Variations In Adolescents Research Articles

Longitudinal variation in resilient psychosocial functioning is associated with ongoing cortical myelination and functional reorganization during adolescence

Adolescence is a period of dynamic brain remodeling and susceptibility to psychiatric risk factors, mediated by the protracted consolidation of association cortices. Here, we investigated whether longitudinal variation in adolescents’ resilience to psychosocial stressors during this vulnerable period is associated with ongoing myeloarchitectural maturation and consolidation of functional networks. We used repeated myelin-sensitive Magnetic Transfer (MT) and resting-state functional neuroimaging (n = 141), and captured adversity exposure by adverse life events, dysfunctional family settings, and socio-economic status at two timepoints, one to two years apart. Development toward more resilient psychosocial functioning was associated with increasing myelination in the anterolateral prefrontal cortex, which showed stabilized functional connectivity. Studying depth-specific intracortical MT profiles and the cortex-wide synchronization of myeloarchitectural maturation, we further observed wide-spread myeloarchitectural reconfiguration of association cortices paralleled by attenuated functional reorganization with increasingly resilient outcomes. Together, resilient/susceptible psychosocial functioning showed considerable intra-individual change associated with multi-modal cortical refinement processes at the local and system-level.

Hospitalized Adolescents' Perspectives on Sexual and Reproductive Health Discussions.

Experts recommend that providers discuss adolescent patients' sexual and reproductive health (SRH) at any health care encounter, including hospitalizations. The purpose of this qualitative study was to gain insight into hospitalized adolescents' experiences and perspectives on SRH discussions (SHDs) to better inform patient-centered care. Private semistructured interviews were conducted with hospitalized adolescents aged 13 to 17 years. Interviews were coded and analyzed using thematic analysis. Themes were developed through an iterative process with focus on the primary research aim. Twenty participants were interviewed with a median age of 15.4 years. Adolescents expressed a range of preferences related to SHDs with providers. Themes included (1) experiences discussing SRH with providers, (2) SHDs during hospitalization, (3) communication preferences, and (4) perceptions of why providers initiate SHDs. Viewpoints about SHDs during hospitalizations varied, including that they addressed unmet needs, as well as that they seemed irrelevant to some participants. Aspects that facilitate SHDs include brevity with relevant depth, nonjudgmental provider demeanor, and reassurance of privacy. Some participants believed providers could judge the depth of discussion needed on the basis of the adolescent's age or personality. This study highlights variation in adolescents' preferences around SHDs with health care providers. Providers should initiate SHDs with statements of purpose and confidentiality. Given the variation in adolescents' perspectives, tools to privately collect self-reported behaviors before an SHD may help providers frame the conversation to the adolescent's specific SRH needs and communication style preferences.

Microalbuminuria and lipid variations in adolescents diagnosed with type 1 diabetes

ObjectiveThis study investigates the prevalence of lipid abnormalities among adolescents diagnosed with Type 1 Diabetes Mellitus (T1DM) and explores potential associations with microalbuminuria and cardiovascular disease (CVD) risk factors.Research Design and Methods: A retrospective study analyzed lipid profiles, microalbuminuria, and CVD risk in adolescents with T1DM. Six hundred individuals were assessed for lipid levels, BMI, and microalbuminuria. ResultsDyslipidemia prevalence was 59.7 %, with 22.7 % exhibiting abnormal total cholesterol (TC) and triglycerides (TG), and 15.8 % with elevated TC alone. A2 microalbuminuria was found in 59.2 %, with 14.6 % showing A3. Females had higher A2 prevalence and mild eGFR decrease (P = 0.02). Lipid levels correlated significantly with microalbuminuria (TC: r = 0.761; TG: r = 0.572, P = 0.03 and 0.04, respectively). The prevalence of high total cholesterol (TC) + high triglycerides (TG), as well as the high TG alone, was considerably higher in patients belonging to the A2 Microalbuminuria group. AIP, HbA1c, and UACR showed a strong positive correlation (r = 0.542, P = 0.04; r = 0.621, P = 0.02). ConclusionOur study highlights the prevalence of elevated or borderline lipid levels among adolescents with Type 1 Diabetes Mellitus (T1DM), indicating a heightened risk of dyslipidemia in this population. Particularly concerning is the significantly increased incidence of dyslipidemia among young individuals with T1DM, with females exhibiting a notable susceptibility to cardiovascular disease (CVD) due to dyslipidemia's impact on the Atherogenic Index of Plasma (AIP). Furthermore, Microalbuminuria, specifically type A2 and A3, was prevalent among our study participants, with females showing a significantly higher occurrence of A2 microalbuminuria compared to males. The association between microalbuminuria and dyslipidemia, especially the combination of high total cholesterol (TC) and high triglycerides (TG), emphasizes the importance of comprehensive screening protocols for both microalbuminuria and dyslipidemia in managing the cardiovascular risk profile of individuals with T1DM.

