non-Hispanic White Youth Research Articles

Parental Educational Attainment and Frequency of Marijuana Use in Youth: Hispanics’ Diminished Returns

Background: While socioeconomic status (SES) indicators such as parental educational attainment show robust associations with health behaviors such as substance use, the protective effects of these indicators may differ across racial groups. This phenomenon of weaker associations between SES indicators and health outcomes for marginalized and minoritized groups relative to non-Hispanic White people has been labeled “Marginalization-related Diminished Returns” (MDRs). Here, we test both whether parental educational attainment is associated with marijuana use frequency in youth as well as whether we observe racial and ethnic variation in this association consistent with MDRs. Methods: This study used data from the cross-sectional 2019 Monitoring the Future survey (MTF 2019). Participants included 29,230 youth who were either Hispanic (24.1%), non-Hispanic Black (16.1%), or non-Hispanic White (59.9%). We used weighted logistic regression models to test for (1) associations between maternal educational attainment and youth cannabis use frequency as well as (2) moderation of this association by race/ethnicity, while adjusting for the complex sample design of the MTF 2019 data. Age, sex, father presence, and maternal employment were entered into models as covariates. Results: Overall, children born to mothers with higher educational attainment reported less frequent marijuana use than peers born to mothers with lower educational attainment. However, this association was significantly weaker in Hispanic versus non-Hispanic White youth. Conclusion: The strength of the association between parental educational attainment and youth marijuana use frequency appears to differ across ethnic groups. Specifically, we observed that whereas non-Hispanic White youth from high-SES families tend to report less marijuana use than peers from lower-SES families, Hispanic youth report roughly equal levels of use across the full SES spectrum. This finding is in line with the MDRs framework and may reflect factors such as structural racism, social stratification, and the marginalization of ethnic minority families in the US.

5.19 A Literature Review: Racial and Ethnic Disparities in the Diagnosis and Treatment of ADHD

ADHD is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. ADHD has a prevalence rate of approximately 5% in children and responds well to therapeutic interventions. If untreated, ADHD can cause impairment in academic and social functioning. This review aims to study the current literature to identify disparities in diagnoses and treatment among non-Hispanic White and ethnic and racial minority patients. A literature review was conducted among studies from the last 10 years from PubMed and PsycINFO. The search terms used in PsycINFO were “treat/intervention or diagnosis/assess or clinical decision” and “ADHD and racial bias/racial or ethnic differences.” The search terms used in PubMed were “ADHD,” “ADHD and racial disparity,” and “ADHD, treatment and racial disparities.” Combined, 36 studies were imported for screening from 2 sources with 9 duplicates, leaving 27 studies. Of these, 5 were considered irrelevant by authors. A full-text review was done for 22 studies. Nearly all studies showed that ethnic and racial minority children, mainly African Americans and Latinx, were less likely to be diagnosed with ADHD when compared to the non-Hispanic White youth. These disparities remained even after various environmental and sociocultural confounding factors were statistically controlled for by logistic regression. Furthermore, minority children were also less likely to receive care and were at risk of early discontinuation of treatment. Two recent studies have shown increasing rates of diagnosis and treatment of ADHD in Black children; however, the disparity remains. Although ethnic and racial minority children exhibit the same severity of ADHD symptoms when compared to non-Hispanic White youth, they are less likely to be diagnosed with ADHD and have decreased odds of receiving appropriate psychopharmacologic and other treatment modalities. Barriers to care included minority status, less parental education, and lack of insurance, which decreased the chances of getting a comprehensive evaluation and which also decreased the odds of identifying comorbidities associated with ADHD. When ethnic minority children receive less comprehensive evaluations, there may be more opportunities for unconscious bias to impact diagnosis and treatment.

Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes in the Pediatric Diabetes Consortium (PDC).

