Large Youth Cohorts Research Articles

Abstract P409: Cardiovascular Health Assessment and Intervention by AHA Pediatric Risk Category in Youth with Hypertension Disorders: a SUPERHERO Analysis

Background: Early intervention for modifiable cardiovascular (CV) health factors may decrease incidence of CV disease later in life, though whether youth at higher risk are more likely to have CV assessment and intervention is unknown. Our objective was to determine CV health initial assessment and intervention including echocardiogram (ECHO) order, anti-hypertensive medication prescription, and dietician referral by participant risk category from the 2019 American Heart Association (AHA) CV Risk Reduction in High-Risk Pediatric Patients scientific statement in a large cohort of youth with hypertension (HTN) disorders. Methods: Cross-sectional analysis of baseline data from the SUPERHERO Registry, a multisite retrospective cohort of youth referred for HTN disorders. Inclusion criteria were age <19 years and HTN disorder identified by ICD-10 codes from 1/1/2015–12/31/2023 at index visit to a subspecialty clinic. Exclusion criteria were kidney replacement therapy by dialysis or transplant or pregnancy by ICD-10 codes. Exposure was AHA Pediatric Risk Category (High, Moderate, At-risk). We used clinic BP by U.S. guidelines, clinic BMI percentile to define obesity, and ICD-10 codes to define other risk category medical diagnoses. Outcomes were ECHO order, anti-hypertensive medication prescription, and dietician referral. We used unadjusted generalized linear models. Results: Of 9356 participants, 1034 (11.1%), 6100 (65.2%), and 634 (6.8%) participants were categorized as High, Moderate, and At-risk groups. Overall, 3053 (32.6%) of participants had an ECHO order, 943 (16.4%) had anti-hypertensive medication prescribed, and 661 (7.1%) had a dietician referral. With At-risk group as reference, participants in High or Moderate risk groups were more likely to have an anti-hypertensive medication prescription (RR 3.12; 95% CL 2.23 to 4.36, RR 1.38; 95% CL 1.02 to 1.85). Participants in the Moderate risk group were more likely to have an ECHO order (RR 1.24; 95% CL 1.06 to 1.44). No difference between risk groups was seen for dietician referral. Conclusions: Among a large cohort of youth with HTN disorders, we found that higher risk groups were more likely to have an anti-hypertensive medication prescribed compared to lower risk group. The overall proportion of participants with medication prescriptions, ECHO orders, or dietician referrals were low. Next steps include investigating the association of risk category with target organ injury.

Abstract P188: Prevalence of AHA Pediatric Risk Categories in Youth with Hypertension Disorders: a SUPERHERO Analysis

Background: Cardiovascular (CV) risk factors in childhood contribute to the development of CV disease (CVD) later in life. In higher risk groups of youth, increased risk of CV events begins early in adulthood. The American Heart Association (AHA) 2019 CV Risk Reduction in High-Risk Pediatric Patients scientific statement uses medical diagnoses and CV health factors to classify patients into High, Moderate, and At-risk categories. The prevalence of these risk categories in youth with hypertension (HTN) disorders is unknown. Methods: Cross-sectional analysis of baseline electronic health record data from youth referred for HTN disorders in the multisite retrospective SUPERHERO Registry. Inclusion criteria were age <19 years and index subspecialty clinic visit for a HTN disorder by ICD-10 codes from 1/1/2015–12/31/2023. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. We report prevalence of AHA Pediatric Risk Category (High, Moderate, At-risk). We used clinic BP and 2017 AAP Clinical Practice Guidelines to define HTN, clinic BMI percentile to define obesity, and ICD-10 codes to define other risk category medical diagnoses. We report frequencies and proportions in this descriptive analysis. Results: Of 9356 participants, 3544 (37.9%) were female and 5464 (58.4%) were ≥13 years. At the index visit, 5563 participants (63.5%) were hypertensive. A total of 634 participants (6.8%) were classified as High risk, 6100 participants (65.2%) as Moderate risk, and 1034 participants (11.1%) were in the At-risk group. There were 1588 participants (17.0%) not classified into a risk category with available data. Conclusions: In a large cohort of youth with HTN disorders, we found that over 80% of participants were in an AHA pediatric risk category with 63.5% of participants having either primary or secondary HTN. Our findings suggest that if only HTN is used to identify youth at early CV risk, we will miss youth who may benefit from early CV health factor intervention. Next steps include confirming our findings using laboratory and prescription data in defining risk categories and investigating the association of AHA pediatric risk category with target organ injury using laboratory and echocardiogram data.

