition from adolescence to young adulthood, which in turn was associated with greater risk of high-intensity binge drinking in young adulthood. Peer drunkenness was a strong risk factor for HED and high-intensity binge drinking among both males and females. DiscussionSexual minority females reported lower levels of parental knowledge during adolescence and higher levels of depressive symptoms during the transition to young adulthood than heterosexual females. Both factors were associated with high-risk drinking behavior, suggesting developmentally sensitive opportunities to mitigate sexual orientation disparities in high-risk drinking.

Longitudinal associations between high school sleep characteristics and young adult health outcomes.

Short sleep duration and evening chronotype are independently associated with negative health outcomes. However, it is unclear how adolescent sleep duration and chronotype are longitudinally associated with health outcomes during early adulthood. Participants from the NEXT Generation Health Study (n = 2,783; 54.5% female) completed measures of sleep duration (scheduled day and unscheduled day) and chronotype in high school. Sleep duration, chronotype, general health, depressive symptoms, and psychosomatic symptoms were also assessed 4 years after high school. Latent variables estimated high school scheduled-day sleep duration, unscheduled-day sleep duration, and chronotype using the during high school measures. Two path analyses tested the prospective associations between high school sleep duration (separate models for scheduled and unscheduled days) and chronotype with 4 years after high school health outcomes as mediated by concurrent sleep duration and chronotype. In the scheduled-day model, longer high school sleep duration and later chronotype were associated with longer duration and later chronotype in early adulthood. Longer high school sleep duration was directly associated with fewer psychosomatic symptoms and indirectly associated with fewer depressive and psychosomatic symptoms through longer sleep duration in early adulthood. Later chronotype in high school was indirectly associated with poorer general health, greater depressive symptoms, and greater psychosomatic symptoms in early adulthood through later chronotype. Findings highlight the roles of scheduled-day sleep duration and evening chronotype in shaping health outcomes and suggest the importance of chronotype and optimal sleep habits among adolescents. Maultsby KD, Temmen CD, Lewin D, etal. Longitudinal associations between high school sleep characteristics and young adult health outcomes. J Clin Sleep Med. 2022;18(11):2527-2536.

Food Addiction, Weight Perception, Dieting, and Maladaptive Eating Behaviors in U.S. Young Adults: An Observational, Prospective, Nationally Representative Cohort Study

ObjectivesThis study examines relations of food addiction with weight-related and maladaptive eating behaviors in a nationally representative sample of U.S. young adults. MethodsData come from the final annual assessment of the NEXT Generation Health Study, which followed a cohort of U.S. emerging adults from 2010–2017 (year 7 n = 2323, age 22.6 ± 0.5 years, 81% retention). Food addiction was assessed using the modified Yale Food Addiction Scale. Participants self-reported height, weight, weight perception (underweight, about right, overweight), currently attempting weight loss (vs. not), and 10 maladaptive eating behaviors (e.g., self-induced vomiting, laxative use, diet pills). Logistic (rare outcomes) and log-binomial (common outcomes) regression analyses accounting for the complex survey design estimated relations of food addiction with dieting, perceived overweight, and maladaptive eating behaviors. ResultsThe prevalence of food addiction was 4.7% (95% CI: 3.6% –6.2%). Forty-seven percent of young adults (95% CI: 46.9%, 52.1%) reported attempting weight loss; 45.6% reported perceived overweight (95% CI: 40.9%, 50.3%) and 7.1% (95% CI: 4.5%, 11.0%) reported any maladaptive eating behavior. In bivariate regressions, females had greater odds of food addiction, maladaptive eating behaviors, perceived overweight, and attempting weight loss; outcomes were not associated with other sociodemographics. Attempting weight loss (RR = 3.4, 95% CI: 1.7, 7.1, p = .002), perceived overweight (RR = 6.3, 95% CI: 2.9, 13.6, p < .001), and maladaptive eating behaviors (OR = 3.3, 95% CI: 1.7, 6.5, p = .001) were positively associated with food addiction adjusted for sex and weight status. ConclusionsFindings indicate considerable overlap between food addiction, perceived overweight, weight loss attempt, and subclinical maladaptive eating behaviors. Food addiction may be an important consideration in the treatment and management of young adults with multiple aspects of problematic eating. Funding SourcesFunding was provided by the NICHD Intramural Research Program, NIAAA, MCHB of HRSA, and NIDA.

Impact of the external school food environment on the associations of internal school food environment with high schoolers' diet and BMI.

