Lower Socioeconomic Status Youth Research Articles

Characteristics of Youth Presenting for Gender Care Compared to Background Populations: Examination of Social Determinants of Health.

Purpose: Transgender and gender diverse (TGD) youth in North American clinical reports are predominantly White with relatively high socioeconomic status suggesting that access to gender-affirming care is inequitable. This study examined whether socioeconomic and social determinant of health discrepancies exist between a clinical population of TGD youth and surrounding communities. Methods: Patient postal codes were used to link the Ontario Marginalization Index (ON-MARG) to a clinic-based TGD youth cohort (n = 298). Using ON-MARG, each patient was assigned a quintile score from 1 (least marginalized) to 5 (most marginalized) on four marginalization measures. Mean quintile scores were compared to background populations. Census-based Toronto neighborhood-level data on ethnic diversity and educational status were also examined. Neighborhoods were categorized as highly represented, less represented, or unrepresented based on representation in the clinic cohort. One-way analysis of covariance was used to determine associations between neighborhood-level variables and the degree of neighborhood representation. Results: ON-MARG data demonstrated that clinic patients hailed from areas with more individuals having paid employment. Patients from Toronto and surrounding areas came, in general, from communities with fewer recent immigrants and visible minorities. Highly represented Toronto neighborhoods had smaller proportions of visible minorities and immigrants compared with less and unrepresented neighborhoods. Educational status, represented by adults with bachelor's degrees, was lower among unrepresented neighborhoods. Conclusion: TGD youth seen in clinic, particularly those from Toronto, are disproportionally White and socioeconomically advantaged. Further research is needed to better understand the underrepresentation of racialized and low-socioeconomic status youth and to inform strategies to improve access to care.

B - 11 Early Life Traumatic Brain Injury Constrains the Benefits of High Socioeconomic Status on White Matter Microstructure and Language.

We examined contributions of socioeconomic status (SES) and Traumatic Brain Injury (TBI) to change in language and white matter microstructure (WMM) during adolescence. Data are from 11,876 youth with baseline assessment (T1) and 24-month follow-up (T2) in the Adolescent Brain Cognitive Development study (general community sample). TBI data were from the parent-reported Ohio State TBI Identification Method. Language was measured using the NIH-toolbox picture-vocabulary test. TBI cases, with complete data, were nearest-neighbor propensity score matched with non-TBI cases considering handedness, income, race, age, sex, and diffusion tensor imaging quality (N-analyses = 141). WMM in the uncinate fasciculus (UF) was assessed using fractional anisotropy (FA). Analyses were conducted using nested linear models accounting for dependencies, age, sex, and handedness. TBI was not independently associated with language or WMM at T1 (mean age in months (MA) = 118.8) or T2 (MA = 142.8) (all p > 0.05). TBI and SES interacted in association with T1 UF-FA (p = 0.03, CI = -0.05, -0.02). Low SES youth did not differ in T1 UF-FA. Among high SES youth, those without TBI had higher UF-FA (p = 0.04). A 3-way interaction between SES, TBI and change in UF-FA between T1 and T2 in predicting language emerged (p = 0.01, CI = 0.12, 1.06). Youth with moderate-to-high levels of UF change did not differ in language. For youth with low increases in UF, SES and language were positively associated only in youth without TBI (p = 0.0003). TBI does not have a direct effect on adolescent WMM or language but interacts with SES and WMM to blunt benefit of SES on language.

An exploration of risk factors in a community sample of low socioeconomic status youth in South Africa

Youth in low socioeconomic status communities experience multiple risks which disrupts their emotional, cognitive, and psychological development. In South Africa, there is a tacit acceptance of risk constructs as researched globally. This study examines risk occurrence with the aim of identifying and examining the uniqueness of risks in a community sample of youth. Data were collected from youth and their maternal caregivers through interviews and standardized instruments. Youth from grade 7 and grade 10, 9 to 18 years ( M = 13.11; SD = 1.54) were recruited. Sixty-five percent were female. Thirty-five frequent risk factors were identified using a z-test for proportion of means. Five risk factors, namely, low household income, race, English not being the primary home language of the parent, low maternal self-esteem, and low dyadic satisfaction, emerged as significant risks. Other risk factors (e.g., single-parent household), which feature prominently in international studies, did not emerge as significantly present. While risk occurrence in our sample shares commonalities with international trends, our study further highlights how risk is underscored and shaped by South Africa’s socioeconomic and political history. We argue that traditional concepts, like family, race, and language require conceptual review when undertaking research and developing policies and interventions that are relevant to South African communities.

