non-Hispanic White Adolescents Research Articles

Emotional Eating Prevalence and Correlates in Adolescents in the United States.

Background: Adolescent obesity rates continue to rise. A better understanding of who engages in emotional eating, a maladaptive eating style, is needed. Despite emotional eating being a frequent research target, the prevalence of emotional eating in US adolescents is currently unknown. Methods: Nationally representative adolescents (n = 1622, m = 14.48 years, 63.8% non-Hispanic White, 50.6% female) reported eating behaviors in the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Frequencies and one-way ANOVAs were conducted to examine the rates of emotional eating across demographic and weight status groups. Correlations between emotional eating and dietary intake were examined. Results: In total, 30% of adolescents engaged in emotional eating. Older adolescents (35% of 17-year-olds), females (39%), non-Hispanic White individuals (32%), and adolescents with obesity (44%) had significantly higher rates of emotional eating. Controlling for weight status, greater adolescent emotional eating was correlated with more frequent intake of energy-dense/nutrient-poor foods (β = 0.10, p < 0.001), junk food (β = 0.12, p < 0.001), and convenience foods (β = 0.13, p < 0.001). Conclusions: This study fills a critical gap by providing insight into how common adolescent emotional eating is and highlighting demographic factors that are associated with higher rates. Nearly a third of adolescents in the United States reported eating due to anxiety or sadness, with rates higher in older adolescents, girls, non-Hispanic White adolescents, and adolescents with obesity. Emotional eating was associated with consuming less healthy foods, which conveys immediate and long-term health risks. Practitioners can intervene with emotional eating to reduce obesity and comorbid health risks.

Abstract 66: US Asian and Pacific Islander Adolescents With Obesity Have Triple the Risk of Prediabetes When Compared to Non Hispanic White Children

Introduction: Race and ethnicity and elevated body mass index (BMI) are risk factors for pre-diabetes (preDM) among adolescents. We recently observed high preDM prevalence among aggregated US Asian and Pacific Islander (API) children with obesity, but data pertaining to disaggregated API subgroups remain limited. Aim: To examine the risk of preDM among API subgroups compared to non-Hispanic White (NHW) adolescents with obesity. Methods: This retrospective study included 3233 API and 4150 NHW children age 13-17y with obesity and without DM who were identified at preventive health well-child visits in 2016-2019 and had hemoglobin A1c (HA1c) measured within 1 year of the visit. Visit data included self-reported diet/lifestyle behaviors and BMI measurement. PreDM (outcome) was defined by HA1c 5.7-6.4%. Obesity was categorized as Class 1-3 based on BMI percent of the 95th BMI percentile (obesity threshold). Four obesogenic behaviors were ascertained from clinic data: Fruit/vegetable consumption &lt;5 servings/day; juice/sugary beverage intake &gt;12 ounces/day; exercising &lt;60 minutes/day; and screen time 2+ hours/day. A neighborhood deprivation index (NDI) was calculated using area of residence and 2010 US Census data. Log binomial regression was used to examine the association of API ethnicity and preDM, reporting relative risk (RR) and 95% confidence intervals [CI]. Results: The cohort included 210 Chinese, 900 Filipino, 200 South Asian, 132 Southeast Asian, 283 Native Hawaiian/Pacific Islander (NHPI), 1508 other/unspecified API ethnicity, and 4150 NHW children. Overall, 22.4% of API vs 9.4% NHW (p&lt;0.001) children had preDM. PreDM prevalence ranged from 19.1% for Chinese, 21.7% for Filipino, 22.5% for South Asian, 24.2% for Southeast Asian, to 26.5% for NHPI subgroups. After adjusting for age, sex, NDI, obesity class, and obesogenic health behaviors, risk of preDM was about 3-fold higher (RR 2.9 [2.6-3.4] for API compared to NHW adolescents, ranging from RR 2.5 [1.8-3.6] for Chinese, RR 2.8 [2.3-3.4] for Filipino, RR 3.1 [2.2- 4.4] for South Asian, RR 3.2 [2.1-4.9] for Southeast Asian, RR 3.3 [2.5-4.4] for NHPI, and RR 3.0 [2.5-3.5] for other/unspecified API children. Obesity severity (RR 1.4 [1.2-1.6] for Class 2 and RR 2.1 [1.7-2.6] for Class 3 compared to Class 1 obesity) was also associated with preDM risk. Conclusion: PreDM risk was about 3-fold higher for API compared to NHW children with obesity even after adjusting for sociodemographic, lifestyle, and BMI differences. The risk of preDM ranged from 2.5-fold to 3.3-fold higher for the major API subgroups, especially Southeast Asian and Filipino groups compared to NHW children. These findings highlight the importance of preDM screening among API children and demonstrate heterogeneity of risk among API subgroups. Future efforts should focus on effective screening and monitoring of at-risk populations to prevent progression to Type 2 DM.

