Early Adult Health Research Articles

1517The effect of pregnancy on cardiovascular health in early adulthood: a difference in difference analysis

Abstract Background Pregnancy causes extreme cardiometabolic changes, yet evidence of its long-term cardiovascular effects is limited. Our aim was to estimate the causal effect of pregnancy on cardiovascular health. Methods We used a difference-in-difference (DiD) model to estimate the causal effect of pregnancy on multiple cardiovascular health measures (N = 445–1822 for cardiac echocardiography, blood based markers, blood pressure (BP) and anthropometry) in female participants in the Avon Longitudinal Study of Parents and Children with a pregnancy between 18-25 years. We differentiated between live birth and miscarriage/termination. Briefly, DiD assumes baseline differences in the outcome reflect confounding, that the rate of change in the outcome is similar in exposed and unexposed prior to the exposure, and that no new confounding was introduced after baseline. Any DiD at follow up is then attributed to the exposure. Results 289 women had a pregnancy between ages 18-25 (15%). We found no effect of pregnancy on various echocardiography measures including left ventricular mass index. When accounting for changes in BMI, HDL-c and systolic BP at age 25 was -0.22mmol/L (95%CI:-0.28, -0.15) and -1.37mmHg (95%CI:-3.25, 0.52) lower, respectively, in women who had a live birth compared to no pregnancy. BMI, fat mass, and lean mass were higher in women who had a live birth versus no pregnancy. Conclusions Findings are consistent with limited existing evidence of BP lowering and lipid increasing effects of pregnancy. Future studies should investigate underlying mechanisms. Key messages Pregnancy results in a reduction in systolic BP and an adverse effect on HDL-c levels.

Racial disparities in sleep-related cardiac function in young, healthy adults: implications for cardiovascular-related health.

Considerable evidence shows that individuals from marginalized racial/ethnic groups in the United States experience greater rates of sleep disturbance and cardiovascular complications. Because sleep is a modifiable factor that is critically involved in cardiovascular health, improved understanding of the association between sleep and cardiovascular health during early adulthood can prevent cardiovascular disparities. This study examined racial/ethnic differences in cardiovascular function during sleep using heart rate and heart-rate-variability analyses. Participants in this laboratory-based sleep study included healthy, "good sleepers" who were in early adulthood and resided in the United States at the time of participation (14 non-Hispanic Black [NHB; age = 30.9 (6.6), 57% female], 12 Asian [Asian, age = 26.0 (5.2), 42% female], and 24 non-Hispanic white [NHW; age = 24.6 (5.8), 79% female]). After adjusting for demographic factors and an apnea-hypopnea index, we found significantly higher heart rate within NREM Stage 2 (N2) (b = -22.6, p = .04) and REM sleep (b = -25.8, p =.048) and lower heart rate variability during N2 sleep (b = -22.6, p = .04) among NHB individuals compared with NHW individuals. Furthermore, NHB and Asian participants demonstrated significantly lower percent of time in slow wave sleep (SWS) compared with NHW participants (NHB: b = -22.6, p =.04; Asian: b = -22.6, p = .04). Individuals' percent of time in SWS significantly mediated differences in heart rate during N2 (indirect = 0.94, 95% CI [0.03, 2.68]) and REM sleep (indirect = 1.02, 95% CI [0.04, 3.04]). Our results showed disparities in sleep-related cardiovascular function in early adulthood that are mediated by SWS. These data suggest targeting sleep health in early adulthood might help reduce cardiovascular disease burden on individuals from marginalized groups.

Associations between Device-measured Physical Activity and Cardiometabolic Health in the Transition to Early Adulthood.