Abstract P407: Sex and age differences in cardiovascular health in youth referred for hypertension disorders at baseline: A SUPERHERO Registry analysis

Background: The prevalence of hypertension (HTN) and other cardiovascular (CV) disease risk factors (e.g., target organ injury (TOI), obesity, dyslipidemia, hyperglycemia) are increasing steadily in youth. In adults, sex and age differences are established, but remain unknown in children (1–12 years) and adolescents (≥13 years). Objective: Determine sex and age differences in blood pressure (BP) severity, TOI, and CV health in youth referred for HTN disorders. Design/Methods: Cross-sectional analysis of baseline data from the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a multisite retrospective Registry of youth referred to subspecialty care for HTN disorders using EHR data. Inclusion criteria were an initial subspecialty clinic visit for HTN disorders identified by ICD-10 codes from 1/1/2016–12/31/2023 and age <19 years. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. The exposures were sex and age at the index visit. Outcomes were BP severity at the index visit based on age, sex, and height-based U.S. guidelines, obesity by BMI or weight-for-length percentiles, and dyslipidemia, hyperglycemia, and TOI (heart and kidney-specific) by ICD-10 codes. We estimated the associations with unadjusted generalized linear models; our directed acyclic graphs did not identify any open, biasing paths necessitating adjustment for confounding factors . Results: Of the 9,356 participants, mean age ± SD was 12.8 ±4.5 years, 36% (n=3,372) were female, 56% (n=5,261) were adolescents, 23% (n=2,162) had stage 2 HTN, 5% (n=451) had TOI (2% heart, 3% kidney), 60% (n=5,655) had obesity, 9% (n=834) had dyslipidemia, and 10% (n=944) had hyperglycemia. Despite less BP severity, females had a higher risk of kidney TOI (RR 1.49, CI: 1.19 to 1.86), hyperglycemia (RR 1.48, CI: 1.3 to 1.68), and number of CV health risk factors (RR 1.1, CI:1.01 to 1.19). Compared to children, adolescents were more likely to have worse BP severity (RR 1.7, CI: 1.6 to 1.8) and HTN (RR 1.1, CI:1.1 to 1.2), and less risk for dyslipidemia (RR: 0.8, 0.7 to 0.9) Conclusions: In a large multisite cohort of youth referred for HTN disorders, females had a 49% higher risk of TOI and 48% greater risk for hyperglycemia despite lower BP severity. Adolescents had more severe BP and HTN compared to children. Next steps in this study include investigating age and sex differences in ambulatory BP and laboratory and echocardiogram data.

Classification of Suicide Attempt Risk Using Environmental and Lifestyle Factors in 3 Large Youth Cohorts

Suicide is the third-leading cause of death among US adolescents. Environmental and lifestyle factors influence suicidal behavior and can inform risk classification, yet quantifying and incorporating them in risk assessment presents a significant challenge for reproducibility and clinical translation. To quantify the aggregate contribution of environmental and lifestyle factors to youth suicide attempt risk classification. This was a cohort study in 3 youth samples: 2 national longitudinal cohorts from the US and the UK and 1 clinical cohort from a tertiary pediatric US hospital. An exposome-wide association study (ExWAS) approach was used to identify risk and protective factors and compute aggregate exposomic scores. Logistic regression models were applied to test associations and model fit of exposomic scores with suicide attempts in independent data. Youth from the Adolescent Brain Cognitive Development (ABCD) study, the UK Millennium Cohort Study (MCS), and the Children's Hospital of Philadelphia emergency department (CHOP-ED) were included in the study. A single-weighted exposomic score that sums significant risk and protective environmental/lifestyle factors. Self-reported suicide attempt. A total of 40 364 youth were included in this analysis: 11 564 from the ABCD study (3 waves of assessment; mean [SD] age, 12.0 [0.7] years; 6034 male [52.2%]; 344 attempted suicide [3.0%]; 1154 environmental/lifestyle factors were included in the ABCD study), 9000 from the MCS cohort (mean [SD] age, 17.2 [0.3] years; 4593 female [51.0%]; 661 attempted suicide [7.3%]; 2864 environmental/lifestyle factors were included in the MCS cohort), and 19 800 from the CHOP-ED cohort (mean [SD] age, 15.3 [1.5] years; 12 937 female [65.3%]; 2051 attempted suicide [10.4%]; 36 environmental/lifestyle factors were included in the CHOP-ED cohort). In the ABCD discovery subsample, ExWAS identified 99 risk and protective exposures significantly associated with suicide attempt. A single weighted exposomic score that sums significant risk and protective exposures was associated with suicide attempt in an independent ABCD testing subsample (odds ratio [OR], 2.2; 95% CI, 2.0-2.6; P < .001) and explained 17.6% of the variance (based on regression pseudo-R2) in suicide attempt over and above that explained by age, sex, race, and ethnicity (2.8%) and by family history of suicide (6.3%). Findings were consistent in the MCS and CHOP-ED cohorts (explaining 22.6% and 19.3% of the variance in suicide attempt, respectively) despite clinical, demographic, and exposure differences. In all cohorts, compared with youth at the median quintile of the exposomic score, youth at the top fifth quintile were substantially more likely to have made a suicide attempt (OR, 4.3; 95% CI, 2.6-7.2 in the ABCD study; OR, 3.8; 95% CI, 2.7-5.3 in the MCS cohort; OR, 5.8; 95% CI, 4.7-7.1 in the CHOP-ED cohort). Results suggest that exposomic scores of suicide attempt provided a generalizable method for risk classification that can be applied in diverse samples from clinical or population settings.

