non-Hispanic White Adolescents Research Articles

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.

Social determinants of human papillomavirus vaccine series completion among U.S. adolescents: A mixed-methods study

IntroductionHuman papillomavirus (HPV) vaccination can significantly reduce HPV-associated cancers. In the US, two doses are recommended for vaccine completion for younger adolescents. However, series completion rates remain below the nation's goal of 80% coverage. Multi-faceted factors may influence adolescent series completion. The purpose of this study was to identify individual-level, relationship-level, and community-level factors of timely series completion among adolescents, ages 11–14, initiating the HPV vaccine series in 2017. MethodsA convergent, mixed-methods design was used combining adolescent electronic health record data (n = 803) and qualitative interviews with adolescents and their parents (n = 32) to assess timely series completion within 14-months (e.g., January 2018 to February 2019). Multivariable logistic regression analysis examined individual-level and community-level factors influencing timely series completion. Directed content analysis was used to identify relevant themes and subthemes. We provided an integrative summary to assess patterns of convergence or divergence between quantitative and qualitative data. ResultsIn the quantitative phase, 61.0% of adolescents completed the vaccine series and 47.3% completed it on-time. Higher odds of timely series completion were among younger adolescents at vaccine initiation (aOR = 1.82, 95%CI = 1.07, 3.11) and lower among adolescents who were Black (aOR = 0.57, 95%CI = 0.37, 0.89) and Hispanic (aOR = 0.54, 95%CI = 0.30, 0.95) compared to Non-Hispanic White adolescents and those without private insurance (aOR = 0.56, 95%CI = 0.37, 0.85). Qualitative findings revealed increased risk for HPV at sexual debut as a motivator for timely series completion. Family/peers and healthcare providers influenced timely series completion among minority adolescents. Community-level factors were not significantly associated with timely series completion, however, qualitative findings revealed lack of transportation as a barrier to timely series completion. ConclusionMulti-level factors continue to influence timely series completion, despite fewer doses needed for series completion. Innovative strategies are needed to improve care coordination for receiving vaccine doses, patient-provider communication about series completion and increase access to HPV vaccine.

Examination of the Interaction between Parental Military-Status and Race among Non-Hispanic Black and Non-Hispanic White Adolescents with Overweight/Obesity.

Adolescent military-dependents experience distinct risk and protective factors, which may necessitate additional clinical considerations. In civilian youth, overweight/obesity is associated with eating, internalizing, and externalizing difficulties, with some studies reporting more difficulties among non-Hispanic White (vs. non-Hispanic Black) youth. It is unknown if these disparities exist among adolescent military-dependents, or between civilian and military-dependent youth. Non-Hispanic Black (187 civilian, 38 military-dependent) and non-Hispanic White (205 civilian, 84 military-dependent) adolescents with overweight/obesity (14.7 ± 1.6 years; 73.9% girls; body mass index adjusted for age and sex 1.9 ± 0.5) completed a disordered-eating interview; parents completed a measure assessing their child's internalizing and externalizing difficulties. Multiple linear regressions examined parental military-status as a moderator of the relationship of participant race with eating, internalizing, and externalizing difficulties. White civilian youth with overweight/obesity reported significantly greater disordered-eating than their Black peers (p < .001); there were no other significant racial differences. In all regressions, parental military-status significantly moderated the association between race and each dependent variable (ps < .047). Black military-dependents (vs. civilians) reported more disordered-eating and internalizing difficulties (ps = .01). White military-dependents (vs. civilians) reported fewer externalizing difficulties (p = .01). Black adolescent military-dependents with overweight/obesity may experience more eating and internalizing difficulties (vs. civilians), a pattern not observed among White participants. Future work should examine if being a military-dependent and a historically marginalized racial group member accounts for these findings. Such data may inform providers of youth with intersecting minority identities.