The aims of this study were to investigate the cross-sectional and prospective associations between accelerometer-measured physical activity and cardiometabolic health in the transition to adulthood. Data from the 1993 Pelotas (Brazil) Birth Cohort were analyzed (n = 2280). Moderate-to-vigorous intensity physical activity (MVPA) (measured using a triaxial accelerometer) and cardiometabolic health (total fat mass, blood glucose, non-high-density lipoprotein cholesterol, triglycerides, and mean resting blood pressure) were examined at age 18 and 22 yr. Overall, inverse dose-response associations between MVPA and cardiometabolic health at age 18 and 22 yr were observed in cross-sectional analyses of data from men and women. Prospective analyses showed that, in general, MVPA declined, and cardiometabolic health worsened in this 4-yr period in both men and women. Cardiometabolic health at age 22 yr reflected both MVPA at age 18 yr (β, -0.007; 95% confidence interval [CI], -0.014 to 0.000) and changes in MVPA from 18 to 22 yr (β, -0.030; 95% CI, -0.043 to -0.016) in men, but only changes in MVPA in women (β, -0.035; 95% CI, -0.058 to -0.011). In analyses of change over time, men who improved MVPA by 20 to 30 min·d-1 showed significant improvements in cardiometabolic health over 4 yr. The magnitude of association was slightly stronger for MVPA in 10-min bouts than for MVPA accumulated in bouts of 1 min, especially in women. Moderate-to-vigorous intensity physical activity is an important predictor of cardiometabolic health in early adulthood. Strategies to prevent declines in MVPA at this life stage are required to prevent deteriorating cardiometabolic health profiles.

The association between perceived social support in adolescence and positive mental health outcomes in early adulthood: a prospective cohort study.

The link between perceived social support and mental health has received much attention from numerous scientific fields in recent years. Most studies, however, have examined associations only over relatively short follow-up periods using global measures of perceived social support and dichotomous negative indicators of mental health. We investigated the long-term association between perceived social support from friends, parents and teachers and multiple positive hedonic and eudemonic indicators of mental health, including hope, meaningfulness and subjective well-being. This study used questionnaire data from 2004, 2007 and 2010 from the West Jutland Birth Cohort study with linked register data. The study population consisted of 3681 adolescents born in 1989. Multiple linear and ordered logistic regression were used to analyse the association between perceived social support at age 14/15 years and mental health indicators at age 20/21 years while controlling for possible confounders, including the Big Five personality traits and baseline symptoms of depression. The results show that perceived social support from friends in adolescence was positively associated with all indicators of mental health in early adulthood. Furthermore, perceived paternal social support was positively associated with meaningfulness and subjective well-being, while perceived social support from teachers was positively associated with meaningfulness. Overall, the results from this study indicate that perceived social support in adolescence, particularly support from friends, could promote positive mental health outcomes in early adulthood.

Higher Ed as a Leveler: How Early Life and Higher Education Shape Resilience and Health in Adulthood

Growing evidence shows that individuals who have high levels of psychological resilience maintain higher levels of physical and psychological health in later life. Individuals cultivate psychological resilience over the life course, yet little research has explored its mechanistic effects on health during midlife. One source of resilience may be formal education, which is a well-established determinant of health in adulthood. Resilience might be one reason for this robust association, as education helps individuals develop greater psychological resources in adulthood. On the other hand, having a college degree also increases access to other health-promoting resources that can be leveraged over the life course, such as better-paying and higher-quality jobs. Using data drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the current paper examines: 1) how early-life factors shape psychological resilience in early adulthood (24-32 years); and 2) the effects of early adulthood resilience on the association between education and health in mid-life (36-44 years). Results show that psychological resilience and college education have significant direct effects on health in midlife, net of health in early adulthood. However, first-generation college graduates cultivate more psychological resilience from their educational attainment than do those with college-educated parents. That is, higher education serves as a leveler for health gaps in midlife for those with fewer resources available in early life by bolstering resilience. These results provide important insights about how early life factors play an important role in shaping successful aging processes.

Cardiovascular health in early adulthood predicts the development of coronary heart disease in individuals with type 1 diabetes: 25year follow-up from the Pittsburgh Epidemiology of Diabetes Complications study.

