Low-income Minority Adolescents Research Articles

Assessment of Exposure to High-Performing Schools and Risk of Adolescent Substance Use

Although school environments are thought to influence health behaviors, experimental data assessing causality are lacking, and which aspects of school environments may be most important for adolescent health are unknown. To test whether exposure to high-performing schools is associated with risky adolescent health behaviors. This natural experiment used admission lotteries, which mimic random assignment, to estimate the association of school environments and adolescent health. A survey of 1270 students who applied to at least 1 of 5 high-performing public charter schools in low-income minority communities in Los Angeles, California. Schools had an academic performance ranked in the top tertile of Los Angeles County public high schools, applicants outnumbered available seats by at least 50, and an admissions lottery was used. Participants included lottery winners (intervention group [n = 694]) and lottery losers (control group [n = 576]) from the end of 8th grade and beginning of 9th grade through the end of 11th grade. Intention-to-treat (ITT) and instrumental variable techniques estimated the association of winning the lottery and attending high-performing schools with health behaviors and whether the association varied by sex. Data were collected from March 11, 2013, through February 22, 2017, and analyzed from October 1, 2017, through July 1, 2018. Schools were considered high performing if they placed in the top tercile of public high schools in LA County on 2012 state standardized tests. Most students attended that same school for 3 years (9th-11th grades). Primary self-reported outcomes were 30-day and high-risk self-reported marijuana use. Additional health outcomes included 30-day alcohol use, alcohol misuse, ever being in a fight, ever having sex, and past-year delinquency. Potential intermediate factors (time studying, truancy, school mobility, school culture, school order, teacher support for college, and proportion of substance-using peers in students' social networks) were also examined. Among the 1270 participating students (52.6% female; mean [SD] age at enrollment, 14.3 [0.5] years), ITT analysis showed that the intervention group reported less marijuana misuse than the control group (mean marijuana misuse score, 0.46 vs 0.71), as well as fewer substance-using peers (9.6% vs 12.7%), more time studying (mean, 2.63 vs 2.49 hours), less truancy (84.3% vs 77.3% with no truancy), greater teacher support for college (mean scores, 7.20 vs 7.02), more orderly schools (mean order score, 7.06 vs 6.83), and less school mobility (21.4% vs 28.4%) (all P < .05). Stratified analyses suggest that among boys, intervention participants had significantly lower marijuana use (mean misuse score, 0.43 vs 0.88; difference, -0.45; 95% CI, -0.78 to -0.13) and alcohol misuse (mean misuse score, 0.52 vs 0.97; difference, -0.44; 95% CI, -0.80 to -0.09) scores compared with control participants, whereas no significant health outcomes were noted for girls. This natural experiment provides evidence that school environments can improve risky behaviors for low-income minority adolescents.

School Disciplinary Style and Adolescent Health

PurposeParenting style is strongly associated with adolescent health. However, little is known about how school disciplinary style relates to health. We categorized adolescents' perceptions of their schools as authoritative, authoritarian, permissive, or neglectful, and test whether perceived school disciplinary style is associated with health. MethodsWe analyze data from the RISE Up study (Reducing Health Inequities Through Social and Educational Change Follow-up), comprised of baseline (eighth grade) and 2-year follow-up surveys (10th grade) from 1,159 low-income minority adolescents in Los Angeles attending 157 schools. At 10th grade, students' ratings of school support and structure were used to categorize perceived school disciplinary style as authoritative (highest tertile for support and structure), authoritarian (low support, high structure), permissive (high support, low structure), neglectful (low on both dimensions), and average (middle tertile on either dimension). Mixed effects logistic regressions controlling for sociodemographic factors, parenting style, grades, and baseline health tested whether school disciplinary style was associated with substance use, violence, bullying, and depression symptoms. ResultsRisky behaviors varied by school disciplinary style. After adjusting for covariates, compared with an average school disciplinary style, a neglectful school was associated with higher odds of substance use (adjusted odds ratio [AOR] 2.3, p < .001) and bullying (AOR 1.5, p = .02), a permissive school was associated with higher odds of depression symptoms (AOR 2.1, p = .04), and an authoritative school was associated with lower odds of substance use (AOR .6, p = .049), violence (AOR .6, p = .03), and bullying (AOR .5, p = .001). ConclusionsStructured and supportive school environments may impact the health of vulnerable adolescents.