To examine associations of school food availability with student intake frequency and BMI, and whether the number of neighbourhood food outlets modifies these associations. Baseline assessment of a nationally representative cohort study of US 10th graders. Students reported intake frequency of fruits and vegetables (FV), snacks and soda. BMI was calculated from measured height and weight. Administrators of seventy-two high schools reported the frequency of school availability of FV, snacks and soda. The number of food outlets within 1 km and 5 km were linked with geocoded school addresses. Data were analysed using adjusted linear and logistic mixed models with multiple imputation for missing data. US 2009-2010. Totally, 2263 US 10th graders from the Next Generation Health Study (NEXT). Greater school FV availability was positively associated with student FV intake. Food outlets within 5 km of schools (but not 1 km) attenuated the association of school FV availability with student intake; this was no longer significant at schools with > 58 food outlets within 5 km. School food availability was not associated with student BMI or student snack or soda intake. School food availability was associated with student intake of FV, but not with snacks, soda or BMI. Attenuation of the observed associations by the school neighbourhood food environment indicates a need to find ways to support healthy student eating behaviours in neighbourhoods with higher food outlet density.

Is Delayed Driving Licensure Associated With Emerging Adult Health, Education, and Employment?

PurposeDriving licensure remains a major developmental milestone for adolescents as they become more independent to access important health, education, and employment opportunities. Today, more teens are delaying driving licensure than before. We investigated associations of delayed licensure with health, education, and employment 4 years after high school. MethodsWe analyzed data from all seven annual assessments (W1–W7) of the NEXT Generation Health Study, a nationally representative cohort survey starting at 10th grade (W1, 2009–2010). The independent variable was delaying driving licensure (DDL [delaying ≥1 year] vs. No-DDL), defined as participants receiving driver licensure ≥1 year after the initial legal eligibility time until W7. Outcome variables were self-reported health, education, and employment at W7. Covariates included sex, race/ethnicity, family affluence, parental education, and urbanicity. Multinomial logistic regressions were conducted considering complex survey features. ResultsNo-DDL versus DDL was associated with a higher likelihood of (1) excellent (adjusted odds ratio [AOR] = 2.06, p < .001), good (AOR = 1.74, p < .001), and fair (AOR = 1.34, p = .008) health compared with poor health; (2) completing a 4-year college or graduate school [AOR = 2.71, p < .001] and tech/community college [AOR = 1.92, p = .004] compared with high school or less; and (3) working ≥30 hours/week (AOR = 7.63, p = .011) and working <30 hours/week (AOR = 1.54, p = .016) compared with not working. DiscussionAmong emerging adults, no delay in driving licensure was associated with better self-reported health, higher education, and more working hours four years after leaving high school. Although earlier driving licensure increases driving exposure and risk, avoiding DDL appears to provide advantages for health, education, and employment during early adulthood.

Association between adolescent smoking and subsequent college completion by parent education – A national longitudinal study

BackgroundEducational attainment is a social determinant of health associated with better quality of life and health outcomes. Current understanding of the association between adolescent smoking and college completion is limited. This study examined the association between adolescent smoking and subsequent college completion and how it varied by parent education in a longitudinal study of U.S. adolescents followed into young adulthood. MethodsData were collected annually from a nationally representative cohort of 10th graders who participated in the NEXT Generation Health Study (2009 −2017; N = 1407). Participants reported if they smoked during 10th-12th grades (2009–2013). Self-report college completion was assessed in 2017. Parent reported their educational attainment at baseline. Weighted logistic regression models were used to assess the association between adolescent smoking during 10th-12th grades and subsequent college completion in the entire sample and stratified by parent educational attainment, adjusting for demographics, depressive symptoms, alcohol use, and parental monitoring. ResultsOverall, adolescents who smoked during 10th-12th grade had lower odds of subsequently completing college compared to those who did not smoke (AOR=0.33, 95%CI=0.20–0.57). This association was stronger among those whose parents had ≤high school education (AOR=0.08, 95% CI=0.02–0.31) and some college education (AOR=0.18, 95%CI=0.08–0.39). DiscussionAdolescents from lower educational attainment households showed disproportionately stronger association between adolescent smoking and subsequent college completion. Future research needs to determine whether and how strategies to reduce adolescent smoking may promote educational attainment especially among adolescents whose parents have less than a college education.

