US Adolescents Research Articles

Identifying the Strongest Correlates of Condom Use Among US Adolescents: A Systematic Review and Meta-Analysis.

Condoms are effective at preventing sexually transmitted infections and pregnancy; however, only 52% of sexually active US adolescents used a condom at last intercourse. To examine (1) the association between 36 psychosocial variables and adolescent condom use to determine the strongest correlates of condom use behavior across the literature, (2) heterogeneity of these effects, and (3) the moderating roles of age, gender/sex, race/ethnicity, sexual orientation, and year of study. A systematic search was conducted of studies published between January 2000 and February 2024 using Medline, CINAHL, PsycINFO, and Communication Source databases, plus relevant review articles and unpublished data. Studies were included if they (1) were observational studies of US adolescents (mean sample age <19 years), (2) included adolescent reports of condom use behavior and a correlate of interest, and (3) were available in English after January 2000. Investigators extracted data on participant characteristics, study methods, settings, correlates, condom use outcomes, and study quality. Correlation coefficients and 95% CIs were computed from studies and meta-analyzed using random-effects models. The primary outcome was adolescent-reported condom use behavior. A total of 249 studies with 283 independent samples (251 713 adolescents; weighted mean age, 16.2 years) were synthesized. Twenty-three correlates were significantly associated with adolescent condom use. The correlates of condom use with the largest weighted mean effects were condom use at first sex (Pearson r = 0.47; 95% CI, 0.36-0.56), condom use intentions (Pearson r = 0.42; 95% CI, 0.35-0.48), and condom communication with a partner (Pearson r = 0.41; 95% CI, 0.29-0.52). Safer sex knowledge-a primary focus of many sex education efforts-was not significantly associated with condom use (Pearson r = -0.03; 95% CI, -0.10 to 0.05). Most effects (24 of 31 [77%]) were statistically significantly heterogeneous; age, gender/sex, sexual orientation, and year of study explained heterogeneity in only a few effects. This systematic review and meta-analysis identified the strongest and weakest correlates of adolescent condom use across nearly 25 years of research. These results can be used to refine sexual behavior theory and guide more targeted evidence-based intervention efforts for adolescents.

Associations Between Sugar-Sweetened Beverage Taxes and Weight Outcomes Among US Adolescents.

Given the recent implementation and preemption of sugar-sweetened beverage taxes across the United States, we aimed to evaluate the associations between sugar-sweetened beverage (SSB) taxes and adolescent weight-related outcomes using data on 364,540 adolescents drawn from 1999 to 2021 district Youth Risk Behavior Surveys. We used difference-in-differences models to assess the associations and the potential mediating roles of SSBs, milk, and 100% fruit juice consumption. We found that a one cent per ounce increase in SSB taxes was associated with a 0.26 lower body mass index (P <.01), and a 2.19 (P <.01) and 1.68 (P <.01) percentage point decrease in the probability of being affected by overweight and obesity, respectively. SSB consumption had a mediating role, as tax increases were associated with a 2.45 (P <.01) percentage point decrease in adolescents' probability of drinking any SSB. Milk and 100% fruit juices likely also played a role, as we found changes in their consumption in response to tax increases.

A positive relationship between weight-adjusted waist index and non-alcoholic fatty liver disease: a study on US adolescents.

