United States Adolescents Research Articles

Dietary Zinc Intakes Are Associated With Skeletal Muscle Mass and Strength in Children and Adolescents: Zinc and Muscle in Children.

The purpose of this study was to evaluate the relationship between dietary zinc intakes and skeletal muscle mass and strength in children and adolescents. A retrospective study was conducted using data on United States adolescents aged 8 to 19 years. Data were extracted from the National Health and Nutrition Examination Survey 2011-2014 cycles. Subjects were divided into 3 groups based on the tertiles of dietary zinc intakes. The levels of appendicular skeletal muscle mass divided by weight (ASM/Wt, %) and grip in subjects with the highest tertile were higher than those in subjects with the middle and lowest tertiles (P < .05). Dietary zinc intakes were positively correlated with ASM/Wt (r = .221, P < .001) and grip (r = 0.169, P < .001). After a multivariate analysis, dietary zinc intakes were still significantly associated with ASM/Wt (β = 0.059, P < .001) and grip (β = 0.245, P < .001). The present study demonstrates that dietary zinc intakes were positively associated with skeletal muscle mass and strength in children and adolescents.

Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence.

Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.

Are rhinitis and Eustachian tube dysfunction associated in United States adolescents?

Despite longstanding clinical gestalt of a relationship between rhinitis and Eustachian tube dysfunction (ETD), population-level evidence supporting this connection is lacking, particularly among adolescents. We aimed to investigate the association between rhinitis and ETD in a nationally-representative sample of United States adolescents. We performed cross-sectional analyses of 2005-2006 National Health and Nutrition Examination Survey data (n=1955, ages 12-19). Rhinitis (self-reported hay fever and/or nasal symptoms in the past 12 months) was stratified as allergic (AR) or nonallergic rhinitis (NAR) based on serum IgE aeroallergen positivity. History of ear disease and procedures was recorded. Tympanometry was classified by type (A, B, C). Multivariable logistic regression was used to test the association of rhinitis and ETD. Among US adolescents, 29.4% reported rhinitis (NAR 38.9%, AR 61.1%), and 14.0% had abnormal tympanometry. Adolescents with rhinitis were more likely to report a history of ≥3 ear infections (NAR: OR 2.40, 95% CI: 1.72-3.34, p<0.001; AR: OR 1.89, 95% CI: 1.21-2.95, p=0.008) and tympanostomy tube placement (NAR: OR 3.53, 95% CI: 2.07-6.03, p<0.001; AR: OR 1.91, 95% CI: 1.24-2.94, p=0.006), compared to those without rhinitis. There was no association between rhinitis and abnormal tympanometry (NAR: p=0.357; AR: p=0.625). NAR and AR are both associated with history of frequent ear infections and tympanostomy tube placement in US adolescents, supporting an association with ETD. This association is strongest for NAR, suggesting that specific inflammatory mechanisms may be involved in this condition and potentially explaining why traditional therapies for AR are largely ineffective for ETD.

Mental Health and Life Events among United States adolescents with Substance Use Disorders