The Role of Social-Emotional and Social Network Factors in the Relationship Between Academic Achievement and Risky Behaviors

BackgroundWe examined whether standardized test scores and grades are related to risky behaviors among low-income minority adolescents and whether social networks and social-emotional factors explained those relationships. MethodsWe analyzed data from 929 high school students exposed by natural experiment to high- or low-performing academic environments in Los Angeles. We collected information on grade point average (GPA), substance use, sexual behaviors, participation in fights, and carrying a weapon from face-to-face interviews and obtained California math and English standardized test results. Logistic regression and mediation analyses were used to examine the relationship between achievement and risky behaviors. ResultsBetter GPA and California standardized test scores were strongly associated with lower rates of substance use, high-risk sexual behaviors, and fighting. The unadjusted relative odds of monthly binge drinking was 0.72 (95% confidence interval, 0.56–0.93) for 1 SD increase in standardized test scores and 0.46 (95% confidence interval, 0.29–0.74) for GPA of B− or higher compared with C+ or lower. Most associations disappeared after controlling for social-emotional and social network factors. Averaged across the risky behaviors, mediation analysis revealed social-emotional factors accounted for 33% of the relationship between test scores and risky behaviors and 43% of the relationship between GPA with risky behaviors. Social network characteristics accounted for 31% and 38% of the relationship between behaviors with test scores and GPA, respectively. Demographic factors, parenting, and school characteristics were less important explanatory factors. ConclusionsSocial-emotional factors and social network characteristics were the strongest explanatory factors of the achievement-risky behavior relationship and might be important to understanding the relationship between academic achievement and risky behaviors.

What Do You Want to Be When You Grow up? Career Aspirations as a Marker for Adolescent Well-being

Objective“What do you want to be when you grow up?” is a simple, commonly asked question that might provide insight into adolescent well-being. Career aspirations might reflect an adolescent's sense of identity, hope for the future, and self-efficacy, all of which are critical to identifying at-risk youth and intervening on risky behaviors. However, there are no studies on whether career aspirations are associated with adolescent emotional and health behavior outcomes. MethodsWe analyzed cross-sectional surveys of 929 ninth to 12th grade low-income minority adolescents in Los Angeles assessing career aspirations and its association with hopelessness, self-efficacy, substance use, violence, and risky sexual activity. We used Department of Labor statistics to categorize career aspirations according to amount of education required, income, and prestige. Generalized estimating equations accounted for sociodemographic characteristics, school type, academic performance, and clustering at the school level. ResultsGrades, standardized test scores, and health behaviors varied according to career type. Adolescents with higher career aspirations, measured according to career-related education, income, and prestige reported less hopelessness and more self-efficacy. After adjusting for confounders, aspirations requiring high levels of education were associated with decreased odds of alcohol use, at-school substance use, and risky sexual activity, and higher prestige scores were associated with decreased odds of other drug use. ConclusionsCareer aspirations might be a marker for adolescent health and well-being. Adults might consider asking a teen what they want to be when they grow up to gain insight into their levels of hopelessness and self-efficacy and provide context for counseling on healthy behavior change.

Teachers and Coaches in Adolescent Social Networks Are Associated With Healthier Self-Concept and Decreased Substance Use.

Poor academic (eg, "I am a bad student") and behavioral (eg, "I am a troublemaker") self-concepts are strongly linked to adolescent substance use. Social networks likely influence self-concept. However, little is understood about the role teachers and athletic coaches play in shaping both academic and behavioral self-concepts. We analyzed cross-sectional surveys of 929 9th-12th grade low-income minority adolescents in Los Angeles assessing self-concept, social networks, and 30-day use of alcohol, marijuana and other drugs. We performed generalized estimating equations, accounting for clustering at the school level and controlling for family and peer influences and contextual factors. We also tested whether self-concept-mediated associations between relationships with teachers or coaches and 30-day substance use. More perceived teacher support was associated with lower odds of marijuana and other drug use and better academic and behavioral self-concepts. Behavioral self-concept mediated the associations between teacher support and substance use. By facilitating relationships with adults and improving teachers' capacity to build supportive environments, schools may positively shape how adolescents see themselves, which might help reduce adolescent substance use.

Patterns of time use among low-income urban minority adolescents and associations with academic outcomes and problem behaviors.