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver condition in children, underscoring the urgent need for non-invasive markers for early detection in this population. We utilized survey data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 regarding liver ultrasound transient elastography (LUTE) for the diagnosis of NAFLD (dependent variable), and used multiple logistic regression models to explore the association between weight-adjusted waist circumference index (WWI) and the prevalence of NAFLD in US adolescents. Smoothing curves and threshold effect analyses were used to assess the non-linear association between the independent variables and the dependent variable. Subgroup analysis was conducted to pinpoint particularly susceptible subgroups within our study cohort of 1,711 participants. Our findings indicated a positive correlation between WWI and NAFLD scores. Adjusting for all covariates revealed a significant association between increased WWI and the presence of NAFLD, with an odds ratio of 3.37 (95% CI: 2.74, 4.15). This association proved stronger than those observed with waist circumference, body mass index, and NAFLD. Stratifying WWI into quartiles showed a clear and strong positive correlation (P for trend < 0.0001). The results of smoothing curves and threshold effect analysis showed a non-linear relationship between WWI and NAFLD (LLR < 0.001). Notably, for WWI values below 10.65, a significant correlation was observed (OR = 5.25, 95% CI: 3.77,7.31). Additionally, our subgroup analysis revealed that WWI and NAFLD were associated more positively among male participants aged 16 years and older. WWI is positively correlated with NAFLD in American adolescents and offers a straightforward and cost-effective method for identifying hepatic steatosis. The findings highlight the importance of focusing on individuals with a WWI below 10.65, where the risk of NAFLD increases. Priority should be given to the male adolescent population aged 16 and above.

Estimated Prevalence of Substance Use Disorders Among US Adolescents and Emerging Adults by Substance Class, Severity, and Age, 2021

Estimated Prevalence of Substance Use Disorders Among US Adolescents and Emerging Adults by Substance Class, Severity, and Age, 2021

Association of Dietary Intake of Vitamin A With Adolescent Hypertension: A Cross-Sectional Study Based on NHANES 1999-2018.

We aimed to investigate the association between dietary intake of vitamin A and risk of hypertension during adolescence. We interrogated the National Health and Nutrition Examination Survey (NHANES) database, from which individual-level data on dietary intake of vitamin A were garnered from 13,909 adolescents (aged 10-19 years) participating in the 1999-2018 study cycle. After dividing vitamin A intake into four quartiles, we leveraged weighted multivariate logistic regression to investigate the association of vitamin A intake with hypertension by each quartile, with the restricted cubic spline (RCS) curve plotted to assess the nonlinearity of association. Additionally, we performed subgroup analysis to examine whether gender remarkably affects vitamin A's effect on hypertension. Of all the adolescent participants, 1477 (10.6%) were found to have hypertension. Following thorough adjustments for confounding factors, per 1-SD increment in vitamin A intake was associated with a 23%, 26%, and 31% reduction in the risk of hypertension for the 2nd, 3rd, and 4th quartiles, respectively. Consistently, the RCS curve indicated that the risk of adolescent hypertension presented a decreasing trend as vitamin A intake creeped up. Intriguingly, gender-stratified subgroup analysis demonstrated that the observed association between vitamin A and adolescent hypertension was more pronounced in boys. Together, our findings outlined vitamin A as a protective dietary factor against hypertension among US adolescents. When using vitamin A supplements for preventing hypertension, boys may gain more practical benefits.

Investigating risk profiles of smartphone activities and psychosocial factors in adolescents during the COVID‐19 pandemic

AbstractAssociations of adolescents' smartphone use and well‐being have been contradictory. The present study investigates patterns of smartphone use and psychosocial risk / protective factors in US adolescents during COVID‐19 and examines their associations with depression symptom trajectories from 5 yearly waves beginning prior to the COVID‐19 pandemic. Latent profile analyses revealed three risk profiles, including a high risk profile (18.9% adolescents) characterized by elevated social media use, high levels of psychosocial risk, and low levels of protective variables. Latent growth mixture modeling identified three depression trajectories; stable low, moderate‐increasing, and high‐severely increasing depression. Both the moderate‐increasing and high‐severely increasing depression trajectories were associated with membership in the high risk profile. Results highlight the impacts of type of smartphone activity rather than use per se and can inform targeted intervention strategies.

The role of character age and content type in US adolescents’ involvement with television characters engaging in drinking and sex-related behaviors

ABSTRACT This study uses an online experiment among 15–17-year-old participants (n = 566) to test whether adolescents’ involvement with television characters (i.e. wishful identification, parasocial interaction, perceived age similarity, attraction) varied based on character age (teen or adult), and whether involvement moderated the relationship between exposure to onscreen risk behaviors (drinking and combining drinking and sex) and intention to engage in alcohol and sex-related behaviors. Character age was associated with increased perceived age similarity, but not wishful identification, parasocial interaction, or physical attraction. However, risk content moderated the relationship in that exposure to younger characters drinking or combining drinking and sex resulted in lower ratings on wishful identification, parasocial interaction, and physical attractiveness. Increased character involvement did not affect the exposure-intention relationships. Implications for understanding character attributes that resonate with adolescent audiences are discussed.