Racial differences in psychological stress and insulin sensitivity in non-Hispanic Black and White adolescents with overweight/obesity

Introduction: Racial differences in type 2 diabetes risk persist among non-Hispanic Black and non-Hispanic White adolescents with overweight/obesity; however, the role of psychological stress in this disparity is less clear. Purpose: To examine racial differences in the association between psychological stress, insulin sensitivity (Si), acute insulin response to glucose (AIRg), and disposition index (DI) among non-Hispanic Black and non-Hispanic White adolescents with overweight/obesity. Methods: Ninety-six adolescents (60% female; 51% non-Hispanic Black; 16.6 ± 1.8 years of age) with overweight/obesity (BMI percentile ≥ 85th percentile) were included in this analysis. Psychological stress was assessed using the 14-item Perceived Stress Scale. Glucose and insulin data from an intravenous glucose tolerance test was modeled to obtain Si, AIRg, and DI. Multivariable linear regression models were used to examine the association between race, psychological stress and metabolic outcomes (Si, AIRg, and DI). Results: Race was a significant predictor of log-AIRg and log-DI (ps < 0.05) independent of all covariates in the main effect models. Lower Si (pinteraction = 0.014) and DI (pinteraction = 0.012) was also observed among Black adolescents who reported higher stress levels, whereas higher Si and DI was observed among non-Hispanic White adolescents reporting higher stress in the race interaction models. Race however, did not moderate the association between psychological stress and AIRg (p > 0.05), nor was stress associated with Si, AIRg, or DI ("p" "s" > 0.05) across all other models. Conclusions: Psychological stress may play an important and distinct role in shaping racial differences in type 2 diabetes risk among adolescents with overweight/obesity. Additional research is needed to understand the long-term effects of psychological stress on metabolic health among non-Hispanic Black and non-Hispanic White adolescents with overweight/obesity.

Factors Influencing Racial and Ethnic Differences in Prescription Opioid Misuse Among Young Adolescents in the USA, 2009-2019.

Prescription opioid misuse (POM) is an important public health concern. Not many studies have evaluated factors influencing racial and ethnic differences in POM exclusively in young adolescents. We evaluated factors influencing the racial and ethnic differences in POM in a nationally representative sample of 8th- and 10th-grade (12-15years old) US adolescents. Data were from 107,786 adolescents who participated in the 2009-2019 Monitoring the Future survey. Logistic regression and mediation analysis were used to identify risk factors for POM and evaluate mediators of the association of race and ethnicity on the frequency of POM in the past year. From 2009 to 2019, the prevalence of POM in the past year decreased from 3.2% to 1.8% (p = 0.032), with significant differences in POM trends by race and ethnicity. Overall, the prevalence was higher among non-Hispanic White adolescents (3.2%) than Hispanic (2.5%) and non-Hispanic Black adolescents (1.6%), p < 0.001. After adjustment for demographic, substance use, lifestyle, and family-related factors, the odds of POM were lower among Black (odds ratio (OR) = 0.81, 95% confidence interval (CI): 0.66-0.98) and Hispanic adolescents (OR = 0.64, CI: 0.55-0.74) compared to White adolescents. Illicit drug use and misuse of other prescription drugs together explained 77.2% and 47.3% of the racial and ethnic disparities in POM among Black and Hispanic adolescents, respectively. In this study, significant racial and ethnic differences in the trends of POM were observed. Illicit drug use and misuse of other prescription drugs substantially explained the racial and ethnic disparities in POM among young adolescents.

Duration-Weighted Exposure to Neighborhood Disadvantage and Racial-Ethnic Differences in Adolescent Sexual Behavior.

Racial-ethnic disparities in adolescent sexual risk behavior are associated with health disparities during adulthood and are therefore important to understand. Some scholars argue that neighborhood disadvantage induces disparities, yet prior research is mixed. We extend neighborhood-effects research by addressing long-term exposure to neighborhood disadvantage and estimation bias resulting from inclusion of time-varying covariates. Drawing from the Fragile Families and Child Well-Being Study, we compare a point-in-time proximal measure of neighborhood disadvantage with a duration-weighted measure using marginal structural models with inverse probability of treatment weights. Findings indicate that multiracial, non-Hispanic black, and Hispanic youth exhibit significantly higher sexual risk and duration-weighted exposure to neighborhood disadvantage than non-Hispanic white adolescents. Duration-weighted exposure is a better predictor of sexual initiation and number of partners by age 15 than a point-in-time proximal measure of neighborhood disadvantage and accounts for a substantial portion of the race-ethnic differences in sexual risk.

COVID-19 and Adolescent Depression and Suicide Risk Screening Outcomes.