Patient-caregiver dyad concordance of transition readiness assessment for adolescent with cancer: A network analysis.

The concordance of adolescents with cancer and caregivers was examined, and the core elements of transition readiness were identified. In this cross-sectional study, 196 adolescent-caregiver dyads completed the Chinese version of Self-Management and Transition to Adulthood with Rx = Treatment Questionnaire and its parent version between March 2023 and August 2023. Intraclass correlation coefficients, paired t-tests and network analysis were used for data analysis. Caregivers reported slightly lower scores for transition readiness than adolescents (3.28 vs. 3.32). Healthcare engagement and provider communication were core elements in transition readiness networks. At the dyad level, agreement between adolescents' and caregivers' transition readiness ranged from poor to fair (intraclass correlation coefficients 0.103-0.486), and a significant difference in structure was found between the two networks. Caregivers tended to underestimate adolescents' transition readiness. Attaining better concordance between adolescents and family caregivers is critical to aligning roles and responsibilities in the transition process. This study extends the evidence on the variation in adolescents' transition readiness, clarifying the complex associative relationships among the elements of transition readiness, which can be potential pathways for improving transition readiness. Second, this study is the first to assess transition readiness from a dyad's perspective. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness, suggesting that targeted dyadic interventions should be developed and implemented to improve patient-caregiver transition readiness concordance, facilitate effective communication and mutuality between patients and caregivers, and contribute to their collaboration during the transition of adolescents and optimization of outcomes. WHAT PROBLEM DID THE STUDY ADDRESS?: Increased long-term survival rates of survivors of paediatric cancer highlighted the significant need for care continuity. Transitional readiness is an important predictor of adolescent survivor's ability to adapt to a long-term survival period. Assessments of adolescents' transition readiness are limited and overlook the synergies between family caregivers and adolescents in the transition period. WHAT WERE THE MAIN FINDINGS?: The levels of agreement on rating transition readiness varied from poor to fair among adolescent-caregiver dyads, and caregivers tended to underestimate adolescents' transition readiness. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness. Targeted dyadic interventions should be developed and implemented to improve patient-caregiver's transition readiness concordance, and facilitate effective communication and mutuality between patients and caregivers. Study methods and results reported in adherence to the STROBE checklist. No patients or members of the public were involved in the study. The main findings introduce pathways for improving transition readiness, which can enhance healthcare transition among other medical populations.

Online food advertisements and the role of emotions in adolescents’ food choices

AbstractAdolescence is a critical period for future health outcomes. Food habits and cognitive development are underway, and it is a period of heightened sensitivity to external influences and emotional shifts. We experimentally test the individual and combined influence of food advertisements and emotional primes (i.e., positive, negative, neutral) on adolescent food choices. Participants completed a food choice task selecting five snacks out of twenty healthy and unhealthy options in an online experiment. Prior to the food choice, we randomized whether adolescents were exposed to unhealthy food or non‐food online advertisements. To induce experimental variation in adolescents’ emotions, they were assigned to watch two, two‐minute film clips validated to elicit the targeted emotion. The online food advertisement did not significantly impact food choices, except that Black and Hispanic groups selected a higher share of calories from unhealthy foods. Participants in a negative emotional state selected more unhealthy sweet snacks. Finally, we find only weak evidence that a positive emotional state amplified the impact of food advertisements on the nutritional quality of food selection. Together, results suggest that while a negative emotional state drives food choices, this pattern occurs independently from food advertisement exposure.

