White Adolescents Research Articles

High Socioeconomic Status Black Adolescents Attend Worse Schools than Whites.

School characteristics - including poverty levels, teacher experience, graduation rates, and college enrollment - are essential determinants of students' academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, Minorities' Diminished Returns (MDRs) theory suggests that Black families may not experience the same benefits of high family SES due to structural barriers. This study examines the association between family SES and school characteristics, focusing on racial disparities in access to high-quality educational environments. To investigate the relationship between family SES (parental education and household income) and multiple school characteristics (poverty, teacher experience, graduation rates, and college enrollment), and to assess racial differences in these associations. Data from the Adolescent Brain Cognitive Development (ABCD) study, a national sample of US adolescents, was analyzed. We used multivariate regression models to examine associations between family SES and school characteristics and to test for interactions by race, specifically comparing Black and White adolescents. Higher family SES was associated with positive school characteristics overall, including lower school poverty, greater teacher experience, and increased graduation and college enrollment rates. However, these positive effects of high family SES on school characteristics were significantly weaker for Black adolescents than for White adolescents. Black adolescents from high-income families were more likely than White adolescents from similar backgrounds to attend schools with higher poverty rates, less experienced teachers, and reduced graduation and college enrollment rates. Our findings highlight persistent racial inequities in access to educational opportunities, even among families with comparable socioeconomic resources. The diminished returns of family SES for Black adolescents underscore the role of structural barriers in limiting access to high-quality schools. These findings emphasize the need for policy interventions to address systemic inequalities that hinder Black families from fully leveraging their SES to access favorable educational environments.

Learning (Not) to Know: Examining How White Ignorance Manifests and Functions in White Adolescents' Racial Identity Narratives.

In critical approaches to the study of whiteness, white ignorance refers to systematic and intentional ways of (not) knowing that function to perpetuate racism. The current critical qualitative analysis examines how white ignorance surfaces in the racial identity narratives of white adolescents (N = 69, Mage = 15.91, SD = 0.49, data collected 2017-2019). Using semi-structured interview data, we identified three manifestations of accommodation to white ignorance: constructing white as disadvantaged, framing race(ism) as unimportant and elsewhere, and the active refusal to know or imagine racial oppression. Alongside this accommodation we also observed a less common but important thread of resistance to white ignorance: seeing (and naming) systemic racism. The findings reveal how white ignorance as a macrosystemic cultural practice becomes embedded in, and strengthened through, the micro-level racial identities of white adolescents. Implications for conceptualizing and contextualizing white racial identity in developmental science are discussed.

Adolescence Does Not Divert Sex Offending Adolescents of Color from Criminal Legal System Involvement.

After the United States Civil War, during Reconstruction, Southern states targeted Black youth and men for incarceration and forced labor, often charging them with rape, spawning the Black male rapist myth. This study explores evidence of a Reconstruction-era ethos in present-day treatment of youth of color accused of sexual assault. Specifically, we examined effects of perpetrator age and race on legal outcomes in 382 alleged child sexual abuse cases. There were 291 adult perpetrators (91% men, M age = 34; 76% White, 20% Black, 2% biracial, 2% Latinx, and 1% Asian) and 91 adolescent perpetrators (96% boys, M age = 14; 73% White, 22% Black, 4% biracial, and 1% Latinx). Supporting hypotheses, adolescent (vs. adult) perpetrators were less frequently arrested or referred for prosecution-but only when they were White. In contrast, for perpetrators of color, being an adolescent (vs. an adult) did not reduce arrest or prosecutorial referral likelihood. Additionally, cases involving adolescents of color (vs. White adolescents) were more immediately criminally investigated. Thus, youthfulness does not proffer protection from criminal legal system involvement for adolescents of color accused of sex offending-evidence of modern and persistent racism rooted in a nation's past.

Girls and Boys Typically Have Similar Math Value Beliefs: Replication Evidence Across Historical Time, High School, and Racial/Ethnic Groups.

