United States Adolescents Research Articles

Prevalence of steatotic liver disease (MASLD, MetALD, ALD) and clinically significant fibrosis in US adolescents

We aim to evaluate the prevalence of steatotic liver disease (SLD) in United States (US) adolescents and explore whether metabolic dysfunction-associated steatotic liver disease (MASLD) can identify individuals with clinically significant fibrosis (CSF) in this study. The prevalence of SLD and its categories, including MASLD, metabolic dysfunction and alcohol associated liver disease (MetALD), alcohol related liver disease (ALD) and other SLD were determined. Weighted multivariable logistic regression analysis was conducted to evaluate the association between MASLD and CSF in adolescents with SLD. Among the total 1,446 US adolescents, SLD was present in 291 (20.1%) of individuals, including 260 (17.9%) for MASLD, 9 (0.6%) for MetALD and 5 (0.3%) for ALD. Only 58 (4%) had CSF. Patients with SLD showed a higher prevalence of CSF (9.6% vs. 2.6%, p < 0.001). Among patients with SLD, 89.3% met the MASLD criteria. The risk of CSF in patients with MASLD was not significantly different (odds ratio [OR] = 1.07, 95% confidence interval [CI] = 0.30–3.83, p = 0.9180) compared with those without MASLD. MASLD was met by most of the US adolescents with SLD. Moreover, MASLD was not associated with higher prevalence of CSF among adolescents with SLD.

Trends in Marijuana Use among Adolescents in the United States.

Marijuana is a widely used substance in the United States (US) and worldwide. We explored trends in self-reported marijuana use among US adolescents overall as well as by gender, race/ethnicity, and school grade. Biennial data from the Youth Risk Behavior Survey from 2011 to 2021 included 88,183 adolescents in grades 9th through 12th. We used percentage change as a measure of effect and the chi-square test for significance. All analyses were conducted at the national level. The percentage of adolescents who reported current marijuana use dropped significantly from 23.1% in 2011 to 15.8% in 2021 (p < 0.05). The self-report of trying marijuana for the first time before age 13 also decreased significantly from 8.1% in 2011 to 4.9% in 2021 (p < 0.05). For current use, there were similar significant decreases by race/ethnicity, with Asian, Hispanic, and White adolescents experiencing the steepest declines. In 2021, the percentage of Black adolescents self-reporting marijuana use was significantly higher (20.5%) compared to White (14.8%), Hispanic (16.7%), and Asian (5.1%) adolescents. Although current marijuana use declined significantly for both girls and boys over time, in 2021 girls were more likely (17.8%) to currently use marijuana than boys (13.6%). In 2011, the opposite was true, with boys (25.9%) being more likely to use marijuana than girls (20.1%). In US adolescents in 2021, there were decreases in self-reports of marijuana use compared to 2011. Behavioral interventions within school and family environments may be critical in mitigating the risk of marijuana use.

Trends and key disparities of obesity among US adolescents: The NHANES from 2007 to 2020.

This study aimed to estimate the trends in the body mass index (BMI) and prevalence of obesity among United States (U.S.) adolescents (10-19 years) and to examine the associations between sociodemographic factors and both BMI and obesity prevalence. The 2007-2020 National Health and Nutrition Examination Survey (NHANES), a nationally representative repeated cross-sectional survey data (n = 9,826) were used. Outcomes included: 1) Mean BMI and 2) obesity (yes/no; defined as BMI ≥95% percentile). Sociodemographic variables included age, sex, race/ethnicity, and poverty income ratio (PIR; low-income <1.3, middle-income ≥1.3 and <3.5, high-income ≥3.5). By accounting for the complex survey design, weighted generalized linear/Poisson models were used to conduct the analyses. Girls constituted 49% of the sample. From 2007-2008 to 2017-2020, there was an increase in BMI and obesity prevalence, particularly among Black and Hispanic adolescents, and those from low- and middle-income families. Additionally, there was an increase in obesity prevalence among both boys and girls. However, there were no significant changes in BMI and obesity prevalence in the other race and ethnic adolescents. Girls had a 12% (Adjusted Prevalence Ratio [APR] = 0.88; 95% CI, 0.81-0.96) lower likelihood of being obese than boys. Compared to White adolescents, Black and Hispanic adolescents had 22% (APR = 1.22; 95% CI, 1.06-1.40) and 19% (APR = 1.19; 95% CI, 1.05-1.36) greater risk of being obese. Compared to high-income families, adolescents from low- and middle-income families had 62% (APR = 1.62; 95% CI, 1.39-1.90) and 47% (APR = 1.47; 95% CI, 1.24-1.76) greater risk of being obese, respectively. The results indicated persistent disparities in obesity prevalence among different race/ethnic and sociodemographic groups. Future obesity intervention should address key disparities by targeting specific race/ethnic adolescents from low-income families and promoting health equality.

