Early Adolescent Health Research Articles

Differential Contributions of Peer and Teacher–Student Relationships to Mental Health in Early Adolescence

This longitudinal study examined the unique contributions of positive and negative dimensions of early adolescents’ relationships and interactions with teachers and peers to self-esteem and depressive symptoms. Teacher–student relationships and interactions were measured by student reports of teacher closeness and conflict as well as observations of teacher praise and reprimands to the class. Peer acceptance and friendship quantity were used as positive dimensions of peer relationships, and peer rejection and number of mutual antipathies were used as negative dimensions. Data from 990 fourth- to sixth-grade students across 13 schools (53.35% girls, M age = 10.61 years, SD = 0.91) were collected over three waves in one school year. Teacher conflict and peer antipathies predicted depressive symptoms. Teacher closeness, teacher conflict, and friendship quantity predicted self-esteem. The findings highlight the importance of relationships and interactions with both peers and the teacher for early adolescents’ mental health and the need for a multidimensional view on school social experiences. Impact Statement Findings of this study show that it is important to consider multiple dimensions of early adolescents’ relationships and interactions with their teachers and classmates when studying social experiences and when aiming to improve their mental health.

Prenatal exposure to green space and mental health in early adolescence: findings from the TRAILS study.

Little is known about whether prenatal green space exposure contributes to mental health later in life. Using data from a Dutch cohort (TRAILS; n=1,476), we assessed associations between prenatal (1989-1991) green space exposure and four mental health outcomes, namely externalizing problems, internalizing problems, tobacco use, and alcohol use, self-reported at eleven-year-old (2001-2002), and mediation of gestational age and birthweight on these associations. In a structural equational model, adolescents with one standard deviation (SD) unit more prenatal green space exposure showed a 0.119 SD (95%CI:0.028,0.210) more externalizing problems in early adolescence. There are two potential explanations for this unexpected positive association. First, controlling for urbanicity attenuated this association to become insignificant, but the degree of attenuation was minor [0.096, (95%CI:-0.003,0.195)]. Second, this unexpected association might be a consequence of changes in green space exposure in the intervening years, namely childhood (from birth to early adolescence), indicating that individuals with increased green space exposure over childhood exhibited fewer externalizing problems in early adolescence. For the prenatal green space-externalizing problems association, we did not observe mediation by gestational age or birthweight. Overall, these findings suggest no beneficial role of prenatal green space on adolescent mental health. Instead, increased green space exposure in childhood may lead to lower externalizing problems in early adolescence.

Impact of hypertensive disorders of pregnancy and gestational diabetes mellitus on offspring cardiovascular health in early adolescence

Adverse pregnancy outcomes, including hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), influence maternal cardiovascular heath (CVH) long after pregnancy, but their relationship to offspring CVH following in utero exposure remains uncertain. To examine associations of HDP or GDM with offspring CVH in early adolescence. This analysis used data from the prospective Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study from 2000 to 2006 and the HAPO Follow-Up Study from 2013 to 2016. This analysis included 3,317 mother-child dyads from 10 field centers, comprising 70.8% of HAPO Follow-Up Study participants. Those with pregestational diabetes and chronic hypertension were excluded. The exposures were having any HDP or GDM compared with not having HDP or GDM, respectively (reference). The outcome was offspring CVH at ages 10 to 14 years, based on four metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Each metric was categorized as ideal, intermediate, or poor using a framework provided by the American Heart Association. The outcome was primarily defined as having at least one CVH metric that was non-ideal versus all ideal (reference), and secondarily as the number of non-ideal CVH metrics: at least one intermediate metric, one poor metric, or at least two poor metrics versus all ideal (reference). Modified Poisson regression with robust error variance was used and adjusted for covariates at pregnancy enrollment, including field center, parity, age, gestational age, alcohol or tobacco use, child's assigned sex at birth, and child's age at follow-up. Among 3,317 maternal-child dyads, the median (IQR) ages were 30.4 (25.6, 33.9) years for pregnant individuals and 11.6 (10.9, 12.3) years for children. During pregnancy, 10.4% of individuals developed HDP and 14.6% developed GDM. At follow-up, 55.5% of offspring had at least one non-ideal CVH metric. In adjusted models, having HDP (aRR 1.14; 95% CI 1.04, 1.25) or having GDM (aRR 1.10; 95% CI 1.02, 1.19) was associated with greater risk that offspring developed less-than-ideal CVH at ages 10 to 14 years. The above associations strengthened in magnitude as the severity of adverse CVH metrics increased (i.e., with the outcome measured as >1 intermediate, 1 poor, and >2 poor adverse metrics), albeit the only statistically significant association was with the "1-poor-metric" exposure. In this multi-national prospective cohort, pregnant individuals who experienced either HDP and GDM were at significantly increased risk of having offspring with worse CVH in early adolescence. Reducing adverse pregnancy outcomes and increasing surveillance with targeted interventions after an adverse pregnancy outcome should be studied as potential avenues to enhance long-term cardiovascular health in the offspring exposed in utero.