Racial, socioeconomic, and neighborhood characteristics in relation to COVID-19 severity of illness for adolescents and young adults.

This study tests the hypotheses that insurance status, race and ethnicity, and neighborhood characteristics are associated with hospital admission and severe health outcomes (Intensive Care Unit [ICU] admission and oxygen assistance) for youth and young adults who present to the emergency department (ED) with COVID-19 in a single, academic health system in Illinois, Rush University System for Health (RUSH). Demographic and clinical data from the electronic health record were collected for all 13- to 24-y-old patients seen at RUSH who tested positive for COVID-19 between March 2020 and 2021. Individual-level and neighborhood characteristics were analyzed to determine their association with hospital admission and severe health outcomes through generalized estimating equations. As of March 2021, 1,057 patients were seen in the ED within RUSH in which non-Hispanic White (odds ratio [OR], 2.96; 95% CI, 1.61-5.46; P = 0.001) and Hispanic (OR, 3.34; 95% CI, 1.84-6.10; P < 0.001) adolescents and youth were more likely to be admitted to the hospital compared with non-Hispanic Black/other adolescents and youth. Patients with public insurance or who were uninsured were less likely to be admitted to the ICU compared with those with private insurance (OR, 0.24; 95% CI, 0.09-0.64; P = 0.004). None of the neighborhood characteristics were significantly associated with hospital admission or severe health outcomes after adjusting for covariates. Our findings demonstrated that race and ethnicity were related to hospitalization, while insurance was associated with presentation severity due to COVID-19 for adolescents and young adults. These findings can aid public health investigators in understanding COVID-19 disparities among adolescents and young adults.

U.S. Adolescent Rest-Activity patterns: insights from functional principal component analysis (NHANES 2011–2014)

BackgroundSuboptimal rest-activity patterns in adolescence are associated with worse health outcomes in adulthood. Understanding sociodemographic factors associated with rest-activity rhythms may help identify subgroups who may benefit from interventions. This study aimed to investigate the association of rest-activity rhythm with demographic and socioeconomic characteristics in adolescents.MethodsUsing cross-sectional data from the nationally representative National Health and Nutrition Examination Survey (NHANES) 2011–2014 adolescents (N = 1814), this study derived rest-activity profiles from 7-day 24-hour accelerometer data using functional principal component analysis. Multiple linear regression was used to assess the association between participant characteristics and rest-activity profiles. Weekday and weekend specific analyses were performed in addition to the overall analysis.ResultsFour rest-activity rhythm profiles were identified, which explained a total of 82.7% of variance in the study sample, including (1) High amplitude profile; (2) Early activity window profile; (3) Early activity peak profile; and (4) Prolonged activity/reduced rest window profile. The rest-activity profiles were associated with subgroups of age, sex, race/ethnicity, and household income. On average, older age was associated with a lower value for the high amplitude and early activity window profiles, but a higher value for the early activity peak and prolonged activity/reduced rest window profiles. Compared to boys, girls had a higher value for the prolonged activity/reduced rest window profiles. When compared to Non-Hispanic White adolescents, Asian showed a lower value for the high amplitude profile, Mexican American group showed a higher value for the early activity window profile, and the Non-Hispanic Black group showed a higher value for the prolonged activity/reduced rest window profiles. Adolescents reported the lowest household income had the lowest average value for the early activity window profile.ConclusionsThis study characterized main rest-activity profiles among the US adolescents, and demonstrated that demographic and socioeconomic status factors may shape rest-activity behaviors in this population.

OR24-04 High Prevalence Of Elevated ALT In Adolescent Females With Obesity And PCOS