Expanding the use of patient-reported outcomes (PROs): Screening youth with type 1 diabetes from underrepresented populations

AimYouth from lower socioeconomic status (SES) have suboptimal type 1 diabetes (T1D) outcomes. Patient reported outcomes (PROs) measure psychosocial states and are associated with T1D outcomes, however are understudied in low SES youth. We aimed to evaluate associations between PROs and public insurance status, a proxy for low SES. MethodsWe analyzed survey data from 129 youth with T1D (age 15.7 ± 2.3 years, 33 % publicly insured) screened with PROMIS Global Health (PGH, measuring global health) and Patient Health Questionnaire (PHQ-9, measuring depressive symptoms) during diabetes appointments. Correlation and regression analyses evaluated differences in PGH and PHQ-9 by insurance status. ResultsFor youth with public insurance, lower global health correlated with lower self-monitoring blood glucose (SMBG; r = 0.38,p = 0.033) and older age (r = −0.45,p = 0.005). In youth with private insurance, lower global health correlated with lower SMBG (r = 0.27,p = 0.018) and female sex (rho = 0.26,p = 0.015). For youth with private insurance, higher depressive symptoms correlated with higher body mass index (r = 0.22,p = 0.03) and fewer SMBG (r = −0.35,p = 0.04). In multivariate regression analyses, public insurance was inversely associated with global health (p = 0.027). ConclusionPGH is a particularly salient PRO in youth with public insurance. Global health may be an important psychosocial factor to assess in youth with T1D from low SES backgrounds.

The Current Youth Sport Culture and its Impact on Sport Participation Experiences of Low Socioeconomic Status Families

Purpose: The rise of sport specialization can jeopardize the opportunities for families of low socioeconomic status (SES) to participate in organized sport. However, obtaining an athletic scholarship may be a motivating factor for low SES youth to sport specialize. Yet, the experiences of low SES athletes in sport participation are not well known. Method: We used an Interpretative phenomenological analysis (IPA) to explore experiences of low SES families with children participating in sport and how this may be impacted by the current youth sport culture that promotes sport specialization. We engaged in semi-structured interviews with 12 low SES parents. Results: The following 4 interrelated themes emerged: (a) Benefits of youth sport participation, (b) Negatives and/or barriers to youth sport participation, (c) Strategies to get involved in youth sport, and (d) Facilitators for youth sport participation. Conclusions: Findings indicate that while low SES youth sport parents are motivated to involve their children in sports, there are many barriers that hinder their opportunities for their child to participate in organized sports. These issues are exacerbated by the current youth sport culture which emphasizes sport specialization with very few existing facilitators to involve their child in organize sport.

Review of Use Prevalence, Susceptibility, Advertisement Exposure, and Access to Electronic Nicotine Delivery Systems among Minorities and Low-Income Populations in the United States.

Increased use of electronic nicotine delivery systems (ENDS) and improper disposal after use pose a public health and an environmental justice (EJ) concern if use prevalence is disproportionately high among minorities and people of low socioeconomic status (SES) (broadly termed “EJ populations” for the purposes of this review). This review synthesizes literature on demographic patterns of use prevalence, susceptibility, advertisement exposure, and access to ENDS, and extrapolates environmental tobacco exposure (ETE) from ENDS among EJ populations. Seven electronic databases were searched using ENDS-related terms. We included studies published between 2017 and May 2020 that described ENDS use prevalence, susceptibility to ENDS use, advertisement exposure, and access to ENDS by race, ethnicity, or SES. Data synthesis was based on the assumptions that ETE increases with high use prevalence, susceptibility may influence future use, and advertisement exposure and access may impact demographic differences in use. We identified 32 studies describing use prevalence, susceptibility, advertisement exposure, or access to vape shops and other tobacco retail outlets by race/ethnicity or SES. We found higher prevalence of ENDS use among non-Hispanic Whites and inconclusive use patterns by SES. Patterns of susceptibility to use, advertisement exposure, and access were also mixed, with slightly higher outcomes observed among low SES youth. However, the evidence base on advertisement exposure was limited, with limited generalizability. Our findings indicate low prevalence of ENDS use among EJ populations. While this suggests low potential ETE among these groups, mixed outcomes on susceptibility, advertisement exposure, and access to ENDS among low SES groups may affect future ENDS use and ETE. Educational campaigns that discourage ENDS uptake should target EJ youth. Initiatives aimed at managing vape shop presence in EJ communities and monitoring targeted advertisement are also needed.