Trajectories and outcomes of adolescents that ride with an impaired driver/drive while impaired

IntroductionFor young drivers, independent transportation has been noted to offer them opportunities that can be beneficial as they enter early adulthood. However, those that choose to engage in riding with an impaired driver (RWI) and drive while impaired (DWI) over time can face negative consequences reducing such opportunities. This study examined the prospective association of identified longitudinal trajectory classes among adolescents that RWI and DWI with their later health, education, and employment in emerging adulthood. MethodsWe analyzed all seven annual assessments (Waves, W1–W7) of the NEXT Generation Health Study, a nationally representative longitudinal study starting with 10th grade (2009–2010 school year). Using all seven waves, trajectory classes were identified by latent class analysis with RWI (last 12 months) and DWI (last 30 days) dichotomized as ≥ once = 1 vs. none = 0. ResultsFour RWI trajectories and four DWI trajectories were identified: abstainer, escalator, decliner, and persister. For RWI and DWI trajectories respectively, 45.0% (N = 647) and 76.2% (N = 1657) were abstainers, 15.6% (N = 226) and 14.2% (N = 337) were escalators, 25.0% (N = 352) and 5.4% (N = 99) were decliners, and 14.4% (N = 197) and 3.8% (N = 83) persisters. RWI trajectories were associated with W7 health status (χ2 = 13.20, p < .01) and education attainment (χ2 = 18.37, p < .01). Adolescent RWI abstainers reported better later health status than RWI escalators, decliners, and persisters; and decliners reported less favorable later education attainment than abstainers, escalators, and persisters. DWI trajectories showed no association with health status, education attainment, or employment. ConclusionsOur findings suggest the importance of later health outcomes of adolescent RWI. The mixed findings point to the need for more detailed understanding of contextual and time-dependent trajectory outcomes among adolescents engaging in RWI and DWI.

The association of motivation and perceived social norms with eating behaviors in emerging adults

ABSTRACT Objective This study examines the associations of eating-related motivation, perceived norms, and their interaction with eating behaviors in emerging adults. Design Data are from the NEXT Generation Health Study, a nationally representative sample of US emerging adults. Binominal logistic regression analyses estimated associations of eating behaviors with self-determined motivation, non-self-determined motivation, and perceived social norms. Multiplicative interaction terms between each motivation construct and perceived social norms were tested in the models. Results Self-determined motivation was positively associated with intake frequency of whole grains, low-fat dairy, and fruit and vegetables. Soda intake frequency was inversely associated with greater non-self-determined motivation, but not self-determined motivation or perceived social norms. Perceived social norms were positively associated with the intake of whole grains, low-fat dairy, and fruit and vegetables. Perceived social norms did not moderate the association of motivation constructs with eating behaviors. Conclusion Self-determined motivation and perceived social norms may be considered in intervention targeting healthful eating behaviors in emerging adults.

Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior.

To determine if sexual minority adolescents have earlier onset of suicidality and faster progressions from ideation to plan and attempt than heterosexual adolescents. A population-based longitudinal cohort of 1771 adolescents participated in the NEXT Generation Health Study. Participants reported sexual minority status (defined by sexual attraction) in 2010-2011 and retrospectively reported age at onset of suicidality in 2015-2016. Sexual minority adolescents (5.8% of weighted sample) had higher lifetime risk of suicide ideation (26.1% vs 13.0%), plan (16.6% vs 5.4%), and attempt (12.0% vs 5.4%) than heterosexual adolescents. Survival analyses adjusted for demographic characteristics and depressive symptoms revealed positive associations of sexual minority status with time to first onset of suicide ideation (hazard ratio [HR] = 1.77; 95% confidence interval [CI] 1.03-3.06) and plan (HR = 2.69; 95% CI 1.30-5.56). The association between sexual minority status and age at onset of suicide attempt was stronger at age <15 (HR = 3.26; 95% CI 1.25-8.47) than age ≥15 (HR = 0.59; 95% CI 0.21-1.66). The association between sexual minority status and progression from ideation to plan was stronger in the same year of first ideation (HR = 2.01; 95% CI 1.07-3.77) than ≥1 year after first ideation (HR = 1.33; 95% CI 0.26-6.77). Sexual minority adolescents had earlier onset of suicidality and faster progression from suicide ideation to plan than heterosexual adolescents. The assessment of sexual minority status in routine pediatric care has the potential to inform suicide risk screening, management, and intervention efforts among early sexual minority adolescents.