Mental health concerns increased during the coronavirus disease 2019 pandemic, but previous studies have not examined depression screening in pediatric primary care. We aimed to describe changes in screening, depressive symptoms, and suicide risk among adolescents during the coronavirus disease 2019 pandemic. In a repeat cross-sectional analysis of electronic health record data from a large pediatric primary care network, we compared the percentage of primary care visits where adolescents aged 12 to 21 were screened for depression, screened positive for depressive symptoms, or screened positive for suicide risk between June and December 2019 (prepandemic) and June and December 2020 (pandemic). Changes were examined overall, by month, and by sex, race and ethnicity, insurance type, and income. Modified Poisson regression was used to calculate prevalence ratios (PRs) for the prepandemic to pandemic changes. Depression screening at primary care visits declined from 77.6% to 75.8% during the pandemic period (PR: 0.98, 95% confidence interval [CI]: 0.90-1.06). The percentage of adolescents screening positive for depressive symptoms increased from 5.0% to 6.2% (PR: 1.24, 95% CI: 1.15-1.34), with greater increases among female, non-Hispanic Black, and non-Hispanic white adolescents. Positive suicide risk screens increased from 6.1% to 7.1% (PR: 1.16, 95% CI: 1.08-1.26), with a 34% relative increase in reporting recent suicidal thoughts among female adolescents (PR: 1.34, 95% CI: 1.18-1.52). Results suggest that depression and suicide concerns have increased during the pandemic, especially among female adolescents. Results underscore the importance of consistent depression and suicidality screening.

A factor analytic approach to understanding health risk behaviors and resilience among multi-racial/ethnic adolescents in New Mexico

ABSTRACT Objective This study examined the factor validity of health risk behaviors and resilience indicators and their covariation across a large racially/ethnically diverse adolescent population. Design The study subsample (47% Hispanic, 31% White Non-Hispanic, 17% American Indian) was derived from the 2013 New Mexico Youth Risk Resilience Survey (YRRS; N-19,033). We conducted a confirmatory factor analysis on the 6 health risk domains identified by the CDC as contributing most to adolescent morbidity/mortality: (1) cigarette use, (2) alcohol and other illicit drug use, (3) marijuana use, (4) sexual activity, (5) nutrition habits, and (6) physical activity. Results A 4-factor CFA model of adolescent health risk behaviors was replicated, and a hypothesized 6-factor structure based on behaviors that contribute most to adolescent morbidity/mortality was confirmed. The pattern of covarying risk behaviors differed by Hispanic, Native American, and Non-Hispanic White groups. We also confirmed a single external resilience-interference factor (decreased parental support, low school/community engagement, negative peer associations) that positively correlated with all six risk behaviors. Conclusion This study described the structure of adolescent health risk behaviors within a context of psychosocial resilience for American Indian and Hispanic adolescents in contrast to Non-Hispanic White adolescents. Our findings provided evidence for the construct validity of six health-risk behavior dimensions within a large racially/ethnically diverse adolescent sample, which reveal different patterns of loadings, degrees of model fit, and factor inter-correlations across the three racial/ethnic groups. Patterns of covarying risk behaviors differed in strength and direction by racial/ethnic group. Results suggest that interventions should target multiple behaviors and be tailored for different racial/ethnic groups. Targeting health risk and resilience indicators supports the use of multi-level health interventions at the individual, school, family, and community level by identifying individuals based on external resilience scores.

Adolescents’ Patterns of Well-Care Use Over Time: Who Stays Connected

Well-care use can positively impact adolescents' current and future health. Understanding adolescents' longitudinal well-care use is critical to determine to whom and when to target engagement strategies to improve healthcare access. This study describes prospective well-care use patterns from childhood through adolescence stratified by sex. The sample (N=6,872) was drawn from the Child/Young Adult component of the household-based 1979 National Longitudinal Survey of Youth consisting of biological children born to female respondents (1980-1997). Well-care use (routine checkup with a doctor within last year) data were assessed from age 5 years (1986-2003) until age 17 years (1998-2015). Conducted in 2019, latent class analyses stratified by sex identified well-care use patterns reported over 7 biennial time points adjusted for cohort, race/ethnicity, urbanicity, maternal education, and insurance. A total of 4 well-care use classes emerged for female adolescents: the majority belonged to Engaged (37%) and Moderately Engaged (39%) classes and the remainder belonged to Gradually Re-engaged (14%) and Disengaged-with-Rebound (10%) classes. A total of 3 classes emerged for male adolescents: the majority belonged to the Persistently Disengaged (48%) class and the remainder belonged to Engaged (34%) and Gradually Re-engaged (18%) classes. For both sexes, comparing each cohort with the first, Engaged class membership increased for subsequent cohorts. Less engaged well-care use classes had more non-Hispanic White adolescents living in rural areas with lower insurance coverage. Maternal education differentiated well-care use classes for male but not for female adolescents, being higher for male adolescents in the Engaged class than in other classes. These findings highlight that well-care use patterns for both sexes changed during the transition from childhood to adolescence and that class membership differed by covariates. These results suggest that sex-specific strategies may be needed to enhance adolescents' well-care use engagement over time.