Abstract Disclosure: S. Zhang: None. J.A. Darbinian: None. L.C. Greenspan: None. J.B. Schwimmer: Grant Recipient; Self; Intercept, Seraphina. J.C. Lo: None. Background: We recently observed that US Asian/Pacific Islander (PI) adolescents have two-fold higher odds of polycystic ovary syndrome (PCOS) compared to non-Hispanic White adolescents, with prevalence strongly associated with higher BMI. Moreover, similar to Hispanic/Latina adolescents, Asian/PI adolescents with obesity have much higher odds of elevated alanine aminotransferase (ALT), a biochemical marker for suspected non-alcoholic fatty liver disease (NAFLD). In a pilot study, we observed that PCOS was an independent predictor of elevated ALT in adolescent females with obesity. In this study, we characterized the association of PCOS and elevated ALT in a much larger population of adolescent females and further examined the burden of elevated ALT within the PCOS subset. Methods: We used data from 15,683 females aged 13-17 years who were members of a US integrated healthcare system, had a well-child visit in 2012-2018, met BMI criteria for obesity (BMI ≥95th percentile), and had ALT measured within 1 year of the visit. Elevated ALT was defined as ≥44 U/L (NASPHGAN criteria). PCOS was identified based on clinical diagnosis within 1 year of the visit. Class I, II, III obesity were defined by BMI percent of the 95th percentile from 100 to &amp;lt;120%, 120% to &amp;lt;140%, and ≥140%, respectively. Differences between PCOS and non-PCOS groups were compared using the Chi-square test. Multivariable logistic regression was used to examine the association of PCOS and elevated ALT. Results: Among 15,683 adolescent females with obesity and measured ALT (23.5% White, 14.1% Black, 11.0% Asian/PI, 46.8% Hispanic, and 4.7% other/unknown race and ethnicity), 5.5% had diagnosed PCOS and 39.5% had severe (class II-III) obesity. The prevalence of elevated ALT was 5.1% overall and was substantially higher among those with PCOS (10.6%) compared to those without PCOS (4.7%, p&amp;lt;0.001). In multivariable analyses, PCOS was associated with a 1.8-fold (CI 1.4-2.2) higher odds of elevated ALT, adjusting for age, race/ethnicity, and level of obesity. Similar to our prior report, greater obesity severity, Asian/PI race, and Hispanic ethnicity were significant predictors of elevated ALT. Among the subset of 865 adolescents with obesity and PCOS (40.9% class I, 34.9% class II, 24.2% class III obesity), the prevalence of elevated ALT varied by race and ethnicity, ranging from 15.8% among Asian/PI, 12.8% among Hispanic/Latina, 8.5% among White, and 2.0% among Black females. Conclusion: Our findings confirm a strong independent association of PCOS and elevated ALT among adolescent females with obesity. Among those with both obesity and PCOS, about 1 in 10 had elevated ALT, increasing to 1 in 8 among Hispanic/Latina females and nearly 1 in 6 among Asian/PI females. These findings support recommendations for NAFLD screening in adolescents with PCOS and consideration of screening in young adult women with PCOS, especially high-risk subsets. Presentation: Saturday, June 17, 2023

Trends in Repeat Opioid Analgesic Prescription Utilization for Acute Pain in Children: 2013–2018

Our study examined the change in repeat opioid analgesic prescription trends in children and adolescents experiencing acute pain between 2013 and 2018. Eligible individuals were children and adolescents between 1 and 17 years of age enrolled in a Medicaid Managed Care plan and filled an incident opioid analgesic prescription from 2013 to 2018. A repeat opioid prescription was defined as receiving a subsequent opioid prescription within 30 days from the end of the incident opioid prescription. A generalized linear regression analysis was conducted to examine changes in repeat opioid analgesic dispensing over time at quarterly intervals from January 1, 2013, to December 31, 2018. The cohort comprised 17,086 children and adolescents receiving an incident opioid analgesic. Of these, 1780 (10.4%) filled a repeat opioid analgesic prescription. There was a significant decline in the repeat opioid analgesic trend from 11.5% in Q1 2013 to 9.6% in Q4 2018. Stratified analyses by age, sex, and race and ethnicity in a sub-cohort of patients undergoing surgical procedures showed that a significant decline in repeat opioid utilization over time has been observed in all racial/ethnic groups stratified by age and sex, with the most significant decline found in non-Hispanic White children and Hispanic adolescents. At the end of the 6-year follow-up, the racial and ethnic variations in repeat opioid utilization associated with surgical procedures had significantly reduced in children yet persisted among adolescents. Approximately 10% of incident pediatric opioid analgesic recipients received a repeat opioid prescription. There has been a moderate but steady decline (∼7% per quarter) in repeat opioid analgesic utilization between 2013 and 2018.

The Prevalence of HPV Vaccination among Racial/Ethnic Minority Adolescents During the COVID-19 Pandemic.