2 Association between HDP and GDM and Child Cardiovascular Health in Early Adolescence

2 Association between HDP and GDM and Child Cardiovascular Health in Early Adolescence

Student- and School-Level Factors Associated With Mental Health and Well-Being in Early Adolescence

Adolescence is a key developmental window that may determine long-term mental health. As schools may influence mental health of students, this study aimed to examine the association of school-level characteristics with students' mental health over time. Longitudinal data from a cluster randomized controlled trial comprising 8,376 students (55% female; aged 11-14 years at baseline) across 84 schools in the United Kingdom were analyzed. Data collection started in the academic years 2016/2017 (cohort 1) and 2017/2018 (cohort 2), with follow-up at 1, 1.5, and 2 years. Students' mental health (risk for depression [Center for Epidemiologic Studies Depression Scale], social-emotional-behavioral difficulties [Strength and Difficulties Questionnaire]) and well-being (Warwick-Edinburgh Mental Well-Being Scale) and relationships with student- and school-level characteristics were explored using multilevel regression models. Mental health difficulties and poorer well-being increased over time, particularly in girls. Differences among schools represented a small but statistically significant proportion of variation (95% CI) in students' mental health at each time point: depression, 1.7% (0.9%-2.5%) to 2.5% (1.6%-3.4%); social-emotional-behavioral difficulties, 1.9% (1.1%-2.7%) to 2.8% (2.1%-3.5%); and well-being, 1.8% (0.9%-2.7%) to 2.2% (1.4%-3.0%). Better student-rated school climate analyzed as a time-varying factor at the student and school level was associated with lower risk of depression (regression coefficient [95%CI] student level:-4.25 [-4.48,-4.01]; school level:-4.28 [-5.81,-2.75]), fewer social-emotional-behavioral difficulties (student level:-2.46 [-2.57,-2.35]; school level:-2.36 [-3.08,-1.63]), and higher well-being (student level: 3.88 [3.70, 4.05]; school-level: 4.28 [3.17, 5.38]), which was a stable relationship. Student-rated school climate predicted mental health in early adolescence. Policy and system interventions that focus on school climate may promote students' mental health.

Factors Influencing Risky Actions on Early Adolescent Reproductive Health at Junior High School 30 Kerinci

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Deviations in sexual behavior often occur among adolescents. The development of the current era makes information disclosure through media and electronics have a major influence on adolescent sexual behavior. The research objective was to determine the factors influencing risky actions on the reproductive health of early adolescents at public junior high school 30 Kerinci. This type of quantitative analytic research with a cross-sectional design approach. The research was conducted in November - December 2022 at public junior high school 30 Kerinci with a total sample of 77 people. The sampling technique for this research is total sampling. Data collection using a questionnaire. Analysis of the research data with the chi-square statistical test and multivariate analysis with the binary logistic test. The results showed that there was a relationship between knowledge and risky actions for reproductive health (p=0.001), there was a relationship between attitude and risky actions for reproductive health (p=0.039), there was a relationship between the role of parents and risky actions for reproductive health (p=0.014), there was no relationship between the role of health workers and reproductive health risky actions (p=0.647), there is a relationship between the role of peers and reproductive health risky actions (p=0.027), the dominant factor that has the most influence on reproductive health risky actions in early adolescents in junior high school 30 Kerinci is the knowledge factor (p-value=0.001; POR=16.619). It is suggested that the school activate youth care activity services activities at schools in cooperation with local health workers. I</em><em>t’s</em><em> also suggested that health workers provide health education or youth health seminars at schools to provide information about reproductive health for adolescents. Furthermore, it is suggested to parents of students to control adolescents so that adolescents are correct in receiving health information, especially reproductive health, and seeking information related to adolescent reproductive health together. </em></p><p><em> </em></p></td></tr></tbody></table></div><p><strong><em>Keywords : Adolescents, Risky Action , Reproductive Health</em></strong></p>

Surface electromyography (sEMG) biofeedback posture training improves the physical and mental health of early adolescents with mild scoliosis: A qualitative study.