Time budgets represent key opportunities for developmental support and contribute to an understanding of achievement gaps and adjustment across populations of youth. This study assessed the connection between out-of-school time use patterns and academic performance outcomes, academic motivations and goals, and problem behaviors for 504 low-income urban African American and Latino adolescents (54% female; M = 16.6 years). Time use patterns were measured across eight activity types using cluster analysis. Four groups of adolescents were identified, based on their different profiles of time use: (1) Academic: those with most time in academic activities; (2) Social: those with most time in social activities; (3) Maintenance/work: those with most time in maintenance and work activities; and (4) TV/computer: those with most time in TV or computer activities. Time use patterns were meaningfully associated with variation in outcomes in this population. Adolescents in the Academic cluster had the highest levels of adjustment across all domains; adolescents in the Social cluster had the lowest academic performance and highest problem behaviors; and adolescents in the TV/computer cluster had the lowest levels of intrinsic motivation. Females were more likely to be in the Academic cluster, and less likely to be in the other three clusters compared to males. No differences by race or gender were found in assessing the relationship between time use and outcomes. The study's results indicate that time use patterns are meaningfully associated with within-group variation in adjustment for low-income minority adolescents, and that shared contexts may shape time use more than individual differences in race/ethnicity for this population.

Successful schools and risky behaviors among low-income adolescents.

We examined whether exposure to high-performing schools reduces the rates of risky health behaviors among low-income minority adolescents and whether this is due to better academic performance, peer influence, or other factors. By using a natural experimental study design, we used the random admissions lottery into high-performing public charter high schools in low-income Los Angeles neighborhoods to determine whether exposure to successful school environments leads to fewer risky (eg, alcohol, tobacco, drug use, unprotected sex) and very risky health behaviors (e.g., binge drinking, substance use at school, risky sex, gang participation). We surveyed 521 ninth- through twelfth-grade students who were offered admission through a random lottery (intervention group) and 409 students who were not offered admission (control group) about their health behaviors and obtained their state-standardized test scores. The intervention and control groups had similar demographic characteristics and eighth-grade test scores. Being offered admission to a high-performing school (intervention effect) led to improved math (P < .001) and English (P = .04) standard test scores, greater school retention (91% vs. 76%; P < .001), and lower rates of engaging in ≥1 very risky behaviors (odds ratio = 0.73, P < .05) but no difference in risky behaviors, such as any recent use of alcohol, tobacco, or drugs. School retention and test scores explained 58.0% and 16.2% of the intervention effect on engagement in very risky behaviors, respectively. Increasing performance of public schools in low-income communities may be a powerful mechanism to decrease very risky health behaviors among low-income adolescents and to decrease health disparities across the life span.

Preliminary Longitudinal Findings From Multicultural Integrated Kidney Education Program (MIKE Program): Preventing Precursors to Kidney Disease in Low-income Minority Adolescents

Preliminary Longitudinal Findings From Multicultural Integrated Kidney Education Program (MIKE Program): Preventing Precursors to Kidney Disease in Low-income Minority Adolescents

The Impact of Peer Support and mp3 Messaging on Adherence to Inhaled Corticosteroids in Minority Adolescents with Asthma: A Randomized, Controlled Trial

Poor adherence to inhaled corticosteroids (ICS) is a critical risk factor contributing to asthma morbidity among low-income minority adolescents. This trial tested whether peer support group meetings and peer asthma messages delivered via mp3 players improved adherence to ICS. Low-income African American and/or Hispanic adolescents, ages 11-16 years old, with persistent asthma, and poor (≤ 48%) adherence to prescription ICS during the 3-week run-in were randomized to intervention or attention control groups (ATG) for the 10-week treatment. During treatment, the intervention arm subjects participated in weekly coping peer group support sessions and received mp3 peer-recorded asthma messages that promoted adherence. The ATG participated in weekly meetings with a research assistant and received an equivalent number of mp3 physician-recorded asthma messages. Adherence was measured by using self-report and the Doser CT, an electronic dose counter. The primary outcome was the difference in adherence at 10 weeks between the 2 arms. Thirty-four subjects were randomized to each arm. At 10 weeks, no statistical difference in objectively measured adherence could be detected between the 2 arms when adjusting for baseline adherence (P = .929). Adherence declined in both groups over the course of the active treatment period. In both study arms, self-reported adherence by participants was significantly higher than their objectively measured adherence at week 10 (P < .0001). Improving medication adherence in longitudinal studies is challenging. Peer support and mp3-delivered peer asthma messages may not be of sufficient dose to improve outcomes.