Individuals' math value beliefs are theorized to influence who persists in STEM. However, the existing findings on gender differences in adolescents' math value beliefs are inconsistent. The goal of this study was to use three existing datasets to help clarify when gender differences emerge for high school adolescents and for whom (i.e., adolescents across historical time, grade level, and race/ethnicity). Specifically, we examined the extent to which gender differences in adolescents' math value beliefs (i.e., interest, utility, and attainment) replicated (1) across three datasets spanning the 1990s to 2010s, (2) from 9th-12th grade, and (3) within each of the four largest U.S. racial/ethnic groups (i.e., Asian, Black, Latine, and White adolescents). We tested these aims with three existing longitudinal U.S. datasets: the California Achievement Motivation Project (CAMP) (n = 8855), the Childhood and Beyond Study (CAB) (n = 582), and the High School Longitudinal Study (HSLS) (n = 21,000). Students were in high school (9th-12th grade) and half were girls (49%-53%). All three datasets included measures with the same or similar math value belief items, making conceptual replication possible. Overall, we did not find strong evidence for meaningful gender differences in adolescents' math value beliefs overall. We did find meaningful gender differences in the oldest data set (CAB). When examined within each racial/ethnic group, we found no evidence of gender differences in math value beliefs among Black or Latine adolescents, but some differences among Asian and White adolescents. The findings align with the gender similarities hypothesis, suggesting adolescent girls and boys had similar math value beliefs.

Comparison of original and new South African formulae for age estimation in African Black and white children and adolescents using dental and hand-wrist methods.

Methods for age estimation in children involve measurements of: (1) the projections of open apices and tooth heights (T), (2) the total area of the carpal bones and the epiphyses of the ulna and radius (HW), and (3) a combination of these parameters (THW). This study aimed to compare the accuracy of the original formulae for T, HW, and THW in Black South African (BSA) and White South African (WSA) samples of children and adolescents. The sample comprised 556 subjects, 164 BSA (71 males and 93 females) and 392 WSA (171 males and 221 females) aged 6 to 16 years. The main sample comprised 556 subjects and was divided into two parts. The first part was used to develop new formulae specific to the South African population, while the second part, consisting of 183 subjects and referred to as the test sample, was used to evaluate the accuracy of these formulae and to quantify their uncertainty when applied to real cases. Adjusted R2 and standard errors of the estimate (SEEs) were calculated for each regression model. The mean absolute difference or error (MAE) between estimated and chronological age and the percentage of individuals within specific age ranges of ± 0.25, ± 0.5, ± 1, and ± 2 years of chronological age was used to compare the accuracy of formulae. Teeth showed the most significant underestimation in the training sample, -0.49 years in males and - 0.29 years in females, as much as -0.70 years in WSA males, while BSA males were overestimated by + 0.03 years. Combining teeth and hand-wrist, the new formula showed the best performance in age estimation compared to only teeth or hand-wrist, except in WSA males (-0.51 years). New South African-specific formula improved accuracy, especially in males, suggesting their suitability alongside the original Cameriere et al. methods for precise age estimation. The original regression formulae by Cameriere et al., along with the newly developed formulaespecific to South African populations, shows promise for age estimation, considering potential estimation errors and the accuracy rates demonstrated in this study.

Family criminal legal system exposure and early adolescents' pubertal development: The mediating role of family strain.

Pubertal trends, wherein adolescents today are experiencing puberty earlier than prior generations, have coincided with the expansion of the criminal legal system, which is disproportionately impacting communities of color. However, whether pubertal development and criminal legal system exposure among adolescents are inter-related is unknown. We tested whether family members' criminal legal system exposure predicted adolescents' pubertal development, whether family strain explained the relation between criminal legal system exposure and pubertal development, and whether race/ethnicity moderated our results. We used three yearly waves of longitudinal data among a national sample of 9,518 adolescents. Results illustrated that 40% of Black, 20% of Latinx, 16% of Other, and 10% of White adolescents experienced one or more family criminal legal system exposures. In structural equation models within a case-crossover design controlling for measured confounders and unmeasured confounders that do not change over time, including neighborhood-level socioeconomic status and crime, family criminal legal system exposure predicted adolescents' advanced pubertal development, and family strain explained this relation between family criminal legal system exposure and pubertal development. The United States' approach to law and order has public health implications that may be perpetuating health inequities, as accelerated pubertal development can have downstream consequences across the life course.

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.

Factors Associated With Adolescents' Human Papillomavirus Vaccination Intention: A Cross-Sectional Survey.