Domain-specific associations between psychopathology and neurocognitive functioning.

Neurocognitive dysfunction is a transdiagnostic finding in psychopathology, but relationships among cognitive domains and general and specific psychopathology dimensions remain unclear. This study aimed to examine associations between cognition and psychopathology dimensions in a large youth cohort. The sample (N = 9350; age 8-21 years) was drawn from the Philadelphia Neurodevelopmental Cohort. Data from structured clinical interviews were modeled using bifactor confirmatory factor analysis (CFA), resulting in an overall psychopathology ('p') factor score and six orthogonal psychopathology dimensions: dysphoria/distress, obsessive-compulsive, behavioral/externalizing, attention-deficit/hyperactivity, phobias, and psychosis. Neurocognitive data were aggregated using correlated-traits CFA into five factors: executive functioning, memory, complex cognition, social cognition, and sensorimotor speed. We examined relationships among specific and general psychopathology dimensions and neurocognitive factors. The final model showed both overall and specific associations between cognitive functioning and psychopathology, with acceptable fit (CFI = 0.91; TLI = 0.90; RMSEA = 0.024; SRMR = 0.054). Overall psychopathology and most psychopathology dimensions were negatively associated with neurocognitive functioning (phobias [p < 0.0005], behavioral/externalizing [p < 0.0005], attention-deficit/hyperactivity [p < 0.0005], psychosis [p < 0.0005 to p < 0.05]), except for dysphoria/distress and obsessive-compulsive symptoms, which were positively associated with complex cognition (p < 0.05 and p < 0.01, respectively). By modeling a broad range of cognitive and psychopathology domains in a large, diverse sample of youth, we found aspects of neurocognitive functioning shared across clinical phenotypes, as well as domain-specific patterns. Findings support transdiagnostic examination of cognitive performance to parse variability in the link between neurocognitive functioning and clinical phenotypes.

Unveiling common psychological characteristics of proneness to aggression and general psychopathology in a large community youth cohort

Elevated aggression in individuals with psychiatric disorders is frequently reported yet aggressive acts among people with mental illness are often intertwined with proneness to aggression and other risk factors. Evidence has suggested that both general psychopathology and proneness to aggression may share common psychological characteristics. This study aims to investigate the complex relationship between general psychopathology, proneness to aggression, and their contributing factors in community youth. Here, we first examined the association between proneness to aggression and the level of general psychopathology in 2184 community youths (male: 41.2%). To identify common characteristics, we trained machine learning models using LASSO based on 230 features covering sociodemographic, cognitive functions, lifestyle, well-being, and psychological characteristics to predict levels of general psychopathology and proneness to aggression. A subsequent Gaussian Graph Model (GGM) was fitted to understand the relationships between the general psychopathology, proneness to aggression, and selected features. We showed that proneness to aggression was associated with a higher level of general psychopathology (discovery: r = 0.56, 95% CI: [0.52–0.59]; holdout: r = 0.60, 95% CI: [0.54–0.65]). The LASSO model trained on the discovery dataset for general psychopathology was able to predict proneness to aggression in the holdout dataset with a moderate correlation coefficient of 0.606. Similarly, the model trained on the proneness to aggression in the discovery dataset was able to predict general psychopathology in the holdout dataset with a correlation coefficient of 0.717. These results suggest that there is substantial shared information between the two outcomes. The GGM model revealed that isolation and impulsivity factors were directly associated with both general psychopathology and proneness to aggression. These results revealed shared psychological characteristics of general psychopathology and proneness to aggression in a community sample of youths.

Anti-democratic youth? The influence of youth cohort size and quality of democracy on young people’s support for democracy

ABSTRACT This paper aims to investigate whether a country’s youth cohort size and quality of democracy, independently and jointly predict young people’s propensity to support democracy as a political system. We use pooled data from World Values Survey Waves 5–7, comprising 81 country-waves with 25,125 observations from 39 established and new democracies, in multilevel binary logistic regression analyses. The paper finds evidence that firstly, against conventional expectations, a large youth cohort exerts a positive influence on young people’s support for democracy as a political system. Secondly, the effect of youth cohort size depends on the quality of democracy of countries: young people growing as part of the youth cohorts in established democracies show stronger propensities to support democracy than their peers in new democracies. This has implications for both theory and empirical research.