Text Messaging to Extend School-Based Suicide Prevention: Pilot Randomized Controlled Trial.

Suicide is the third-leading cause of death among US adolescents aged 10-19 years, and about 10% attempt suicide each year. School-based universal prevention may reduce youth suicidal behavior. Sources of Strength uses a peer leader network diffusion model to promote healthy norms across a school population. A key challenge within schoolwide programs is reaching a large and diverse array of students, especially those less engaged with their peers. Motivated by this challenge, we developed and field-tested Text4Strength-a program of automated text messages targeting help-seeking attitudes and norms, social coping resources, and emotion regulation skills. This study conducted a pilot randomized controlled trial of Text4Strength in 1 high school as an extension of an ongoing schoolwide program (Sources of Strength), to test its impact on targets that have the potential to reduce suicidal behavior. Students at an upstate New York high school (N=223) received 1-2 text messages per week for 9 weeks, targeting strategies for coping with difficult feelings and experiences through clarifying emotions and focusing on positive affect concepts, awareness, and strengthening of youth-adult relationships; and positive help-seeking norms, skills, and resources. Surveys were administered at baseline, immediately post intervention and 3 months after texting ended. We measured proximal intervention targets (methods of coping during stressful events, ability to make sense of their own emotions, feelings of powerlessness during emotion management and recovery, relations with trusted adults at school, and help-seeking behaviors), symptoms and suicide ideation, and student replies to messages. No significant effects were observed for any outcome at either follow-up time point. Results showed that if there is a true (but undetected) intervention effect, it is small. Students with fewer friend nominations did not interact any more or less with the text messages. Exploratory moderation analyses observed no interaction between the intervention condition and the number of friends or baseline suicide ideation at any time point. In contrast to a promising previous field test, these results suggest that Text4Strength is unlikely to have impacted the outcomes of interest and that undetected moderate or large effects can be ruled out with high confidence. Although motivated by the need to reach more isolated students, students with fewer friends did not engage more or show a greater effect than other participants. This study was conducted in a single high school that was already implementing Sources of Strength, so the bar for showing a distinct effect from texting alone was high. Many further channels for reaching youth through private messaging remain unexplored. Alternative delivery systems should be investigated, such as embedding messaging in gaming chat systems and other media. More sophisticated systems drawing on chatbots may also achieve better outcomes. ClinicalTrials.gov NCT03145363; https://clinicaltrials.gov/study/NCT03145363.

The moderation effect of mental health services use on the relationship between exposures to adverse childhood experiences and mental health outcomes among US adolescents.

The prevailing exposure to Adverse Childhood Experiences (ACEs) among youth is associated with adolescents' mental health. However, few studies have examined whether receiving help from mental health services affects mental health outcomes among adolescents with ACEs. Therefore, this study examines the moderated effects of mental health services use on the relationship between exposures to ACEs and mental health outcomes among US adolescents. The sample was restricted to adolescents aged 11-17 using data from the National Health Interview Survey (NHIS) from 2019, 2021, and 2022. Multivariate logistic regressions and descriptive analyses were performed to estimate the moderation effect of mental health services use. Using mental health services buffered the associations between ACEs and severe anxiety and depressive symptoms. Receiving counseling/therapy moderated the impact of ever living with an individual who had severe anxiety (Adjusted Odds Ratio, AOR: 0.58, p < .05) and depressive symptoms (AOR: 0.38, p < .01) among adolescents. Furthermore, counseling/therapy moderated the effect of ever living with an individual with a history of alcohol or drug abuse on severe depressive symptoms (AOR: 0.49, p < .05) and the effect of being a victim or witness of violence on severe anxiety symptoms (AOR: 0.45, p < .01). In addition, taking prescription medication moderated the effect of the experience of incarcerated family members on severe anxiety symptoms (AOR: 0.41, p < .05). Our findings suggest that policy and practice need to encourage access to mental health care for vulnerable adolescents with ACEs to reduce the detrimental effect of their experiences on their mental health problems.