IntroductionSubstance use during adolescence is linked to adverse biopsychosocial events, including poor mental health, cognitive deficits, low academic performance, and delinquency (Deas &amp; Brown J Clin Psych 2006; 67 18; Armstrong &amp; Costello JCCP 2002; 70 1224; Cox et al. JSH 2007; 77 109-115; Chassin JJSU 2008; 165-183). Identifying risks for these events is critical, given they are associated with adverse outcomes in adulthood.Post-pandemic, rates of adolescent depression and anxiety have more than doubled (Racine et al. JAMA Ped 2021; 175 1142-1150). Adolescents often use substances, most commonly alcohol and cannabis, to manage mental health (Colder et al. JCCP 2019; 87 629).Cannabis is increasingly viewed by adolescents as safe, while alcohol is viewed negatively (SAMHSA 2021). Non-disordered alcohol use (ND-AU), alcohol use below diagnostic criteria level, has adverse developmental impacts for adolescents, including increased risk-taking behavior and heavy substance use in adulthood (Marshall Alcohol Alcohol. 2014; 49 160-164).With growing normalization of cannabis use, important questions still remain whether non-disordered cannabis use (ND-CU) among adolescents is linked to adverse life events.ObjectivesUsing data from the 2018-2020 National Survey on Drug Use and Health (NSDUH), an annual US representative survey on substance use and mental health, we compared associations among common adolescent substance use and adverse life events.MethodsResponses from adolescents aged 12-17 (N=32,407) from the 2018-2020 NSDUH were analyzed. Logistic regression was used to evaluate associations between substance use disorder (SUD) diagnoses and adverse adolescent life events. Adjusted odds ratios (aOR) were obtained while controlling for age, sex, and race/ethnicity. Analyses included sampling weights to account for the US population. Adolescents in ND-CU and ND-AU groups were defined by either past-month or past-year use without their respective SUD diagnosis.ResultsApproximately 5% of adolescents had any SUD, and 1.3% had more than one SUD (Table 1). All SUD variables, including cannabis use disorder (CUD) and alcohol use disorder (AUD), were significant for all adverse adolescent life events (Table 2). Adolescents with a SUD were nearly 3 times more likely to have major depression in the past year, 2.5 times more likely to have a C+ or below grade average, and 10 times more likely to be arrested, than controls. These risks increased with more than one SUD (Table 2). Adverse events were similar between ND-CU and ND-AU. (Figure 1).Image:Image 2:Image 3:ConclusionsGiven the biopsychosocial risks to ND-CU and ND-AU in adolescents, there may be reason to reevaluate whether the DSM adequately captures the population of youth affected by their cannabis and alcohol use. Clinicians can use these nationally representative data to stratify risks and direct to appropriate treatment.Disclosure of InterestNone Declared

Differences in American adolescent sport participation during the COVID-19 pandemic by learning mode: A national survey

This study aimed to examine the relation between learning mode with sport participation and compare participation prevalence in different settings by learning mode among United States adolescents during the COVID-19 pandemic. A cross-sectional, national survey was conducted by a market research company (December 2021-January 2022) among parents whose child participated in sports pre-pandemic. Parents were asked about their child’s learning mode (in-person, online, hybrid); sports participation (yes/no) during the pandemic; and participation setting (school, community, club/elite). Weighted logistic regression models examined the relation between learning mode with sport participation. Weighted prevalence estimates of participation setting were compared by learning mode. Among youth included in the analysis (n = 500; Meanage = 14.0 years), 71.0% played sports during the pandemic. Learning mode was significantly associated with participating (versus not participating) among adolescents attending school online (aOR = 0.09; 95% CI: 0.04–0.18) and in a hybrid modality (aOR = 0.30; 95% CI: 0.15–0.58) versus those attending in-person. Those attending school online (versus in-person or hybrid) had significantly lower participation prevalence in community, school, and club/elite sports. Findings may reflect parents opting out of in-person activities or schools canceling organized sport opportunities. To inform engagement strategies, research is needed to understand reasons for declined participation and extent to which participation resumed.

Associations between dietary copper intake and hypertriglyceridemia among children and adolescents in the US

Background and aimsA relationship exists between dietary copper intake and hypertriglyceridemia in the United States (US). However, children and adolescents have there is limited research data for children and adolescents, who have not been thoroughly investigated. This study aimed to carefully evaluate this relationship. Methods and resultsThis cross-sectional study included 3982 children and adolescents who participated in the US National Health and Nutrition Examination Survey 1999–2006. The outcome variable was hypertriglyceridemia, defined as a triglyceride (TG) concentration >150 mg/dL. Multivariate and binary logistic regression models were applied in this study. The median (Q1–Q3) copper intake and TG levels were 0.98 (0.71–1.32) mg/d and 72.00 (53.00–100.00) mg/dL, respectively. The smoothing curve showed an inverted L-shaped relationship between copper intake and the prevalence of hypertriglyceridemia in American children and adolescents. A binary logistic regression model was developed to evaluate the relationship between copper intake and the prevalence of hypertriglyceridemia, and the inflection point was 0.76 mg/d. The odds of developing hypertriglyceridemia significantly increased with increasing levels of copper intake (odds ratio (OR), 2.00; 95% confidence interval (CI): 1.39–2.86) in participants with copper intake >0.76 mg/d (P for log likelihood ratio test = 0.032). The association between high copper intake and increased hypertriglyceridemia risk was significantly stronger in participants with a high body mass index (BMI; ≥23 kg/m2) (OR: 2.09; 95% CI: 1.42–3.07) than in those with a low BMI (tertile 1–2) (p for interaction = 0.048). Moreover, the increase in copper intake in adolescents aged 13–18 years significantly increased the prevalence of hypertriglyceridemia (OR: 1.95; 95% CI: 1.38–2.76; p for interaction = 0.001). ConclusionHigher dietary copper intake increases the prevalence of hypertriglyceridemia, especially among US adolescents with a BMI ≥23 kg/m2.