Type 2 diabetes in the U.S. is more prevalent in youth of minority racial-ethnic background, but disparities in health outcomes have not been examined in this population. We examined racial-ethnic differences in the initial presentation and subsequent comorbidities in 1,217 youth with type 2 diabetes (63% girls) enrolled in the Pediatric Diabetes Consortium (PDC) Registry from February 2012 to June 2018. Demographic and clinical data were collected from medical records and participant self-report. Overall, the mean age at presentation was 13.4 ± 2.4 years, and BMI was 35.0 ± 9.4 kg/m2. HbA1c was higher and C-peptide was lower in non-Hispanic Black (NHB) and Hispanic (H) youth compared with non-Hispanic White (NHW) youth. NHB were three times as likely to present in diabetic ketoacidosis (19%) versus NHW (6.3%) and H (7.5%), and NHB and H both had a worse HbA1c trajectory compared with NHW peers. Microalbuminuria was documented in 11%, hypertension in 34%, and dyslipidemia in 42% of Registry participants, with no significant difference among racial-ethnic groups. Nonalcoholic fatty liver disease (NAFLD) was diagnosed in 9% and 11% of H and NHW, respectively, versus 2% in NHB. NHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA1c trajectories compared with NHW. Comorbidities exist in a large percentage of these youth independent of race-ethnicity, except for NAFLD being less prevalent in NHB. Greater efforts are needed to mitigate racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.

Longitudinal Impact of Childhood Adversity on Early Adolescent Mental Health During the COVID-19 Pandemic in the ABCD Study Cohort: Does Race or Ethnicity Moderate Findings?

BackgroundDuring the COVID-19 pandemic in the United States, mental health among youth has been negatively affected. Youth with a history of adverse childhood experiences (ACEs), as well as youth from minoritized racial-ethnic backgrounds, may be especially vulnerable to experiencing COVID-19–related distress. The aims of this study are to examine whether exposure to pre-pandemic ACEs predicts mental health during the COVID-19 pandemic in youth and whether racial-ethnic background moderates these effects. MethodsFrom May to August 2020, 7983 youths (mean age, 12.5 years; range, 10.6–14.6 years) in the Adolescent Brain Cognitive Development (ABCD) Study completed at least one of three online surveys measuring the impact of the pandemic on their mental health. Data were evaluated in relation to youths' pre-pandemic mental health and ACEs. ResultsPre-pandemic ACE history significantly predicted poorer mental health across all outcomes and greater COVID-19–related stress and impact of fears on well-being. Youths reported improved mental health during the pandemic (from May to August 2020). While reporting similar levels of mental health, youths from minoritized racial-ethnic backgrounds had elevated COVID-19–related worry, stress, and impact on well-being. Race and ethnicity generally did not moderate ACE effects. Older youths, girls, and those with greater pre-pandemic internalizing symptoms also reported greater mental health symptoms. ConclusionsYouths who experienced greater childhood adversity reported greater negative affect and COVID-19–related distress during the pandemic. Although they reported generally better mood, Asian American, Black, and multiracial youths reported greater COVID-19–related distress and experienced COVID-19–related discrimination compared with non-Hispanic White youths, highlighting potential health disparities.

Inequalities in Glycemic Control in Youth with Type 1 Diabetes Over Time: Intersectionality Between Socioeconomic Position and Race and Ethnicity.

Racial/ethnic health inequities have been well-documented among youth and young adults with type 1 diabetes (T1D), yet little is known about how socioeconomic position (SEP) intersects with the risk marker of race/ethnicity to predict inequities in longitudinal glycemic control. To identify patterns of SEP, race/ethnicity, and clinical characteristics that differentiate hemoglobin A1c (HbA1c) trajectories among youth and young adults after T1D diagnosis. The SEARCH for Diabetes in Youth cohort includes youth with diabetes diagnosed from 2002 to 2006 and 2008 who were followed through 2015. We analyzed data from 1,313 youth and young adults with T1D with ≥3 HbA1c measures. Classification tree analysis identified patterns of baseline demographic, SEP, and clinical characteristic that best predicted HbA1c trajectories over an average of 8.3 years using group-based trajectory modeling. Two HbA1c trajectories were identified: Trajectory 1 (77%) with lower baseline HbA1c and mild increases (from mean 7.4% to 8.4%) and Trajectory 2 (23%) with higher baseline HbA1c and major increases (from 8.5% to 11.2%). Race/ethnicity intersected with different SEP characteristics among non-Hispanic white (NHW) than in non-whites. Public health insurance predicted high-risk Trajectory 2 membership in non-whites, whereas parental education, household structure, diagnosis age and glucose checking frequency predicted membership for NHW youth and young adults. Two characteristics, race/ethnicity and parental education alone identified 80% of the Trajectory 2 members. Race/ethnicity intersects with multiple SEP and clinical characteristics among youth and young adults with T1D, which is associated with particularly high risk of poor long-term glycemic control.