Poor housing conditions in adolescence and adult health outcomes: an outcome-wide longitudinal approach

BackgroundWhile prior literature has documented the impact of housing quality on health, the long-lasting effects of poor housing conditions in adolescence on adult health remain understudied. This study employs an...

Does State-Level Structural Racism Impact Risk for Suicide Attempts Among US Adolescents Across Race and Ethnicity?

Our study examined the association between state-level structural racism and past year rates of suicide ideation (SI) and suicide attempts (SA) among non-Hispanic Black, Hispanic, and non-Hispanic White adolescents. This secondary analysis used state- and individual-level linked data combining multiple years (ie, 2011-2019) of the Youth Risk Behavior Surveys, the 2019 American Community Survey, and the 2019 state-level Structural Racism Index (SRI), a composite measuring state-level Black-White (B-W) and Hispanic-White (H-W) racial inequities across 5 domains: residential segregation, incarceration rates, educational attainment, economic indicators, and employment status. A series of generalized estimating equations were used to examine the association between structural racism and past-year SI and past-year SA, with race/ethnicity as a moderator, adjusting for state- and individual-level covariates, among US adolescents. Negative associations were observed between B-W SRI with SI (adjusted b [95% CI]=-0.011 [-0.017,-0.003], p=.004), and SA (-0.011 [-0.018,-0.004], p= .002), as well as between H-W SRI with SI (-0.008 [-0.016,-0.0002], p= .044), and SA (-0.011 [-0.018,-0.004], p= .001). These associations were significantly modified by race and ethnicity for both B-W SRI and H-W SRI. Both Black (SI=-0.011 [-0.02,-0.002]; SA=-0.011 [-0.019,-0.004]) and Hispanic (SI=-0.097 [-0.011,-0.004]; SA=-0.011 [-0.018,-0.004]) adolescents living in states with higher structural racism had lower rates of past-year SI and SA relative to White adolescents. Exploratory analyses identified a negative association between the residential segregation index and past-year SI and SA among Black and Hispanic adolescents. Meanwhile, a positive association emerged between B-W incarceration index and past-year SA, but not past-year SI, among Black adolescents. Adolescents in states with higher SRI were at lower risk for past-year SI and SA. Racial inequities across various institutions may differentially influence suicide-related risk among adolescents. Structural racism may play an important role in conferring risk for SI and SA, and its impact may vary across Black, Hispanic, and White adolescents. Attending to institutional level markers of racism may help to improve the cultural responsiveness of youth suicide prevention strategies. Study Preregistration: Does State-level Structural Racism Impact Risk for Suicidal Thoughts and Behaviors Among US Adolescents Across Race and Ethnicity? https://www.jaacap.org/article/S0890-8567(23)00124-7/fulltext DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

Atopic Dermatitis and Bullying Among US Adolescents

Atopic Dermatitis and Bullying Among US Adolescents

Feasibility and Acceptability of a Virtual Reality Curriculum to Support Firearm Safety Counseling Skills Among Pediatric Residents.