Association of Obesity, Suicide Behaviors, and Psychosocial Wellness Among Adolescents in the United States

BackgroundAdolescents with obesity are more likely to exhibit suicide behaviors, but this association may be confounded by psychosocial stigma related to obesity. We examined whether the obesity is independently associated with suicide behaviors among United States adolescents, after adjusting for the psychosocial factors. MethodsWe analyzed data from 2019 Youth Risk Behavior Survey data (N = 13,871 United States adolescents) on recent (past year) suicide behavior (attempt, ideation, and plan); demographics (age, sex, and race/ethnicity); and psychosocial factors (feeling sad/hopeless, alcohol and illegal drug use, being bullied, and sexually abused). Participants were classified as having obesity (Y/N) per standardized percentiles. Logistic regression was employed to examine the association between obesity and suicide attempt, ideation, and plan, while adjusting for psychosocial covariates. ResultsThe prevalence of suicide attempt, ideation, and plan was 8.90%, 18.75%, and 15.71%, respectively. Obesity prevalence was 15.5%. The odds of suicide attempt, ideation, and plan were 1.65 (1.30–2.11), 1.31 (0.89–1.61), and 1.27 (1.02–1.57), respectively, among those with obesity versus without obesity. DiscussionObesity is significantly associated with a suicide attempt, ideation, and plan among United States adolescents, even after adjusting for confounding psychosocial factors. Further research on the temporality and causality of this association is needed.

Meningococcal serogroup B vaccination series initiation in the United States: A real-world claims data analysis

ABSTRACT In the United States (US), meningococcal serogroup B (MenB) vaccination has been recommended for 16–23-year-olds (preferably 16–18 years) based on shared clinical decision-making since 2015. MenB vaccine coverage (≥1 dose) by age 17 years has been reported, but initiation at older ages and by insurance type is unknown. In this retrospective cohort study, MarketScan claims data were analyzed to assess MenB vaccine series initiation (i.e. receipt of a first dose) during 2017–2020 among US commercially insured and Medicaid-covered individuals aged 16–18 and 19–23 years. Kaplan–Meier curves were generated to estimate series initiation at various times from index (latest of 1/1/2017 or 16th/19th birthday, depending on the cohort). Multivariable analyses were conducted to identify factors associated with series initiation. Among 1,450,354 Commercial and 1,140,977 Medicaid 16–18-year-olds, MenB vaccine series initiation rates within 3 years of each person’s first eligibility were estimated to be 33% and 20%, respectively; among 1,857,628 Commercial and 747,483 Medicaid 19–23-year-olds, 3% and 1%, respectively. Factors identified to be significantly associated with increased likelihood of initiating a MenB vaccine series included co-administration of meningococcal serogroups ACWY (MenACWY) vaccine, younger age, female sex, nonwhite race (Medicaid only), New England or Middle Atlantic location (Commercial only), urban residence, and previous influenza vaccination. MenB vaccine series initiation among the studied US adolescents and young adults was low. There is a need for continued efforts to better understand barriers to the uptake of vaccines that are recommended based on shared clinical decision-making.

Trends in Cigarette Smoking Among United States Adolescents

Trends in Cigarette Smoking Among United States Adolescents

Old Dog, New Tricks: A Review of Identifying and Addressing Youth Cannabis Vaping in the Pediatric Clinical Setting