Trends in HPV Vaccination

Source: Chido-Amajuoyi OG, Talluri R, Wonodi C, et al. Trends in HPV vaccination initiation and completion within ages 9-12 years: 2008–2018. Pediatrics. 2021;147(6): e2020012765; doi:10.1542/peds.2020-012765Investigators from multiple institutions conducted a retrospective study to evaluate trends in human papillomavirus (HPV) vaccination in US children 9-12 years old during the period 2008–2018. For the study they reviewed data from the National Immunization Survey-Teen (NIS-Teen). NIS-Teen is an annual population-based survey used to collect vaccination information on US teens between the ages of 13 and 17. Random digit dialing is used to contact households to collect demographic and immunization data. Dates of vaccinations are verified using a questionnaire mailed to health care providers identified by survey respondents. Data from NIS-Teen are weighted to provide nationally representative estimates. For the current study, data on the cohort of youths who were 13 years old at the time of each survey between 2008 and 2018 were abstracted. Rates of HPV initiation between the ages of 9 and 12 years were determined, and, when full data became available in 2011, annual rates of HPV up-to-date (HPV-UTD) status calculated. HPV-UTD was defined as receipt of 3 doses of HPV vaccine, or receipt of 2 doses at least 5 months (minus 4 days) apart, before a child’s 13th birthday. Results were stratified by sex, race (white or Black), ethnicity, and state. Logistic regression was used to assess the differences in HPV initiation and HPV-UTD rates over time.During the study period, nationally representative HPV vaccination rates for children 9-12 years old were based on annual number of responses ranging from 3,455 to 4,763. Overall, HPV initiation rates rose from 17.3% in 2008 to 62.8% in 2018 (P < 0.0001 for trend), and HPV-UTD increased from 13.5% in 2011 to 32.8% in 2018 (P < 0.0001). HPV-UTD rates increased by 31.9% between 2011 and 2018 among boys, compared to a 6.6% increase in girls. Throughout the study period HPV-UTD rates were higher in Hispanic children than those in non-Hispanic white and non-Hispanic Black youths. Similarly, HPV-UTD rates were higher in non-Hispanic Black youths than in non-Hispanic whites. By 2018, HPV initiation rates were >60% in 32 US states and >70% in 16. HPV-UTD rates were <50% in all states except Rhode Island (61.6%), Colorado (58.7%), Hawaii (53.5%), and Ohio (50%), as well as the District of Columbia (53.2%). States with the lowest HPV-UTD rates were Mississippi (12.5%), Missouri (14.2%), and Utah (15.7%).The authors conclude that HPV vaccination status in US children 9-12 years old is suboptimal.Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The HPV vaccine is unique. It is the first to protect against adult cancers rather than a childhood infectious disease. Cervical cancer is the second leading cause of cancer death of women worldwide.1 Numerous studies have shown that the HPV vaccine reduces transmission of the carcinogenic strains of HPV virus in nearly 100% of individuals, as well as greatly reduces the development of cervical dysplasia.1,2 The vaccine is recommended by the AAP in both boys and girls between the ages of 9-12, before most sexual activity and when immunogenicity is high.2 Approximately 23% of parents are hesitant about the safety, efficacy, and importance of the HPV vaccine.3 To reach herd immunity, the Healthy People 2020 initiative set a goal of 80% vaccination, giving promise for the near eradication of cervical and penile cancer.4 The present rate of completed vaccination in the US is 51.1%.5The current investigators followed trends of HPV vaccination over a period of 10 years using a large national database. There was wide variation in vaccine adherence across the country—from a low of 12.5% in Mississippi to the high of 61.6%% in Rhode Island. The investigators cite several programs that improve the success of Rhode Island, such as free access to vaccines, school-based vaccine programs, and a physician-led program to assist poorly performing practices.6 The success of some state programs and failure of others suggests differences in vaccine priority and healthcare infrastructure. The downstream effects of a failed HPV vaccine policy have serious consequences to the public health. The results of the current study highlight this national failure and serves as a clarion call for health care leaders to address this shortfall.The HPV vaccination rate for US children is suboptimal.Concurrent data from the CDC reveal marked decreases in the 9 vaccine serotypes infection rates since introduction of the quadrivalent and 9-valent HPV vaccines.7 Single-dose HPV vaccines, currently being investigated, hold promise to further increase vaccination and to decrease infection rates.8

Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018

The childhood obesity rate has been steadily rising among US youths during the past 2 decades. Increasing evidence links consumption of ultraprocessed foods to excessive calorie consumption and weight gain, but trends in the consumption of ultraprocessed foods among US youths have not been well characterized. To characterize trends in the consumption of ultraprocessed foods among US youths. Serial cross-sectional analysis using 24-hour dietary recall data from a nationally representative sample of US youths aged 2-19 years (n = 33 795) from 10 cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999-2000 to 2017-2018. Secular time. Percentage of total energy consumed from ultraprocessed foods as defined by NOVA, an established food classification system that categorizes food according to the degree of food processing. Dietary intake from youths were analyzed (weighted mean age, 10.7 years; 49.1% were girls). From 1999 to 2018, the estimated percentage of total energy from consumption of ultraprocessed foods increased from 61.4% to 67.0% (difference, 5.6% [95% CI, 3.5% to 7.7%]; P < .001 for trend), whereas the percentage of total energy from consumption of unprocessed or minimally processed foods decreased from 28.8% to 23.5% (difference, -5.3% [95% CI, -7.5% to -3.2%]; P < .001 for trend). Among the subgroups of ultraprocessed foods, the estimated percentage of energy from consumption of ready-to-heat and -eat mixed dishes increased from 2.2% to 11.2% (difference, 8.9% [95% CI, 7.7% to 10.2%]) and from consumption of sweet snacks and sweets increased from 10.7% to 12.9% (difference, 2.3% [95% CI, 1.0% to 3.6%]), but the estimated percentage of energy decreased for sugar-sweetened beverages from 10.8% to 5.3% (difference, -5.5% [95% CI, -6.5% to -4.5%]) and for processed fats and oils, condiments, and sauces from 7.1% to 4.0% (difference, -3.1% [95% CI, -3.7% to -2.6%]) (all P < .05 for trend). There was a significantly larger increase in the estimated percentage of energy from consumption of ultraprocessed foods among non-Hispanic Black youths (from 62.2% to 72.5%; difference, 10.3% [95% CI, 6.8% to 13.8%]) and Mexican American youths (from 55.8% to 63.5%; difference, 7.6% [95% CI, 4.4% to 10.9%]) than the increase among non-Hispanic White youths (from 63.4% to 68.6%; difference, 5.2% [95% CI, 2.1% to 8.3%]) (P = .04 for trends). Based on the NHANES cycles from 1999 to 2018, the estimated proportion of energy intake from consumption of ultraprocessed foods has increased among youths in the US and has consistently comprised the majority of their total energy intake.

Effect of reducing ultraprocessed food consumption on obesity among US children and adolescents aged 7–18 years: evidence from a simulation model

BackgroundChildren and adolescents in the USA consume large amounts of daily calories from ultraprocessed foods (UPFs). Recent evidence links UPF consumption to increased body fat in youth. We aimed to...

Pilot evaluation of obesity-specific health-related quality of life following a 12-week non-randomized lifestyle intervention in youth.

BackgroundHealth‐related quality of life (HRQOL), a multifaceted construct for understanding health and healthcare outcomes, is comprised of eight domains of well‐being and functioning over time and has become an essential factor in assessing outcomes for youth with obesity.AimsTo evaluate the effect of a community based, lifestyle intervention, on obesity‐specific HRQOL using the Sizing Me Up (SMU) in this group of Latino and White youth.Materials and MethodsFor this 12‐week family and community‐based intervention (ACT; Actively Changing Together), HRQOL was measured before and after the intervention concluded using the obesity‐specific HRQOL tool, SMU. This study enrolled 68 youth (10.9 ± 2 years; 54% male; 50% non‐Hispanic white). Paired t‐tests were used to examine the Sizing Me Up sub‐scales: Emotion, Physical, Social Avoidance, Positive Attributes, Teasing, and the total score. A greater change score indicated a larger increase in quality of life sub‐scale.ResultsSignificant improvements from baseline to follow‐up were found in the total SMU (mean change = 5.27, SD 10.76, p = 0.00) and for the sub‐scores of: emotion (mean change = 8.06, SD 16.85, p ≤ 0.00), teasing (mean change = 5.65, SD 16.79, p = 0.01), and social avoidance (mean change = 3.92, SD 11.21, p = 0.01).ConclusionsSizing Me Up provided a clinically meaningful tool for this research study to evaluate obesity‐specific HRQOL among Hispanic and non‐Hispanic White youth with obesity.