Impacts of Changing Sexual Behavior on Chlamydia and Gonorrhea Burden Among US High School Students, 2007 to 2017.

Rates of adolescent sexual activity have long been declining in the United States. We sought to estimate the number of cases of gonorrhea and chlamydia averted over 1 decade associated with these declines and associated costs saved. We analyzed data from the Centers for Disease Control and Prevention's Youth Risk Behavior Survey of US high school students from 2007 to 2017 and combined it with epidemiological estimates drawn from the literature to parameterize a dynamic population transmission model. We compared transmissions from observed behavioral trends with a counterfactual scenario that assumed sexual behaviors from 2007 remained constant for 10 years. We calculated outcomes by age and for 3 racial/ethnic groups (Hispanic, non-Hispanic Black, and non-Hispanic White adolescents) who vary on underlying burden and amount of behavioral change. We estimated 1,118,483 cases of chlamydia and 214,762 cases of gonorrhea were averted (19.5% of burden across all ages). This yielded $474 million (2017 dollars) savings in medical costs over the decade. The largest number of averted cases (767,543) was among Black adolescents, but the largest proportion (28.7%) was among Hispanic adolescents. Whatever its origins, changing sexual behavior among adolescents results in large estimated reductions in STI burden and medical costs relative to previous cohorts. Although diagnoses among adolescents have not declined at this rate, multiple explanations could make these apparently divergent trends consistent. Efforts to continue supporting effective sex education in and out of school along with STI screening for adolescents should reinforce these gains.

Nicotine and cannabis vaping among adolescents in treatment for substance use disorders

This study examined nicotine and cannabis vaping among adolescents in treatment for substance use disorders. Participants were 363 adolescents aged 12–17 (66% male, mean age = 15.5 [SD = 1.3], 46% non-Hispanic white) seen for a specialty addiction intake evaluation between 2017 and 2019 at one of six medical offices of a large, integrated health care system in Northern California. Multivariable logistic regression models tested for associations of sociodemographics, cigarette smoking, and substance use disorders with vaping behaviors. A majority of adolescents reported ever (68%) or current vaping (60%) of nicotine and/or cannabis; current vaping was similar for nicotine (50%) and cannabis (51%); 40% reported current vaping of both. Current smokers (6% of the sample) had higher odds of ever vaping (aOR = 3.95, 95%CI: 1.04–14.95). Black (versus non-Hispanic white) adolescents had lower odds of current nicotine vaping (aOR = 0.08, 95%CI: 0.02–0.37) and current vaping of both nicotine and cannabis (aOR = 0.12, 95%CI: 0.03–0.60). Having an alcohol use disorder was associated with current vaping (aOR = 2.14, 95%CI: 1.06–4.33). Those who endorsed that most friends get drunk/high (aOR = 1.87, 95%CI: 1.02–3.42) or that cannabis was their substance of choice (aOR = 2.36, 95%CI: 1.16–4.81) had higher odds of current cannabis vaping. Higher neighborhood household income ($80,000–$120,000 and >$120,000 vs. <$80,000, aORs = 2.05–9.48), never versus ever blunt use (aORs = 2.47–8.68), and intakes in 2018 and 2019 versus 2017 (aORs = 2.18–5.38) were associated with higher odds of all vaping outcomes. Vaping was common among adolescents in addiction treatment and varied with sociodemographics and substance-related factors. Research should assess how vaping impacts the development of substance use disorders and whether it interferes with addiction treatment.

Neighborhood Poverty and Amygdala Response to Negative Face.