Asymmetry in paraspinal muscle activities is observed in adolescent idiopathic scoliosis and may be of value for predicting curve progression. We have reported the effects of the surface electromyography biofeedback posture training program in improving the symmetry of paraspinal muscle activities and reducing the curve progression of early adolescents with mild scoliosis. This study further explored their subjective experience of the training program on posture correction and health-related quality of life. Using purposive sampling, 13 early adolescents aged between 11 and 13 years with mild scoliosis participated in semi-structured in-depth interviews after completing 30 sessions of training. The data were recorded, transcribed, and coded using thematic analysis with NVivo 10. Significant statements and phrases were categorized into themes and subthemes. As assessed by X-ray, five early adolescents showed at least a 5° Cobb angle reduction in spinal curvature, while eight showed no significant curve progression (a Cobb angle change under 5°). Several subthemes related to the benefits of the training program on the health-related quality of life were generated, namely (a) posture correction, (b) improvement in body appearance, (c) restoration of muscle relaxation, (d) reduction in bodily pain and fatigue, (e) enhancement of self-confidence/self-image, and (f) improvement in social functioning. Given its positive effects, the sEMG biofeedback posture training program has the potential to be an alternative early intervention for early adolescents with mild scoliosis. Further empirical studies need to be carried out to substantiate its effectiveness and evaluate the sustainability of its benefits over time.

The relationship between perceived income inequality, adverse mental health and interpersonal difficulties in UK adolescents.

Adolescence is a period of life when young people increasingly define themselves through peer comparison and are vulnerable to developing mental health problems. In the current study, we investigated whether the subjective experience of economic disadvantage among friends is associated with social difficulties and poorer mental health in early adolescence. We used latent change score modelling (LCSM) on data from the UK Millennium Cohort Study, collected at ages 11 and 14 (N=12,995). Each LCSM modelled the mean of an outcome related to mental health and interpersonal difficulties at age 11 (including self-esteem, well-being, emotional difficulties, peer problems, bullying, victimisation and externalising difficulties), the change of the outcome from ages 11 to 14 and its predictors, including perceived income inequality among friends (i.e. perceiving oneself as belonging to a poorer family than the families of one's friends). Perceived income inequality predicted adverse mental health and a range of interpersonal difficulties during adolescence, even when controlling for objective family income. Follow-up analyses highlighted that, at 11 years, young people who perceived themselves as belonging to poorer families than their friends reported worse well-being, self-esteem, internalising problems, externalising problems and victimisation at the same age (relative to those who perceived themselves as richer than or equal to their friends, or who did not know). Longitudinal analyses suggested that victimisation decreased from ages 11 to 14 to a greater extent for adolescents who perceived themselves as poorer than other adolescents. The salience of economic inequalities in proximal social environments (e.g. among friends) in early adolescence could further amplify the negative effects of economic disadvantage on mental health and behavioural difficulties during this period.

Cumulative exposure to per- and polyfluoroalkyl substances from pregnancy to age 12 years and bone health in early adolescence: the HOME Study

Cumulative exposure to per- and polyfluoroalkyl substances from pregnancy to age 12 years and bone health in early adolescence: the HOME Study

Universal process-based CBT for positive mental health in early adolescence: A cluster randomized controlled trial

Early adolescence is a key developmental phase for promoting positive mental health and preventing psychological difficulties. Despite calls to develop the evidence base for universal interventions in early adolescence and the promise of process-based CBT, the literature is devoid of empirical investigations of the efficacy of universal process-based CBT in this cohort. This cluster randomized controlled trial aimed to extend the empirical literature by evaluating the efficacy of a six-session universal process-based CBT intervention in elementary schools. Twenty-nine schools were randomly allocated to intervention or waiting list control groups. Six hundred four participants completed measures of positive mental health, resilience, emotional literacy, and mindfulness at baseline, post-intervention, and six-week follow-up. Although participants reported that the intervention was satisfactory, it did not yield significantly superior growth rates on the outcome measures than the control condition at post-intervention or follow-up. Implications of the findings and directions for future research are discussed.