Eating Egg-Rich Diets and Modeling the Addition of One Daily Egg Reduced Risk of Nutrient Inadequacy among United States Adolescents with and without Food Insecurity

BackgroundAdolescents have the poorest dietary intake throughout their lifespan. Food insecurity worsens these nutritional risks. Eggs are a nutrient-dense strategy to increase nutrient quality. Objectives1) compare usual nutrient intakes, Dietary Reference Intake and protein compliance with recommendations and scores of micronutrient quality; and 2) analyze how adding 1 egg affects adolescents’ nutrient profiles, by food security status and egg-rich diets. MethodsDietary data of United States adolescents in the 2007–2018 National Health and Nutrition Examination Survey were analyzed (14–17 y; n = 3633). Egg-rich diet levels were categorized as 1) no eggs, 2) eggs as ingredients in dishes, or 3) primarily egg dishes. Food security status was classified using the United States Household Food Security Survey Module. The National Cancer Institute method was used to estimate usual nutrient intake and nutrient exposure scores [i.e., Food Nutrient Index (FNI) and Total Nutrient Index (TNI)]. Nutrient amounts from 1 medium egg were modeled on existing intakes. Pairwise t-tests determined significant differences. ResultsOver 60% of adolescents risked inadequate intake of calcium, choline, magnesium, vitamin D, and vitamin E regardless of food security status. Food-secure adolescents consuming primarily egg dishes had higher mean usual intakes of lutein + zeaxanthin (1544.1 μg), choline (408.4 mg), vitamin B2 (2.3 mg), selenium (128.6 μg), vitamin D (6 μg), docosahexaenoic acid (70 mg), and protein (89.1 g) than other groups (P < 0.0002). Those who were food secure and consuming eggs as ingredients in dishes demonstrated higher nutrient adequacy for magnesium (scored ∼66 out of 100), potassium (scored 81), and total scores (scored 72 and 69, respectively) for the TNI and FNI; and folate only (scored 92) for the TNI, than those who were food insecure and not consuming eggs (P < 0.0002). Adding 1 egg increased choline and vitamin D usual intakes for some groups and nutrient index scores for all groups (P < 0.0005). ConclusionsAdolescents are at substantial nutritional risk that was exacerbated by food insecurity and less egg consumption.

Association between blood lead levels and parathyroid hormone among United States adolescents aged 12-19: a cross-sectional study.

Studies on the association between serum lead levels and parathyroid function in adolescents are lacking. Therefore, in this study, we elucidated the possible association between blood lead levels (BLLs) and the parathyroid hormone (PTH) in adolescents aged 12-19 years in the United States. In this study, information from the database of the National Health and Nutrition Examination Survey was utilized. The study included 3919 participants from survey cycles between 2003-2004 and 2005-2006. Multivariable linear regression analysis was performed to determine the correlation between BLLs and PTH. Furthermore, smooth curve fitting was utilized to analyze the dose-response relationship between BLLs and PTH. Multivariable linear regression analysis revealed that every 1 μg/dL increase in BLLs was associated with 0.67 pg/mL increase in PTH (β = 0.67, 95% CI: 0.16-1.18, p < 0.01). However, sex-stratified subgroup analysis revealed that this positive association was only observed in males (β = 1.16, 95% CI: 0.50-1.83 p < 0.01). Smooth curve fitting revealed a positive correlation between BLLs and PTH. In adolescents in the United States, BLLs are positively correlated with PTH, particularly in males.