Background Firearm-related injury is the leading cause of death among US children and adolescents. Residents across specialties report low preparedness to provide firearm safety counseling. Virtual reality (VR) may offer a modality to support residents' skills through deliberate practice in a simulated setting. Objective To describe a novel screen-based VR curriculum on firearm safety counseling and report feasibility and acceptability outcomes, including residents' perceptions. Methods Fifteen senior pediatric residents were recruited from 2 large children's hospitals. The curriculum included 4 simulated scenarios in VR during which residents verbally counseled graphical caregivers who responded in real time, driven by a human facilitator. The curriculum focused on introducing firearm safety, discussing storage devices, and navigating the conversation through motivational interviewing. Following participation, residents completed the Measurement, Effects, Conditions Spatial Presence Questionnaire (MEC-SPQ) to indicate the degree of immersion in the virtual environment. Additional study data were derived from semistructured interviews. We used a constructivist general inductive approach to explore perspectives via coding and pattern identification. Results Quantitatively 14 of 14 residents completing the survey indicated notable attention allocation and spatial presence in the VR environment. During the 15 interviews, residents identified VR as an acceptable modality for deliberate practice of firearm safety counseling skills in a realistic, scaffolded manner. They indicated the rehearsal of specific verbiage as critical to supporting behavior change. Notably, residents reported that the training helped overcome prior barriers to counseling by providing a framework for efficient counseling. Conclusions Among pediatric residents, VR proved a feasible and acceptable modality for training on firearm safety counseling.

Prevalence of Cardiovascular-Kidney-Metabolic Stages in US Adolescents and Relationship to Social Determinants of Health.

Given that many risk factors for atherosclerotic cardiovascular disease (ASCVD) begin in childhood, knowledge of the prevalence of cardio-kidney metabolic syndrome (CKM) in adolescents and its risk factors is critical to understanding the etiology of ASCVD risk burden. To calculate the proportion of US adolescents with CKM stages 0, 1, and 2 and to assess the social factors and behaviors most strongly associated with advanced CKM stage. Cross-sectional analysis of 2017-2020 US National Health and Nutrition Examination Survey (NHANES) sample data. United States. Adolescents. Social determinants of health, including family income to poverty ratio, health insurance, routine healthcare access, and food security, as well as behaviors including smoking, physical activity, and diet. The prevalence of CKM stages 0, 1, and 2 in adolescents was measured using survey-weighted data. Generalized linear models were used to quantify associations between social factors, behaviors, and CKM staging. Of the 1,774 surveyed adolescents ages 12-18 years, representing 30,327,145 US adolescents, 56% (95% CI 52-60%) had CKM stage 0, 37% (33-40%) had CKM stage 1, and 7% (5-9%) had CKM stage 2. Physical activity score (1 to 100, 100=highest) was lowest among adolescents with CKM stage 2 (physical activity score for CKM 0: 60 (31), CKM 1: 60 (32), and CKM 2 49 (33); p=0.025). Other health behaviors, such as the DASH diet and nicotine scores, did not differ according to the CKM stage (p=0.477 and p=0.932, respectively). According to sex, race, ethnicity, and age-adjusted multivariate logistic regression analyses, a ratio of income to poverty level >1.85, having health insurance, and food security, were associated with a 32% (OR 0.68 [95% CI:0.52,0.89]), 40% (OR 0.60 [95% CI: 0.37, 0.99]), and 45% (OR 0.55 [95% CI: 0.41,0.73]) lower odds of CKM stage 1-2, respectively. After adjustment for all sociodemographic factors, only food security was associated with 41% lower odds of CKM stage 1-2 (OR 0.59 [0.43, 0.81]). CKM stage 1-2 in adolescents is most strongly associated with food insecurity. Improved access to healthy food and policies to address food security may help prevent higher CKM stage, beginning in adolescence.

Modeling Health and Economic Outcomes of Eliminating Sex Disparities in Youth Physical Activity