Cannabis vaping has emerged as a predominant mode of cannabis use among United States (US) adolescents and young adults (AYA) primarily due to the popularity of modifiable designs of vaping devices coupled with changes in cannabis policies and increased availability of cannabinoid products. New methods for cannabis vaping by e-liquid/oil vaping, dry plant vaping, and cannabis concentrate vaping (ie, dabbing) have had high uptake among American youth with unclear long-term health implications. Issues with contamination, mislabeling, and expansion of the vaped cannabis market to include not only delta-9-tetrahydrocannabinol (delta-9-THC) and cannabidiol (CBD) but also delta-9-THC analogs (eg, delta-8 and delta-10) sold as hemp-derived "legal highs" further complicated this healthcare space. Recent research suggests that cannabis/THC vaping carries distinct and overlapping risks when compared to cannabis smoking and may be associated with greater risk for acute lung injuries, seizures, and acute psychiatric symptoms. Primary care clinicians providing care for AYA are in an ideal position to identify cannabis misuse and intervene early to address cannabis vaping. To improve public health outcomes, a need exists for pediatric clinicians to be educated about different ways/methods that youth are vaping cannabinoid products and associated risks related to cannabinoid vaping. Further, pediatric clinicians need to be trained how to effectively screen for and discuss cannabis vaping with their youth patients. In the current article, we present a clinically focused review of cannabis vaping among young people with 3 main aims to: (1) identify and describe the cannabis vaping products commonly used by American youth; (2) review the health correlates of youth cannabis vaping; and (3) discuss clinical considerations related to identifying and treating youth who vape cannabis.

Association between serum vitamin D and refractive status in United States adolescents: A cross-sectional study.

We performed this study to determine the relationship between serum vitamin D levels and refractive status in adolescents aged 12-19 years. Cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database from 2001 to 2006. We used weighted multivariate linear regression models to assess the association between serum vitamin levels and adolescent refractive status and then built a smooth curve fitting to investigate their internal non-linear relationships. Finally, subgroup analysis was performed according to gender, and the threshold effect of serum vitamin D levels on spherical equivalent degree was analyzed using a two-piecewise linear regression model. A total of 5,901 adolescents aged 12 to 19 years were included in this study. After adjusting for all confounding factors, the multiple linear regression model showed no significant correlation between adolescent spherical equivalent degree and serum vitamin D [0.0019 (-0.0018, 0.0046)]. However, smooth curve fitting analysis showed an inverted U-shaped curve relationship between spherical equivalent degree and serum vitamin D levels in adolescents (turning point: 58.1 nmol/L). In analyses by gender subgroup, this inverted U-shaped relationship was found to be more pronounced in female adolescents (turning point: 61.6 nmol/L). Our results suggest that the correlation between refractive status and serum vitamin D in adolescents differs by gender. When serum vitamin D concentrations were <61.6 nmol/L in female adolescents and <53.2 nmol/L in male adolescents, the spherical equivalent degree showed a positive correlation with serum vitamin D levels. However, there was no significant correlation when adolescent vitamin levels exceeded this threshold.

Marked Disparities in COVID-19 Vaccination among US Children and Adolescents by Racial/Ethnic, Socioeconomic, Geographic, and Health Characteristics, United States, December 2021 - April 2022.

The COVID-19 pandemic has had a substantial adverse impact on the health and well-being of populations in the United States (US) and globally. Although COVID-19 vaccine disparities among US adults aged ≥18 years are well documented, COVID-19 vaccination inequalities among US children are not well studied. Using the recent nationally representative data, we examine disparities in COVID-19 vaccination among US children aged 5-17 years by a wide range of social determinants and parental characteristics. Using the US Census Bureau's Household Pulse Survey from December 1, 2021 to April 11, 2022 (N=86,335), disparities in child vaccination rates by race/ethnicity, socioeconomic status, health insurance, parental vaccination status, parental COVID-19 diagnosis, and metropolitan area were modeled by multivariate logistic regression. During December 2021-April 2022, an estimated 40.1 million or 57.2% of US children aged 5-17 received COVID-19 vaccination. Vaccination rates were lowest among children of parents aged 25-34 (34.9%) and highest among children of parents aged 45-54 (69.2%). Children of non-Hispanic Black parents, divorced/separated and single individuals, parents with lower education and household income levels, renters, not-employed parents, the uninsured, and parents without COVID-19 vaccination or with COVID-19 diagnoses had significantly lower rates of vaccination. Controlling for covariates, Asian and Hispanic children aged 5-17 had 134% and 47% higher odds of receiving vaccination than their non-Hispanic White counterparts. Children of parents with a high school education had 47% lower adjusted odds of receiving vaccination than children of parents with a master's degree or higher. Children with annual household income <$25,000 had 48% lower adjusted odds of vaccination than those with income ≥$200,000. Although vaccination rates were higher among children aged 12-17 than among children aged 5-11, sociodemographic patterns in vaccination rates were similar. Parental vaccination status was the strongest predictor of children's vaccination status. Vaccination rates for children aged 5-17 ranged from 49.6% in Atlanta, Georgia to 82.6% in San Francisco, California. Ethnic minorities, socioeconomically-disadvantaged children, uninsured children, and children of parents without COVID-19 vaccination or with COVID-19 diagnoses had significantly lower vaccination rates. Equitable vaccination coverage among children and adolescents is critical to reducing inequities in COVID-19 health outcomes in the US and globally.