Showing Up Is Half the Battle: The Impact of Telehealth on Psychiatric Appointment Attendance for Hospital-Based Intensive Outpatient Services During COVID-19.

Introduction: The COVID-19 pandemic accelerated telehealth to deliver psychiatric services. Continuation of psychiatric services for individuals with high clinical acuity was critical. This study examined attendance to rapidly deployed telehealth services for psychiatrically high-risk individuals receiving intensive outpatient program (IOP), primarily group-based psychotherapy services for adults and adolescents by race/ethnicity, insurance, and clinical treatment program within a large hospital-based outpatient psychiatric setting. Methods: Chi-square tests compared whether attendance rates for telehealth versus in-person IOP services varied by population group, race, insurance, and clinical program, using observational data of adolescent and adult patients treated between October 1, 2019, and July 31, 2020. Results: Appointment attendance increased for telehealth versus in-person services for adolescents (χ2 (df = 1) = 27.49, p < 0.0001) and adults (χ2 (df = 1) = 434.37, p < 0.0001). For adults, increased appointment attendance for telehealth was observed across insurance type (Medicaid: +11.5%; Medicare: +13.79%; Commercial: +6.94%), race/ethnicity (+6.23% to +15.76% across groups), and for IOP groups across all five diagnostic treatment programs (between 7.59% and 15.9% increases across groups). Adolescent results were mixed; increased appointment attendance for telehealth was observed among commercially insured youth (+7.11%), but no differences were observed for Medicaid-insured youth. Non-Hispanic white youth had increased attendance for telehealth (+8.38%) and no differences were observed for non-Hispanic black youth. Decreases were found in telehealth attendance for Hispanic/Latinx youth (-13.49%). Discussion: Rapidly deployed telehealth increased attendance to intensive services for psychiatrically high-risk individuals, particularly among adults and for adolescents with commercial insurance and non-Hispanic white youth. Trends among racial/ethnic and Medicaid-insured youth warrant further investigation regarding the potential for special challenges or vulnerabilities and advocacy needs. Findings highlight telehealth as an important tool in supporting availability of services for individuals with high levels of psychiatric acuity, particularly for group-based services, during the pandemic.

COVID-19 and Changes in Child Obesity.

* Abbreviation: COVID-19 — : coronavirus disease 2019 The coronavirus disease 2019 (COVID-19) pandemic has caused economic hardship, school closings, shutdowns, limited physical activities, and increased food insecurity for many families. In December 2020, the American Academy of Pediatrics released interim guidance on how pediatricians can help children and families address healthy lifestyles and obesity management during the pandemic.1 To best support pediatric health system obesity prevention and management efforts, a better understanding of emerging disparities is needed to identify at-risk populations and develop focused interventions.2 Through a large pediatric primary care network, we evaluated the shifting rates of obesity for patients attending visits and explored disparities based on age, race and ethnicity, insurance, and income. The Children’s Hospital of Philadelphia Care Network includes 29 urban, suburban, and semirural … Address correspondence to Brian P. Jenssen, MD, MSHP, Children’s Hospital of Philadelphia, 2716 South St, 11-201, Philadelphia, PA 19146. E-mail: jenssenb{at}email.chop.edu

Puberty and the definition of overweight and obesity

The prevalence of overweight and obesity among children and adolescents is obviously high in the United States. However, the best way to define overweight and obesity in young individuals has been a topic of debate. Historically, the approach has been to use percentile values for body mass index by age and sex produced by the Centers of Disease Control and Prevention. However, some have argued that this approach is not optimum for a range of reasons. One concern has been the impact of puberty on growth in height and weight, suggesting that age and sex alone are not adequate as control variables. In this volume of The Journal, Bomberg et al evaluated the impact of including pubertal maturation to characterize weight status by comparing the prevalence of overweight and obesity before and after adjusting for Tanner stage. They found that adjusting for pubertal status reduced the prevalence of overweight and obesity. Whether this approach would be practical from a clinical perspective remains an open question. However, from a qualitative standpoint, it is worth considering, especially for early maturers, when considering a diagnosis of overweight or obesity. Article page 200 ▸ Adjusting for Pubertal Status Reduces Overweight and Obesity Prevalence in the United StatesThe Journal of PediatricsVol. 231PreviewTo compare pediatric overweight and obesity prevalence among non-Hispanic white, Mexican American, and non-Hispanic black US youths before and after adjusting body mass index (BMI) for pubertal status, as assessed by Tanner stage. Full-Text PDF