Working Harder than Others to Prove Yourself: High-Effort Coping as a Buffer between Teacher-Perpetrated Racial Discrimination and Mental Health among Black American Adolescents.

High-effort coping (feeling like one must work harder than others to succeed due to anticipated discrimination) is an understudied concept in adolescence. The current study examined among Black American adolescents surveyed in eighth and 11th grade (N = 630, 49% female) how high-effort coping moderated the relations between teacher-perpetrated racial discrimination and psychological distress across time, and whether the buffering role of high-effort coping varied by adolescent gender and socioeconomic status. Experiencing racial discrimination from teachers in eighth grade was positively related with depressive symptoms, anger, and suicidal ideation in 11th grade. High-effort coping buffered against teacher discrimination for suicidal ideation among low socioeconomic status youth, as well as for anger among high socioeconomic status youth. Findings underscore the harmful influence of racial discrimination on Black American adolescents' mental health, as well as suggest that among certain subpopulations, high-effort coping may be one psychologically protective resource through which Black American youth retain positive feelings that are undermined by racial discrimination, and thus promote mental well-being.

Examining Truth and State-Sponsored Media Campaigns as a Means of Decreasing Youth Smoking and Related Disparities in the United States.

To analyze the impact of Truth and state-sponsored anti-tobacco media campaigns on youth smoking in the United States, and their potential to reduce tobacco-related health disparities. Our study included data from the 2000-2015 Monitoring the Future study, an annual nationally representative survey of youth in 8th (n = 201 913), 10th (n = 194 468), and 12th grades (n = 178 379). Our primary exposure was Gross Rating Points (GRPs) of Truth or state-sponsored anti-tobacco advertisements, from Nielsen Media Research. Modified Poisson regression was used to assess the impact of a respondent's GRPs on smoking intentions, past 30-day smoking participation, and first and daily smoking initiation. Additive interactions with sex, parental education, college plans, and race/ethnicity were used to test for differential effects of campaign exposure on each outcome. Greater campaign exposure (80th vs. 20th GRP percentile) was associated with lower probabilities of smoking intentions among 8th graders, smoking participation among 8th and 12th graders, and initiation among 8th graders. Greater exposure was associated with a greater reduction in the likelihood of smoking participation among 10th and 12th grade males than females; 10th and 12th graders with parents of lower education versus those with a college degree; and 12th graders who did not definitely plan to go to college relative to those who did. Media campaign exposure was associated with a lower likelihood of youth smoking behaviors. Associations were more pronounced for groups disproportionately affected by smoking, including youth of lower socioeconomic status. Media campaigns may be useful in reducing smoking disparities and improving health equity. Few recent studies have investigated the impact of anti-tobacco media campaigns on youth smoking and their potential to reduce tobacco-related health disparities in the United States. We found media campaigns-specifically state-sponsored media campaigns-reduced the likelihood of several smoking outcomes among youth, with some evidence that they mitigate disparities for disproportionately affected groups.

Diabetes distress and HbA1c in racially/ethnically and socioeconomically diverse youth with type 1 diabetes.