To examine relationships between hypothesized potential predictors of vaccination and adolescent's Human papillomavirus (HPV) vaccination intention and whether these predictors differed by sex. We also investigated adolescents' experiences and preferences regarding learning about HPV through social media and other technology, to inform future tailored interventions. Cross-sectional research design. 119 adolescents ages 11-17 years who had not received any HPV vaccine were enrolled. Purposive sampling was used to recruit participants from community and clinical settings, with the majority of households located in economically disadvantaged neighbourhoods in a southwest state. Participants completed an anonymous survey. Descriptive statistics, independent t-tests, chi-square test and hierarchical logistic regression were conducted to describe the sample, examine relationships between potential predictors and HPV vaccination intention and investigate sex differences. The mean sample age was 13.76 years (SD = 2.03); 63% female; 42% Hispanic/Latino; 55.5% received free or reduced-price lunch. Compared to White adolescents, Hispanic/Latino adolescents reported higher HPV vaccination intention (AOR = 24.10, CI 95% [3.85-150.82]; p < 0.001). Adolescents who had higher perceived risk of contracting HPV (AOR = 1.89, CI 95% [1.23-2.91]; p = 0.004) and perceived more facilitators (AOR = 1.61, CI 95% [1.22-2.12]; p < 0.001) reported higher HPV vaccination intention. Compared to boys, girls (AOR = 0.28, CI 95% [0.08-0.97]; p = 0.045) had lower HPV vaccination intention. Adolescents also showed strong interest in learning HPV-related issues through digital education. Adolescent HPV vaccination rates in the United States are significantly below the targeted 80% completion goal. Nurses play a critical role in protecting adolescents from HPV infection and related cancers. Digital interventions addressing HPV vaccine-related risks and facilitators and engaging key personnel (adolescent, parent, healthcare provider, teacher) in different settings have the potential to increase adolescent's vaccination intention. Patients or the general public were not involved in the design, analysis or interpretation of the data in this study.

When Common Becomes Normal: Weaker Association Between Neighborhood Stress and Body Mass Index Among Black Adolescents Compared to White Adolescents.

This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents. Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress (defined as a composite score based on three items measuring perceived safety and neighborhood fear) and BMI in adolescents, controlling for demographic and socioeconomic variables. We tested models both with and without interaction terms to assess whether race moderated the association. Stratified analyses were conducted to further explore potential differences between Black and White adolescents. A positive association was observed between neighborhood stress and BMI across the overall sample. However, this association was weaker for Black adolescents compared to White adolescents, even after adjusting for potential confounders. The contribution of neighborhood stress to higher BMI in adolescents may vary by race. Our findings suggest that while neighborhood stress is associated with increased BMI, Black adolescents appear to be less affected by these stressors than their White peers. This weaker association could be due to the normalization of stress in environments where it is pervasive (what is common becomes normal) or the presence of other significant risk factors affecting BMI in Black youth, such as poverty, limited food access, food culture, and food deserts. Future research should explore processes of habituation, inoculation, or even sensitization to stress among Black populations, who are often exposed to a wide range of stressors throughout the life course.

Importance of Community Context in Understanding Substance Use Among Adolescents With Allegations of Maltreatment

This study examined the association between community disadvantage and substance use among adolescents referred to child protective services (CPS) and the interaction role of race/ethnicity in the association between community disadvantage and adolescent substance use. Findings revealed that higher county-level alcohol/drug mortality rates were associated with a higher risk of substance use across non-Hispanic Black, non-Hispanic white, and Hispanic adolescents. An interaction test showed that the association between county-level alcohol/drug mortality rates and risk of substance use was particularly stronger for non-Hispanic Black adolescents compared to non-Hispanic white adolescents. However, county-level vacant housing rates and low median household income did not show a significant association with adolescent substance use across all racial/ethnic groups. Results suggest that practitioners should screen for community-level substance risk levels to prevent substance use among historically marginalized racial-ethnic adolescents involved in CPS.

Does High Self-Control Accelerate Epigenetic Aging in Low-Income Adolescents?

PurposePersistent self-control in the context of upward mobility in low-income adolescents, especially those of color, may have physiological costs, such as greater risks of developing cardiometabolic diseases in young adulthood. One potential mechanism linking self-control to cardiometabolic health is epigenetic age acceleration (EAA). However, little is known regarding the association between high self-control and EAA, as well as what factors may play protective roles. Therefore, we evaluated (1) the association between self-control and EAA and if this association varies by race and ethnicity, and (2) whether neighborhood collective efficacy (NCE) and school connectedness moderate the association in low-income adolescents. MethodsThis study used data from the Future of Families and Child Wellbeing Study. Participants included 772 adolescents with a household income <300% of poverty level (mean age: 15.6 years). Self-control, NCE, and school connectedness were all self-reported. EAA was assessed in saliva and estimated using Horvath, Skin and Blood, and Pediatric-Buccal-Epigenetic clocks. Multiple linear regression and PROCESS analyses were employed. ResultsHigher self-control was positively associated with EAA estimated by the skin and blood clock in low-income adolescents of color. Further, the association of higher self-control with EAA was not significant among low-income adolescents of color with higher NCE. No significant association was found among low-income White adolescents. DiscussionThe results suggest that supportive resources like neighborhood collective efficacy could mitigate adverse associations of high self-control with health in low-income adolescents of color.