A cross-sectional National Health and Nutrition Examination survey-based study of the association between systemic immune-inflammation index and blood urea nitrogen levels in United States adolescents

Blood urea nitrogen (BUN) level is one of the commonly used indicators to assess renal function and systemic immune-inflammatory status. In the adolescent population, changes in BUN levels may be associated with a variety of factors, including physiologic dehydration, lifestyle influences such as nutritional intake, physical activity, and possible endocrine or metabolic disorders. In recent years, more and more studies have shown that BUN levels are not only a reflection of kidney function, but it may also be related to the inflammatory state of the body. The Systemic Immune Inflammatory Index (SII) is a comprehensive index that takes into account platelet counts, neutrophil and lymphocyte counts, and is thought to be effective in reflecting the body's immune status and inflammatory response. However, research on the relationship between the two, SII and BUN, remains understudied in the adolescent population. The purpose of this study was to examine the relationship between SII and BUN levels in a population of American adolescents and to further analyze the factors that influence it. We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) database. Using descriptive statistics, correlation analysis, and regression analysis, we explored the relationship between SII and BUN levels. We found a significant negative correlation between SII and BUN levels, with BUN levels decreasing when SII levels increased (BUN as the dependent variable and SII as the outcome variable). We performed a multiple regression analysis of this relationship, controlling for possible confounders such as gender, age, race, and BMI, and found that this negative correlation remained significant. Our findings reveal an important relationship between SII and BUN levels and provide new perspectives for understanding adolescent health.

Trends in Cardiovascular Health Among US Adolescents Aged 12–19 Years Using the New “Life's Essential 8” Metrics, 2007-2018

PurposeThe American Heart Association recently issued a substantial update to the definition and scoring of cardiovascular health (CVH), now called “Life's Essential 8” (LE8). We aimed to assess the trends in overall and individual LE8 CVH metrics among adolescents in the United States. MethodsA total of 6,999 United States adolescents aged 12–19 years from six cycles of the National Health and Nutrition Examination Survey from 2007–2008 to 2017–2018 were included in this study. The individual LE8 metrics included diet, physical activity, nicotine exposure, sleep health, body mass index (BMI), blood lipids, blood glucose, and blood pressure (BP). A higher CVH score indicates better CVH health. ResultsThe mean score of overall CVH significantly increased from 72.8 (95% confidence interval: 71.2–74.3) in 2007–2008 to 77.3 (76.1–78.5) in 2017–2018 in US adolescents (p-trend < .001). From 2007–2008 to 2017–2018, the mean scores increased from 75.5 (72.0–79.1) to 90.0 (88.0–91.9) for nicotine exposure, from 65.2 (61.6–68.8) to 73.3 (69.9–76.8) for sleep health, from 69.9 (67.1–72.8) to 73.0 (69.1–76.9) for blood lipids, and from 94.4 (93.0–95.9) to 96.2 (95.2–97.3) for BP (all p-trend < .05). However, the mean scores for diet, physical activity, and blood glucose did not significantly change (all p-trend > .05), whereas the mean score decreased from 81.4 (78.9-84.0) to 78.6 (76.4–80.8) for BMI (p-trend = .023). DiscussionIn United States adolescents, the overall CVH and four components (nicotine exposure, sleep health, blood lipids, and BP) significantly improved over time, diet, physical activity, and blood glucose remained unchanged, whereas BMI worsened.

The COVID-19 Pandemic, Adolescent Media Use, and Mental Health: Comparing Relationships Among Adolescents From South Korea and the United States

The COVID-19 pandemic had a detrimental impact on adolescent mental health, but few studies have explicitly compared adolescents’ mental health across countries, nor have they explored how different uses of media by adolescents in different countries may serve as protective or detrimental factors. To explore these associations, we use data collected from 958 South Korean adolescents and 1,253 United States (U.S.) adolescents in spring 2022 (ages 14–18). U.S. adolescents scored higher on anxiety and loneliness, relative to South Korean adolescents, and U.S. adolescents’ social media use frequency related positively to these variables. Conversely, South Korean adolescents’ social media use frequency was not related to anxiety or depression, and was negatively related to loneliness. Thus, social media use appears to relate detrimentally to U.S. adolescents’ mental health but relates in a more protective way to South Korean adolescents’ mental health. We discuss differential social media use and country differences to contextualize these findings.

Electronic Vapor Products: Alarming Trends in United States Adolescents.