PMON307 Adipokines and Bone Health in Hispanic Children

Abstract Introduction Leptin and adiponectin are adipocytokines with important metabolic functions. Leptin to adiponectin ratio is a marker of adipose tissue dysfunction and is associated with insulin resistance and cardiometabolic risk. We previously reported a negative effect of adiposity on bone health. We examined the relationship of adipokines to bone mass in a large cohort of Hispanic youth. We hypothesized that adipocytokine dysregulation in childhood may contribute to adverse bone health in children with obesity. Methods We studied 501 (237 males and 264 females) children and adolescents from the Viva la Familia Study. They were all pubertal; mean age (SD) 14.1 (2.5) years; 27% were normal weight (NW), 20% overweight (OW) and 53% obese (OB). They underwent measurement of body composition, total body less head bone mineral content (BMC) and density (BMD) by DXA scan; fasting leptin and adiponectin. The leptin to adiponectin ratio was calculated. Results Leptin concentration and leptin to adiponectin ratio were higher in OW and OB compared to NW (p&amp;lt;.001) whereas adiponectin was lower in OW and OB compared to NW (p&amp;lt;.001). After adjusting for sex, age, Tanner stage and lean mass, BMC was inversely related to leptin (r = -0.15, p =.001) and leptin to adiponectin ratio (r = -0.20, p &amp;lt;.001) but positively related to adiponectin (r = 0.12, p =.007). Similar relationships were found for BMD. In a regression model with BMC as the dependent variable, together and independently of sex, age, Tanner stage, lean mass and fat mass, leptin to adiponectin ratio negatively contributed (β = -0.060, p=.002) to the variance of BMC (R2 = 0.877, p &amp;lt;.001). Similar findings were seen with BMD as the dependent variable. Conclusion Elevated leptin to adiponectin ratio, a manifestation of adipokine dysregulation, may contribute negatively to bone health (BMC and BMD) in children with overweight/obesity. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Differences in retinopathy prevalence and associated risk factors across 11 countries in three continents: A cross-sectional study of 156,090 children and adolescents with type 1 diabetes.

To examine the prevalence, time trends, and risk factors of diabetic retinopathy (DR) among youth with type 1 diabetes (T1D) from 11 countries (Australia, Austria, Denmark, England, Germany, Italy, Luxemburg, Netherlands, Slovenia, United States, and Wales). Data on individuals aged 10-21 years with T1D for >1 year during the period 2000-2020 were analyzed. We used a cross-sectional design using the most recent year of visit to investigate the time trend. For datasets with longitudinal data, we aggregated the variables per participant and observational year, using data of the most recent year to take the longest observation period into account. DR screening was performed through quality assured national screening programs. Multiple logistic regression models adjusted for the year of the eye examination, age, gender, minority status, and duration of T1D were used to evaluate clinical characteristics and the risk of DR. Data from 156,090 individuals (47.1% female, median age 15.7 years, median duration of diabetes 5.2 years) were included. Overall, the unadjusted prevalence of any DR was 5.8%, varying from 0.0% (0/276) to 16.2% between countries. The probability of DR increased with longer disease duration (aORper-1-year-increase = 1.04, 95% CI: 1.03-1.04, p< 0.0001), and decreased over time (aORper-1-year-increase = 0.99, 95% CI: 0.98-1.00, p= 0.0093). Evaluating possible modifiable risk factors in the exploratory analysis, the probability of DR increased with higher HbA1c (aORper-1-mmol/mol-increase-in-HbA1c = 1.03, 95% CI: 1.03-1.03, p< 0.0001) and was higher among individuals with hypertension (aOR=1.24, 95% CI: 1.11-1.38, p< 0.0001) and smokers (aOR=1.30, 95% CI: 1.17-1.44, p< 0.0001). The prevalence of DR in this large cohort of youth with T1D varied among countries, increased with diabetes duration, decreased over time, and was associated with higher HbA1c, hypertension, and smoking.

Impact of the COVID-19 Pandemic on Mental Health in Childhood and Adolescence: The Reality of a Portuguese School.