Ethnoracial variation in school victimization and adolescent substance use

Adolescent substance abuse is a pressing public health concern. While a large literature has investigated factors linked to adolescent substance use and its outcomes, less research considers the intersection of race-ethnicity, school victimization, and substance use. The present study uses nationally representative data from the 2009–2019 Youth Risk Behavior Surveillance System (n = 66,906) and insights from stress process and critical race perspectives to examine ethnoracial variation in associations between school victimization (i.e., bullied, threatened with a weapon, and feeling unsafe on the way to school) and use of substances (i.e., hard drugs, tobacco, alcohol, and marijuana). Results showed that all victimization measures were associated with significant increases in using all four substances. Compared with whites, Native Americans experienced higher odds of using most substances while Asians and Blacks were generally less likely to use substances. Race-ethnicity moderated victimization-substance use associations, but patterns diverged based on victimization form and substance under consideration. Threats involving a weapon were linked to greater hard drug use for white and Hispanic adolescents than Blacks. School safety concerns were associated with larger increases in Asian adolescents’ hard drug use than whites, Blacks, and Hispanics, and greater marijuana use for Hispanic and white adolescents relative to Blacks. This study complicates the significance of school victimization for substance use such that race-ethnicity factors to a great extent into the presence of associations.

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.

Disordered Eating in Early Adolescence: Disparities Among Minoritised Youth.

Disordered eating in early adolescence impacts development, with long-term health implications. Minoritised adolescents might be at higher risk of disordered eating due to minority stress, but most research has focused on White, heterosexual, cisgender individuals; less is known about disordered eating among minoritised adolescents. We examined sexual, gender, racial, and ethnic identities in relation to disordered eating in early adolescence. Using 2-year follow-up data from adolescents ages 10-14 in the Adolescent Brain Cognitive Development Study (N = 9385), we examined associations between sexual, gender, racial, and ethnic identities and past-2 week disordered eating (preoccupation with weight, weight control behaviors, and binge eating). Compared to heterosexual peers, gay/bisexual adolescents had higher odds of all three outcomes (AOR 1.90-3.32); those "questioning" their sexual identity had higher odds of preoccupation with weight (AOR 1.82) and binge eating (AOR 2.53). Compared to cisgender adolescents, transgender adolescents had higher odds of binge eating (AOR 2.62); those "questioning" their gender identity had higher odds of preoccupation with weight (AOR 2.45). Adolescents whose racial identity was categorised as "Another" had higher odds of preoccupation with weight (AOR 1.46) and weight control behaviors (AOR 1.58) compared to White adolescents. Finally, Hispanic adolescents had higher odds of all disordered eating outcomes than non-Hispanic adolescents (AOR 1.25-1.59). This study is among the first to reveal disparities in disordered eating among minoritised early adolescents. Further examination of these disparities can inform future interventions. Healthcare providers are encouraged to screen for disordered eating, recognising that minoritised early adolescents may be at risk.

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.

Inequalities in the risk and prevention of invasive meningococcal disease in the United States – A systematic literature review

ABSTRACT Vaccination remains the most effective strategy to prevent invasive meningococcal disease (IMD), with MenACWY, MenB and MenABCWY recommended for adolescents/young adults in the United States (US). However, vaccination coverage remains suboptimal, which could be related to population inequalities. To understand the impact of IMD risk, prevention and control inequalities, a global systematic literature review (Medline, Embase, 2012–2022) was conducted on individual, socioeconomic, and environmental inequalities associated with IMD risk, prevention and control in all ages. Studies on IMD risk (n = 15) and prevention (n = 14) inequalities were identified. IMD incidence proportions were higher in Medicaid versus commercially insured populations, and IMD mortality was higher in poorer neighborhoods. White adolescents, adolescents from lower income families, and with lower maternal education were more likely to receive MenB vaccination; while Black and Hispanic adolescents, and adolescents with higher family incomes, were more likely to receive MenACWY vaccination. Meningococcal vaccination was associated with being up-to-date with other vaccinations, having multiple healthcare/well child visits, having a pediatrician as healthcare provider (HCP), and attending private facilities; while being uninsured was associated with lower vaccination. States with a MenACWY vaccination mandate and higher pediatrician-to-children ratios had higher vaccination rates. Important inequalities were due to individual differences, socioeconomic, and environmental factors. IMD prevention is suboptimal, especially among adolescents/young adults. To improve health equity, health policy makers could ameliorate meningococcal vaccination coverage across the US, with simplified and stronger meningococcal vaccine recommendations from public health authorities, and initiatives to enhance parental/patient and HCP knowledge of IMD and vaccine recommendations.