Background: The use of electronic vapor products (EVPs) increases the risks of nicotine addiction, drug-seeking behavior, mood disorders, and avoidable premature morbidities and mortality. We explored temporal trends in EVP use among US adolescents. Methods: We used data from the Youth Risk Behavior Survey for school grades 9 through 12 from 2015 (earliest available data) to 2021 (the most recently available data) from the US Centers for Disease Control and Prevention (n=57,006). Results: Daily use of EVPs increased from 2.0% in 2015 to 7.2% in 2019, a greater than 3.5-fold increase. Although the percentage decreased to 5.0% in 2021, it was still a >2.5-fold increase since 2015. In 2015, the percentage of EVP use was significantly higher in boys (2.8%) than girls (1.1%). By 2021, the percentage of EVP use was higher in girls (5.6%) than boys (4.5%), a 1.24-fold increase. In addition, the percentage of EVP use in 2021 was higher in White youth (6.5%) vs Black (3.1%), Asian (1.2%), and Hispanic/Latino (3.4%) youth compared to 2015, but White and Black adolescents had the highest increases of approximately 3.0-fold between 2015 and 2021. Adolescents in grade 12 had the highest percentages of EVP use at all periods. Conclusion: These data show alarming statistically significant and clinically important increases in EVP use in US adolescents in school grades 9 through 12. The magnitude of the increases may have been blunted by coronavirus disease 2019, a hypothesis that requires direct testing in analytic studies. These trends create clinical and public health challenges that require targeted interventions such as mass media campaigns and peer interventions to combat the influences of social norms that promote the adoption of risky health behaviors during adolescence.

Comment: Trends in Cigarette Smoking Among United States Adolescents.

Comment: Trends in Cigarette Smoking Among United States Adolescents.

Impact of Changing Cannabis Laws on Cannabis Use Disorders, Serious Mental Illness, and Mortality Outcomes in US Youth: A Narrative Review

Abstract: Youth cannabis use is a major public health crisis. Cannabis laws carry significant health implications for American youth. Relaxing of these laws – through decriminalization, medical and recreational legalization – by a majority of states in the United States (US) over the past 25 years has dramatically shifted societal perceptions and adult use. How cannabis policy changes have affected the population-wide health of US youth and downstream public health implications of cannabis laws remain topics of significant debate. Cannabis is the most commonly used federally-illicit drug by US adolescents and the main drug for which US teens obtain substance use treatment. Adolescent cannabis use is associated with negative long-term consequences for mental health, risk-taking behaviors, and academic/job achievement. As of January 2023, 37 states and the District of Columbia (DC) have enacted medical cannabis laws; of these, 21 states and DC have recreational cannabis laws. Multiple studies have assessed the association between cannabis laws and youth cannabis use; results indicate mostly null effects for medical laws and mixed effects for recreational laws. Little is known about the effects of cannabis laws on mental health and mortality outcomes for American youth. Methodological limitations have made the interpretation of this literature difficult. This article presents a narrative review of current scientific literature investigating the impact of changing cannabis policies on cannabis and other drug use, mental health, and mortality outcomes in US youth. Implications are framed within a larger discussion on national trends in youth drug use, effects of adolescent cannabis exposure on health outcomes, and research-based policymaking.

Investigating the association between multiple substance Use and dating violence involvement among U.S adolescents

Adolescent dating violence and substance use are clinical and public health concerns. Prior meta-analytic studies indicate that about 20% of adolescents reported having experienced physical dating violence (PDV) and 10% reported sexual dating violence (SDV). This study aims to assess the prevalence of dating violence, and the association between substance use and dating violence among adolescents. Our study population is derived from the 2019 Youth Risk Behavior Surveillance System (YRBSS)a cross-sectional, nationally representative survey of United States (U.S) adolescents. The sample comprised 13,677 adolescents between the ages of 13–19 years currently enrolled in school. Descriptive analysis estimated the prevalence of dating violence and substance use. Multiple logistic regression adjusted for confounders of the association between substance use and dating violence. The confounders adjusted for include sex, school grade, race, academic grade, and duration of night sleep. The prevalence of PDV and SDV was each 8.2%. Only 2.6% of this nationally representative sample had experienced both PDV and SDV. Adolescents who used three or more substances had 2.1 times higher odds of PDV (OR = 2.10, 95% CI = 1.27–3.47, p < 0.0001), and SDV (OR = 2.11, 95% CI = 1.34–3.34, p < 0.0001) respectively, and 2.8 (OR = 2.75, 95% CI = 1.34–5.61, p < 0.0001) times higher odds of both PDV and SDV in the past month. Multiple substance use increases the odds of dating violence. Policy and interventions should be focused on preventing substance use initiation among substance-naïve adolescents and to advocate abstinence and gradual reduction of substances used to mitigate the prevalence of dating violence.