Type 1 diabetes increases CHD risk. We examined the use of the American Heart Association's cardiovascular health metrics (blood pressure, total cholesterol, glucose/HbA1c, BMI, physical activity, diet, smoking) to predict incidence of CHD among individuals with type 1 diabetes, with the hypothesis that a better American Heart Association health metric profile would be associated with lower incident CHD. Prevalence of the seven cardiovascular health metrics was determined using first and second visits from adult participants (mean age 28.6years) in the Epidemiology of Diabetes Complications prospective cohort study of childhood-onset type 1 diabetes. An ideal metric score (0-7) was defined as the sum of all metrics within the ideal range, and a total metric score (0-14) was calculated based on poor, intermediate and ideal categories for each metric. Incident CHD development (medical record-confirmed CHD death, myocardial infarction, revascularisation, ischaemic electrocardiogram changes or Epidemiology of Diabetes Complications physician-determined angina) over 25years of follow-up was examined by metric scores. Among 435 participants, BMI, blood pressure, total cholesterol and smoking demonstrated the highest prevalence within the ideal range, while diet and HbA1c demonstrated the lowest. During 25years of follow-up, 177 participants developed CHD. In Cox models, each additional metric within the ideal range was associated with a 19% lower risk (p = 0.01), and each unit increase in total metric score was associated with a 17% lower risk (p < 0.01) of CHD, adjusting for diabetes duration, estimated glomerular filtration rate, albumin excretion rate, triacylglycerols, depression and white blood cell count. Among individuals with type 1 diabetes, higher cardiovascular health metric scores were associated with lower risk of incident CHD. The American Heart Association-defined cardiovascular health metrics provide straightforward goals for health promotion that may reduce CHD risk in the type 1 diabetes population. Graphical abstract.

Material hardship, perceived stress, and health in early adulthood

PurposeWe examined the associations between material hardship and health outcomes in early adulthood and the extent to which these associations are mediated by perceived stress. MethodsWe used wave I and IV of the National Longitudinal Study of Adolescent Health, a nationally representative survey of young adults aged 18–34 years old (n = 13,313). Multivariate logistic regression and decomposition methods were used to evaluate the associations between types and depth of material hardship (food, bill-paying, and health resource hardship), health outcomes (self-rated health, depression, sleep problems, and suicidal thoughts) in early adulthood, and the extent to which these associations were mediated by perceived stress. ResultsThe adjusted odds of fair or poor health status, depression, sleep problems, and suicidal thoughts were higher among individuals with material hardship than counterparts without. A considerable proportion of the association between material hardship and health outcomes was attributable to perceived stress. ConclusionsMaterial hardship is associated with adverse health outcomes in early adulthood, and these relationships are robust after accounting for various sociodemographic characteristics and family background. Perceived stress accounted for a sizable portion of the effects of material hardship on health. Public Health ImplicationsEfforts to promote health equity in young adults should focus on material hardship and associated stressful conditions.

The Influence of Health in Early Adulthood on Male Fertility

AbstractDespite the large literature examining predictors of fertility, previous research has not offered a population‐level perspective on how health in early adulthood is related to male fertility. Using Swedish population and military conscription registers, we study how body mass index (BMI), physical fitness, and height are associated with total fertility and parity transitions by 2012 among 405,427 Swedish men born 1965–1972, meaning we observe fertility up to age 40 or older. Applying linear regression and sibling fixed effects, we find that these anthropometric measures are strong predictors of fertility, even after accounting for education and cumulative income. Men with a “normal” BMI and in the highest decile of physical fitness have the most children. Men who were obese at ages 17–20 had a relative probability of childlessness almost twice as high as men who had a “normal” BMI, and men in the bottom decile of physical fitness had a relatively probability of childlessness more than 50 percent higher than men in the top decile. In sibling comparison models the tallest men have the most children and men in the lowest two deciles of height have significantly lower fertility. Further analyses show that the strong associations persist even among men who married.