Human papillomavirus (HPV) vaccination among adolescents has steadily improved over the past several years. However, research conducted to determine whether the COVID-19 pandemic disrupted this positive trend in HPV vaccine initiation among racial/ethnic minority adolescents is limited. Therefore, this study was conducted to determine if the COVID-19 pandemic and the resulting changes in the U.S. health care sector affected the increasing HPV vaccine initiation among non-Hispanic Black and Hispanic adolescents aged 13-17 years. Using a cross-sectional design to examine data from the National Immunization Survey-Teen (2019-2021), logistic regression and moderation analysis were used to model race-specific variations in HPV vaccine initiation (n = 49,031). Two-sided P values of up to .05 were considered significant. Hispanic (adjusted odds ratio [aOR], 1.35 [95% CI, 1.16-1.57]) and non-Hispanic Black (aOR, 1.29 [95% CI, 1.10-1.51]) adolescents had higher odds of HPV vaccine initiation than did non-Hispanic White adolescents. Additionally, the odds of HPV vaccine initiation were higher in 2021 (aOR, 1.22 [95% CI, 1.08-1.38]) than in 2019. Other variables-age, region, sex, insurance status, and poverty status-were also associated with HPV vaccine initiation. These findings demonstrate that during the COVID-19 pandemic, racial and ethnic minorities had higher odds of receiving the HPV vaccine. Therefore, more research of the impact of the pandemic on HPV vaccine initiation among non-Hispanic White and racial/ethnic minority adolescents is needed.

Geographic variation and trends in prevalence of obesity among US adolescents, 2016–2021

ObjectiveRecent updates of geographic variations, trends, and sociodemographic disparities in obesity prevalence among US adolescents are limited. The study aimed to fill those research gaps. Study designSerial cross-sectional analysis of the US nationally representative study. MethodsData from six cycles of the National Survey of Children's Health (2016, 2017, 2018, 2019, 2020, and 2021) with information on physical health at the national and state level were used. A total of 107,274 adolescents aged 10–17 years old were included with sociodemographic data (age, sex, race/ethnicity, parental education level, and family income) and state of residence. Logistic regression models were used to estimate the odds ratios (ORs) associated with obesity across sociodemographic groups. In addition, ORs were calculated to compare obesity rates between the pandemic period (2020–2021) and the pre-pandemic period (2018–2019) overall and by sociodemographic subgroups. Survey analysis procedures were used to account for complex survey designs to derive representative estimates. ResultsFrom 2016 to 2021, obesity prevalence increased from 16.1% (95% confidence interval [CI], 14.9%–17.4%) to 17.6% (95% CI, 16.4%–18.9%) (P-trend = 0.04). The combined prevalence of obesity varies substantially by state, from 9.34% (95% CI, 6.96%–12.4%; Colorado) to 27.1% (95% CI, 23.1%–31.5%; Mississippi) for adolescents aged 10–13 years and ranged from 9.86% (95% CI, 7.63%–12.7%; Utah) to 22.4% (95% CI, 19.0%–26.1%; West Virginia) for adolescents aged 14–17 years. Except for subgroups male gender and parents with college degrees or above, the prevalence of obesity showed stable trends across sociodemographic subgroups. Compared to the pre-pandemic period, the multivariable-adjusted ORs of obesity were 1.18 (95% CI, 1.06–1.32) for male adolescents, 1.16 (95% CI, 1.04–1.28) for non-Hispanic White adolescents, 1.81 (95% CI, 1.15–2.84) for non-Hispanic Asian adolescents, 1.26 (95% CI, 1.05–1.52) for adolescents whose parents had a high school education, and 1.15 (95% CI, 1.0–1.33) for adolescents whose parents had a college degree or higher. ConclusionsThe prevalence of obesity among US adolescents increased significantly between 2016 and 2021. The prevalence of obesity was relatively high in southern states. Those with low household income, low parental education, or being non-Hispanic Black or Hispanic were also more likely to be obese. Compared to the pre-pandemic period, several groups of adolescents increased their likelihood of obesity during the pandemic period.

Racial and ethnic and socioeconomic disparities in childhood cancer incidence trends in the United States, 2000-2019.

Population-based surveillance of pediatric cancer incidence trends is critical to determine high-risk populations, drive hypothesis generation, and uncover etiologic heterogeneity. We provide a comprehensive update to the current understanding of pediatric cancer incidence trends by sex, race and ethnicity, and socioeconomic status (SES). The Surveillance, Epidemiology, and End Results 22 data (2000-2019) was used to summarize age-adjusted incidence rates for children and adolescents aged 0-19 years at diagnosis. The annual percentage change (APC) and 95% confidence interval (CI) were estimated to evaluate incidence trends by sex, race and ethnicity, and SES overall and for cancer subtypes. Tests of statistical significance were 2-sided. Substantial variation was observed overall and for several histologic types in race and ethnicity- and SES-specific rates. Overall, we observed a statistically significant increase in incidence rates (APC = 0.8%, 95% CI = 0.6% to 1.1%). All race and ethnic groups saw an increase in incidence rates, with the largest occurring among non-Hispanic American Indian and Alaska Native children and adolescents (APC = 1.7%, 95% CI = 0.5% to 2.8%) and the smallest increase occurring among non-Hispanic White children and adolescents (APC = 0.7%, 95% CI = 0.5% to 1.0%). The lowest SES quintiles saw statistically significant increasing trends, while the highest quintile remained relatively stable (quintile 1 [Q1] APC = 1.6%, 95% CI = 0.6% to 2.6%; quintile 5 [Q5] APC = 0.3%, 95% CI = -0.1% to 0.7%). Childhood cancer incidence is increasing overall and among every race and ethnic group. Variation by race and ethnicity and SES may enable hypothesis generation on drivers of disparities observed.