Do I want to learn today? Day-to-day variations in adolescents’ academic motivation and effort

In this preregistered study, we examined factors influencing academic motivation among secondary school students (aged 13 – 15) on a day-to-day basis. Using cognitive effort-discounting (Cog-ED) as behavioral manifestation of motivation and self-report for internal motivational state, we utilized a daily diary method (two-week protocol, N = 39, total N = 342 diaries) to explore how these measures relate to daily experiences of need satisfaction (i.e., autonomy, competence, relatedness), social support, invested homework hours, stress and physical (versus online) school attendance both at within- and between-person levels. Employing Bayesian hierarchical modeling, we found that motivation to invest effort in learning (Cog-ED) and self-reported academic motivation were higher on days when students experienced greater competence. In addition self-reported academic motivation was higher on days when students experienced more social support from classmates and teachers, invested more effort in homework and physically attended school, but lower on days when students experienced more stress. Additionally, both motivation to invest effort in learning (Cog-ED) and self-reported academic motivation were higher for those with greater average levels of perceived autonomy and support from parents. Moreover, students who, on average, dedicated more time to homework, reported elevated stress levels, and received greater support from teachers reported higher academic motivation. Conversely, those with greater support from classmates reported lower academic motivation. These findings stress the importance of cultivating feelings of competence, supportive environments and stress reduction on a daily basis, while highlighting the importance of perceived autonomy, adult social support and physical school attendance for academic motivation. Importantly, the current study contributes by assessing motivation both behaviorally and via self-report, and fills a gap by extending trait-level motivation research to the daily-level.

Visualized peritoneal fluid variation in adolescents and young adults with endometriosis: is there more to it?

Peritoneal fluid is a medium for endometriosis-associated biomarker discovery from which the local peritoneal environment and pathophysiologic pathways are often inferred. Therefore, we evaluated the associations between peritoneal fluid color and volume at time of endometriosis-related laparoscopic surgery with patient characteristics, endometriosis type and lesion location in adolescents and young adults with endometriosis. We conducted a cross-sectional analysis among 545 patients undergoing surgery for endometriosis who enrolled in the Women's Health Study: from Adolescence to Adulthood cohort study. Patient characteristics, surgically visualized endometriosis phenotypes, and gross characteristics of peritoneal fluid were collected in compliance with World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project (EPHect) tools. Chi-square or Fisher's exact tests were applied to test for differences across categories. Most of the patients were adolescents or young adults (86% age <25 years) of white race (89%), with only superficial peritoneal lesions and rASRM stage = I/II observed at surgery (both 95%). We observed variation in peritoneal fluid color across different menstrual cycle phases at time of surgery (p = 0.006). Among those who were cycling at time of surgery, endometriosis patients with red peritoneal fluid were most likely to be in the proliferative phase (49%) compared to the secretory phase (27%), while those with yellow or orange peritoneal fluid were most likely to be in the secretory phase (57% and 86% respectively). Yellow color was significantly less common in those taking combined oral contraceptives but much more common with progesterone only formulation exposure (p = 0.002). Peritoneal fluid volume did not differ by cycle phase but was more likely to be low (≤6 ml) for those exposed to hormones at time of surgery (p = 0.01). Those with acyclic pelvic pain were less likely to have red peritoneal fluid (p = 0.001) but had greater volume (p = 0.02) compared to those without. Our findings highlight the importance of accounting for menstrual cycle phase and hormonal exposures when designing research using peritoneal fluid samples and inferring from biomarker results intended to advance our understanding of endometriosis and associated symptom pathophysiology.