Family Structure and Parents’ Health: Implications for the Reproduction of Health Inequality across Generations

Early life disadvantage has enduring effects on health into adulthood. In this analysis, we are interested in the social reproduction of health inequality across generations within families. We use data from the National Longitudinal Study of Adolescent to Adult Health, a representative sample of U.S. adolescents in grades 7–12 and their parents ( N = 11,171) interviewed during the 1994–1995 school year and followed into young adulthood. We investigate whether the intersection of family structure and parents’ health predicts poor health in early adulthood and several potential explanations for health continuity across generations. We also examine whether social mobility across generations changes the association between parent and child health. Results indicate an intergenerational persistence in health, net of childhood socioeconomic context, childhood health, educational attainment, and social mobility. Findings suggest that adult health reflects the transmission of resources and practices across generations within one’s family, reproducing health inequalities.

Childhood Urinary Tract Infections and Pregnancy-Related Complications in Adult Women.

Long-term outcomes of urinary tract infection (UTI) in childhood are not well known. Pregnancy may reveal latent renal damage caused by a UTI because of stress on the kidneys. Our cohort included adult women with an ultrasonography taken because of a childhood UTI in 1981-1991 (N = 1175). Nine women with a severe congenital kidney malformation or urinary tract obstruction were excluded. Altogether, 260 mothers with a childhood UTI and 500 population-based control mothers without a childhood UTI matched for age, and delivery dates were compared. Our primary end point was the proportion of women with essential or gestational hypertension, preeclampsia, proteinuria, or pyelonephritis during the first pregnancy. The pregnancy outcomes of the women with a UTI in childhood did not differ from those of the controls because 105 of 260 (40%) patients met the primary end point compared with 204 of 500 (41%) controls (relative risk [RR] 0.99; 95% confidence interval [CI] 0.82 to 1.2; P = .91). Similarly, there were no significant differences between the 2 groups in essential hypertension (RR 1.0; 95% CI 0.65 to 1.6; P = .92), gestational hypertension (RR 0.93; 95% CI 0.74 to 1.2; P = .54), preeclampsia (RR 1.5; 95% CI 0.91 to 2.5; P = .11), proteinuria (RR 1.2; 95% CI 0.81 to 1.8; P = .36) or pyelonephritis (2 controls and none of the patients; P = .55) during the first pregnancy. Childhood UTIs did not increase the risk of pregnancy-related complications in this controlled population-based study. Thus, UTIs in childhood without severe urinary tract abnormalities appear to have a minimal effect on kidney health in early adulthood.

Longitudinal Study on Metabolic Health in Adults SGA During 5 Years After GH With or Without 2 Years of GnRHa Treatment.

In children born small for gestational age (SGA) with persistent short stature, 2 years of gonadotropin-releasing hormone analogue (GnRHa), in addition to long-term growth hormone (GH) treatment, can improve adult height. We assessed safety on metabolic and bone health of GnRHa/GH treatment during 5 years after cessation of GH. A total of 363 young adults born SGA, previously treated with combined GnRHa/GH or GH-only, were followed for 5 years after attainment of adult height at GH cessation and 2 and 5 years thereafter. Data at 5 years after GH cessation, at age 21 years, were also compared with 145 age-matched adults born appropriate for gestational age (AGA). Frequently sampled intravenous glucose tolerance (FSIGT) tests were used to assess insulin sensitivity, acute insulin response, and β-cell function. Body composition and bone mineral density (BMD) was determined by dual-energy x-ray absorptiometry (DXA) scans. In the GnRHa/GH and GH-only groups, fat mass increased during the 5 years after GH cessation, but the changes in FSIGT results, body composition, blood pressure, serum lipid levels, and BMD were similar in both groups. At age 21 years, the GnRHa/GH group had similar fat mass, FSIGT results, blood pressure, serum lipid levels and BMD-total body as the GH-only group and the AGA control group, a higher BMD-lumbar spine and lower lean body mass than the AGA control group. This study during 5 years after GH cessation shows that addition of 2 years of GnRHa treatment to long-term GH treatment of children short in stature born SGA has no unfavorable effects on metabolic and bone health in early adulthood. ISRCTN96883876, ISRCTN65230311 and ISRCTN18062389.