Arthritis Among Children and Adolescents Aged

Arthritis affects persons of all ages, including younger adults, adolescents, and children; however, recent arthritis prevalence estimates among children and adolescents aged <18 years are not available. Previous prevalence estimates among U.S. children and adolescents aged <18 years ranged from 21 to 403 per 100,000 population depending upon the case definition used. CDC analyzed aggregated 2017-2021 National Survey of Children's Health data to estimate the national prevalence of parent-reported arthritis diagnosed among children and adolescents aged <18 years. An estimated 220,000 (95% CI = 187,000-260,000) U.S. children and adolescents aged <18 years (305 per 100,000) had diagnosed arthritis. Arthritis prevalence among non-Hispanic Black or African American children and adolescents was twice that of non-Hispanic White children and adolescents. Co-occurring conditions, including depression, anxiety, overweight, physical inactivity, and food insecurity were associated with higher prevalences of arthritis. These findings highlight that children and adolescents should be prioritized for arthritis prevention and treatments by identifying risk factors for arthritis, developing self-management interventions to improve arthritis, physical activity or weight control, and screening and linking to mental health services. Health systems and payors can take steps to ensure equitable access to therapies (e.g., physical therapies and medications).

Counts, incidence rates, and trends of pediatric cancer in the United States, 2003-2019.

Cancer is a leading cause of death by disease among children and adolescents in the United States. This study updates cancer incidence rates and trends using the most recent and comprehensive US cancer registry data available. We used data from US Cancer Statistics to evaluate counts, age-adjusted incidence rates, and trends among children and adolescents younger than 20 years of age diagnosed with malignant tumors between 2003 and 2019. We calculated the average annual percent change (APC) and APC using joinpoint regression. Rates and trends were stratified by demographic and geographic characteristics and by cancer type. With 248 749 cases reported between 2003 and 2019, the overall cancer incidence rate was 178.3 per 1million; incidence rates were highest for leukemia (46.6), central nervous system neoplasms (30.8), and lymphoma (27.3). Rates were highest for males, children 0 to 4 years of age, Non-Hispanic White children and adolescents, those in the Northeast census region, the top 25% of counties by economic status, and metropolitan counties with a population of 1 million people or more. Although the overall incidence rate of pediatric cancer increased 0.5% per year on average between 2003 and 2019, the rate increased between 2003 and 2016 (APC = 1.1%), and then decreased between 2016 and 2019 (APC = -2.1%). Between 2003 and 2019, rates of leukemia, lymphoma, hepatic tumors, bone tumors, and thyroid carcinomas increased, while melanoma rates decreased. Rates of central nervous system neoplasms increased until 2017, and then decreased. Rates of other cancer types remained stable. Incidence of pediatric cancer increased overall, although increases were limited to certain cancer types. These findings may guide future public health and research priorities.

American Indian/Alaskan Native Child and Adolescent Mortality.

The American Indian/Alaskan Native (AI/AN) population experiences substantial health disparities, but the extent is not well characterized especially among children and adolescents. In data from the National Center for Health Statistics, AI/AN persons are often not recognized as such on death certificates. As AI/AN deaths are undercounted, racial/ethnic comparisons showing greater death rates among AI/AN are "Estimates of Minimal Difference" (EMD): the difference in rates between groups that is an estimate of the minimal difference. It is the minimal difference because that difference would only be increased by more accurate race/ethnic classification on certificates as more AI/AN individuals would be counted as such. We compare rates of non-Hispanic AI/AN leading causes of death to non-Hispanic White (n-HW) and non-Hispanic Black (n-HB) children and adolescents using annual reports for "Deaths: Leading Causes" from 2015 to 2017 from the National Vital Statistics System. Among AI/AN 1-19 year-olds, suicide deaths are significantly higher (p<0.00001) than among n-HB (OR=4.34; CI=3.68-5.1) and n-HWs (p<0.007; OR=1.23; CI=1.05-1.42); deaths from accidents are significantly higher (p<0.001) than among n-HB (OR=1.71; CI=1.49-1.93); and deaths due to assault (homicide) are significantly higher (p<0.00002) than among n-HWs (OR=1.64; CI=1.3-2.05). The appearance of suicide as a leading cause of death among AI/AN children and adolescents occurs in the 10-14-year age group and is significantly more common in the 15-19-year age group compared to both n-HB (p<0.00001; OR=5.35; CI=4.40-6.48) and n-HW (p=0.00064; OR=1.36; CI=1.14-1.63). Even without adjusting for undercounting, EMDs show that there are significant health disparities for preventable deaths of AI/AN children and adolescents to be addressed by public health policy.