Adolescent and caregiver preferences for juvenile idiopathic arthritis treatment: a discrete-choice experiment

BackgroundThis study aimed to elicit and quantify preferences for treatments for juvenile idiopathic arthritis (JIA).MethodsWe conducted a discrete-choice experiment among adolescents with JIA in the United States (US) (n = 197) and United Kingdom (UK) (n = 100) and caregivers of children with JIA in the US (n = 207) and UK (n = 200). In a series of questions, respondents chose between experimentally designed profiles for hypothetical JIA treatments that varied in efficacy (symptom control; time until next flare-up), side effects (stomachache, nausea, and vomiting; headaches), mode and frequency of administration, and the need for combination therapy. Using a random-parameters logit model, we estimated preference weights for these attributes, from which we derived their conditional relative importance.ResultsOn average, respondents preferred greater symptom control; greater time until the next flare-up; less stomachache, nausea, and vomiting; and fewer headaches. However, adolescents and caregivers in the US were generally indifferent across varying modes and frequencies of administration. UK adolescents and caregivers preferred tablets, syrup, or injections to intravenous infusions. US and UK adolescents were indifferent between treatment with monotherapy or combination therapy; caregivers in the UK preferred treatment with combination therapy to monotherapy. Subgroup analysis showed preference heterogeneity across characteristics including gender, treatment experience, and symptom experience in both adolescents and caregivers.ConclusionsImproved symptom control, prolonged time to next flare-up, and avoidance of adverse events such as headache, stomachache, nausea, and vomiting are desirable characteristics of treatment regimens for adolescents with JIA and their caregivers.

Engagement in types of activities and frequency of alcohol use in a national sample of United States adolescents.

Adolescents with fewer sources of environmental reinforcement may be at risk for alcohol use. Behavioral economic theories posit that engagement in some activities may facilitate alcohol use, whereas other activities may be incompatible with use and reduce likelihood of alcohol use. It is unclear which types of activities may facilitate or may be incompatible with alcohol use in adolescence. Using a national sample of adolescents, the current study examined differences in engagement with types of activities that may be incompatible with alcohol use, compared among adolescents who endorsed alcohol use, and adolescents who did not. Data from the 2019 Monitoring the Future (MTF) study (N = 4626) were analyzed. Potentially incompatible and facilitating activities, and alcohol-involved activities were identified from pre-existing survey measures. Confirmatory factor analysis, measurement invariance, and structural equation modeling were used to examine patterns in activity engagement among those who endorsed alcohol use and those who did not. Participants who did not endorse alcohol use reported higher engagement in activities that may be incompatible with alcohol use, including enjoyment from school and going to the mall (p < .001). Participants who endorsed alcohol use reported higher engagement in activities that may facilitate alcohol use (p < .001), such as spending time with friends and attending parties. Facilitating activities (β = 0.15, p < .001) and alcohol-involved activities (β = 0.70, p < .001) were positively associated with alcohol use frequency. Observed effect sizes were small in magnitude for all findings. The findings support the premise of behavioral economic theory, suggesting some activities may serve as protective factors against alcohol use frequency while other activities may facilitate alcohol use among adolescents. National surveys may consider adding specific measure of activity engagement to identify activities that may be incompatible with alcohol use among adolescents.

Mutual pathways between peer and own e-cigarette use among youth in the United States: a cross-lagged model

BackgroundElectronic cigarettes (e-cigarettes) have become the most common tobacco product used among adolescents in the United States (US). Prior research has shown that peer e-cigarette use was associated with increased risk of own e-cigarette use. Nonetheless, there is little empirical evidence on the directionality of these associations—if peer use predicts own use (peer influence) or if own use predicts peer use (peer selection).MethodsWe estimated the association between peer and own e-cigarette use among US adolescents 12–17 years of age. We used the cross-lagged model to investigate the mutual relationship between peer and own e-cigarette use over time using data from a population-based longitudinal study, Population Assessment of Tobacco and Health. Stratified analyses were conducted by sex and age subgroups.ResultsResults from a cross-lagged model showed a statistically significant predicting path leading from peer use at the prior time point to own use at the following time point, but not vice versa.ConclusionsWe found strong relationships between peer e-cigarette use and own e-cigarette use at within-individual levels. Peer influence paths were more robust than peer selection paths for e-cigarette use. Incorporating peers into prevention and intervention programs may help enhance these strategies.