Precarious Childhoods: Childhood Family Income Volatility and Mental Health in Early Adulthood

AbstractThe rise of income volatility in western countries has been extensively documented in the literature, but empirical research has just started to examine how childhood exposure to family income volatility affects subsequent wellbeing. This study takes advantage of several nation-wide, population registers from Sweden with linkages within and across generations to examine the intergenerational impact of childhood family income volatility on psychiatric disorders in early adulthood. In addition to the population-average effects, we also examine the heterogeneity in the impact of family income volatility for families at the top, bottom, and middle of the family income distribution. Our results suggest that after controlling for a set of family- and child-level characteristics, childhood family income volatility has a negative effect on mental wellbeing, and this finding is consistent across a range of psychiatric outcomes. Furthermore, we show that while children from low-income families exhibit the greatest likelihood of psychiatric disorder, children from families in the middle of the income distribution experience the greatest negative impact of income volatility.

Association of Childhood History of Parental Incarceration and Juvenile Justice Involvement With Mental Health in Early Adulthood

Young adults with a childhood history of parental incarceration (PI) or juvenile justice involvement (JJI) are more likely to have worse mental health outcomes than their peers. However, the association between mental health and exposure to both PI and JJI (PI plus JJI) is unclear. To determine the association of PI plus JJI exposure with mental health outcomes in young adulthood. A cross-sectional study of the US National Longitudinal Survey of Adolescent to Adult Health was conducted to examine the associations between PI, JJI, and PI plus JJI and mental health outcomes (ie, depression, anxiety, posttraumatic stress disorder, suicidal ideation, and mental health counseling). In-home interviews were conducted of 13 083 participants; 704 participants with PI after age 18 years were excluded, and 12 379 participants formed the analysis sample. Participants were in grades 7 to 12 in 1994 to 1995 and were ages 24 to 32 years at follow-up in 2008. Data analysis was completed in 2019. Parental incarceration, JJI, or PI plus JJI before age 18 years. Mental health outcomes in early adulthood (ages 24-32 years). The analysis included multivariable logistic regression models; accounted for individual, family, and geographic-level factors; and generated adjusted odds ratios. Among 13 083 participants (6962 female; weighted proportion, 49.6%) with a mean age at wave 1 of 15.4 years (95% CI, 15.2-15.7 years), 10 499 (80.2%) did not have a history of PI or JJI, 1247 (9.1%) had childhood PI, 704 (5.2%) had PI after age 18 years, 492 (4.5%) had JJI only, and 141 (1.2%) had PI plus JJI. Sociodemographic characteristics varied by exposure. Exposure to both PI and JJI was associated with a greater risk of depression (adjusted odds ratio, 2.80; 95% CI, 1.60-4.90), anxiety (adjusted odds ratio, 1.89; 95% CI, 1.08-3.31), and posttraumatic stress disorder (adjusted odds ratio, 2.92; 95% CI, 1.09-7.82) compared with peers with neither exposure. Exposure to both PI and JJI did not have an additive association with mental health beyond PI or JJI alone. This study suggests that exposure to the criminal justice system during childhood places individuals at risk for poor mental health outcomes in early adulthood. Clinical, advocacy, and policy efforts that prioritize reducing the impact of the US criminal justice system on children may yield substantive improvements in the mental well-being of those individuals as adults.

Health and Functional Outcomes for Shared and Unique Variances of Interpersonal Callousness and Low Prosocial Behavior

Previous factor-analytic studies identify significant comorbidity between interpersonal-callous (IC) traits and low prosocial behavior (LPB), which, in turn, is associated with high levels of childhood risk exposure and psychopathology. Longitudinal associations between IC, LPB, or their combination, and early-adult health and social functioning have not been investigated, however. Extending a previously-identified bifactor model within a prospective birth cohort, this study applied latent path analysis to test direct and indirect pathways (via adolescent delinquency, substance use, and physical activity) between these general and specific factors (age 13) and (i) emotional problems (age 18), (ii) physical health problems (age 18), and (iii) classification as ‘not in education, employment, or training’ (NEET; age 20). All models controlled for childhood adversity and IQ. Bifactor-specific estimates indicated that the residual IC factor did not reliably denote unique variance over and above a general factor (IC/LPB). IC/LPB itself was directly associated with NEET classification, while the residual LPB factor was associated with better emotional and physical health. IC/LPB also indirectly associated with emotional problems via greater adolescent delinquency, and with physical health problems via lower physical activity. In contrast, residual LPB variance was either non-significantly or negatively related to these adolescent domains. Findings indicate that the shared variance underlying IC and LPB confers an increased risk for poor health and functional outcomes in emerging adulthood, and highlight delinquency and physical inactivity as potential adolescent treatment targets that may mitigate the risk for health difficulties at high levels of this IC/LPB construct.