Development of Perceived Family Support and Positive Mental Health in Junior High School Students: A Three-Year Longitudinal Study

The study aimed to explore the development trend of positive mental health and the interaction between adolescents’ perceived family support and positive mental health. A 3-year longitudinal survey of perceived family support and positive mental health (resilience and self-efficacy) for four waves was conducted with 564 junior high school students (297 girls, mean age = 11.12 ± 0.38 years at baseline). The Latent Growth Curve Modeling indicated that adolescents’ resilience and general self-efficacy showed a curve upward trend, which increased first and then decreased. The development rate decreased each year. The cross-lagged panel model and a random intercept cross-lagged panel model concluded that perceived family support was strongly associated with positive mental health of junior high school students. Family support was important for developing positive mental health in early adolescence. Therefore, attention and interventions targeting positive mental health changes in early adolescence are particularly effective. And, it is important to encourage parents of adolescents to continue to provide support and guidance.

Long-term labour market and economic consequences of school exclusions in England: Evidence from two counterfactual approaches.

BackgroundPrevious research suggests that school exclusion during childhood is a precursor to social exclusion in adulthood. Past literature on the consequences of school exclusion is, however, scarce and mainly focused on short‐term outcomes such as educational attainment, delinquency, and mental health in early adolescence. Moreover, this evidence is based primarily on descriptive and correlational analysis, whereas robust causal evidence is required to best inform policy.AimsWe aimed to estimate the mid‐to‐long‐term impact of school exclusion on labour market and economic outcomes.SampleThe sample included 6,632 young people who at the age of 25/26 in the year 2015 participated in the Next Steps survey of whom 86 were expelled from school and 711 were suspended between the ages of 13/14 and 16/17.MethodUsing high quality existing longitudinal data, we utilized four approaches to evaluate the impact of school exclusion: logistic regression‐adjustment models, propensity score matching, school fixed‐effects analysis, and inverse propensity weighting. The latter two counterfactual approaches were used to estimate causal effects.ResultsWe found that school exclusion increased the risk of becoming NEET at the age of 19/20, and then remaining economically inactive at the age of 25/26, as well as experiencing higher unemployment risk and earning lower wages also at the age of 25/26.ConclusionSchool exclusion has pervasive negative effects into adulthood. Policy interventions should focus on both prevention and mitigating its negative effects. Interventions aimed at re‐integrating excluded individuals into education or vocational training could be key in reducing the risk of poor socio‐economic outcomes and social exclusion.

Perceptions of the Uses of Cell Phones and Their Impact on the Health of Early Adolescents in Barcelona: a Qualitative Study

The use of cell phones and video games has transformed rapidly in adolescents, posing a challenge for the scientific community. Using qualitative methodology and a socioconstructivist perspective, we identified perceptions and beliefs about the different uses of cell phones and video games and their relationship with the health and wellbeing of the adolescent population of Barcelona. From an analysis of discussion groups among early adolescents (n = 66 students aged 13–14 years, segmented by gender and socioeconomic level of the school neighborhood), information was obtained on (i) digital devices and their uses, (ii) the determinants of the uses of cell phones and video games, and (iii) the relationship between possible problematic uses and health and wellbeing. Responsible and problematic uses were identified. Problematic use was associated with compensation for social deficits and sometimes with dependency on the device. Differences were identified by gender (boys preferred video games and girls’ social networks). The adolescents were aware of the possible negative impacts on their health associated with problematic use of cell phones and video games and highlighted a lack of critical education in digital skills.

Conditional cash transfers and adolescent mental health in Brazil: Evidence from the 2004 Pelotas Birth Cohort.