Leisure activities and mental well-being among adolescents across Norwegian municipalities

Abstract Background Engagement in organized leisure activities (OLAs) may benefit health and well-being in adolescents. The social inequalities in OLA participation, and growing share of non-participants, is a public health concern in Norway. Thus, the present study aims to examine the association between OLA participation and mental health outcomes, and the interaction effect of overall share of adolescents participating in OLAs at municipal level. Methods This study, based on the nationwide Ungdata survey, includes 342,161 adolescents attending lower and upper secondary education in 276 municipalities in Norway between 2019 and 2022. A series of two-level random intercept models were fitted to distinguish the individual and municipality sources of variation in adolescents’ mental well-being measured by depression symptom scores and quality of life. Results Adolescents’ participation in OLAs varied considerably between Norwegian municipalities from lowest 33 % to highest 88 %. Being female, increase in age and decrease in family affluence level was negatively associated with both OLA participation and mental wellbeing. Overall, and particularly among girls and the least affluence adolescents, participation in OLAs was associated with higher quality of life and lower depressive symptoms. Among girls, the positive association between OLA participation (at individual level) and mental well-being was most evident in municipalities with high share of adolescents participating in OLAs. The overall share of OLA participants in municipality of residence had no or little impact on boys’ mental wellbeing. Conclusions Both the personal leisure involvement and the overall share of individuals participating in OLAs at local community level may impact adolescents mental well-being. Ensuring that all adolescents, regardless of family affluence level and gender, are able to participate in OLAs may promote adolescent's mental well-being that benefits the local public health. Key messages • Participation in leisure activities was associated with higher mental well-being in boys and girls, and across the socioeconomic spectrum. • In girls, highest mental wellbeing was observed among individuals living in municipalities with high share of leisure activity participating, and particularly for those who participates themselves.

Which anthropometric equation to predict body fat percentage is more strongly associated with maximum oxygen uptake in adolescents? A cross-sectional study.

Identifying the relationship between maximum consumption of oxygen and body fat percentage is important due to increased cardiovascular risk factors. This study aimed to verify the association between body fat percentage determined by three predictive equations using anthropometric measures (Lohman, Boileau, and Slaughter) and maximum oxygen uptake (VO2max). We also aimed to estimate the capacity of these equations for explaining VO2max variations in adolescents according to sex. This was a cross-sectional study conducted in high schools in São José, Southern Brazil. This study included 879 adolescents (14-19 years) from Southern Brazil. Aerobic fitness was assessed using the modified Canadian Aerobic Fitness Test. The independent variable was body fat percentage predicted by the Lohman, Boileau, and Slaughter equations. Analyses adjusted for sociodemographic variables, physical activity level, and sexual maturation were performed with P value < 0.05. All anthropometric prediction equations used to estimate body fat percentage explained VO2max variations in adolescents. In male adolescents, both regression models based on the Boileau et al.12 and Lohman10 equations revealed higher explanatory power for VO2max (20%) compared with that based on the Slaughter et al.13 equation (19%). In female adolescents, the model based on the anthropometric equation of Slaughter et al.13 showed the greatest explanatory power for VO2max (18%). The inverse relationship between VO2max and body fat intensifies the need for effective intervention programs that prioritize maintenance of appropriate body fat and aerobic fitness levels because inadequate levels of both factors result in negative health consequences.

Explaining variation in adolescents’ social media-related distraction: The role of social connectivity and disconnectivity factors

Social media are often believed to distract adolescents’ attention. While existing research has shown that some adolescents experience more social media-related distraction than others, the explanations for these differences remain largely unknown. Based on Self-Determination Theory, this preregistered study investigated two social connectivity factors (fear of missing out [FoMO] and friendship accessibility expectations) and two disconnectivity factors (self-control strategies and parental restrictions) that may explain heterogeneity in social media-related distraction. We used data collected through a measurement burst design, consisting of a three-week experience sampling method study among 300 adolescents (21,970 assessments) and online surveys. Using N = 1 analyses, we found that most adolescents (77%) experienced social media-related distraction. Contrary to expectations, none of the connectivity or disconnectivity factors explained differences in social media-related distraction. The findings indicate that social media are a powerful distractor many adolescents seem to struggle with.

Civic education and social interactions at school as drivers of intended electoral participation: Similarities and differences in four European school systems

Through civic education and social interactions at school, students are able to develop more or less political knowledge and trust in political institutions. Both precede intended electoral participation. However, it is disputed whether the relationship between political knowledge, trust, and intended participation is consistent across countries. We analyze data from the International Civic and Citizenship Education Study 2016 that consist of representative subsamples for 14-year-old students ( N = 14,567) in Bulgaria, Croatia, Denmark, and Germany (North Rhine-Westphalia). A structural equation model approach reveals that both political knowledge and trust in political institutions contribute to explaining variation in adolescents’ intended electoral participation. The effect of political knowledge is partly mediated by trust, which in turn is negatively associated with political knowledge in Bulgaria and Croatia and positively in Denmark and Germany (NRW). These results are discussed in the light of country-specific differences in the political context of civic education.