The Use of Coping Peer Support and MP3 Technology to Improve Adherence to Inhaled Corticosteroids Among Low-Income Minority Adolescents

The Use of Coping Peer Support and MP3 Technology to Improve Adherence to Inhaled Corticosteroids Among Low-Income Minority Adolescents

Cyclopedia: sustaining a positive youth development program through community partnership

Background: Urban, low income minority adolescents are disproportionately affected by numerous preventable morbidities, including poor school performance, obesity, and teen pregnancy. Owing to the complex interplay of social, cultural, and economic factors that contribute to the morbidities, no single intervention has shown consistent success in categorically improving outcomes. Recent research suggests a common root problem is lack of empowerment. Effective positive youth development (PYD) initiatives can prevent many morbidities by fostering empowerment in at-risk youths. However, little is published on how to implement and sustain such interventions. Methods: Cyclopedia is an annual summer curriculum of mentored bicycle rides consisting of educational lessons, local exploration, and creative self-expression (photography and writing). It is structured on a PYD model and is supported by a core partnership between a medical institution and a community based organization (CBO). Results: Cyclopedia has completed two full seasons with expansion from 18 boys to 50 boys and girls. The cost per trip has dropped from approximately $400 per rider to $100 per rider. The number of rides increased from 13 to 20, and total mileage increased from 740 to 870 miles per year. However, miles per rider dropped from 41 to 17, and writings per rider dropped from 2.6 to 0.5. Conclusions: Cyclopedia, supported by a core partnership between a medical institution and a CBO, shows significant promise in cost-effectively reaching large numbers of at-risk children with PYD programming. Ongoing curriculum adjustments aim to address decrements in individual participation.

The puzzle of continued use of nebulized therapy by those with asthma

The nebulized route of administration of drugs to the lungs may involve antibiotics in cystic fibrosis, bronchodilators in asthma, COPD and cystic fibrosis, and occasionally steroids in asthma and some other conditions. This review concerns the use of the nebulizer to administer bronchodilators in asthma. Such use may occur on a regular basis at home, but more usually is for management of acute episodes of worsening asthma, either self administered by patient or parent in the home or by health professionals in the emergency department (ED) and hospital. Use for acute situations appears to be common and may be especially prevalent in low income communities. The provision of nebulized bronchodilator therapies to manage asthma patients for management of home continues to puzzle. Use of nebulized treatment is accompanied by low levels of metered dose inhaler (MDI) and spacer use in general and in minority patients, particularly inner city children. One study showed that in minority children between the ages of 10 and 13, 48% were prescribed nebulized therapy and this use was not associated with age or severity of the asthma (Clark NM, Prescribed nebulized therapy in urban minority preteens with asthma. Unpublished data). Other studies have shown levels of use ranging from 33% to 71% in children under 12 years of age. A qualitative study of 35 low-income minority adolescents revealed that almost half had nebulizers available at home and there was no significant difference between those with and without nebulizers concerning outcomes related to asthma control.

Daily diaries and minority adolescents: Random coefficient regression modeling of attributional style, coping, and affect

Many researchers underscore the importance of coping in the daily lives of adolescents, yet very few studies measure this and related constructs at this level. Using a daily diary approach to stress and coping, the current study evaluated a series of mediational coping models in a sample of low-income minority adolescents (N = 89). Specifically, coping was hypothesized to mediate the relationship between attributional style (and dimensions) and daily affect. Using random coefficient regression modeling, the relationship between (a) the locus of causality dimension and positive affect was completely mediated by the use of acceptance and humor as coping strategies; (b) the stability dimension and positive affect was completely mediated by the use of both problem-solving and positive thinking; and (c) the stability dimension and negative affect was partially mediated by the use of religious coping. In addition, the locus of causality and stability (but not globality) dimensions were also directly related to affect. However, the relationship between pessimistic explanatory style and affect was not mediated by coping. Consistent with previous research, these findings suggest that attributions are both directly and indirectly related to indices of affect or adjustment. Thus, attributions may not only influence the type of coping strategy employed, but may also serve as coping strategies themselves.