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak has led to social isolation, with the potential to increase depressive symptoms, even at the pediatric age. Before the COVID-19 pandemic, the rate of depressive symptoms in large youth cohorts was 12.9% worldwide.AimsThis study aims to characterize the impact of the COVID-19 pandemic on the pediatric population’s mental health.Materials and methodsThis was an observational, descriptive, and cross-sectional study conducted through the use of a questionnaire, including the Children's Depression Inventory (CDI), between April 5 and May 5, 2021. The study was conducted on children and adolescents aged 7 to 17 years old in a school in the geographical area of ​​a Portuguese grade II hospital. Incomplete data were excluded. Data were statistically analyzed using the IBM SPSS® program (version 28; IBM Corp., Armonk, NY), considering statistical significance if p<0.05.ResultsA total of 228 children and adolescents were included; 113 were female (49.6%). The average age of the population was 12.2 years. Fifteen point four percent (15.4%) had depressive symptoms, of which 51,9% were female. Of the children and adolescents with depressive symptoms, 5.7% had a personal history of past COVID-19 infection and 42.9% had at least one family member with a history of past COVID-19 infection. Seventeen point one percent (17.1%) had at least one family member involved in pandemic-related work. Children and adolescents who were infected with COVID-19 had more depressive symptoms than noninfected children and adolescents (p=0.013). At the same time, children and adolescents, with at least one family member with a history of past COVID-19 infection, had more depressive symptoms than children and adolescents without a family history of past COVID-19 infection (p=0.004). Children and adolescents with a family member involved in pandemic-related work had more depressive symptoms than children and adolescents without any family member involved in pandemic-related work (p=0.004).ConclusionsCOVID-19 infection, whether personal or familiar, has an impact on mental health, even in the pediatric age, and it is imperative to know the consequences of emotional and mental changes in this population.

Hepatic abnormalities in youth with Turner syndrome.

Liver disease in children with Turner Syndrome (TS) is poorly understood relative to associated growth, cardiac and reproductive complications. This study sought to better characterize hepatic abnormalities in a large national cohort of youth with TS. Using electronic health record data from PEDSnet institutions, 2145 females with TS were matched to 8580 females without TS on eight demographic variables. Outcomes included liver enzymes (AST and ALT) stratified as normal, 1-2 times above the upper limit of normal (ULN), 2-3 times ULN and >3 times ULN, as well as specific liver disease diagnoses. Fifty-eight percent of youth with TS had elevated liver enzymes. Patients with TS had higher odds of enzymes 1-2 times ULN (OR: 1.7, 95% CI: 1.4-1.9), 2-3 times ULN (OR: 2.7, 95% CI: 1.7-3.3) and >3 times ULN (OR: 1.7, 95% CI: 1.3-2.2). They also had higher odds of any liver diagnosis (OR: 2.4, 95% CI: 1.7-3.3), fatty liver disease (OR: 1.9, 95% CI: 1.1-3.2), hepatitis (OR: 3.7, 95% CI: 1.9-7.1), cirrhosis/fibrosis (OR: 5.8, 95% CI: 1.3-25.0) and liver tumour/malignancy (OR: 4.8, 95% CI: 1.4-17.0). In a multinomial model, age, BMI and presence of cardiovascular disease or diabetes significantly increased the odds of elevated liver enzymes in girls with TS. Youth with TS have higher odds for elevated liver enzymes and clinically significant liver disease compared with matched controls. These results emphasize the need for clinical screening and additional research into the aetiology and treatment of liver disease in TS. Turner Syndrome, a chromosomal condition in which females are missing the second sex chromosome, is often associated with short stature, infertility and cardiac complications. Liver abnormalities are less well described in the literature. In this study, nearly 60% of youth with TS have elevated liver enzymes. Furthermore, patients with TS had a diagnosis of liver disease more often than patients without TS. Our results support the importance of early and consistent liver function screening and of additional research to define mechanisms that disrupt liver function in paediatric TS females.

Longitudinal Trajectory of the Link Between Ventral Striatum and Depression in Adolescence.

Research in adolescent depression has found aberrant intrinsic functional connectivity (iFC) among the ventral striatum (VS) and several brain regions implicated in reward processing. The present study probes this question by taking advantage of the availability of data from a large youth cohort, the IMAGEN Consortium. iFC data from 303 adolescents (48% of them female) were used to examine associations of VS connectivity at baseline (at age 14) with depressive disorders at baseline and at 2-year (N=250) and 4-year (N=219) follow-ups. Eleven regions of interest, key nodes of the reward system, were used to probe the reward network and calculate the connectivity strength of the VS within this network (VS connectivityrw). The main analyses assessed associations of VS connectivityrw with depressive disorders, anhedonia, and low mood using logistic regression. Autoregressive models accounting for carryover effects over time were conducted to further evaluate these brain-behavior associations. Higher right VS connectivityrw was associated with higher probability of depressive disorders at baseline (odds ratio=2.65, 95% CI=1.40, 5.05). This finding was confirmed in the autoregressive model, adjusting for carryover effects of the depressive disorders across the three time points. VS connectivityrw was not predictive of depressive disorders at follow-up assessments. Longitudinal associations between VS connectivityrw and anhedonia emerged in the structural equation model: left VS connectivityrw was associated with anhedonia at 2 years (odds ratio=2.20, 95% CI=1.54, 3.14), and right VS connectivityrw was linked to anhedonia at 4 years (odds ratio=1.87, 95% CI=1.09, 3.21). VS connectivityrw did not predict low mood at any time point in the structural equation model. The connectivity strength of the VS within the reward network showed distinct patterns of association with depressive disorders and anhedonia from mid to late adolescence, suggesting that the role of this circuitry in depression changes with age. This study replicates, in an independent sample, the association between the VS and depression previously reported in younger adolescents. The findings suggest a role of VS connectivityrw in anhedonia but not in low mood.