Trajectories of risky driving among emerging adults with their mental and psychosomatic health predictors in the 12th grade

Objective To identify trajectory classes of risky driving among emerging adults and examine predictive associations of depressive and psychosomatic symptoms in the 12th grade with the identified trajectory classes. Methods Data were from the last year in high school (12th-Grade - Wave 3 [W3]) and years 1–4 after high school (Waves 4-7 [W4-7]) of the NEXT Generation Health Study, a nationally representative study starting with 10th grade (2009–2010). We measured risky driving with the 21-item Checkpoints Self-Reported Risky Driving Scale (C-RDS). Using C-RDS data from W3-7, the latent class growth modeling (LCGM) was used to identify risky driving trajectory classes. Independent variables were W3 depressive symptoms and W3 psychosomatic symptoms. Covariates included family affluence and urbanicity. The LCGM was conducted with SAS PROC Traj. The multinomial logistic regressions were used to examine the associations between the trajectory classes and independent variables, taking complex survey sampling features into account. Results Three risky driving trajectories were identified: low (N = 583, 21.43%, weighted and hereafter), medium (N = 1423, 59.22%), and high (N = 389, 19.35%) risky driving classes. Compared to the low risky driving class, one unit increase in W3 depressive symptoms was significantly associated with a higher likelihood of belonging to the medium (adjusted odds ratio [AOR] = 1.04, 95% CI 1.01, 1.07) and the high (AOR = 1.05, 95% CI 1.02, 1.08) risky driving classes, respectfully, when controlling for the covariates. Likewise, compared to the low risky driving class, one unit increase in W3 psychosomatic symptoms was significantly associated with a higher likelihood of belonging to the medium (AOR = 1.06, 95% CI 1.00, 1.13) and the high (AOR = 1.10, 95% CI 1.04, 1.16) risky driving classes, respectively, when controlling for the covariates. Conclusions High school students with depressive and psychosomatic symptoms were at higher risk of engaging in risky driving in the immediate years after leaving high school. These findings suggest that prevention programs that incorporate screening, referral to treatment, and treatment of mental and psychosomatic symptoms in high school may be important opportunities to reduce risky driving among youth as they transition from adolescence to emerging adulthood.

Time to licensure for driving among U.S. teens: Survival analysis of interval-censored survey data

Objective Novice drivers who delay in driving licensure may miss safety benefits of Graduate Driver Licensing (GDL) programs, potentially putting themselves at higher crash-risk. Time to licensure relates their access to independent transportation to potential future economic- and educational-related opportunities. The objective of this study was to explore time to licensure associations with teens’ race/ethnicity and GDL restrictions. Methods Secondary analysis using all seven annual assessments of the NEXT Generation Health Study, a nationally representative longitudinal study starting with 10th grade (N = 2785; 2009–2010 school year). Data were collected in U.S. public/private schools, colleges, workplaces, and other settings. The outcome variable was interval-censored time to licensure (event = obtained driving licensure). Independent variables included race/ethnicity and state-specific GDL restrictions. Covariates included family affluence, parent education, nativity, sex, and urbanicity. Proportional hazards (PH) models were conducted for interval-censored survival analysis based on stepwise backward elimination for fitting multivariate models with consideration of complex survey features. In the PH models, a hazard ratio (HR) estimates a greater (>1) or lesser (<1) likelihood of licensure at all timepoints. Results Median time to licensure after reaching legal driving age for Latinos, African Americans, and Non-Latino Whites was 3.47, 2.90, and 0.41 years, respectively. Multivariate PH models showed that Latinos were 46% less likely (HR = 0.54, 95%CI: 0.35–0.72) and African Americans were 56% less likely (HR = 0.44, 95%CI: 0.32–0.56) to have obtained licensure at any time compared to Non-Latino Whites. Only learner minimum age GDL restriction was associated with time to licensure. Living in a state with a required learner driving minimum age of ≥16 years (HR = 0.57, 95%CI: 0.16–0.98) also corresponded with 43% lower likelihood of licensure at legal eligibility compared to living in other states with a required learner driving minimum age of <16 years. Conclusion Latinos and African American teens obtained their license approximately three years after eligibility on average, and much later than Non-Latino Whites. Time to licensure likelihood was associated with race/ethnicity and required minimum age of learner permit, indicating important implications for teens of different racial/ethnic groups in relation to licensure, access to independent transportation, and exposure to GDL programs.

Autonomous motivation and action planning are longitudinally associated with physical activity during adolescence and early adulthood

We examined the associations of autonomous motivation, controlled motivation, and physical activity (PA) planning with PA participation over six years across the adolescent-to-adult transition. Participants from the NEXT Generation Health Study, a nationally representative cohort study of U.S. 10th graders (N = 2785), completed surveys yearly from 2010 to 2016 (four years post-high school). This study used data from Waves 2 (W2) through 7 (W7). Data were analyzed using growth models accounting for the complex survey design and controlling for sex, race/ethnicity, and body mass index. A piecewise growth model with two pieces (Piece 1: W2–W4; Piece 2: W4–W7) indicated that PA declined during late adolescence (W2–W4) (b = −0.31, β = −0.22, p < .001), but did not decline after the transition into early adulthood (W4–W7) (b = −0.08, β = −0.04, p = .052). Autonomous motivation was positively associated with PA at all waves (b = 0.23–0.33, β = 1.90–4.37, p < .001). Controlled motivation was only positively associated with PA at W3 (12th grade) (b = 0.13, β = 1.54, p = .011). PA planning varied significantly between individuals and significantly predicted PA (b = 0.44, β = 0.21, p < .001). Although PA decreased significantly during late adolescence, PA did not decrease significantly after transitioning into early adulthood (one to four years post-high school). Elevated autonomous motivation and PA planning were consistently and significantly associated with higher PA, suggesting that these may be useful intervention targets during this adolescent-to-adult transition.