Examination of the Relationship Between Daily Perceptions of Collective Efficacy and Marijuana Use Among Black Youth: Does the Location of the Perception Matters?

Neighborhood-level collective efficacy protects Black youth from substance use; however, neighborhood research does not account for the entirety of adolescents' exposure or their perceptions of space which may be critical to understanding the role of context in substance use. To address this limitation, the SPIN Project recruited 65 Black adolescents (M(SD) = 15.32(1.06)) to complete four brief surveys each day for a month describing their perceptions of spaces and marijuana use. Multilevel negative binomial models were estimated to test the relationship between an individual's perceptions of collective efficacy and the marijuana used during a day, and if the location of the observations moderated these relationships. Findings indicated that the perceptions of collective efficacy protected adolescents from marijuana use when occurring within their home neighborhood, but not outside of it; thereby suggesting important variations in adolescents' perceptions based on the location that matter for Black youth marijuana use.

Prevalence and temporal evolution of asthma symptoms in Spain. Global Asthma Network (GAN) study

IntroductionThe temporal evolution of the prevalence of asthma described in the ISAAC (International Study of Asthma and Allergies in Childhood) in 2002 is unknown, or if the geographical or age differences are maintained in Spain. ObjectiveTo describe the prevalence of asthma symptoms in different Spanish geographic areas and compare it with that of those centers that participated in the ISAAC. MethodsCross-sectional study of asthma prevalence, carried out in 2016–2019 with 19,943 adolescents aged 13−14 years and 17,215 schoolchildren aged 6−7 years from 6 Spanish geographical areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona and Salamanca). Asthma symptoms were collected using a written questionnaire and video questionnaire according to the Global Asthma Network (GAN) protocol. ResultsThe prevalence of recent wheezing (last 12 months) was 15.3% at 13−14 years and 10.4% at 6−7 years, with variations in adolescents, from 19% in Bilbao to 10.2% in Cartagena; and in schoolchildren, from 11.7% in Cartagena to 7% in Pamplona. These prevalences were higher than those of the ISAAC (10.6% in adolescents and 9.9% in schoolchildren). 21.3% of adolescents and 12.4% of schoolchildren reported asthma at some time. ConclusionsThere is a high prevalence of asthmatic symptoms with an increase in adolescents and a stabilization in Spanish schoolchildren with respect to the ISAAC. Geographic variations in asthma prevalence are not so clearly appreciated, but areas with high prevalences maintain high numbers.

Adolescent Partnership Quality and Emotional Health: Insights from an Intensive Longitudinal Study.

Prior research has documented an association between adolescents' romantic experiences and poor emotional health. However, lack of intensive longitudinal measurement and an emphasis on negative affect have limited understanding about the extent to which adolescent relationship quality influences the emotional health of adolescents in partnerships, including the potential benefits of high-quality partnerships. Previous research has also been limited in its ability to account for factors that select adolescents into lower or higher quality partnerships. Using biweekly intensive longitudinal data from the mDiary Study of Adolescent Relationships linked to six waves of birth cohort data from the Fragile Families and Child Wellbeing Study, this paper uses multilevel mixed-effects models to address three questions: (1) How are changes in partnership quality (defined as validation, frequency of disagreements, and global quality) associated with changes in both positive and negative affect; (2) Do observed associations persist net of factors that potentially select adolescents into lower or higher quality partnerships (e.g., childhood family experiences); and (3) Do associations between partnership quality and affect differ by gender? Results show that higher quality partnerships are associated with both decreases in negative affect and increases in positive affect. There were no significant gender differences on average. The study's findings highlight the importance of partnership quality as a key source of temporal variation in adolescents' emotional states.