Considerable research has established a link between socioeconomic status (SES) and brain function. While studies have shown a link between poverty status and amygdala response to negative stimuli, a paucity of knowledge exists on whether neighborhood poverty is also independently associated with amygdala hyperactive response to negative stimuli. Using functional brain imaging data, this study tested the association between neighborhood SES and the amygdala's response to negative stimuli. Considering race as a sociological rather than a biological construct, we also explored racial heterogeneity in this association between non-Hispanic Black and non-Hispanic White youth. We borrowed the functional Magnetic Resonance Imaging (fMRI) data of the Adolescent Brain Cognitive Development (ABCD) study. The sample was 2,490 nine to ten year old non-Hispanic Black and non-Hispanic White adolescents. The independent variable was neighborhood income which was treated as a continuous measure. The primary outcomes were the right and left amygdala response to negative face during an N-Back task. Age, sex, race, marital status, and family SES were the covariates. To analyze the data, we used linear regression models. Low neighborhood income was independently associated with a higher level of amygdala response to negative face. Similar results were seen for the right and left amygdala. These effects were significant net of race, age, sex, marital status, and family SES. An association between low neighborhood SES and higher left but not right amygdala response to negative face could be observed for non-Hispanic Black youth. No association between neighborhood SES and left or right amygdala response to negative face could be observed for non-Hispanic White youth. For American youth, particularly non-Hispanic Black youth, living in a poor neighborhood predicts the left amygdala reaction to negative face. This result suggested that Black youth who live in poor neighborhoods are at a high risk of poor emotion regulation. This finding has implications for policy making to reduce inequalities in undesired behavioral and emotional outcomes. Policy solutions to health inequalities should address inequalities in neighborhood SES.

Adverse childhood experiences and suicidality: school connectedness as a protective factor for ethnic minority adolescents

Adverse childhood experiences (ACEs) increase risk for suicidality. School connectedness can be protective, whether it buffers the negative effects of ACEs across ethnic backgrounds is understudied. Data came from the 2016 Minnesota Student Survey. The analytic sample included Latino (n = 11,888), Somali (n = 2,302), Hmong (n = 3,503), and non-Hispanic (NH) White (n = 10,968) adolescents. Multivariable logistic regression models, stratified by ethnicity and sex, examined associations between ACEs, school connectedness, and suicide ideation and attempts. More than 40% of students reported ≥1 ACE. Significant differences in suicidality across ethnicity and sex were noted, with Latinas reporting the highest rates and Somali boys and girls reporting some of the lowest. The likelihood of suicidality was significantly higher with each additional ACE (OR range 1.70–2.23), regardless of ethnicity or sex. School connectedness was generally protective against suicidal ideation; e.g., for each unit of school connectedness, the odds of ideation were 29% lower for Latinas (OR = 0.71; 95%, CI: 0.62, 0.80). However, it only buffered the impact of ACEs on suicidality for NH White adolescents. Suicide prevention programs should be designed through an intersectional framework and be adapted and relevant to promote social connectedness to increase access to tangible, emotional social support for youth of diverse ethnic backgrounds. Findings suggest further studies are needed to identify factors that moderate the impact of ACEs for all adolescents.

Race, Socioeconomic Status, and Sex Hormones among Male and Female American Adolescents.

Although early sexual initiation and childbearing are major barriers against the upward social mobility of American adolescents, particularly those who belong to a low socioeconomic status (SES) and racial minorities such as Blacks, less is known on how SES and race correlate with adolescents' sex hormones. An understanding of the associations between race and SES with adolescents' sex hormones may help better understand why racial, and SES gaps exist in sexual risk behaviors and teen pregnancies. To extend the existing knowledge on social patterning of adolescents' sex hormones, in the current study, we studied social patterning of sex hormones in a national sample of male and female American adolescents, with a particular interest in the role of race and SES. For this cross-sectional study, data came from the baseline data (wave 1) of the Adolescent Brain Cognitive Development (ABCD) study, a national longitudinal prospective study of American adolescents. This analysis included 717 male and 576 female non-Hispanic White or Black adolescents ages 9-10. The dependent variables were sex hormones (testosterone for males and estradiol for females). Independent variables were age, race, family marital status, parental education, and financial difficulties. For data analysis, linear regression models were used. Age, race, parental education, and financial difficulties were associated with estradiol in female and testosterone levels in male adolescents. Associations were not identical for males and females, but the patterns were mainly similar. Low SES explained why race is associated with higher estradiol in female adolescents. Marital status of the family did not correlate with any of the sex hormones. Being Black and low SES were associated with a higher level of sex hormones in male and female adolescents. This information may help us understand the social patterning of sexual initiation and childbearing. Addressing racial and economic inequalities in early puberty, sexual initiation, and childbearing is an essential part of closing the racial and economic gaps in the US.

Child disclosure, parental solicitation, and adjustment problems: Parental support as a mediator.