Gun carrying among US adolescents: the mutual impact of violence experiences, safety concerns, and substance use behaviors

ObjectivesYouth firearm carriage significantly contributes to firearm-related injuries and deaths in the United States (US). This study examined the sex-specific patterns and cumulative effects of violence experiences, safety concerns, and substance use behaviors on youth firearm carriage. Study designCross-sectional study. MethodsBased on a nationally representative sample (N = 13,526), the multigroup structural equation modeling (SEM) was used to examine the interplay of violence experiences (weapon threats, physical fights, and sexual violence), safety concerns, and substance use behaviors (cigarette, electronic vapor, alcohol, marijuana, and prescription opioid), and their direct, indirect, and total effects on youth gun carrying behavior. ResultsAbout one in 50 females and one in 15 males reported firearm carriage in the past year. Sex-specific patterns existed. Among female adolescents, gun carrying was strongly correlated with violence experiences (standardized coefficient (β) = 0.77, P < 0.001), but no direct connection was observed with substance use behaviors. Among males, both violence experiences (β = 0.56, P < 0.001) and substance use behaviors (β = 0.26, P < 0.001) were significantly correlated with gun carrying. Although safety concerns did not show a direct effect on gun carrying, a significant indirect effect was observed via the pathway of violence experiences. Collectively, the three clusters of predictors explained about 59.9% of variance in gun carrying among females and 54.6% of variance among males. ConclusionsViolence experiences have a robust impact on gun carrying behavior in both female and male adolescents. Effective violence prevention programs and sex-specific strategies (e.g., substance use intervention for males) are needed to reduce youth firearm carriage.

The impact of Social Media Affinity on eating attitudes and body dissatisfaction among school-age children and adolescent girls studying in Farasan governorate school, Kingdom of Saudi Arabia

Purpose: The use of the internet for social networking has become a global phenomenon, as the number of social network users worldwide increased from 2.3 billion in 2016 to around 2.6 billion in 2018. 92% of United States adolescents report daily usage of social media, and 24% of them go online “almost constantly”. This study aimed to evaluate the Impact of social media affinity on Eating Attitudes and Body Dissatisfaction among School and adolescent children. Methods: A descriptive cross-sectional study was conducted in Farasan school from January 2022 to February 2022. A total of 75 students were selected by the non-probability purposive sampling technique. 5-point Likert scale on social media affinity (13 items), Body dissatisfaction was assessed by BSQ 8-c, and a 4-point Likert scale (26 items) was used to assess the eating attitude.Results: The majority of participants were females (81%). Out of this 75% were using social media every day and half of the percentage (50.7%) using WhatsApp. The total mean score for social media affinity was 49.72±5.61 out of 55. It concludes that higher scores indicate higher social media affinity. The mean score for eating attitude was 53.48±9.74. It interprets that a cut-off score of 20 or above indicates children had a high risk of developing an eating disorder. The participants’ Body Shape Dissatisfaction Questionnaire mean score was 23.37±6.39. it shows scores less than 25 mean mild concerns with a shape that indicates probable cases of distorted body image. Conclusion: social media and peer pressure has greatly affected the lifestyle and eating choices of students. Emphasizing the importance of parenting style for adolescents’ sense of empowerment and underscoring the need for parental involvement in prevention programs.Keywords: Social media Affinity, Eating Attitudes, Body Dissatisfaction, School Age Children, Adolescent Girls

What Do United States Adolescents Eat? Food Group Consumption Patterns and Dietary Diversity from a Decade of Nationally Representative Data