Rural-Urban Variation in the Association of Adolescent Violence and Handgun Carrying in the United States, 2002-2019

Adolescent handgun carrying is associated with increased risk of firearm-related violence. Most evidence on adolescent handgun carrying is from urban areas, but these findings may not generalize to rural areas. To examine differences in associations of adolescent interpersonal violence with handgun carrying across the rural-urban continuum. This cross-sectional study used nationally representative data from the US National Survey on Drug Use and Health among adolescents aged 12 to 17 years from 2002 to 2019 to estimate time-varying prevalence ratios (PRs) and prevalence differences (PDs) between interpersonal violence and handgun carrying across the rural-urban continuum. Analyses were conducted in April to July 2022. Any past-year serious fighting, group fighting, and attacking with intent to harm. Any past-year handgun carrying. Associations were estimated within county rural-urban strata using the US Department of Agriculture's Rural-Urban Continuum Codes. In each year, the sample included a weighted count of almost 25 million adolescents, with 50.9% (95% CI, 50.2%-51.6%) males and 24.7% (95% CI, 23.8%-25.6%) Hispanic adolescents, 13.5% (95% CI, 12.8%-14.2%) non-Hispanic Black adolescents, and 51.8% (95% CI, 50.8%-52.8%) non-Hispanic White adolescents in 2019. More rural counties had less racial and ethnic diversity. For example, 81.1% (95% CI, 75.9%-85.4%) of adolescents were non-Hispanic White in the most rural counties vs 43.1% (95% CI, 41.7%-44.6%) of adolescents were non-Hispanic White in the most urban counties in 2019. Adolescent handgun carrying increased over time, with the largest increases in the most rural counties, where the prevalence of adolescent handgun carrying increased from 5.2% (95% CI, 3.8%-7.0%) in 2003 to 12.4% (95% CI, 8.9%-16.9%) in 2019. PRs for the association of violence and handgun carrying were greater in more urban counties. For example, in the most urban counties in 2019, adolescents involved in a group fight had 3.7 (95% CI, 2.9-4.8) times the prevalence of handgun carrying vs those not involved in a group fight; this PR was 3.1 (95% CI, 1.6-5.6) in the most rural counties. PDs were similar and, in some cases, larger in rural areas. For example, in the most urban counties in 2019, handgun carrying prevalence was 7.5% (95% CI, 5.7%-9.5%) higher among adolescents who were involved in a group fight compared with those who were not; this PD was 21.8% (95% CI, 8.2%-37.8%) in the most rural counties, where handgun carrying was more common. This cross-sectional study found that associations of interpersonal violence with handgun carrying were stronger in relative terms in urban areas than in rural areas; however, a higher percentage of rural than urban adolescents carried handguns, resulting in a greater absolute prevalence of handgun carrying associated with violence in rural areas than in urban areas. These findings suggest opportunities for preventing handgun carrying-related harms may differ between rural and urban communities.

Is anybody there? A longitudinal examination of help-seeking and suicidal risk among Latino, Black, and non-Hispanic white adolescents.

Understanding adolescents' and emerging adults' help-seeking behaviors is important to curb suicidal thoughts and behaviors (STB), especially among racial/ethnic minorities who have some of the highest chronic rates of STB in the United States. Learning how diverse groups of adolescents seek help during emotional crises can help us understand the stark health disparities related to suicide risk and respond to them in culturally informed ways. The study observed adolescents via a nationally representative sample (n=20,745) over 14 years (National Longitudinal Study of Adolescents to Adult Health [Add Health]) to examine the association between help-seeking behaviors and STB. Longitudinal multinomial logistic regressions were run to assess for racial/ethnic and gender disparities. Help-seeking was not protective for Black female STB but alternatively was protective for each male group (non-Hispanic white, Black, and Latino). Latinas in their early-to-late 20s with no self-reported STB were at an extremely high risk of suicide attempts just 6 years later. This is the first study to examine race/ethnicity*gender in six independent groups to assess suicidality longitudinally among a nationally representative sample. Tailoring existing interventions to meet the needs of growing and diverse communities is critical for suicide prevention programs and policies.