Sex disparities in physical activity (PA) and sports participation among US children and adolescents have been persistent. Quantifying the impact of reducing or eliminating these disparities may help determine how much to prioritize this problem and invest in interventions and policies to reduce them. To quantify what might happen if existing PA and sports participation disparities were reduced or eliminated between male and female children and adolescents. This simulation study used an agent-based model representing all children (aged 6 to 17 years) in the US, their PA and sports participation levels, and relevant physical and physiologic characteristics (eg, body mass index) as of 2023. Experiments conducted from April 5, 2024, to September 10, 2024, simulated what would happen during the lifetime of each cohort member if PA and sports participation levels for female participants were increased (to varying degrees) to match male participants in the same age group. Health outcomes, such as body mass index, incidence of weight-related conditions (eg, stroke, coronary heart disease, type 2 diabetes, and cancer), and economic outcomes (eg, direct medical costs and productivity losses). This simulation study modeled 8 299 353 US children and adolescents (4 240 119 [51.1%] male and 4 059 234 [48.9%] female) aged 6 to 17 years. Eliminating PA sex disparities averted 28 061 (95% CI, 25 358-30 763) overweight and obesity cases per cohort by age 18 years, which in turn averted 4869 (95% CI, 4007-5732) weight-related disease cases during their lifetimes and resulted in recurring savings of $333.45 million (95% CI, $290.22 million to $376.68 million) in direct medical costs and $446.42 million (95% CI, $327.39 million to $565.44 million) in productivity losses (in 2024 US dollars) for every new cohort of 6- to 17-year-olds. Reducing PA disparities by 50% averted 9027 (95% CI, 6942-11 112) overweight and obesity cases. Eliminating sex disparities in sports participation averted 41 499 (95% CI, 37 874-45 125) cases of overweight and obesity and 8939 (95% CI, 8088-9790) weight-related disease cases during their lifetimes, generating recurring savings of $713.48 million (95% CI, $668.80 million to $758.16 million) in direct medical costs and $839.68 million (95% CI, $721.18 million to $958.18 million) in productivity losses. In this simulation study of youth PA and sports participation, eliminating sex disparities could save millions of dollars for each new cohort of 6- to 17-year-olds, which could exceed the cost of programs and investments that could enable greater equity.

Cannabis and the overdose crisis among US adolescents.

Since 2019, the drug overdose death rate among adolescents 14-18 years of age in the United States more than doubled. That cannabis legalization may have contributed to this tragedy is investigated by comparing the death rate in jurisdictions that have legalized medicinal or both medicinal and recreational use with those that have not. Unintentional drug overdose death data for each state and District of Columbia (jurisdictions) were obtained from CDC WONDER and separately evaluated according to the jurisdiction legalization implementation of cannabis: recreational legalization, medicinal legalization but not recreational legalization, and nonlegalization. After a decade of similar and decreasing overdose death rates, jurisdictions that implemented cannabis legalization had a statistically significant greater increase in overdose deaths than nonlegalizing states. Those that implemented recreational legalization had the greatest increase, in which the rate was 88%, 479%, and 115% greater in 2019, 2020, and 2021, respectively, than in nonlegalizing jurisdictions. The overdose death rate versus cannabis legalization correlations are apparent in both females and males and in White, Black, and Hispanic individuals, and a statistically significant greater rate increases between recreational cannabis legalization implementation and nonlegalization. Legalization of cannabis is associated with overdose deaths in American adolescents, especially recreational legalization, and regardless of sex or White-Black-Hispanic race/ethnicity. Cause and effect relationships of these previously unreported correlations, if verified, merit investigation of biologic and psychosocial mechanisms, interventions, and prevention strategies.

All you need is [somebody’s] love “third-party reproduction” and the existential density of biological affinity

What is the true significance of biological kinship? During the last decades, it seemed to be uncontroversial that abandoned and even adopted people feel the negative impact of biological parents’ absence throughout life in several ways (Miller et al. 2000; Keyes, Margaret A., Anu Sharma, Irene J Elkins, and William G. Iacono, Matt McGue. 2008. The Mental Health of US Adolescents Adopted in Infancy. Archive Pediatric Adolescense Medicine 162(5): 419–425.). However, in the case of people conceived via “third-party reproduction”, especially in sperm donation, the disruption of the kinship network derived from natural bonds tends to be presented as something irrelevant. This article disputes that assumption, explores its relationship with a deconstructivist vision that presents kinship as a purely social construct and defends the personal and existential value of a person’s biological bonds with her parents. While analysing the anthropological shift inherent to the way some political discourses present the nuclear family and heterologous biotechnology, it proposes renewed philosophical attention on the significance of filiation and human affinity. This article argues for the density of genealogical ties and defends that the consecration of an individual “right to a child”, namely (but not exclusively) through the normalised access to sperm banks, is incompatible with the rights of the child, since it deprives people from knowing not only who but also how is their father.