Long-term Evaluation of Multi-disciplinary Treatment of Morbid Obesity in Low-income Minority Adolescents: La Rabida Children’s Hospital’s FitMatters Program

Purpose Long-term evaluation of an empirically based program for the treatment of morbidly obese, low-income, minority adolescents. Methods In the first year, 150 participants received cognitive-behavior therapy, nutritional education, medical monitoring, and structured exercise training. Weights and heights were collected at follow-up. Successful and Less Successful groups were delineated based on change in body mass index z-scores. Medical record review provided weight and height data one year before treatment for a subset of participants (comparison group). Analyses of variance examined differences between groups. Discriminant function analyses examined predictors of success in the domains of socioeconomic status, individual factors and psychological functioning, family factors, and prior weight loss behaviors. Correlates of success were explored. Results Eighty-three adolescents participated in the follow-up, on average 23 months (SD = 3.8) after initial assessment. Nineteen (23%) participants achieved clinically meaningful weight change (−.70 z-scores or better). Discriminant function analyses, correlations, and direct comparisons showed that the Successful group, compared with the Less Successful group, on average, attended 50% more sessions over 84% more weeks, were heavier initially, had somewhat better critical weight control skills (e.g., self-monitoring) before and during the program, and were somewhat more psychologically and intellectually challenged before treatment. Conclusion Although some of these very high risk adolescents made clinically significant progress, more intensive treatments, like long-term residential treatments and bariatric surgery, may produce even more favorable outcomes.

Use of an Orientation Session May Help Decrease Attrition in a Pediatric Weight Management Program for Low-Income Minority Adolescents

This study examined predictors of attrition from a pediatric weight-control program in a lowincome minority community and the potential usefulness of an orientation session to increase length of treatment. Participants were 342 children and adolescents (M age = 13.0 years old; 54% female; 89% African American; M BMI = 44.2, M BMI z-score = 6.0) and their caregivers who attended FitMatters, a multidisciplinary cognitive-behavioral program focused on long-term participation. Those who attended an orientation session stayed in treatment significantly longer, but attrition was not affected by demographic factors, weight status, or psychological functioning. These results indicate that an orientation session that clearly delineates the structure of a program and expected attitudinal and behavioral requirements for the families may help align expectations, as well as more effectively identify families who are ready to make concerted efforts to change the family lifestyle in support of their obese children’s efforts.

Treatment of Morbid Obesity in Low‐income Adolescents: Effects of Parental Self‐monitoring

This study examined the extent to which consistency of self-monitoring by participants and their parents was related to weight control over an initial period of 3 months within the context of a treatment program for morbidly obese low-income minority adolescents. Eighty-three obese adolescents (mean age, 13.0 years; 51% boys; 92% African American; mean BMI, 43.0 kg/m2; mean BMI z-score, 6.0) and at least one parent participated in a long-term treatment program that included a very-low-fat dietary focus, weekly group cognitive-behavior therapy, monthly nutrition education classes, a 12-week physical therapy class, and medical monitoring. Participants who self-monitored on the majority of days compared with those who did not self-monitor at all or who self-monitored infrequently attended more sessions and generally lost more weight over the first 3 months. Although parents signed behavioral contracts committing to self-monitor their own eating and exercising over the first month, only 12% did so. Nonetheless, participants whose parents self-monitored were much more likely to self-monitor consistently and lose weight during the first 3 months. These results indicate that self-monitoring is a cornerstone of successful weight control even for morbidly obese low-income minority adolescents; targeting consistency of self-monitoring among these high-risk weight controllers and their parents should be just as important as it is for more affluent and less overweight adolescents.

Infusing a Diversity Perspective into Human Development Courses

Students of human development must be well versed in issues of diversity if they are to appreciate the importance of developmental contextualism, and comprehend policy and professional issues related to poverty and ethnicity. One difficulty in addressing diversity issues in the minimal empirical foundation, a fact that was confirmed in Study 1 by content analyses of research on child and adolescent development. More problematic, sampling patterns reinforce a deficit perspective on low-income minority adolescents. Study 2 describes evaluation findings from a curriculum enhancement project, in which multicultural content was infused into a sequence of human development courses. Significant changes in attitudes toward poverty and racial minorities were observed in targeted courses, relative to comparison groups. Evidence is presented that this curriculum project decreased ethnocentrism and increased critical thinking skills and awareness of poverty as a developmental risk factor. Implications for pedagogy, research, and the culture of higher education are discussed.