COVID-19 Bivalent Booster Vaccination Coverage and Intent to Receive Booster Vaccination Among Adolescents and Adults — United States, November–December 2022

COVID-19 vaccine booster doses are safe and maintain protection after receipt of a primary vaccination series and reduce the risk for serious COVID-19-related outcomes, including emergency department visits, hospitalization, and death (1,2). CDC recommended an updated (bivalent) booster for adolescents aged 12-17 years and adults aged ≥18 years on September 1, 2022 (3). The bivalent booster is formulated to protect against the Omicron BA.4 and BA.5 subvariants of SARS-CoV-2 as well as the original (ancestral) strain (3). Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Child COVID Module (NIS-CCM) (4), among all adolescents aged 12-17 years who completed a primary series, 18.5% had received a bivalent booster dose, 52.0% had not yet received a bivalent booster but had parents open to booster vaccination for their child, 15.1% had not received a bivalent booster and had parents who were unsure about getting a booster vaccination for their child, and 14.4% had parents who were reluctant to seek booster vaccination for their child. Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Adult COVID Module (NIS-ACM) (4), 27.1% of adults who had completed a COVID-19 primary series had received a bivalent booster, 39.4% had not yet received a bivalent booster but were open to receiving booster vaccination, 12.4% had not yet received a bivalent booster and were unsure about getting a booster vaccination, and 21.1% were reluctant to receive a booster. Adolescents and adults in rural areas had a much lower primary series completion rate and up-to-date vaccination coverage. Bivalent booster coverage was lower among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) adolescents and adults compared with non-Hispanic White (White) adolescents and adults. Among adults who were open to receiving booster vaccination, 58.9% reported not having received a provider recommendation for booster vaccination, 16.9% had safety concerns, and 4.4% reported difficulty getting a booster vaccine. Among adolescents with parents who were open to getting a booster vaccination for their child, 32.4% had not received a provider recommendation for any COVID-19 vaccination, and 11.8% had parents who reported safety concerns. Although bivalent booster vaccination coverage among adults differed by factors such as income, health insurance status, and social vulnerability index (SVI), these factors were not associated with differences in reluctance to seek booster vaccination. Health care provider recommendations for COVID-19 vaccination; dissemination of information by trusted messengers about the continued risk for COVID-19-related illness and the benefits and safety of bivalent booster vaccination; and reducing barriers to vaccination could improve COVID-19 bivalent booster coverage among adolescents and adults.

Association of ethnicity and adaptive functioning with health-related quality of life in pediatric myelomeningocele.

The purpose of this study was to evaluate associations of ethnicity and adaptive function with health-related quality of life (HRQOL) in youths with spina bifida myelomeningocele (SBM). Participants included Hispanic (n = 75) and non-Hispanic White (n = 86) children and adolescents with SBM. Participants completed ratings of adaptive function and SBM-specific HRQOL. A series of linear multiple regression models was computed to investigate whether ethnicity moderates the relation between adaptive function and HRQOL. Results showed that greater adaptive function was associated with higher HRQOL. While no relations were found between ethnicity and HRQOL, a significant interaction was observed between adaptive function and ethnicity over and above other terms. Although groups did not differ on HRQOL at lower levels of adaptive function, Hispanic participants rated higher HRQOL relative to non-Hispanic White participants at higher levels of adaptive function. Further analysis showed this was true of both nonmotor and motor aspects of adaptive function. Results suggested complex relations between ethnicity and adaptive function with HRQOL, highlighting the importance of optimizing adaptive functioning in youth with SBM.

Measurement and Functional Equivalence of a Reduced Version of the UPPS Impulsivity Scale Among Hispanic, Non-Hispanic Black, and Non-Hispanic White Adolescents.

The current study aimed to assess the measurement equivalence and functional equivalence of the UPPS (Urgency, Premeditation, Perseverance, Sensation Seeking) Impulsivity Scale among three ethnoracial adolescent samples in the U.S. seventh-grade students who self-identified as Hispanic (n = 472), non-Hispanic Black (n = 89), or non-Hispanic White (n = 90), and completed an English-language version of the Child version of the UPPS, which was shortened and modified to include positive urgency items. Through a series of confirmatory factor analyses, the UPPS demonstrated configural, metric, and partial threshold invariance. Fisher's r-to-z transformations were used to assess the functional equivalence of the UPPS against well-validated measures of self-regulation and mental health commonly associated with impulsivity. We found some group differences in the magnitude of associations. Yet, overall, this study provides evidence that the UPPS can be used to measure distinct factors of impulsivity among Hispanic, non-Hispanic Black, and non-Hispanic White adolescents.