Diabetes distress, the emotional burden of caring for the chronic demands of diabetes, has not been well described in children and preadolescents with type 1 diabetes (T1D). This gap is particularly evident among youth of lower socioeconomic status (SES) and/or racial/ethnic minorities. Since these groups are more likely to have disparities in health outcomes and healthcare related to their diabetes, factors that could potentially improve glycemic and other diabetes-related outcomes should be studied closely. We hypothesized that (a) diabetes distress levels would be elevated in children with markers of lower SES and those of racial/ethnic minorities, and (b) higher HbA1c would be predicted by higher diabetes distress levels, when controlling for race/ethnicity, SES, and clinical covariates. One hundred and eighty-seven youth age 9 to 13 with T1D completed age-appropriate Problem Areas in Diabetes (PAID) questionnaires using a web-based portal during routine diabetes care visits. PAID scores were significantly elevated in youth who had surrogate markers of lower SES and who were from racial/ethnic minority backgrounds. In multivariate models including race/ethnicity or the SES variables and controlling for clinical covariates, the factor most predictive of higher HbA1c was elevated PAID score. Diabetes distress is elevated in a younger population of children with T1D who are from racial/ethnic minority backgrounds or have markers of lower SES. Interventions that target distress and/or expand the safety net in these populations could potentially improve glycemic outcomes.

Exploring Dietary Behavior Differences among Children by Race/Ethnicity and Socioeconomic Status.

In Spartanburg County, SC, nearly 33.7% of children are overweight or obese. The purpose of this study was to investigate differences in eating behavior of youth by race/ethnicity and socioeconomic status. Students (N=997) in 4th to 5th grades completed the School Nutrition and Physical Activity Survey. School databases categorized students as either White or racial/ethnic minority and free/reduced or full paid lunch status. Dietary behaviors included 13 composite measures: unhealthy proteins, healthy proteins, dairy, refined grains, whole grains, vegetables, fruit, fried snacks, sugar-sweetened beverages, sweets, and consumption of a breakfast, evening, and/or restaurant meal. Logistic regression, controlling for sex, was used to analyze differences in consumption for each nutrition variable. Minority youth were less likely to consume healthy proteins (odds ratio [OR]=0.71, 95% confidence interval [CI]=0.55-0.92) and more likely to eat at a restaurant (OR=1.32, 95% CI=1.02-1.70) compared to white youth. Lower socioeconomic status youth were less likely to eat an evening meal compared to higher socioeconomic status youth (OR=0.59, 95% CI=0.39-0.89). Differences in dietary behaviors may result from food accessibility and insecurity in minority and/or low-income neighborhoods. Future research should explore policy strategies that can help ensure all youth maintain healthy eating habits and weight status.

The Prevalence of Pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in a Community‑Based Sample.

Most pediatric prevalence studies of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been based upon data from tertiary care centers, a process known for systematic biases such as excluding youth of lower socioeconomic status and those less likely to have access to health care. In addition, most pediatric ME/CFS epidemiologic studies have not included a thorough medical and psychiatric examination. The purpose of this study was to determine the prevalence of pediatric ME/CFS from an ethnically and sociodemographically diverse community-based random sample. A sample of 10,119 youth aged 5-17 from 5622 households in the Chicagoland area were screened. Following evaluations, a team of physicians made final diagnoses. Youth were given a diagnosis of ME/CFS if they met criteria for three selected case definitions. A probabilistic, multi-stage formula was used for final prevalence calculations. The prevalence of pediatric ME/CFS was 0.75%, with a higher percentage being African American and Latinx than Caucasian. Of the youth diagnosed with ME/CFS, less than 5% had been previously diagnosed with the illness. Many youth with the illness have not been previously diagnosed with ME/CFS. These findings point to the need for better ways to identify and diagnose youth with this illness.

Process Evaluation of Training Model for School-Based Mental Health

There is a need to examine collaborative mental health practices in geographic regions serving high populations of under-represented minority and low socio-economic status youth in order to reduce the barriers in access to care and support. In response, a counselor education program at a large land-grant university in the Southwestern United States worked in collaboration with a local school district to create a school-based mental health program. The program provides no-cost and timely mental health counseling services to students and their families using a practicum training model. This article presents process evaluation data that examine program level functioning during the implementation stage of the training model. Implications for program improvements in the next phase of implementation are discussed as well as implications of this type of service delivery model within the context of counselor education and social justice.

A belief in socioeconomic mobility promotes the development of academically motivating identities among low-socioeconomic status youth

ABSTRACT Despite barriers to educational attainment, low-SES youth often maintain strong academic intentions and performance if they continue to view school as important for obtaining the desired futures they envision for themselves. We undertook three related studies to examine the importance of one aspiration central to the desired futures of many low-SES youth: attaining upward socioeconomic mobility. Cross-sectional, longitudinal (Study 1), and experimental data (Study 2) demonstrate that low-SES youth’s beliefs about their likelihood of attaining mobility affects their likelihood of envisioning futures that hinge on educational attainment, which ultimately predict their academic intentions and performance. Study 3 then tests a novel intervention for promoting the adoption of education-dependent futures among low-SES youth: highlighting multiple viable school-based paths to future mobility.