Age at Initiation of Cigarette Use in a Nationally Representative Sample of US Youth, 2013-2017

Cigarettes are still a commonly used tobacco product among youth despite recent declines in cigarette use. The aim of this study was to prospectively estimate the age of cigarette use initiation among youth (aged 12-17 years) overall, by sex, and by race/ethnicity. This cohort study used data from waves 1 through 4 of the nationally representative Population Assessment of Tobacco and Health (PATH) study, conducted from September 12, 2013, to January 3, 2018. Two subpopulations of youth were assessed: (1) those nonsusceptible to cigarette use and (2) never users of cigarettes at their first wave of PATH participation. Weighted interval-censoring survival analyses were used to prospectively estimate the age of initiation of cigarette use outcomes. Weighted interval-censoring Cox proportional hazard models were used to estimate differences in the age of initiation by sex and by race/ethnicity. Statistical analyses were performed from October 7, 2019, to May 1, 2020. Differences in the age of initiation by sex and race/ethnicity. Age of initiation of susceptibility to cigarette use, ever use, past 30-day use, and fairly regular cigarette use overall, by sex, and by race/ethnicity. A total of 15 776 youth never users and, among them, 11 022 youth who were nonsusceptible to cigarette use, were included in this study (weighted mean [SE] age, 13.5 [0.01] years; 58.6% [SE, 0.46%] non-Hispanic White; and 51.0% [SE, 0.32%] boys) and 15 776 were never users of cigarettes at their first wave of PATH participation (weighted mean [SE] age, 13.7 [0.01] years; 55.0% [SE, 0.29%] non-Hispanic White; and 51.0% [SE, 0.15%] boys). By age 18 years, among those who were nonsusceptible, 46.2% (95% CI, 44.3%-48.2%) became susceptible to cigarette use. Among never users, 24.4% (95% CI, 22.9%-25.9%) initiated ever cigarette use, 16.4% (95% CI, 15.2%-17.6%) initiated past 30-day cigarette use, and 4.3% (95% CI, 3.9%-4.8%) initiated fairly regular cigarette use. Boys had a higher risk of initiating ever (hazard ratio [HR], 1.21; 95% CI, 1.08-1.36) and past 30-day cigarette use (HR, 1.27; 95% CI, 1.10-1.47) at earlier ages compared with girls. Non-Hispanic White youth had a higher risk of an earlier age of initiation of susceptibility to cigarette use (HR, 0.77; 95% CI, 0.68-0.88), ever use (HR, 0.59; 95% CI, 0.49-0.71), past 30-day use (HR, 0.64; 95% CI, 0.52-0.77), and fairly regular cigarette use (HR, 0.25; 95% CI, 0.14-0.43) compared with non-Hispanic Black youth. The results of this cohort study suggest that, despite current interventions and existing laws, a large number of youth initiated cigarette use before the legal age to purchase tobacco products.

Prospective estimation of the age of initiation of hookah use among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study waves 1–4 (2013–2017)

ObjectiveThis study reports the prospectively estimated age of initiation of susceptibility to, ever, past 30-day, and fairly regular hookah use. DesignSecondary data analyses of the first four waves (2013–2017) of the PATH study, a nationally representative longitudinal cohort study of US youth (ages 12–17). MethodsYouth who were never hookah users at their first wave of participation were identified (n = 16,678; N = 31,136,834). Four outcomes were analyzed, age of first report of: (i) susceptibility to use, (ii) ever use, (iii) past 30-day use, and (iv) fairly regular hookah use. The age of hookah initiation of each outcome was estimated. Weighted interval censoring survival analyses and Cox regression models were conducted to estimate the age of initiation of each hookah use outcome, and to estimate differences in age of initiation by sex and by race, respectively. ResultsAround 11% of youth were classified as susceptible to hookah use by 13 years of age, 8% reported initiating ever hookah use by age 17, almost 10% reported initiating past 30-day hookah use by age 19, and 3% reported initiating fairly regular hookah use by age 20. Females and Hispanics were at higher risk of becoming susceptible to and ever hookah use at earlier ages compared to males and Non-Hispanic White youth. ConclusionEducation, communication campaigns, and proven culturally targeted tobacco interventions that reach youth at ages before they first become susceptible or start using hookah use are needed to prevent the onset of hookah use among vulnerable youth.