Adult hypophosphatasia with compound heterozygous p.Phe327Leu missense and c.1559delT frameshift mutations in tissue-nonspecific alkaline phosphatase gene: a case report

BackgroundHypophosphatasia is an inherited bone disease characterized by low alkaline phosphatase activity encoded by ALPL. Clinically, hypophosphatasia can be categorized as perinatal, infantile, childhood, and adult forms, as well as odonto-hypophosphatasia, according to the age at first sign or dental manifestations. Adult hypophosphatasia typically presents in middle-aged patients who appear to be in good health in early adulthood and manifests as painful feet caused by recurrent, slow-healing stress fractures of the lower limb. Because the symptoms of adult hypophosphatasia vary and are common, many patients with hypophosphatasia might be not diagnosed accurately and thus may receive inappropriate treatment.Case presentationWe report a case of a 35-year-old Japanese woman with low serum alkaline phosphatase detected at a routine medical checkup. She had mild muscle/bone pain but no history of rickets, fractures, or dental problems. Measurement of bone mineral density of the lumbar spine and the femoral neck revealed osteopenia below the expected range for age in a young adult. Abdominal ultrasonography revealed numerous microcalcifications in both kidneys. Analysis of amino acids in urine revealed that phosphoethanolamine was elevated. Low serum alkaline phosphatase activity, elevation of phosphoethanolamine, and low bone mineral density supported the diagnosis of hypophosphatasia. ALPL mutation analysis revealed two mutations: p.Phe327Leu and c.1559delT. These genetic abnormalities were previously reported in perinatal, infantile, and childhood but not adult hypophosphatasia. On the basis of the clinical presentation, laboratory and imaging findings, and genetic analyses, the patient was definitively diagnosed with adult hypophosphatasia. To the best of our knowledge, this is the first case report of adult hypophosphatasia with the compound heterozygous mutations p.Phe327Leu and c.1559delT.ConclusionsAlthough the risk of bone fracture was high in this case, treatment approaches differ between osteoporosis and hypophosphatasia. Because adult hypophosphatasia diagnosis is often difficult because of their varied symptoms, hypophosphatasia should be considered in the differential diagnosis of low serum alkaline phosphatase. Early diagnosis is important so that appropriate treatment can be initiated.

Abstract MP45: Cardiovascular Health in Early Adulthood Predicts the Development of Coronary Artery Disease: 25 Year Follow Up in Individuals With Type 1 Diabetes From the Pittsburgh Epidemiology of Diabetes Complications Study

Introduction: Coronary artery disease (CAD) is especially burdensome among individuals with type 1 diabetes (TID). The AHA created metrics to monitor cardiovascular health (CVH) to promote primordial prevention. CVH metrics define 3 health behaviors (diet, physical activity, and smoking), and 4 health factors (BMI, total cholesterol, blood pressure and fasting glucose) as ideal, intermediate or poor based on set criteria. These CVH metrics have been shown to be related to cardiovascular outcomes in the general population. The purpose of this research is to describe the prevalence of CVH metrics in young adults with T1D, a group at particularly high risk for CAD , and assess the hypothesis that more favorable metrics protect against future hard CAD outcomes. Methods: Data are from the longitudinal Pittsburgh Epidemiology of Diabetes Complications (EDC) study. CVH metrics are defined by an average of measures taken at first visit and first follow up visit (1986-1990, “baseline”) for participants age ≥20 at study entry without prevalent CAD. CVH metrics were scored according to AHA criteria, with HbA1c in place of fasting glucose. Total CVH score (possible range 0-14) is the sum of subscores for each metric where poor=0, intermediate=1 and ideal=2. Cox proportional hazards models were used to assess the association between baseline CVH and CAD incidence during 25 years of follow-up. Results: Characteristics of the 463 individuals analyzed after exclusions (179 age &lt;20 or prevalent CAD, 15 missing data) are shown in Table 1. No participants achieved ideal status for all 7 CVH metrics. Each unit increase in ideal CVH score was associated with 28% lower risk (95% CI: 0.63-0.82, p&lt;0.01), while each unit increase in total CVH score was associated with 23% lower risk of CAD (95% CI: 0.71-0.84, p&lt;0.01), adjusting for baseline diabetes duration, sex, race, albumin excretion rate, and triglycerides. Conclusions: CVH metric scores appear to be predictive of CAD in adults with T1D, demonstrating the value of promoting ideal CVH for CAD prevention.