Working with incarcerated indigenous and low socioeconomic status youth and their teachers to improve learning outcomes in mathematics

This research addresses an important problem related to Indigenous and low Socioeconomic status (SES) disadvantage in education and the increasing numbers of Indigenous and low SES young people involved in detention in the juvenile justice system. These groups have historically underachieved in mathematics. They continue to experience lower than expected achievement in the subject which limits their engagement in learning and future educational opportunities, and this reality presents new challenges for teachers. The project draws on two conceptual frameworks to advance knowledge about mathematics teaching and incarcerated and low SES young people’s learning. It is based on decolonising methodology in that it collaborates with Indigenous and low SES young people and teachers and focuses on improving learning outcomes (ensuring that the researched benefit). The researchers conducted a cohort study involving one hundred and twenty incarcerated young people and a mathematics teaching team of ten teachers who participated in the first eighteen months of a three-year study. Students were administered mathematics diagnostic tasks before and at the completion of the first year of the study, participated in focus group interviews and completed an efficacy survey. Teachers participated in lesson modelling, semi-structured interviews, focus group interviews and were also administered an efficacy survey. Students indicated their preferred approach to learning mathematics and the types of support they required. Teachers provided a range of instructional strategies to support students and included making reasonable adjustments and differentiation in their instruction. Teachers were identified as drawing on a range of curricula to support the young people. Such curricula included the Australian Core Skills Framework and the Basic Key Skill Builder.

Socioeconomic status is associated with the prevalence and co-occurrence of risk factors for cigarette smoking initiation during adolescence.

To investigate whether the prevalence or co-occurrence of risk factors for cigarette smoking initiation differ by socioeconomic status (SES) and whether SES interacts with risk factors to increase initiation. In 2005, 1451 5th grade never smokers (mean age 10.7years) in Montréal, Canada, provided baseline data, with follow-up in 6th and/or 7th grade (2005-2007). Poisson regression analyses estimated the association between 13 risk factors and initiation. Excess risk of each risk factor in low vs. moderate-high SES participants was assessed. Cigarette smoking was initiated by 9.4% of participants (n=137). Low SES was associated with a higher prevalence and co-occurrence of risk factors. The estimated association of most risk factors with initiation was similar across SES, although participants from low SES neighborhoods whose mothers had no university education had three times the risk of initiation [ARR=3.10 (1.19, 8.08)] compared to more affluent peers. Tobacco control efforts must address the higher prevalence and co-occurrence of risk factors in lower SES contexts since these may render initiation highly probable in many lower SES youth.

School-Based Health Centers and Adolescent Substance Use: Moderating Effects of Race/Ethnicity and Socioeconomic Status.

School-based health centers (SBHCs) have been associated with many positive health and academic outcomes. The current study extends previous research and examines possible differences in the association between SBHC exposure and adolescent alcohol, tobacco, and other drug use by race/ethnicity, sex, and socioeconomic status (SES). California Healthy Kids Survey data from 504 traditional high schools in California were linked with publicly available data on SBHCs and school demographics. Multilevel logistic regression analyses were conducted controlling for school and individual characteristics. Significant interactions suggest that SBHC exposure was inversely associated with past 30-day alcohol use, binge drinking, and cigarette and e-cigarette use among African American youth and negatively associated with cigarette and marijuana use among Asian youth, relative to whites. There was also a significant interaction between SBHC exposure and parent education for past 30-day alcohol use and binge drinking. No significant sex interactions were observed. SBHC exposure appears to be inversely related to substance use among youth in some ethnic minority groups and youth of lower SES. This may have implications regarding SBHC placement and investment. Additional research is necessary to understand the mechanisms through which SBHCs may influence adolescent substance use and other health behaviors.

Reducing tobacco use among low socio-economic status youth in Delhi, India: outcomes from project ACTIVITY, a cluster randomized trial.