Association of weight status with the types of foods consumed at snacking occasions among US adolescents.

This study aimedto evaluate snack food-group composition by weight status among United States adolescents. Cross-sectional analysis of adolescent food-group-component intake from snacking occasions using two 24-hour dietary recalls from the 2007 through 2018 National Health and Nutrition Examination Survey (NHANES; n=5264; 12-19 years) was conducted. ANCOVA models evaluated food intakes by BMI percentile (BMI%; normal weight [NW]: <85th BMI%; overweight [OW]: 85th-95th BMI%; and obesity [OB]: ≥95th BMI%), adjusting for energy misreporting and key covariates. Adolescents with OB consumed greater total daily energy from snacks (mean [SE]: NW=424 [10]kcal; OW=527 [16]kcal; OB=603 [22]kcal; p < 0.001) than adolescents with OW and NW. Adolescents with OW or OB consumed higher amounts of refined grains, dairy, protein, oil, solid fat, and added sugar from snacks than adolescents with NW (p < 0.05-0.001). Adolescents with OW or OB consume more calories and higher levels of overconsumed dietary components, i.e., added sugar, solid fats, and refined grains, from snacks than adolescents with NW. Age-specific snacking recommendations to inform dietary guidance are needed to prevent excess intake of overconsumed nutrients and calories.

U.S. adolescents' attitudes toward school, social connection, media use, and mental health during the COVID-19 pandemic: Differences as a function of gender identity and school context.

The COVID-19 pandemic changed school contexts and social opportunities dramatically for adolescents around the world. Thus, certain adolescents may have been more susceptible to the stress of the pandemic as a function of differences in schooling. We present data from 1256 United States adolescents (ages 14–16) to examine how the 2020–2021 school context (in-person, hybrid, or virtual) related to feelings of school satisfaction and success, social connection, mental health, and media use. We also examine differences as a function of gender identity. Results demonstrate that school context, particularly in-person compared to virtual schooling, was related to higher school satisfaction and academic success, stronger feelings of social connection and inclusion, lower levels of anxiety and depression, and less problematic media use. Interestingly, adolescents did seem to use media as a tool to support social connection when in hybrid or virtual school contexts, but they also reported higher rates of problematic media use, thus suggesting that media use needs to be examined more carefully to understand its role as a potential protective mechanism for adolescents’ social connection and mental health. These findings provide baseline information about how schools’ responses to the COVID-19 pandemic may have created disparities among youth. These findings have implications for current school interventions.

Association of Total Calcium With Serum Uric Acid Levels Among United States Adolescents Aged 12-19 Years: A Cross-Sectional Study.

AimsEvidence of a link between total calcium (CA) and serum uric acid (SUA) is absent in adolescents. Thus, this study aimed to determine the relationship between total CA levels and SUA levels in United States adolescents.MethodsA cross-sectional study analyzed a sample composed of 8,309 United States adolescents aged 12–19 years from the National Health and Nutrition Examination Survey database (1999–2006 survey cycle). Multivariable linear regression analyses and multivariable logistic regression analyses were used to assess the correlation of total CA with SUA levels and hyperuricemia. Furthermore, the dose-response relationship of total CA and SUA levels was analyzed using smooth curve fitting (penalized spline method).ResultsAccording to multivariable linear regression analysis, every 1 mg/dL increase in total CA level is associated with a 0.33 mg/dL (β = 0.33, 95% CI: 0.27–0.40, p < 0.001) increase in SUA. Multivariable logistic regression analyses showed that every 0.1 mg/dL increase in total CA level is linked with an 8% increased risk of hyperuricemia (OR = 1.08, 95% CI: 1.06–1.10, p < 0.001). The analyses of smooth curve fitting revealed that total CA levels were linearly correlated with SUA levels (Pnon–linearity = 0.152). The results were highly stable in all subgroups. The interaction analysis results presented that race/ethnicity had an interactive role in associating total CA with SUA levels.ConclusionsIn United States adolescents, total CA levels were linearly and positively correlated with SUA levels.