Adjusting for Pubertal Status Reduces Overweight and Obesity Prevalence in the United States

To compare pediatric overweight and obesity prevalence among non-Hispanic white, Mexican American, and non-Hispanic black US youths before and after adjusting body mass index (BMI) for pubertal status, as assessed by Tanner stage. We analyzed cross-sectional anthropometric and pubertal data from non-Hispanic white, Mexican American, and non-Hispanic black youths in the National Health and Nutrition Examination Survey (NHANES) III. We developed specialized Tanner stage and chronological age-adjusted models to establish Tanner-stage adjusted BMI z-scores, which were then used to determine adjusted overweight/obesity prevalence. We compared pediatric overweight/obesity prevalence before and after pubertal status adjustment. Among 3206 youths aged 8-18years (50% male; 26% non-Hispanic white, 35% Mexican American, 39% non-Hispanic black), adjusting BMI for Tanner stage significantly reduced overweight (males, from 29% to 21%; females, from 29% to 17%) and obesity (males, from 14% to 7%; females, from 11% to 5%) prevalence across all races/ethnicities. The obesity prevalence reduction was more pronounced in Mexican Americans (males, 11% reduction; females, 9% reduction) and non-Hispanic blacks (males and females, 10% reduction) compared with non-Hispanic whites (males, 6% reduction; females, 5% reduction). Similar patterns were seen in overweight prevalence. Adjusting for pubertal status reduced the prevalence of overweight/obesity in non-Hispanic white, Mexican American, and non-Hispanic black youth. This suggests that adjusting for puberty incorporates changes otherwise not captured when only considering the age of a child. Adjusting BMI for pubertal status may be important when interpreting a youth's weight status and consideration for obesity management, as well as when interpreting pediatric overweight/obesity prevalence data.

Black-White Achievement Gap: Role of Race, School Urbanity, and Parental Education.

BackgroundRecent research on Marginalization-related Diminished Returns (MDRs) has documented weaker boosting effects of parental educational attainment on educational outcomes of Black than White students. Such MDRs of parental education seem to contribute to the Black-White achievement gap. Given that Blacks are more likely than Whites to attend urban schools, there is a need to study if these MDRs can be replicated at both urban and suburban schools.AimTo test the contribution of diminished returns of parental educational attainment on the Black-White achievement gap in urban and suburban American high schools.MethodsA cross-sectional study that used baseline Education Longitudinal Study (ELS-2002) data, a nationally representative study of 10th grade adolescents in the United States. This study analyzed 8315 youths who were either non-Hispanic White (n = 6539, 78.6%) or non-Hispanic Black (n = 1776, 21.4%) who were attending either suburban (n = 5188, 62.4%) or urban (n = 3127, 37.6%) schools. The outcome was standard math and reading grades. The independent variable was parental educational attainment. Gender, parental marital status, and school characteristics (% free lunch and relationship quality with the teacher) were the confounders. Race/ethnicity was the effect of modifier. School urbanity was the strata. Linear regression was used for data analysis.ResultsIn urban and suburban schools, higher parental educational attainment was associated with higher math and reading test scores. In urban and suburban schools, Black students had considerably lower reading and math scores than White students. At urban but not suburban schools, significant interactions were found between race (Non-Hispanic Black) and parental education attainment (years of schooling) on reading and math scores, suggested that the protective effect of parental education on students’ reading and math scores (ie school achievement) is smaller for Non-Hispanic Black relative to Non-Hispanic White youth only in urban but not sub-urban schools.ConclusionDiminished returns of parental education (MDRs) contribute to the racial achievement gap in urban but not suburban American high schools. This result is important given Black students are more likely to attend urban schools than White students. As MDRs are not universal and depend on context, future research should study contextual characteristics of urban schools that contribute to MDRs.