BackgroundYoung people living in poverty are at higher risk of mental disorders, but whether interventions aimed to reduce poverty have lasting effects on mental health has not been well established. We examined whether exposure to Brazil’s conditional cash transfers programme (CCT), Bolsa Família (BFP), during childhood reduces the risk of mental health problems in early adolescence.MethodsWe used data from 2063 participants in the 2004 Pelotas Birth Cohort study. Propensity score matching (PSM) estimated the association between BFP participation at age 6 and externalising problems (Strengths and Difficulties Questionnaire – SDQ and violent behaviour) and socio-emotional competencies (Development and Well-Being Assessment questionnaire, and the Nowick-Strickland Internal-External Scale) at age 11.ResultsPSM results suggest that programme participation at age of six was not significantly associated with externalising problems (P = 0.433), prosocial behaviour (P = 0.654), violent behaviour (P = 0.342), social aptitudes (P = 0.281), positive attributes (P = 0.439), or locus of control (P = 0.148) at the age of 11 years.ConclusionsParticipation in BFP during childhood was not associated with improved or worsened mental health in early adolescence. While we cannot fully discard that findings may be due to adverse selection, results suggest that CCTs alone may not be sufficient to improve mental health outcomes and would be prudent to assess whether mental health interventions as an addition to CCTs may be helpful.

Associations of midchildhood to early adolescence central adiposity gain with cardiometabolic health in early adolescence.

This study examined the associations of central adiposity gain from midchildhood to early adolescence with cardiometabolic health markers in early adolescence. A total of 620 participants were studied in Project Viva. In midchildhood (mean age = 7.8 years) and early adolescence (12.9 years), waist circumference and dual-energy x-ray absorptiometry-measured visceral adipose tissue, subcutaneous abdominal adipose tissue, and trunk fat were obtained. Central adiposity gain was calculated as change per year between visits. Cardiometabolic health markers, including blood pressure, lipids, markers of insulin resistance, inflammation, and adipokines, were collected in early adolescence. Greater waist circumference gain was associated with higher log triglycerides (β 0.07 mg/dL; 95% CI: 0.02-0.13), log alanine aminotransferase (0.07 U/L; 95% CI: 0.03-0.12), log high-sensitivity C-reactive protein (0.43 mg/L; 95% CI: 0.28-0.58), and other cardiometabolic markers in early adolescence. Directly measured central adiposity gains were associated with higher systolic blood pressure z score in early adolescence (visceral adipose tissue [0.13 SD units; 95% CI: 0.04-0.23], subcutaneous abdominal adipose tissue [0.18 SD units; 95% CI: 0.04-0.31], and trunk fat [0.21 SD units; 95% CI: 0.06-0.36]). These associations were independent of baseline and change in total adiposity from midchildhood to early adolescence. Monitoring central adiposity gain may enable identification and intervention in children vulnerable to developing cardiometabolic health risks.

Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence

(Abstracted from JAMA 2021;325:658–668) The gestational period during pregnancy may be an opportune time to influence not only the health of the mother but also the long-term health of the offspring. Risk factors, such as obesity and diabetes, during pregnancy have been independently associated with higher risks of poor cardiovascular health (CVH).

Resilience mediates the cross-sectional relationship between mindfulness and positive mental health in early adolescence

Resilience has been conceptualised as a pathway through which mindfulness influences mental health. Despite a growing body of research evidence substantiating this claim, the empirical literature is devoid of support for this account in early adolescence. This study aimed to extend the evidence base by investigating resilience as a mediator in the putative cross-sectional relationship between mindfulness and positive mental health. One hundred twenty-nine elementary school students completed the Mindful Attention Awareness Scale for Children, Connor-Davidson Resilience Scale–10, and Adolescent Mental Health Continuum-Short Form. Correlational analyses revealed small-to-moderate, statistically significant relationships between the variables. Mediation analysis demonstrated a statistically significant indirect effect of mindfulness on positive mental health through resilience. The findings provide preliminary support for the aforementioned conceptual model and have implications for innovative research in mindfulness.

Impact of child development at primary school entry on adolescent health\u2014protocol for a participatory systematic review