Child Firearm-Related Homicide and Suicide by State Legislation in the US (2009 to 2020).

Firearms are the leading cause of death among US children and adolescents. This study evaluates whether state gun laws are associated with firearm suicides and homicides in children. This is a cross-sectional database study comparing childhood firearm mortality with 36 state firearm laws using data from CDC WONDER and the RAND State Firearm Law Database. Primary outcomes were firearm-related suicide and homicide mortalities per 100,000 persons. We examined suicide deaths by all firearms, including intentional self-harm by handguns only, intentional self-harm by rifles, shotguns, or large firearms only, and intentional self-harm by other or unspecified firearms, as well as homicide deaths for the same firearm types in each state. Welch's t -tests compared mean rates of suicide and homicide mortality between states with and without these laws. States that either enacted or rescinded firearm legislation during this period were excluded. From 2009 to 2020, there were 6,735 suicides and 10,278 homicides by firearm totaling 17,013 child deaths (younger than 18 years of age) by firearm. States with "child access prevention-negligent storage" laws demonstrated lower suicide mortality rates across all firearm types (handguns: N 13, M [mean per 100,000] 0.68, SD 0.27, p < 0.001; long guns: N 12, M 0.65, SD 0.25, p < 0.001). There were no significant differences in mean suicide death rates across all firearm types when comparing states with or without firearm laws related to "minimum age youth possession," "minimum age youth purchase and sale," or "child access prevention intentional." Comparing homicide mortality rates for all firearm types revealed no notable distinctions between states with and without the identified laws. Firearm legislation is associated with decreased suicide rates for individuals younger than 18 years of age, but its influence on homicides is less certain. Comprehensive research and thoughtful policy formulation are essential for addressing this pressing public health concern.

Abstract 4112845: Trends in Cardiovascular Risk Factors Among Children and Adolescents by Race and Ethnicity and Socioeconomic Status, 1999-2020

Background: Recent findings from large-scale cohort studies indicate that risk factors such as body mass index (BMI), systolic blood pressure (SBP), total cholesterol (TC), triglyceride (TG), and smoking during youth, starting in early childhood and adolescence, are associated with cardiovascular events and cardiovascular-related mortality in adulthood. The secular trends of cardiovascular risk factors among US children and adolescents remain unclear. Objectives: To examine 20-year trends in cardiovascular risk factors in the children and adolescents population by race and ethnicity and by socioeconomic status. Methods: The primary objective of the NHANES is to evaluate the overall health and nutritional status of the U.S. population. In this analysis, data from ten NHANES survey cycles, conducted from 1999-2000 through 2019-2020, were utilized. We calculated the mean and proportion changes in cardiovascular risk factors, and used linear and quadratic tests to assess the linear and nonlinear trends in their changes. Results: A total of 27891 participants aged 6 to 19-year-olds were included. Mean BMI increased significantly from 20.61kg/m 2 in 1999 to 21.71kg/m 2 in 2020 (P for trend &lt; 0.001). COT means decreased from 11.47 ng/ml to 6.17 ng/ml (P for trend &lt; 0.001). The prevalence of high COT decreased from 14.64% to 8.68% (P for trend &lt; 0.001). TC decreased from 4.22mmol/L to 4.02 mmol/L (P for trend &lt; 0.001). In the study population, TG levels decreased from 0.9mmol/L to 0.79 mmol/L (P for trend &lt; 0.001). Mean LDL levels decreased from 2.45 mmol/L to 2.27 mmol/L (P for trend &lt; 0.001). Conclusion: Positive trends were observed in the levels of TG, TC, LDL, and COT in US children and adolescents. Mean BMI and the prevalence of obesity exhibited a gradually increasing unfavorable trend.

Reasons for Vaping Among US Adolescents.

Reasons for Vaping Among US Adolescents.