Age of initiation of cigarillos, filtered cigars and/or traditional cigars among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013-2017.

Early age of initiation of tobacco use is associated with sustained tobacco use and lower rates of smoking cessation. Although much is known about age of initiation of cigarette use, much less is known about the age of initiation of cigar product use among youth. Survival analyses of the Population Assessment of Tobacco and Health youth annual datasets (ages 12-17) from 2013 to 2017 were conducted for any cigar product use, cigarillos or filtered cigars, and traditional cigars across four cigar use outcomes, age of initiation of: susceptibility to use, ever use, past 30-day use and "fairly regular" use. An interval censoring survival method was implemented to estimate the probability of each outcome for age of initiation of each cigar product overall. Differences in age of initiation by sex and race/ethnicity were assessed using weighted Cox proportional hazards models for interval-censored data. For each outcome across the three cigar products, striking increases in the probability of initiation begin before 17 years old. For cigarillo or filtered cigars, males had a higher risk of onset of susceptibility to use, initiating ever use, and initiating past 30-day use at earlier ages than females. Compared to Non-Hispanic Whites, Hispanic and Non-Hispanic Other had lower risk of initiating ever use and past 30-day use at earlier ages. Non-Hispanic Black youth had higher risk of initiating past 30-day use and "fairly regular" use than Non-Hispanic White youth at earlier ages. Similar findings are reported for any cigar use and traditional cigar use. Developmentally and culturally appropriate cigar use interventions and communication campaigns should be provided to youth before 17 years of age to prevent the onset and progression of cigar products. Regulatory policies that reduce appeal of all cigar products should be implemented to curb cigar initiation among youth.

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.

A national analysis of pediatric falls from a building.

Falls remain the leading cause of unintentional pediatric trauma in the United States. Identifying risk factors for pediatric building falls would influence public health policy. We hypothesized that building falls disproportionately affect low income communities. We performed a cross-sectional analysis of the Kids' Inpatient Database for years 2006, 2009, and 2012. We identified cases (age <12 years) of falls from a building using external cause of injury codes. Patient characteristics and injuries were analyzed using ICD-9 codes. National estimates were obtained using case weighting. Multivariable logistic regression was performed to adjust for confounders. There were 2,294 hospitalizations nationally for pediatric falls from a building. The victims were predominately male, in early childhood, non-Hispanic White, in the lowest income quartile, resided in urban settings, and occurred during summer. The mean age was 3.76 years. Logistic regression revealed males were 33% more likely than females, and as compared to non-Hispanic White youth, Black (33%) and Asian or Pacific Islanders (65%) were more likely to experience a fall from a building. Toddlers and those in early childhood were at significantly increased odds than those younger than one year old. Children in the highest income quartile were 29% more likely to experience a building fall. Building falls are a common cause of injury in the U.S. for children under 12 years old. Injury prevention strategies focused on the parents of children aged 1-5 years has the potential to make a significant public health impact.

Healthy People 2020: Social Determinants of Cigarette Smoking and Electronic Cigarette Smoking among Youth in the United States 2010-2018.

The purpose of this study was to determine social determinants of cigarette smoking and ever using electronic cigarettes (e-cigarettes) among young adults aged 18 to 25 years in the United States between 2010 and 2018. Using secondary data from National Health Interview Surveys (NHIS) across the 2010, 2014, and 2018 survey years, this study analyzed the prevalence rates of cigarette smoking and ever using e-cigarettes between 2010 and 2018, demographic and socioeconomic disparities in smoking, and the relationship between previous e-cigarette use and current smoking. First, the past decade witnessed a notable decline in conventional cigarette smoking and a sharp increase in e-cigarette use among youth. These trends were consistent regardless of socioeconomic status. Second, demographic and socioeconomic disparities persisted in cigarette smoking. Non-Hispanic white male youth were more likely to become smokers as they grew older. Young people with lower educational attainment, living below the U.S. federal poverty level, and having a poor physical health status had a higher smoking prevalence. Third, previous e-cigarette use was more likely to relate to subsequent cigarette use among young people. To achieve the Healthy People 2020 objectives, tobacco control programs and interventions need to be more specific in higher prevalence groups and service providers should not assume that there is a one-size-fits-all model for youth.