The relationship between metabolic syndrome and bone mineral density in adolescents: analysis of the National Health and Nutrition Examination Survey.

The purpose of this study was to observe the relationship between metabolic syndrome (MetS) and height (Ht) adjusted Z-scores for areal bone mineral density (aBMD) in adolescents. A retrospective study was conducted on the United States adolescents aged 12-17years. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, 2013-2014 and 2015-2016 cycles. Ht adjusted Z-scores for aBMD were calculated. A total of 969 adolescents (493 boys and 476 girls), aged 14.5±1.7years were enrolled in this study. After control for age, gender, race, 25-hydroxyvitamin D [25(OH)D], and lean body mass index (LBMI) Z-score, adolescents with MetS had significantly lower levels of total body (less head) aBMD Ht-Z-adjusted Z-score than adolescents with one, two components of MetS and without component of MetS (p<0.05) and significantly lower levels of lumbar spine aBMD Ht-Z-adjusted Z-score than adolescents with one component of MetS and without component of MetS (p<0.05). There were significantly negative associations between total body (less head) aBMD Ht-Z-adjusted Z-score and waist circumference (WC) (β=-0.027, p<0.001, R2=0.057) and homeostasis model assessment insulin resistance (HOMA-IR) (β=-0.225, p<0.001, R2=0.016). There were significantly negative associations between lumbar spine aBMD Ht-Z-adjusted Z-score and WC (β=-0.039, p<0.001, R2=0.058) and HOMA-IR (β=-0.251, p<0.001, R2=0.008). The present study demonstrates that MetS may have a negative effect on bone mineral density in adolescents. Abdominal obesity and insulin resistance play a major role on the decline of aBMD in adolescents.

Preferences, use, and perceived access to flavored e-cigarettes among United States adolescents and young adults

BackgroundCiting concern over youth use, the Food and Drug Administration announced a prioritized enforcement policy against cartridge-based (reusable pod) e-cigarettes in non-menthol, non-tobacco flavors, effective February 2020. Data are needed regarding youth e-cigarette access and use behaviors following this policy. MethodsThis cross-sectional national (USA) online panel survey, conducted March/April 2021, included 2253 participants ages 14–20 who ever used e-cigarettes ≥3 times (73% past 30-day users). Participants reported their flavor preferences, use reasons, and perceived ease of access. Latent class analysis categorized participants according to their preferred e-cigarette flavors, and multinominal logistic regression identified sociodemographic and behavioral correlates of class membership. ResultsMost past 30-day e-cigarette users used reusable pod (77%) or modern disposable (68%) devices, ≥1 non-tobacco (92%), sweet (76%), and/or menthol flavors including fruit-ice (70%) (flavor and device categories not mutually exclusive). Most past 30-day users (70%) and non-users (63%) perceived it would be somewhat or very easy to acquire e-cigarettes in flavors they like. Latent class analysis identified four e-cigarette flavor preference classes: mint (34% of sample), no preference (29%), fruit/sweet (28%), and dislikes ≥1 flavor (10%). Relative to no preference, membership in fruit/sweet (RRR: 1.87; 95% CI: 1.37, 2.57) and mint (RRR: 3.85; 95% CI: 2.77, 5.36) classes was associated with using e-cigarettes ≥50 times. Fruit/sweet membership was inversely associated with combustible tobacco use (RRR: 0.50; 95% CI: 0.38, 0.66). ConclusionYoung e-cigarette users maintained ample access to flavored and cartridge-based products. Stronger access restrictions and enforcement are required to reduce youth e-cigarette use.