8768 Initiation of Exogenous Sex Hormones in a Pediatric Gender Clinic

Abstract Disclosure: C.M. Roberts: None. M.M. Knoll: None. G. Robertson: None. A. Egan: None. C. Moser: None. Introduction: The demographics of patients seeking care for gender dysphoria have changed significantly since care was started in 1987. The criteria for prescribing sex hormones have also evolved to allow a greater range of patients to receive gender-affirming hormones. We examined factors associated with prescription of gender-affirming hormones to patients presenting for gender-affirming care our clinic. Methods: Secondary analysis of sex hormone initiation as a minor among 14-17-year-old adolescents diagnosed with gender dysphoria, seen in the pediatric gender clinic between 2/19/2018 and 7/20/2022. We extracted demographic variables, appointment dates, and sex hormone prescription data from our electronic medical record. We collected patient reports of gender identity and suicidal behavior, and parent and adolescent reports of general adolescent well-being, months of gender dysphoria and social transition, and parental support for the adolescent’s gender identity from electronic clinic surveys. Results: We identified 273 adolescent-parent dyads with complete data. Most of our sample were assigned female at birth (74.4%), transgender male (59.3%), and white (83.5%) adolescents who lived in urban (86.4%) and lower-middle-income (64.5%) areas. The average age was 15.9+/-1.1 years. A minority of adolescents reported recent suicidal ideation 60/273 (22%), and prior suicide attempts 20/273 (7%). Parents reported a shorter duration of gender dysphoria (-16.7 months (95%CI: -22.0, -11.5)) and social transition (-4.7: -6.5, -3.0), and higher levels of parental support than adolescents. Approximately half, 146/273 (53.5%), of adolescents started sex hormones. The average age at initiation was 16.5 years +/- 0.9. Age at presentation, length of gender dysphoria or social transition, and the presence of suicidal ideation or attempts were not associated with initiation of sex hormones. Assigned males (OR:1.82:95%CI 1.04, 3.19), adolescents with higher parent-reported parental support for the adolescent’s identity (1.03:1.01, 1.04), and adolescents with private insurance rather than Medicaid (Blue Cross- 5.39:2.73, 10.64) were more likely to start sex hormones as a minor. Conclusion: Published criteria for the initiation of sex hormones among adolescents with gender dysphoria, including age, persistence of dysphoria, and the presence of suicidality, did not predict the prescription of sex hormones to minors in our clinic. Parent-reported support for the adolescent’s gender identity played a small role in predicting the prescription of hormones, but male sex assigned at birth and having private health insurance played larger roles. Further exploration of these findings is needed to ensure equity in the treatment of gender dysphoria. Presentation: 6/3/2024

Inequities in sleep duration and quality among adolescents in Canada

BackgroundSeveral recent global events may have impacted adolescent sleep and exacerbated pre-existing disparities by social positions (i.e., social roles, identity or sociodemographic factors, and/or group memberships that are associated with power and oppression due to the structures and processes in a given society at given time). Current understanding of sleep among adolescents is critical to inform interventions for a more equitable future, given the short and long-term consequences of inadequate sleep on health and well-being. This study aimed to provide contemporary evidence on sleep disparities by key social positions among adolescents in Canada.MethodsCross-sectional analyses were conducted using self-reported data collected during 2020–2021 (the first full school year after the COVID-19 pandemic onset) from 52,138 students (mean [SD] age = 14.9 [1.5]) attending 133 Canadian secondary schools. Multiple regression models were used to test whether sleep quality (how well students slept during past week), duration (weekday, weekend, weighted daily average), and guideline adherence (8–10 h/day) differed by sex and gender, race and ethnicity, and socioeconomic status (SES).ResultsFemales reported a mean [95% CI] difference of -1.7 [-3.7, 0.4] min/day less sleep on weekdays than males, but 7.1 [4.5, 9.6] min/day more sleep on weekends, resulting in no difference in average daily sleep between males and females. Females were less likely to report good quality sleep compared to males (AOR = 0.57 [0.54, 0.60]). SES followed a generally monotonic trend where higher scores were associated with more sleep on weekdays (Δhighest: lowest = -28.6 [-39.5, -17.6]) and weekends (Δhighest: lowest = -17.5 [-3.8, -31.2]) and greater likelihood of higher sleep quality (AORhighest: lowest = 3.04 [2.35, 3.92]). Relative to White adolescents, weekday and average daily sleep duration were lower among all other racial identities; mean differences ranged from ∼ 5–15 min/day, with Black students reporting the least sleep.ConclusionsDifferences in sleep duration and quality were most profound among adolescents from the lowest and highest SES. Racial disparities were more evident on weekdays. Compensatory weekend sleep appears more pronounced in females than males. Addressing sleep inequities is critical, as a robust predictor of multiple health outcomes.