Observed Family and Friendship Dynamics in Adolescence: a Latent Profile Approach to Identifying "Mesosystem" Adaptation for Intervention Tailoring.

Nuanced understanding of adolescents' interpersonal relationships with family and peers is important for developing more personalized interventions that prevent problem behaviors and adjustment issues. We used latent profile analysis (LPA) to classify a community sample of 784 adolescents with respect to their observed relationship dynamics with friends and family using videotaped observations and five-minute audiotaped speech samples collected at ages 16-17. The resulting latent classes served to predict behavioral and emotional health in early adulthood. The LPA of the video- and audio-coded observational variables revealed a three-class model: (1) the healthy relationship group (n = 587), representing low levels of deviant and drug use talk with friends and positive, noncoercive relationship with parents; (2) the disaffected group (n = 90), representing high levels of drug use talk with friends and negativity about their parent(s) in the five-minute speech sample; and (3) the antisocial group (n = 107), representing high levels of deviant talk, drug use talk, coercive joining with friends, and coerciveness in family interactions. In contrast to the healthy relationship group, the disaffected group showed elevated risk for substance use problems and depression and the antisocial group showed higher risk for substance use problems and committing violent crimes in early adulthood. Outcome differences between disaffected and antisocial groups were mostly nonsignificant. We discuss the viability of applying these findings to tailoring and personalizing family-based interventions with adolescents to address key dynamics in the family and friendship relationships to prevent adult substance use problems, depression, and violence.

Behavior problems in adolescence and subsequent mental health in early adulthood: results from the World Trade Center Health Registry Cohort.

BackgroundThe present study examined the association between 9/11-related adolescent behavioral problems on mental health outcomes in early adulthood.MethodsData from enrollees of the World Trade Center Health Registry who completed at least one adolescent (2006-2007 or 2011-2012) and adult survey (2011-2012 or 2015-2016) were analyzed. Adolescent behavioral difficulties were assessed using the adolescent-reported Strengths and Difficulties Questionnaire (SDQ). Adult mental health outcomes included: binge drinking; smoking status history; 9/11-related post-traumatic stress disorder (PTSD); depression; and the self-reported number of physician mental health diagnoses. Multivariable regression was used to estimate associations of SDQ with mental health outcomes.ResultsOf the 297 enrollees, 16.8% (n=50) had abnormal/borderline SDQ as an adolescent. Binge drinking was not associated with adolescent SDQ. Enrollees with abnormal/borderline SDQ as an adolescent were more likely to be a consistent smoker (odds ratio (OR): 5.6, 95% confidence interval (CI): 1.2-25.2), have probable PTSD (OR: 3.5, 95% CI: 1.3-9.8); depression (OR: 6.2, 95% CI: 2.7-13.9); and to have 2 or more self-reported physician diagnosed mental health conditions as an adult (OR 5.6, 95% CI: 2.0-12.5).ConclusionsThis study’s findings underscore the need to intervene early with children exposed to traumatic events so as to avert later adolescent and adult problem behaviors.