Preservation of C-Peptide Levels in Children with New-Onset Type 1 Diabetes: A Comparison Based on Body Mass Index

Aim: The contemporaneous increase in type 1 diabetes (T1D) and obesity prevalence in children has led to conflicting reports regarding the effects of weight excess on beta-cell function and clinical manifestation of T1D. We aimed to analyze the association between body mass index (BMI) and beta-cell function in a large cohort of new-onset T1D youth. Material and Methods: This study included 204 consecutive children with T1D aged 1-18 years. We retrospectively reviewed the medical data. The preservation of C-peptide was defined as a C-peptide level ≥0.6 ng/mL. Comparisons of variables between groups were made using appropriate statistical procedures. Results: Eighteen percent of children were overweight or obese. Overweight/obesity was associated with significantly higher C-peptide levels at onset [0.57 (0.05-2.99) vs 0.41 (0.05-2.58) ng/ml, p=0.01]. Preservation of C-peptide levels was observed in 67% of patients. Patients with preserved C-peptide levels were older at onset [10.4 (1.9-16.5) vs 7.5 (1.1-17.3) yr, p<0.001], more likely to be pubertal (61.2% vs 22.6%, p<0.001) and had a higher BMI SDS (0.03±1.37 vs -0.67±1.47, p=0.001). The proportion of individuals with preserved C-peptide levels increased with increasing BMI, but the difference did not reach statistical significance (29.9% to 45.9%, p=0.06). While there was a positive correlation between BMI SDS and C-peptide levels (rs=0.24, p=0.001), HbA1c levels negatively correlated with BMI SDS (r=-0.16, p=0.025). Conclusion: Overweight/obesity was present in a significant proportion of the study population. Obese and overweight children had a greater residual beta-cell function at the onset of T1D. It could be speculated that they were diagnosed at an earlier phase of beta-cell damage.

Youth Cohort Size, Structural Socioeconomic Conditions, and Youth Protest Behavior in Democratic Societies (1995–2014)

Conventional literature associates large youth cohort size (YCS) with increased risk of political violence in countries with such demographic profiles. Key questions which remain unanswered, however, are whether YCS is also associated with young people’s proclivities toward more peaceful forms of protests, and whether structural socioeconomic conditions influence such a relationship? Using multilevel binary logistic regression techniques on pooled individual level data for 51 democratic countries purposively sampled from World Values Survey Waves 3 to 6, and country level data from World Bank, and UN Population Division, I show that YCS demonstrates a positive relationship with young people’s participation in peaceful demonstrations. This relationship is, however, moderated by structural factors such as education and unemployment, which end up reducing young people’s likelihood of participation. I argue that resource limitation, as predicted by the Civic Voluntarism Model, better explains the relationship between YCS and individual youth protest behavior in democratic societies, more than socioeconomic grievance, as suggested by grievance theory. An important implication of this finding is that participation in elite-challenging behaviors such as peaceful protests, can be expected to be more common among young people in affluent democratic societies, than their peers elsewhere in the democratic world.

Patterns of polyvictimization predict stimulant use, alcohol and marijuana problems in a large cohort of sexual minority and gender minority youth assigned male at birth.

Men who have sex with men (MSM) and gender minorities (GM) are more likely to have substance problems and experience various forms of victimization compared to their heterosexual and cisgender counterparts. Polyvictimization allows for the assessment of the combined impact of multiple forms of victimization on health. This study examines the effects of polyvictimization patterns on stimulant use, alcohol and marijuana problems among a large cohort study. The sample was collected between 2015 and 2019 (n = 1,202). Mean age was 22. The sample was racially diverse (34.4% Black, 29.0% Hispanic/Latinx, 25.8% white, 5.9% other racial identity), 92.4% of the sample were MSM and 7.6% of the sample were GM. Using latent class analysis five qualitatively different polyvictimization classes were identified. Associations between these classes and stimulant use, alcohol and marijuana problems were examined using negative binomial and logistic regressions. Polyvictimization class significantly predicted alcohol problems and cannabis problems, at baseline as well as methamphetamine, and cocaine use at both time points. The polyvictimization profiles that were characterized by intimate partner violence (IPV), childhood sexual abuse (CSA), and high victimization across types were associated with substance outcomes at baseline. The polyvictimization class that was characterized by report of IPV was associated with cocaine use at 6 month follow-up. The polyvictimization class that was characterized by CSA was associated with methamphetamine use at 6 month follow-up. Researchers should examine the effects of victimization experiences more holistically and develop substance interventions that take multiple forms of victimization experiences into account. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

From Bowls to Arms: The Almajiri School System and the Challenges of Internal Security in Niger State, Nigeria.