Little is known about how perceived parental solicitation and child disclosure are negatively associated with early adolescent adjustment problems and/or if these associations are consistent across race/ethnic groups. This study used data from 209 early adolescents to examine perceived parental support as a mediator in the associations between perceived parental solicitation and child disclosure and subsequent adjustment problems, while also examining race/ethnic group differences across non-Hispanic White and Hispanic early adolescents using multi-group path analyses. Perceived parent support did not mediate the associations between child disclosure and perceived parental solicitation and subsequent adjustment problems. However, child disclosure was directly associated with subsequent conduct problems for Hispanic adolescents. Child disclosure and perceived parental solicitation may positively influence the parent-adolescent relationship by increasing parental support but may not entirely help in reducing the prevalence of adjustment problems. Child disclosure may be particularly beneficial for Hispanic early adolescents in reducing adjustment problems.

Subjective Family Socioeconomic Status and Adolescents' Attention: Blacks' Diminished Returns.

Background: Racial minorities, particularly non-Hispanic blacks (NHBs) in the US, experience weaker effects from their families’ socioeconomic status on tangible outcomes, a pattern called the Minorities’ Diminished Returns (MDRs) theory. These MDRs are frequently shown in the effects of the families’ socioeconomic status (SES) on NHB adolescents’ school performance. As a result of these MDRs, NHB adolescents from high SES families show a worse than expected school performance. The existing knowledge is, however, minimal about the role of attention in explaining the diminished returns of the families’ SES with regard to the adolescents’ outcomes. Aim: To investigate the racial differences in the effects of the subjective family SES on adolescents’ attention, we compared non-Hispanic white (NHW) and NHB adolescents to assess the effect of the subjective family SES on adolescents’ attention. Methods: This was a cross-sectional analysis that included 4188 adolescents from the Adolescent Brain Cognitive Development (ABCD) Study. The independent variable was the subjective family SES. The primary outcome was the adolescents’ attention to be measured by the stop-signal task (SST). The attention domain of the Child Behavior Checklist (CBCL) was also measured. Results: Overall, a high subjective family SES was associated with a higher task-based and CBCL-based attention. Race showed statistically significant interactions with subjective family SES in terms of adolescents’ attention outcomes. These interactions suggested that a high subjective family SES has smaller tangible effects on increasing the attention of NHB than NHW adolescents. Conclusion: The boosting effect of subjective family SES on attention is diminished for NHB rather than NHW adolescents. To minimize the racial gap in attention-related behaviors, such as school performance, we need to address the diminished returns of resources in the lives of NHB families. Not only should we equalize SES, but also increase the marginal returns of SES for racial minorities, particularly NHB families. Such efforts require public policies that empower NHB families to better leverage their SES resources and turn them into tangible outcomes. In addition, social policies should directly aim to alter the societal barriers that limit NHB families’ ability to effectively utilize their resources. Discrimination, segregation, and racism should be targets of our policy solutions.

Reward Responsiveness in the Adolescent Brain Cognitive Development (ABCD) Study: African Americans' Diminished Returns of Parental Education.

(1) Background: Reward responsiveness (RR) is a risk factor for high-risk behaviors such as aggressive behaviors and early sexual initiation, which are all reported to be higher in African American and low socioeconomic status adolescents. At the same time, parental education is one of the main drivers of reward responsiveness among adolescents. It is still unknown if some of this racial and economic gap is attributed to weaker effects of parental education for African Americans, a pattern also called minorities’ diminished returns (MDRs). (2) Aim: We compared non-Hispanic White and African American adolescents for the effects of parent education on adolescents RR, a psychological and cognitive construct that is closely associated with high-risk behaviors such as the use of drugs, alcohol, and tobacco. (3) Methods: This was a cross-sectional analysis that included 7072 adolescents from the adolescent brain cognitive development (ABCD) study. The independent variable was parent education. The main outcome as adolescents’ RR measured by the behavioral inhibition system (BIS) and behavioral activation system (BAS) measure. (4) Results: In the overall sample, high parent education was associated with lower levels of RR. In the overall sample, we found a statistically significant interaction between race and parent education on adolescents’ RR. The observed statistical interaction term suggested that high parent education is associated with a weaker effect on RR for African American than non-Hispanic White adolescents. In race-stratified models, high parent education was only associated with lower RR for non-Hispanic White but not African American adolescents. (5) Conclusion: Parent education reduces RR for non-Hispanic White but not African American adolescents. To minimize the racial gap in brain development and risk-taking behaviors, we need to address societal barriers that diminish the returns of parent education and resources in African American families. We need public and social policies that target structural and societal barriers, such as the unequal distribution of opportunities and resources. To meet such an aim, we need to reduce the negative effects of social stratification, segregation, racism, and discrimination in the daily lives of African American parents and families. Through an approach like this, African American families and parents can effectively mobilize their resources and utilize their human capital to secure the best possible tangible outcomes for their adolescents.