Racial and ethnic differences in transfusion rates in adolescent scoliosis surgery: Preoperative anemia as a mediator of disparity.

Pediatric patients from minoritized racial and ethnic groups receive red blood cell (RBC) transfusions more frequently while undergoing major surgical procedures. Our objective was to identify the contribution of preoperative anemia to racial and ethnic differences in RBC transfusion rates in adolescent spine surgery. This is a multicenter, retrospective cohort study of the National Surgical Quality Improvement Program Pediatric database, 2016 to 2021 for patients in the United States and Canada. Adolescents identifying as non-Hispanic Black, Hispanic, and other race/ethnicity presented with higher rates of preoperative anemia than non-Hispanic White adolescents (16.3%, 10.6%, and 9.9%, vs. 7.8%, respectively; p < .0001) and were transfused at higher rates (14.4%, 11.9%, 16.5%, vs. 10.0%, respectively; p < .0001). Minoritized groups demonstrated higher adjusted odds of RBC transfusion compared with non-Hispanic Whites (non-Hispanic Black: aOR 1.45 95% CI 1.26-1.65, Hispanic: aOR 1.17 95% CI 0.96-1.41, other race/ethnicity: aOR 1.63 95% CI 1.26-2.09). Of the total effect of minoritized race and/or ethnicity on RBC transfusion, 13.9% was attributed to the indirect effect through preoperative anemia. In this cohort study, patients from minoritized racial and ethnic groups received RBC transfusions at a higher rate than non-Hispanic White patients, and the difference was partially mediated by preoperative anemia. Future efforts to minimize transfusions and improve health equity should target this modifiable risk factor alongside other sources of disparity and discrimination.

Racial/ethnic differences in the acute effects of reduced nicotine content cigarettes among adolescents who smoke

ObjectiveReducing the nicotine content in cigarettes decreases their addictiveness and abuse liability, including among adolescents. Whether these effects differ by race/ethnicity is unknown. This study is a secondary analysis of previously published data collected between 2014–2017. We examined racial/ethnic differences in the effects of smoking cigarettes with varying nicotine content levels on subjective effects and tobacco withdrawal among adolescents who smoke daily. MethodsAcross two counterbalanced sessions, 50 adolescents recruited from Rhode Island (ages 15–19; 30 % Underrepresented Minorities [URM], 20 % Asians and Pacific Islanders [API]; 50 % Non-Hispanic Whites) self-administered a very low nicotine content (VLNC; 0.4 mg nicotine/g of tobacco) or normal nicotine content control (NNC; 15.8 mg/g) research cigarette following overnight abstinence. Subjective effects were reported post-administration and tobacco withdrawal outcomes were calculated from pre- to post-administration scores. Multilevel linear models tested main and interactive effects between cigarette nicotine content and race/ethnicity on all study outcomes. ResultsParticipants reported lower positive subjective effects and reductions in smoking urges after smoking a VLNC cigarette relative to smoking an NNC cigarette (ps < 0.01). A main effect of race/ethnicity emerged, such that API (vs. URM and White) adolescents reported lower positive subjective effects, greater craving reduction, and higher cigarette aversion after smoking, regardless of nicotine content (ps < 0.05). Significant interactions were found between race/ethnicity and nicotine content for cigarette aversion, such that API adolescents rated VLNC (vs. NNC) cigarettes as less aversive than White and URM adolescents did (p = 0.03). ConclusionsFindings provide evidence that VLNC cigarettes may reduce abuse liability and tobacco withdrawal symptoms for adolescents across racial/ethnic groups and particularly for API youth.