To test the efficacy of an intervention to reduce tobacco use among youth (10-19 years old) in slum communities in Delhi, India. This community-based cluster-randomized trial included 14 slums composed of purposely built resettlement colonies and adjacent inhabitant-built Jhuggi Jhopris. Youth in the intervention received a 2 year multiple-component intervention: (a) youth and adult leader training; (b) peer-led interactive activities and outreach; (c) tobacco cessation camps; and (d) enforcement of India's Tobacco Control Law (smoke-free environments and youth access). Overall, no differences between the intervention and control conditions were observed over time; self-reported tobacco use declined in both groups. However, when stratified by type of residence, a significant decrease was observed among youth in the resettlement colonies in the intervention group for overall tobacco use (slope = -0.69) and cigarette and bidi smoking (slope = -0.66), compared to an increase in the control group (slope = 0.24 and 0.12, respectively) (P < 0.001). No differences in smokeless tobacco (SLT) use were observed for either group. Comprehensive community-based interventions that engage youth can be effective in reducing smoking among disadvantaged youth in India. More intensive interventions, like tax increases or large-scale media campaigns, appear warranted for the most marginalized in this context and for SLT products.

Developing Mobile Apps for Physical Activity in Low Socioeconomic Status Youth

Kacie C.A. Blackman, PhD, Jamie Zoellner, PhD, RD, D. Scott McCrickard, PhD, Judith Harlow, MS, Woodrow W. Winchester III, PhD, Jennie L. Hill, PhD, Wen You, PhD, Paul A. Estabrooks, PhD Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Department of Human Nutrition Foods, & Exercise, Virginia Tech, Blacksburg, VA, USA; Fralin Translational Obesity Research Center, Virginia Tech, Blacksburg, VA, USA; Department of Computer Science, Virginia Tech, Blacksburg, VA, USA; Department of Industrial & Systems Engineering, Virginia Tech, Blacksburg, VA, USA; Department of Systems & Industrial Engineering, Kennesaw State University, Kennesaw, GA, USA; Department of Agricultural & Applied Economics, Virginia Tech, Blacksburg, VA, USA; Department of Family Medicine, Virginia Tech Carilion Medical School, Roanoke, VA, USA Corresponding Author: kblackma@usc.edu

“I Am So Bored!”: Prevalence Rates and Sociodemographic and Contextual Correlates of High Boredom Among American Adolescents

Adolescent boredom is associated with maladaptation and negative developmental outcomes, yet little is known about the prevalence and correlates of high boredom. Drawing from a broad psychosocial framework, the present study examined rates of high boredom and sociodemographic and contextual correlates among nationally representative samples of 8th and 10th graders ( N = 21,173; 51.8% female) from the Monitoring the Future survey. Results indicate that approximately 20% of adolescents reported high levels of boredom. Those who were more likely to report high boredom were eighth graders; females; youth who identified as Black, Biracial, or Native American/Native Hawaiian/Pacific Islander; rural youth; and youth of lower socioeconomic status. Results of multivariable logistic regression analyses show significant associations between high boredom and many elements of school, parent, peer, and extracurricular contexts, controlling for sociodemographic characteristics. Findings highlight the pervasiveness of high boredom among American youth and may benefit prevention and intervention efforts by identifying multiple contextual associations with adolescent boredom.

Do Social Resources Protect Against Lower Quality of Life Among Diverse Young Adolescents?

We examined whether social resources from the family and the community moderate the risk associated with low socioeconomic status (SES) for reduced quality of life (QL) among youth across racial/ethnic groups. Data were from 4,824 fifth-grade youth (age [Formula: see text] = 11.1, SD = 0.6; 49% females) in the Healthy Passages™ study (2004-2006) located in Birmingham, Alabama; Los Angeles County, California; and Houston, Texas. Youth reported their QL using the Pediatric Quality of Life Inventory Version 4.0 and the Global Self-Worth subscale of the Self-Perception Profile and their status for hypothesized protective social mechanisms. Overall, family cohesion, parental nurturance, other adult, and peer support were positively associated with QL across racial/ethnic groups. There were few significant interactions, but all suggested that higher SES youth benefited more than lower SES youth. In fact, family cohesion among African American youth and other adult support among Hispanic youth differentiated QL at higher, but not lower SES. Further research should examine other risk contexts and seek to inform targeted prevention efforts.