BackgroundAlthough the importance of adolescent nutrition has gained attention in the global nutrition community, there is a gap in research focused on adolescent dietary diversity and food group consumption. ObjectivesThis study aimed to characterize population-level food group consumption patterns and quantify the extent of dietary diversity among United States adolescents using a large nationally representative sample of adolescents aged 10–19 y. MethodsWe used 24-h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 to construct the 10 food groups comprising the minimum dietary diversity for women (MDD-W) indicator and estimated the prevalence of intake of each food group. A composite metric adolescent dietary diversity score (ADDS) was derived for each adolescent where 1 point was awarded per food group. Both population scores and the distribution of individual scores were estimated. Differences in proportions of food groups consumed across sociodemographic categories were tested using the Rao–Scott χ2 test, and pairwise comparisons were expressed as population prevalence differences and prevalence ratios. ResultsFood group consumption patterns were very similar across 2 d of dietary recall but varied significantly by sex, race/ethnicity, and income status. The food groups with the highest prevalence of consumption were grains, white roots, and tubers (∼99%), milk products (∼92%), and meat, poultry, and fish (∼85%), whereas <15% of adolescents consumed key micronutrient-dense foods, such as vitamin A–rich fruits and vegetables and dark green vegetables. The mean ADDS was 4.69, with modest variation across strata. ConclusionsOn average, United States youth consumed fewer than 5 food groups on a given day. The lack of dietary variety and relatively low prevalence of consumption of several micronutrient-rich plant-based foods could pose a risk for adolescents’ ability to achieve micronutrient adequacy in the United States.

COVID-19 effects on diet, sleep, and physical activity among mid- to late-adolescents residing in the deep south in the United States

PurposeThis study investigated the differential impact of COVID-19 on United States (US) adolescents' physical health as a function of sociodemographic factors over 18 months. It was hypothesized that the impact of COVID-19 and its mitigation efforts on physical health factors would vary by sociodemographic factors. Design and methodsData were drawn from a longitudinal study in which participants (ages 16 or 18) self-reported sleep, diet, and physical activity over 18months. Participants were enrolled between 2018 and 2022. Participants (n = 190, 73% Black/African American, 53% female) provided 1330 reports over 194 weeks (93 weeks before and 101 weeks after COVID-19 restrictions implementation). ResultsPhysical health outcomes moderated by demographic factors were measured and assessed over 18 months. Multilevel models and general estimated equations estimated the impact of COVID-19 restrictions on participants' health outcomes. Sleep and physical activity worsened after COVID-19 regardless of moderating factors, but some specific outcomes varied across subgroups. ConclusionsThis study diversifies the literature on the impact of COVID-19 and its mitigation measures on adolescents' social health. Further, it is based in the US's Deep South, largely populated by those identifying as Black/African American or of low socioeconomic status. Both subgroups are underrepresented in US-based health outcomes research. COVID-19 directly and indirectly impacted adolescents' physical health. Practice implicationsUnderstanding if and how COVID-19 impacted adolescents' health will inform nursing practice to adapt to and overcome adverse sequelae to promote positive patient health outcomes.

Relationship of Obesity and Severe Penetrating Thoracic and Abdominal Injuries in Adolescent Patients.

Over 20% of United States adolescents are obese. A thicker layer of subcutaneous adiposity might provide a protective "armor" layer against penetrating wounds. We hypothesized that adolescents with obesity presenting after isolated thoracic and abdominal penetrating trauma have lower rates of severe injury and mortality than adolescents without obesity. The 2017-2019 Trauma Quality Improvement Program database was queried for patients between 12 and 17 years old presenting with knife or gunshot wounds. Patients with body mass index (BMI) ≥30 (obese) were compared to patients with BMI <30. Sub-analyses were performed for adolescents with isolated abdominal trauma and isolated thoracic trauma. Severe injury was defined as an abbreviated injury scale grade >3. Bivariate analyses were performed. 12,181 patients were identified; 1603 (13.2%) had obesity. In isolated abdominal gunshot or knife wounds, rates of severe intra-abdominal injuries and mortality were similar (all P > .05) between groups. In isolated thoracic gunshot wounds, adolescents with obesity had a lower rate of severe thoracic injury (5.1% vs 13.4%, P = .005) but statistically similar mortality (2.2% vs 6.3%, P = .053) compared to adolescents without obesity. In isolated thoracic knife wounds, rates of severe thoracic injuries and mortality were similar (all P > .05) between groups. Adolescent trauma patients with and without obesity presenting after isolated abdominal or thoracic knife wounds had similar rates of severe injury, operative intervention, and mortality. However, adolescents with obesity presenting after an isolated thoracic gunshot wound had a lower rate of severe injury. This may impact the future work-up and management of adolescents sustaining isolated thoracic gunshot wounds.