Minorities' Diminished Returns of Parental Educational Attainment on Adolescents' Social, Emotional, and Behavioral Problems.

Aim: To compare racial groups for the effect of parental educational attainment on adolescents’ social, emotional, and behavioral problems. Methods: In this cross-sectional study, 10,762 youth from the Adolescent Brain Cognitive Development (ABCD) study were included. The independent variable was parental educational attainment. The main outcomes were (1) anxious and depressed mood, (2) withdrawn and depressed affect, (3) somatic complaints, (4) social and interpersonal problems, (5) thought problems, (6) rule-breaking behaviors, (7) attention problems, and (8) violent and aggressive behaviors. These scores were generated based on parent-reported behavioral problems measured using the Child Behavior Checklist (CBCL). Race and ethnicity were the moderators. Linear regression was used to analyze the ABCD data. Results: Overall, high parental educational attainment was associated with lower scores across all domains. Race and ethnicity showed statistically significant interactions with parental educational attainment on adolescents’ fewer social, emotional, and behavioral problems (all domains), net of all confounders, indicating smaller tangible gains from their parental educational attainment for Black and Hispanic compared to non-Hispanic White adolescents. Conclusions: The protective effects of parental education against social, emotional, and behavioral problems are systematically diminished for Hispanic and Black than non-Hispanic White adolescents.

Place-Based Diminished Returns of Parental Educational Attainment on School Performance of Non-Hispanic White Youth.

Youth educational outcomes are a function of a wide range of factors including parental education level. This effect, however, is shown to be smaller for African American, Hispanic, and Asian American youth, a pattern called Marginalization-related Diminished Returns (MDRs). It is, however, unknown if it is race/ethnicity or other conditions associated with race/ethnicity (e.g., poor neighborhood quality) which reduces the marginal returns of parental education for youth. To explore whether MDRs are only due to race/ethnicity or if they also remain for non-Hispanic Whites in poor neighborhoods, we compared the association between parental education level and adolescents' school performance based on neighborhood quality in a nationally representative sample of non-Hispanic Whites in the United States. This cross-sectional study used wave 1 of the Add Health study, an ongoing nationally representative cohort, 1994-2019. Participants included 849 non-Hispanic White adolescents between the ages of 12 and 21 years and their parents. The independent variable was parental education level, which was treated as a continuous measure. Age, grade, gender, and parental marital status were the covariates. The dependent variable was school performance (sum of school grades in Math, English, History, and Science). Linear regression models were used for data analysis. Overall, worse neighborhood quality was associated with worse school performance. Parental education level, however, was not directly associated with youth school performance. We found a statistically significant interaction between parental education level and neighborhood quality suggesting that the strength of the association between parental education and youth school performance weakens as neighborhood quality declines. Parental education level is a more salient determinant of youth educational outcomes in better neighborhoods. The result suggests that MDRs may not be solely due to race/ethnicity but contextual factors that commonly covary with marginalization and poverty. These contextual factors may include segregation, concentration of poverty, and social and physical neighborhood disorder.

National Trends in Mental Health Care for US Adolescents

The prevalence of adolescent depression and other internalizing mental health problems has increased in recent years, whereas the prevalence of externalizing behaviors has decreased. The association of these changes with the use of mental health services has not been previously examined. To examine national trends in the care of different mental health problems and in different treatment settings among adolescents. Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analyzed from July 20 to December 1, 2019. Time trends in 12-month prevalence of any mental health treatment or counseling in a wide range of settings were examined overall and for different sociodemographic groups, types of mental health problems (internalizing, externalizing, relationship, and school related), and treatment settings (inpatient mental health, outpatient mental health, general medical, and school counseling). Trends in the number of visits and nights in inpatient settings were also examined. A total of 47 090 of the 230 070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years. The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Internalizing problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalizing problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions. During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counseling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001). Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased. This study's findings suggest that the growing number of adolescents who receive care for internalizing mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.