The longitudinal association between the context of physical activity and mental health in early adulthood

This study examined the associations between the context in which physical activity (PA) is undertaken (team sports, informal group, individual PA), and each of positive mental health, anxiety symptoms and depressive symptoms. It also investigated whether social connectedness or PA volume mediate these associations. A total of 460 students (62.4% female; mean age at baseline = 18.5, SD 2.6) completed questionnaires at baseline and at follow-up 6 months later. Multivariate linear regression was used to model the associations between PA context at baseline and each outcome at follow-up controlling for sex, age, perceived socioeconomic status and baseline values of the outcome. Mediation analyses used causal inference methods to estimate the controlled direct effect (CDE), natural direct (NDE) and indirect effects (NIE) of social connectedness and PA volume. Relative to individual PA, informal group PA and team sports were positively associated with positive mental health (βˆ (95% CI) = 2.24 (0.01, 4.46) and 3.39 (0.74, 5.59) respectively), and inversely associated with depressive symptoms (−0.65 (−1.29, −0.01) and −0.76 (−1.43, −0.09), respectively). A significant CDE was observed for PA volume on the association between team sports and positive mental health (βˆ (95% CI) = 2.72 (0.03, 5.34)), suggesting that there is no benefit from increasing PA volume and that it is specifically the context of team sports that provides the benefit on positive mental health. Efforts to promote mental health and prevent depressive symptoms may benefit from intervention promoting PA in informal group and team sport settings.

Cardiovascular risk factors and carotid intima media thickness in young adults born small for gestational age after cessation of growth hormone treatment: a 5-year longitudinal study

Growth hormone treatment reduces blood pressure and lipid concentrations. We assessed long-term changes in blood pressure, lipid concentrations, and carotid intima media thickness over a 5-year period after cessation of growth hormone treatment in adults born small for gestational age. We did a longitudinal observational study at a medical centre in the Netherlands between April 1, 2004, and April 1, 2016. We included adults born small for gestational age who were treated with growth hormone (1 mg/m2 per day); treatment started during childhood until adult height. Participants were evaluated at cessation of treatment, and 6 months, 2 years, and 5 years later. We compared cardiovascular risk factors with untreated controls from the PROGRAM study. We included 199 participants born small for gestational age and treated with growth hormone along with 285 controls: 51 untreated short adults born small for gestational age, 92 untreated adults born small for gestational age with spontaneous catch-up growth, and 142 adults born appropriate for gestational age. In the 6 months after treatment cessation, systolic blood pressure increased temporarily from 113·00 mm Hg (95% CI 111·18-114·82) to 116·92 mm Hg (115·07 to 118·77; p<0·001) and diastolic blood pressure increased temporarily from 62·19 mm Hg (60·99-63·38) to 66·51 mm Hg (65·14-67·89; p<0·001). At 5 years after treatment cessation, mean systolic blood pressure was 109·2 mm Hg (105·5-113·0) and mean diastolic blood pressure was 63·4 mm Hg (60·9-65·9), similar to the values at cessation. Lipid concentrations were non-significantly higher 5 years after treatment cessation (p values 0·09-0·21) than at treatment cessation. Cessation of growth hormone had no effect on carotid intima media thickness. At 5 years after cessation, total cholesterol was lower in adults treated with growth hormone (mean 4·21 mmol/L, 95% CI 4·04-4·38) than in untreated short adults born small for gestational age (4·66 mmol/L, 4·42-4·92; p=0·0030), as was mean LDL cholesterol (2·28 mmol/L, 2·14-2·43 vs 2·85 mmol/L, 2·62-3·10; p<0·0001); blood pressure and carotid intima media thickness did not differ between these two groups (p values >0·12). At 5 years after cessation, systolic blood pressure, diastolic blood pressure, lipid concentrations, and carotid intima media thickness of adults treated with growth hormone were not different to those in adults born small for gestational age who had spontaneous catch-up growth or adults born appropriate for gestational age. Long-term growth hormone treatment in children born small for gestational age has no unfavourable effects on cardiovascular health in early adulthood and improves lipid profiles. Novo Nordisk (Netherlands).