Exploring differences in adolescent BMI and obesity-related behaviors by urban, suburban, and rural status

Data from the nationally representative 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study was examined to identify differences in adolescent Body Mass Index (BMI) and obesity-related behaviors by rurality status (i.e., urban, suburban, rural) while accounting for relevant demographics (i.e., sex, race/ethnicity, household income). This secondary, cross-sectional analysis included 1,353 adolescents. Analyses included descriptive statistics, one-way analysis of variance, Chi-squared tests, and multiple linear regression models (reported significance level p < 0.05). Rurality was not associated with BMI when controlling for demographics. However, relative to rural adolescents, suburban adolescents had significantly higher junk food, sugar-sweetened beverages (SSB), sugary food (all β=+0.2, p ≤ 0.001), and fruit/vegetable intake (β=+0.1, p ≤ 0.05). Compared to Non-Hispanic White adolescents, Non-Hispanic Black adolescents had significantly higher BMI (β=+4.4, p ≤ 0.05), total sedentary time (β=+4.1, p ≤ 0.001), junk food, SSB, and sugary food intake (all β=+0.2, p ≤ 0.05). Relative to their lower-income household counterparts, adolescents from higher-income households had significantly lower BMI (β = -9.7, p ≤ 0.001), junk food (β = -0.2, p ≤ 0.05), and SSB intake (β = -0.5, p ≤ 0.001). Contrary to literature, rurality was not a significant predictor of adolescent BMI. While suburban status was significantly associated with several diet-related risk factors, it was not in the direction anticipated. Being non-Hispanic Black and from a low-income household had the greatest influence on adolescent BMI. Findings highlight the importance of using a three-category classification for rurality.

Relationship between Family Racial/Ethnic Backgrounds, Parenting Practices and Styles, and Adolescent Eating Behaviors.

Obesity is more prevalent among racial minority children in the United States, as compared to White children. Parenting practices can impact the development of children’s eating behaviors and habits. In this study, we investigated the relationships among racial/ethnic backgrounds, parenting practices and styles, and eating behaviors in adolescents. Fifty-one parent–adolescent dyads were interviewed to characterize parenting practices and styles, as well as the consumption of dairy, fruits and vegetables, and unhealthy snacks. Height and weight were measured to calculate parent BMI and adolescent BMI-for-age percentiles. Three parenting practice categories—modeling, authoritative, and authoritarian—were found to be related to race/ethnicity. A higher score in authoritarian parenting practices was related to higher BMI percentiles among African American adolescents, whereas a higher score in monitoring practices was related to lower BMI percentiles among non-Hispanic White adolescents. Modeling, reasoning, and monitoring led to higher consumption of fruits and vegetables among adolescents; however, the consumption of unhealthy snacks was higher with rule-setting and lower with reasoning and authoritative practices. Finally, an analysis of the relationships between environmental factors and snack intake showed that adolescents consumed significantly more unhealthy snacks when performing other activities while eating. In conclusion, the findings from this study suggest that families’ racial heritages are related to their parenting practices, BMI percentiles, and their adolescents’ food consumption and eating behaviors. The results of this study can be used to develop and improve adolescent nutrition education and interventions with consideration of their racial/ethnic backgrounds.

Anxiety, Depression, and Behavioral and/or Conduct Disorder in Adolescence Among Former Preterm and Term Infants of Different Race and Ethnicities.

To compare parental reports of recent diagnoses of anxiety, depression, and/or behavioral/conduct disorder among former preterm (PT) and term adolescents by race/ethnicity and evaluate receipt of mental healthcare within the past year among those adolescents with any of these conditions. A total of 20,871 Non-Hispanic white (NHW), Non-Hispanic black (NHB), and Hispanic adolescents were evaluated using data from the 2017/2018 National Survey of Children's Health. PT birth and race/ethnicity disparity in the diagnosis of these emotional/behavioral problems and receipt of mental healthcare among adolescents with any of these diagnoses were analyzed using logistic regression. The unadjusted prevalence (95% CI) of these diagnoses was significantly higher among former PT (0.19 [0.17-0.22]) compared to term (0.15 [0.14-0.16]) adolescents. Despite having higher rates of adverse socioeconomic measures, former PT and term NHBs and Hispanics had lower unadjusted prevalence of these diagnoses in comparison to NHWs. After adjusting for differences in demographic, clinical, and socioeconomic characteristics,NHBs (0.47 [0.36-0.64]) and Hispanics (0.40 [0.30-0.54]) remain at lower odds of the composite measure of the emotional and/or behavioral problemscompared to NHWs, while PT birth did not have a significant impact on this outcome measure. Only 53% of adolescents with these diagnoses received recent mental healthcare. No significant differences in the adjusted odds of receipt of mental healthcare were noted across the groups based on PT birth or race/ethnicity. In contrast to PT birth, race/ethnicity had a significant impact on the adjusted odds of emotional/behavioral disorders during adolescence. Among adolescents with these diagnoses, PT birth and race/ethnicity did not significantly influence the adjusted odds of receipt of mental healthcare.