Background: insecurity has become a watchword in humanities; social sciences and a societal problem that has led to the destruction of human lives and acquired property worth millions of dollars. Historically, periarticular in pre-colonial Nigeria, practical modalities were put in place and monitored the welfare of the Almajiri children. Unfortunately, this beautiful system was later shortened by western colonialism. The paper x-rayed the nexus between Almajiri and internal security in Niger State, Nigeria.&#x0D; Objective: The paper x-rayed the nexus between Almajiri and internal security in Niger State, Nigeria.&#x0D; Method: The paper used a survey design in which data were gathered through personal observations by the authors and also the use of an in-depth interview of selected respondents.&#x0D; Findings: The study discovered that the cultural practice in which parents especially from the countryside send their children at a very tender age to the cities under the Almajiri school system paves way for the concentration of a large youth cohort with a strong sense of identity in those cities, in which factors such as unfavorable economic, poverty and political atmosphere combines with the prevailing cultural resistance against western education and value system to facilitate the process of radicalizing these youths.&#x0D; Implications/Originality/Value: the study argued that it is important for the Nigerian state to come up with a policy for compulsory and free primary and secondary school for all the Almajirai and not in separate schools as it is at present being practiced but in an inclusive one.

Motor competence assessment in physical education – convergent validity between fundamental movement skills and functional movement assessments in adolescence

ABSTRACT Background The meaningful assessment of motor competence is well positioned for school-based curricular emphasis, through the integration of motor skills and movement patterns in both primary, and second level school physical education. Aligned with the growing interest in holistic motor competence assessment in physical education, the aim of this study was to assess the convergent validity between fundamental movement skills and functional movement assessments in a large cohort of adolescent youth. Method A sample of 583 adolescents, aged between 12 and 16 years old participated in the study. Ten fundamental movement skills were assessed in line with the behavioural components from the Test of Gross Motor Development, and the Get Skilled Get Active resource. Seven specific functional movements were also assessed, using the existing protocol from the widely established Functional Movement Screen. All data were analysed using Bayesian procedures, in which the Bayes factors provided information about the probability of a hypothesis being true. Findings The results indicate that it is very probable (BF10 > 10,000:1) that boys show higher actual motor competence levels in the object control subset of fundamental movement skills, when compared to girls. Moreover, a positive association between the total scores of the Functional Movement Screen and the locomotion subset of fundamental movement skills was found to be very probable (BF10 = 7.737). Discussion This study provides evidence of convergent validity between functional movement and fundamental movement skill assessments in adolescence. This study presents an evidence-informed rationale for physical education pedagogues to move beyond traditional perceptions of movement as being exclusively pertaining to physical skills, to a more holistic concept of motor competence comprising of both movement skills and movement patterns. Conclusion The current study broadens the assessment perspectives of motor competence within physical education, by specifically heightening physical education teachers’ awareness towards the possible complementarity of both locomotion and movement patterns in the psychomotor domain of adolescent learning in physical education.

702-P: Glycemic Improvement in 5,094 Pediatric Patients with Type 1 Diabetes (T1D) Using the Omnipod Insulin Management System over First 90 Days of Use

Clinical outcomes describing real-world use of various devices by people with T1D are important to support decision-making. This retrospective study characterized patient-reported clinical outcomes in youth in the United States with T1D before (baseline) and 90 days after (follow-up) the initiation of a tubeless insulin pump (Omnipod® or Omnipod DASH® Insulin Management System). The primary outcome was change in self-reported HbA1c from baseline to follow-up. Secondary outcomes were change in self-reported total daily dose (TDD) of insulin and frequency of hypoglycemic events (HE) per week (#/week <70 mg/dL). Outcomes were assessed overall and stratified by prior treatment modality (MDI or CSII) and age group. Patients were aged 11.2±3.8y (mean ± SD). The overall change in self-reported HbA1c at follow-up was -0.5±1.6% (p<0.0001). Overall change in TDD of insulin was -1.2±12.3U/d and the self-reported HE frequency decreased significantly by -1.4±2.9 episodes per week (p<0.0001). Reductions in HbA1c, TDD and HE were seen regardless of prior treatment or age group (except for patients <6y who had a slight increase in TDD). In this large cohort of youth with T1D, initiation of a tubeless insulin pump was associated with significant reductions in HbA1c and number of HE after 90 days of use compared to prior MDI and CSII treatments and across age groups.View largeDownload slideView largeDownload slide DisclosureD. Desalvo: Consultant; Self; Insulet Corporation, Research Support; Self; Insulet Corporation, Speaker’s Bureau; Self; Dexcom, Inc. G. Aleppo: Consultant; Self; Dexcom, Inc., Insulet Corporation, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk. F. Lauand: Employee; Self; Insulet Corporation. L. M. Huyett: Employee; Self; Insulet Corporation, Stock/Shareholder; Self; Insulet Corporation. J. Jantz: Employee; Self; Insulet Corporation. A. Chang: Employee; Self; Insulet Corporation. T. Vienneau: Employee; Self; Insulet Corporation, Stock/Shareholder; Self; Insulet Corporation. T. T. Ly: Employee; Self; Insulet Corporation.FundingInsulet Corporation