Prevalencia y evolución temporal de síntomas de asma en España. Estudio Global Asthma Network (GAN)

IntroductionThe temporal evolution of the prevalence of asthma described in the International Study of Asthma and Allergies in Childhood (ISAAC) in 2002 is unknown, or if the geographical or age differences are maintained in Spain. ObjectiveTo describe the prevalence of asthma symptoms in different Spanish geographical areas and compare it with that of those centers that participated in the ISAAC. MethodsCross-sectional study of asthma prevalence, carried out in 2016–2019 with 19,943 adolescents aged 13–14 years and 17,215 schoolchildren aged 6–7 years from six Spanish geographical areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona and Salamanca). Asthma symptoms were collected using a written questionnaire and video questionnaire according to the Global Asthma Network (GAN) protocol. ResultsThe prevalence of recent wheezing (last 12 months) was 15.3% at 13–14 years and 10.4% at 6–7 years, with variations in adolescents, from 19% in Bilbao to 10.2% in Cartagena; and in schoolchildren, from 11.7% in Cartagena to 7% in Pamplona. These prevalences were higher than those of the ISAAC (10.6% in adolescents and 9.9% in schoolchildren). About 21.3% of adolescents and 12.4% of schoolchildren reported asthma at some time. ConclusionsThere is a high prevalence of asthmatic symptoms with an increase in adolescents and a stabilization in Spanish schoolchildren with respect to the ISAAC. Geographical variations in asthma prevalence are not so clearly appreciated, but areas with high prevalences maintain high numbers.

Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes.

IntroductionVery limited data exist on normal age-related ECG variations in adolescents and no data have been published regarding the ECG anomalies induced by intensive training, which are relevant in pre-participation screening for sudden cardiac death prevention in the adolescent athletic population. The purpose of this study was to establish normal age-related electrocardiographic measurements (P wave duration, PR interval, QRS duration, QT, and QTc interval) grouped according to 2-year age intervals.MethodsA total of 2,151 consecutive healthy adolescent Soccer athletes (trained for a mean of 7.2 ± 1.1 h per week, 100% male Caucasians, mean age 12.4 ± 1.4 years, range 7–18) underwent pre-participation screening, which included ECG and transthoracic echocardiography in a single referral center.ResultsTheir heart rate progressively slowed as age increased (p < 0.001, ranging from 80.8 ± 13.2 to 59.5 ± 10.2 bpm), as expected. The P wave, PR interval, and QRS duration significantly increased in older age classes (p = 0.019, p = 0.001, and p < 0.001, respectively), and after Bonferroni's correction, the difference remained significant in all age classes for QRS duration. The QTc interval diminished progressively with increasing age (p = 0.003) while the QT interval increased progressively (p < 0.001).ConclusionsSignificant variations in the normal ECG characteristics of young athletes exist between different age groups related to increasing age and training burden, thus, age-specific reference values could be adopted, as already done for echocardiographic measurements, and may help to further discriminate potentially pathologic conditions.

Longitudinal Patterns in Adolescent Intentions to Seek Help for Dating Violence: A Latent Transition Analysis.

As a persistent public health problem affecting thousands of adolescents every year, teen dating violence has been studied extensively. However, gaps remain in the knowledge on what adolescents think about seeking help for violence in a dating relationship and how these attitudes might change over time. This study adopts a longitudinal person-oriented approach to explore configurations of help-seeking preferences in a sample of rural adolescents (N at wave 1 = 580, Mage = 13 years, SD = 1.48; 52.7% female; 46.6% African American, 39.4% White, 14% Hispanic and other minorities), surveyed annually for four years, with each assessment approximately 12 months apart. Latent class analyses uncovered variation in adolescents' willingness to disclose dating violence, captured by six groups: (a) Multi-help-seekers (19%), (b) Reluctant help-seekers (15%), (c) Selective help-seekers (16%), (d) Parent confidants (11%), (e) Friends confidants (22%), and (f) Moderate help-seekers (17%). Follow-up analyses revealed that select sociodemographic characteristics (age, gender, and family income) were unevenly distributed among the identified groups, pointing to the need to account for individual and contextual influences in understanding heterogeneity in help-seeking attitudes. Latent transition models further showed that although individual membership in latent classes was generally stable between middle and high school, transitions between help-seeking classes were common as well. The article concludes by discussing these findings in the context of further research and programming to promote help-seeking among developing adolescents, including targeted strategies to address the needs of adolescents who think differently about disclosing dating abuse.