Associations between Graduated Driver Licensing restrictions and delay in driving licensure among U.S. high school students

IntroductionSome of the most vulnerable groups of teens choose to delay driving licensure (DDL). We assessed longitudinal associations between state-level Graduated Driver Licensing (GDL) restrictions and DDL among U.S. high school students. MethodsData from seven waves of the NEXT Generation Health Study (starting 10th-grade (2009–2010)), were analyzed in 2020 using Poisson regression. The outcome was DDL (delay vs. no-delay). Independent variables were driving restrictions (at learner and intermediate phases of licensure), sex, race/ethnicity, family affluence, parent education, family structure, and urbanicity. ResultsOf 2525 eligible for licensure, 887 (38.9%), 1078 (30.4%), 560 (30.7%) reported DDL 1–2 years, >2 years, no DDL, respectively. Interactions between GDL restrictions during the learner permit period and covariates were found. In states requiring ≥30 h of supervised practice driving, Latinos (Adjusted relative risk ratio [aRRR] = 1.55, p < .001) and Blacks (aRRR = 1.38, p < .01) were more likely to DDL than Whites. In states where permit holding periods were <6 months, participants with low (aRRR = 1.61, p < .001) and moderate (aRRR = 1.45, p < .001) vs. high affluence were more likely to DDL. Participants in single-parent households vs. both-biological parent households were also more likely to DDL (aRRR = 1.37, p < .05). In states where permit holding periods were ≥6 months, participants with low (aRRR = 1.33, p < .05) vs. high affluence were more likely to DDL. In states that allowed ≥3 passengers or no passenger restriction, participants living in non-urban vs. urban (aRRR = 1.52, p < .05) areas were more likely to DDL, and in states that allowed only 1 or no passenger, participants living in non-urban vs. urban areas (aRRR = 0.67, p < .001) were less likely to DDL. ConclusionsOur findings heighten concerns about increased crash risk among older teens who age out of state GDL policies thereby circumventing driver safety related restrictions. Significant disparities in DDL exist among more vulnerable teens in states with stricter GDL driving restrictions.

Riding with an impaired driver and driving while impaired among adolescents: Longitudinal trajectories and their characteristics

Purpose The purpose of this study was to identify and characterize trajectory classes of adolescents who ride with an impaired driver (RWI) and drive while impaired (DWI). Methods We analyzed all 7 annual assessments (Waves W1–W7) of the NEXT Generation Health Study, a nationally representative longitudinal study starting with 10th grade (2009–2010 school year). Using all 7 waves, latent class analysis was used to identify trajectory classes with dichotomized RWI (last 12 months) and DWI (last 30 days; once or more = 1 vs. none = 0). Covariates were race/ethnicity, sex, parent education, urbanicity, and family affluence. Results Four RWI trajectories and 4 DWI trajectories were identified: abstainer, escalator, decliner, and persister. For RWI and DWI trajectories respectively, 45.0% (n = 647) and 76.2% (n = 1,657) were abstainers, 15.6% (n = 226) and 14.2% (n = 337) were escalators, 25.0% (n = 352) and 5.4% (n = 99) were decliners, and 14.4% (n = 197) and 3.8% (n = 83) persisters. Race/ethnicity (χ2 = 23.93, P = .004) was significantly associated with the RWI trajectory classes. Race/ethnicity (χ2 = 20.55, P = .02), sex (χ2 = 13.89, P = .003), parent highest education (χ2 = 12.49, P = .05), urbanicity (χ2 = 9.66, P = .02), and family affluence (χ2 = 12.88, P = .05) were significantly associated with DWI trajectory classes. Conclusions Among adolescents transitioning into emerging adulthood, race/ethnicity is a common factor associated with RWI and DWI longitudinal trajectories. Our results suggest that adolescent RWI and DWI are complex behaviors warranting further detailed investigation of the respective trajectory classes. Our study findings can inform the tailoring of prevention and intervention efforts aimed at preventing illness/injury and preserving future opportunities for adolescents to thrive in emerging adulthood.