Parental Management of Adolescents’ Peer Relationships in Ghana and the United States

A sample of Ghanaian (n = 119) and United States (US; n = 70) adolescents was used to examine parental management of peer relationships. Adolescents completed measures of consulting, guiding, parent-adolescent conflict about peers, and social behavior. Compared to US adolescents, Ghanaian adolescents reported higher levels of overt aggression and relational aggression. Ghanaian adolescents reported higher levels of conflict with parents about peers than US adolescents. Ghanaian boys reported the highest level of conflict with parents about peers, US boys reported the lowest level of conflict with parents about peers, and Ghanaian and US girls reported medium levels of conflict about peers. Girls reported higher levels of prosocial behavior than boys. Older adolescents reported higher levels of conflict with parents about peers, higher levels of overt aggression, and higher levels of relational aggression. Across nationality groups, higher levels of consulting were related to lower levels of overt aggression. Multiple regression analyses suggested that higher levels of conflict with parents about peer relationships was related to higher levels of overt aggression and relational aggression across nationality groups. A significant two-way interaction revealed that, for US adolescents, higher levels of consulting were related to higher levels of prosocial behavior. A significant three-way interaction suggested that guiding was not related to prosocial behavior regardless of level of conflict among Ghanaian adolescents. For US adolescents, higher levels of guiding at higher levels of conflict were associated with higher levels of prosocial behavior among US adolescents.

United States adolescents’ responses to sexual consent on television and the moderating role of anxious attachment

ABSTRACT Understanding effects of televised depictions of sexual consent communication on adolescents is important, given that many individuals experience their first romantic and sexual relationships during this developmental period. Using the theory of planned behavior as a framework, we examined how portrayals of verbal and non-verbal sexual consent in adolescent-directed programming influenced attitudes, perceived norms, and perceived behavioral control regarding sexual consent communication among a sample of adolescents (ages 12–17, N = 130). We also examined adolescents’ anxious attachment as a moderator. Results demonstrated a significant main effect of experimental condition on sexual consent norms, but anxious attachment orientation did not moderate the relationships between experimental condition and perceived norms. We discuss findings in the context of individual differences, with implications for the design of media to support sexual consent communication among different adolescents.

Tobacco Use Among Gender-Varying and Gender-Stable Adolescents and Adults Living in the United States.

This study examines the proportion of the United States adolescents and adults who are variable (ie, at least one change in gender identity) versus stable in their gender identities over time, and whether they differ significantly in their nicotine/tobacco use after adjusting for key covariates. We fit multivariable logistic regression models to data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (PATH), a nationally representative study (n = 33 197 U.S. adolescents and adults aged ≥14 years). We examined associations of gender stability/variability over three waves with tobacco use at wave 4 (2016-2018). Differences in any past 30-day tobacco, cigarette, e-cigarette, other tobacco, and poly-tobacco use were assessed among cisgender-stable, transgender-stable, and gender-varying respondents. An estimated 1.0% of adolescents and adults were classified as gender-varying. Prevalence of any past 30-day tobacco use was higher among gender-varying individuals (42.7%) than among gender-stable individuals (transgender-stable, 37.8% and cisgender-stable, 26.7%). There were no significant differences in the odds of nicotine/tobacco use between the two gender-stable groups. However, gender-varying respondents had significant increased odds of any past 30-day tobacco use (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.3 to 3.0), cigarette use (AOR = 1.7, 95% CI = 1.1 to 2.5), e-cigarette use (AOR = 2.2, 95% CI = 1.4-3.5), other tobacco use (AOR = 2.2, 95% CI = 1.4 to 3.4), and poly-tobacco use (AOR = 2.0, 95% CI = 1.3 to 3.1) compared with cisgender-stable individuals. Gender-varying individuals are at higher risk for nicotine/tobacco use, placing them at greater risk for tobacco-related health consequences. Despite increased knowledge about transgender health in recent years, there remains a paucity of research about gender-varying individuals. This study is the first to examine the proportion of gender-varying individuals in the United States using a longitudinal, nationally representative sample and to explore differences in nicotine/tobacco use among gender-varying and gender-stable individuals. Our findings suggest that gender-varying people have an increased risk for nicotine/tobacco use, placing them at higher risk for tobacco-related health consequences. This study increases knowledge about nicotine/tobacco use among this under-represented population in research and underscores the importance of developing an awareness of gender diversity.