Psychological distress in late adolescence: The role of inequalities in family affluence and municipal socioeconomic characteristics in Norway.

The present study aims to explore, in the national context of Norway, how municipal socioeconomic indicators affect anxiety and depressive symptom scores among senior high school students and whether this potential municipal effect is dependent on the adolescents' family affluence levels. This cross-sectional study is based on questionnaire data collected in five waves (2014-2018) of the Ungdata survey. The study sample consisted of 97,460 adolescents aged 16-18 years attending high school in 156 municipalities in Norway. Measures of psychological distress, depression, and anxiety symptoms were based on the screening instrument, Hopkins Symptom Checklist-10. Two-level random intercept models were fitted to distinguish the individual and municipality sources of variation in adolescents' mental health. In general, the results indicate substantial psychological symptom load among the study sample. Inequalities in adolescents' psychological distress between family affluence groups were evident, with the lowest symptom loads in the most affluent families. The predicted depressive and anxiety symptoms among the students increased slightly along with the percentage of municipal residents with tertiary educations and with increasing income inequalities in their residential municipality. However, the interaction models suggest that the adverse effects of higher municipal education level and greater income inequality are, to a certain extent, steepest for adolescents with medium family affluence. This study highlights two key findings. Both municipality effects and family affluence account for a relatively small proportion of the total variance in the students' psychological symptoms loads; however, the mental health inequalities we explored between socioeconomic strata on both the individual and municipal levels are not insignificant in a public health perspective. Results are discussed in the context of psychosocial mechanisms related to social comparison and perceptions of social status that may be applicable in egalitarian welfare states such as Norway.

An analysis of the reach and effectiveness of distance learning in India during school closures due to COVID-19

In India, more than 276 million children and youth were out of school for extended periods since March 2020 due to school closures in response to COVID-19. A key challenge has been how to measure the impact of responses to continuity of learning both to ensure more effective responses in the event of further disruptions, but also to help the education community conceptualize more creative and effective approaches to learning, through blended and flexible approaches. This study reflects on the findings from a UNICEF survey targeting parents and adolescents across 6 states in India, and identifies lessons learned for addressing learning inequities during future school closures. We focus on measuring three key variables – access to technology, their utilization, and perceived learning for different profiles of children. As students began learning from home, technology access rates in households were initially used to determine the estimated maximum reach of different distance learning modalities during school closures. Beyond access, we find significant variations in adolescents’ use of technology for learning purposes and their perceptions of learning, linked to the type of remote learning modality, gender, location and type of school. We discuss the implications for government strategies and policies to ensure better utilization of technologies which are available in households and to address equity gaps in learning opportunities.

Associations of adverse childhood experiences with stress physiology and insulin resistance in adolescents at risk for adult obesity

Adverse childhood experiences (ACEs) heighten the risk for adult obesity and cardiometabolic disease, but physiological factors underlying this connection are not well understood. We determined if ACEs were associated with physiological stress response and insulin resistance in adolescents at risk for adult obesity. Participants were 90 adolescents 12.0-17.5 years (50% female, 30% Hispanic/Latinx), at risk for adult obesity by virtue of above-average body mass index (BMI; kg/m2 ≥ 70th percentile) or parental obesity (BMI ≥ 30 kg/m2 ). ACEs were determined as presence (vs. absence) based upon the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Physiological stress response was measured as heart rate/blood pressure response to the Trier Social Stress Test. Homeostatic model assessment of insulin resistance was determined from fasting glucose/insulin. Sixty-one percent of adolescents reported positive ACE history. The presence of ACEs predicted greater heart rate (p < .001) and diastolic blood pressure (p = .02) response to stress, controlling for age, sex, race/ethnicity, puberty, and BMI standard score. Systolic blood pressure and insulin resistance did not differ by ACE history (p-values > .08). Findings suggest heightened sympathetic stress response in adolescence could be explanatory in how ACEs increase the risk for later cardiometabolic disease. Future studies should characterize ACEs in relationship to day-to-day variations in adolescents' stress physiology and glucose homeostasis.