BackgroundReducing child health inequalities is a global health priority and evidence suggests that optimal development of knowledge, skills and attributes in early childhood could reduce health risks across the life course. Despite a strong policy rhetoric on giving children the ‘best start in life’, socioeconomic inequalities in children’s development when they start school persist. So too do inequalities in child and adolescent health. These in turn influence health inequalities in adulthood. Understanding how developmental processes affect health in the context of socioeconomic factors as children age could inform a holistic policy approach to health and development from childhood through to adolescence. However, the relationship between child development and early adolescent health consequences is poorly understood. Therefore the aim of this review is to summarise evidence on the associations between child development at primary school starting age (3–7 years) and subsequent health in adolescence (8–15 years) and the factors that mediate or moderate this relationship.MethodA participatory systematic review method will be used. The search strategy will include; searches of electronic databases (MEDLINE, PsycINFO, ASSIA and ERIC) from November 1990 onwards, grey literature, reference searches and discussions with stakeholders. Articles will be screened using inclusion and exclusion criteria at title and abstract level, and at full article level. Observational, intervention and review studies reporting a measure of child development at the age of starting school and health outcomes in early adolescence, from a member country of the Organisation for Economic Co-operation and Development, will be included. The primary outcome will be health and wellbeing outcomes (such as weight, mental health, socio-emotional behaviour, dietary habits). Secondary outcomes will include educational outcomes. Studies will be assessed for quality using appropriate tools. A conceptual model, produced with stakeholders at the outset of the study, will act as a framework for extracting and analysing evidence. The model will be refined through analysis of the included literature. Narrative synthesis will be used to generate findings and produce a diagram of the relationship between child development and adolescent health.DiscussionThe review will elucidate how children’s development at the age of starting school is related to subsequent health outcomes in contexts of socioeconomic inequality. This will inform ways to intervene to improve health and reduce health inequality in adolescents. The findings will generate knowledge of cross-sector relevance for health and education and promote inter-sectoral coherence in addressing health inequalities throughout childhood.Protocol RegistrationThis systematic review protocol has been registered with PROSPERO CRD42020210011.

Coping and Mental Health in Early Adolescence during COVID-19.

The current longitudinal study examines changes in overall mental health symptomatology from before to after the COVID-19 outbreak in youth from the southeastern United States as well as the potential mitigating effects of self-efficacy, optimism, and coping. A sample of 105 parent–child dyads participated in the study (49% boys; 81% European American, 1% Alaska Native/American Indian, 9% Asian/Asian American; 4% Black/African American; 4% Latinx; and 4% other; 87% mothers; 25% high school graduate without college education; 30% degree from 4-year college; 45% graduate or professional school). Parents completed surveys when children were aged 6–9, 8–12, 9–13, and 12–16, with the last assessments occurring between May 13, 2020 and July 1, 2020 during the COVID-19 outbreak. Children also completed online surveys at ages 11–16 assessing self-efficacy, optimism, and coping. Multi-level modeling analyses showed a within-person increase in mental health symptoms from before to after the outbreak after controlling for changes associated with maturation. Symptom increases were mitigated in youth with greater self-efficacy and (to some extent) problem-focused engaged coping, and exacerbated in youth with greater emotion-focused engaged and disengaged coping. Implications of this work include the importance of reinforcing self-efficacy in youth during times of crisis, such as the pandemic, and the potential downsides of emotion-focused coping as an early response to the crisis for youth.

Estimating School Race/Ethnic Enrollment Effects on Student Mental Health: Density and Diversity as a Risk or Protective Factor.

To investigate effects of school race/ethnic enrollment on mental health in early adolescence by examining both race/ethnic density (percent non-Latinx [NL] White enrollment) and diversity (range/size of all race/ethnic groups enrolled). Variation by student race/ethnic identity is examined as minority stressors are uniquely experienced by race/ethnic minority students. Longitudinal cohort from a broader mental health study. Fourteen schools in Texas (2011-2015). Sixth-grade participants (mean age 11.5 years) linked to publicly available data about their school (N=389). Self-reported depressive-anxious symptoms over a two-year period. Generalized estimating equations tested main effects of density/diversity on depressive-anxious symptoms across student-reported race/ethnic identity, adjusting for student/school factors. Owing to statistically significant Latinx-group differences by acculturative stress, four unique identities were generated: NL-Black, low-stress Latinx, high-stress Latinx, and NL-White-referent. Points of convergence of student mental health profiles across density/diversity were explored. A significant interaction between density and student race/ethnicity was found (P<.01), with NL-Black and low-stress Latinx vs NL-White students experiencing higher symptoms over the two-year period, net of covariates. In contrast, greater diversity was associated with higher symptoms, net of controls (P<.05). A marginally significant interaction (P=.06) revealed fewer symptoms for high-stress Latinx vs NL-White students. At about 25%, NL-White density and diversity of .5-.6, all students experienced similar mental health profiles. Greater NL-White density increases mental health risk for NL-Black and low-stress Latinx students, while school diversity lowers risk for high-stress Latinx students. These findings demonstrate how educational settings may produce or lessen minority stress.