The Effect of Cardiorespiratory Fitness and Insulin Resistance on Bone Health in Hispanic Children

Obesity appears to have a negative impact on pediatric bone health, and insulin resistance may mediate this relationship. It is unclear if cardiorespiratory fitness (CRF) has a protective effect on bone in obese children. We tested the hypothesis that CRF attenuates the negative effect of obesity and insulin resistance on skeletal health in a large cohort of Hispanic youth.We studied 413 (193 males and 220 females) children and adolescents from the Viva la Familia Study. They were all pubertal; mean age (SD) 13.4 ± 2.3 years; 27% were normal weight (NW), 19% overweight (OW) and 54% obese (OB). They underwent measurement of body composition, total body bone mineral content (BMC) and density (BMD) by DXA scan; VO2peak using the ramp protocol on a treadmill for CRF; fasting glucose and insulin. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. BMC increased from NW to OW to OB (mean 1.35 ± 0.4, 1.41 ± 0.4, and 1.49 ± 0.4 kg, respectively, p=.005). Peak VO2 decreased from NW to OW to OB (41.3 ± 9.7, 35.5 ± 7.7, 28.9. ± 5.5 mL/kg per min, respectively, p <.001). After adjusting for sex, age and lean body mass, BMC was inversely related to fat mass (r = -0.34, p <.001) and HOMA-IR (r = -0.29, p <.001). Similar relationships were found for BMD. In a regression model with BMC as the dependent variable, lean body mass (standardized coefficient (β)=0.95, p <.001) was positively and fat mass (β=-0.18, p <0.001) negatively associated with BMC (model R2=0.88, p<.001). HOMA-IR (β=-0.07, p =0.001) and VO2peak (β=0.09, p =0.003) had significant and opposite associations with BMC (model p<.001) but fat mass was no longer a significant contributor. With BMD as the dependent variable, lean body mass (β=0.82, p <.001), HOMA-IR (β=-0.06, p =0.04) and peak VO2 (β=0.17, p <.001), but not fat mass, contributed to the variance in BMD (R2=0.79, p<.001).In conclusion, lean body mass is the major determinant of BMC and BMD in Hispanic youth. Adiposity associated insulin resistance has a negative effect on BMC and BMD. CRF contributes positively to the variance in BMC and BMD. This suggests that CRF and higher lean mass attenuate the adverse effects of insulin resistance on bone health in children.

Genetic and clinical analyses of psychosis spectrum symptoms in a large multiethnic youth cohort reveal significant link with ADHD

Psychotic symptoms are not only an important feature of severe neuropsychiatric disorders, but are also common in the general population, especially in youth. The genetic etiology of psychosis symptoms in youth remains poorly understood. To characterize genetic risk for psychosis spectrum symptoms (PS), we leverage a community-based multiethnic sample of children and adolescents aged 8–22 years, the Philadelphia Neurodevelopmental Cohort (n = 7225, 20% PS). Using an elastic net regression model, we aim to classify PS status using polygenic scores (PGS) based on a range of heritable psychiatric and brain-related traits in a multi-PGS model. We also perform univariate PGS associations and evaluate age-specific effects. The multi-PGS analyses do not improve prediction of PS status over univariate models, but reveal that the attention deficit hyperactivity disorder (ADHD) PGS is robustly and uniquely associated with PS (OR 1.12 (1.05, 1.18) P = 0.0003). This association is driven by subjects of European ancestry (OR = 1.23 (1.14, 1.34), P = 4.15 × 10−7) but is not observed in African American subjects (P = 0.65). We find a significant interaction of ADHD PGS with age (P = 0.01), with a stronger association in younger children. The association is independent of phenotypic overlap between ADHD and PS, not indirectly driven by substance use or childhood trauma, and appears to be specific to PS rather than reflecting general psychopathology in youth. In an independent sample, we replicate an increased ADHD PGS in 328 youth at clinical high risk for psychosis, compared to 216 unaffected controls (OR 1.06, CI(1.01, 1.11), P = 0.02). Our findings suggest that PS in youth may reflect a different genetic etiology than psychotic symptoms in adulthood, one more akin to ADHD, and shed light on how genetic risk can be investigated across early disease trajectories.