Health behavior changes in adolescence and young adulthood: Implications for cardiometabolic risk

Midlife diseases of despair and cardiometabolic risk: testing shared origins in adolescent psychopathology

BACKGROUND

Rising midlife mortality in the United States is largely attributable to 'deaths of despair' (deaths from suicide, drug poisonings, and alcohol-related diseases) and deaths from cardiometabolic conditions. Although despair- and cardiometabolic-related mortality are increasing concurrently, it is unclear whether they share common developmental origins. We tested adolescent psychopathology as a potential common origin of midlife diseases of despair and cardiometabolic risk.

METHODS

Participants (N = 4578) were from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative cohort followed from adolescence to early midlife. Adolescent psychopathology included depression, anxiety, eating disorders, PTSD, conduct disorder, and ADHD at ages 11-18. Diseases of despair (suicidality, substance misuse, pain, and sleep problems) and cardiometabolic risk (hypertension, hyperlipidemia, high-risk waist circumference, diabetes, and cardiovascular conditions) were multi-modally measured at ages 33-43.

RESULTS

At midlife, adolescents who experienced psychopathology exhibited more indicators of despair-related diseases and cardiometabolic risk (IRRs = 1.67 [1.46-1.87] and 1.13 [1.04-1.21], respectively), even after accounting for demographics, adolescent SES, and adolescent cognitive ability. Associations were evident for internalizing and externalizing conditions, and in a dose-response fashion. In mediation analyses, low education explained little of these associations, but early-adult substance use explained 21.5% of psychopathology's association with despair-related diseases. Midlife despair-related diseases and cardiometabolic risk co-occurred within individuals (IRR = 1.12 [1.08-1.16]). Adolescent psychopathology accounted for 8.3% of this co-occurrence, and 16.7% together with adolescent SES and cognitive ability.

CONCLUSIONS

Adolescent psychopathology precedes both diseases of despair and cardiometabolic risk. Prevention and treatment of psychopathology may mitigate multiple causes of poor midlife health, reducing premature mortality.

Sleep, Affect, and Emotion Reactivity in First-Year College Students: A Daily Diary Study

BACKGROUND

Sleep is an important factor in well-being, especially during the transition to college when academic and social commitments increase. Identifying factors that contribute to poor sleep (including short duration and increased variability in duration) can support development of interventions. Affect and emotion reactivity are factors that could contribute to sleep, and have not been studied in relation to sleep variables among first-year college students during their adjustment to the college environment. This adjustment might be difficult for some students, and therefore elicit affect fluctuations that contribute to poor sleep. Alternatively, sleep could contribute to daily affect. The present daily diary study examined bidirectional relations between daily sleep and affect, as well as between emotion reactivity and sleep (duration and variability) and affect (daily and overall variability) in first-year college students.

METHOD

First-year college students (n = 244; 86.1% female) completed a baseline survey including measures of emotion reactivity and anxiety and depressive symptoms, followed by 7 days of a once-per-day diary, reporting on their affect and sleep duration.

RESULTS

On days when individuals reported increased sleep duration, they also tended to experience greater positive affect the following day (p = .01). Those who experienced high levels of emotion reactivity also experienced more negative affect (p < .001) and negative affect variability (p < .001).

CONCLUSION

Emotion reactivity might identify college students who experience more negative affect and are possibly at risk to develop mental health disorders. The importance of sleep health should continue to be emphasized to students as they transition to college.

Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members

Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW's mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW's health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study's findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW's diverse gender identities and expressions; (2) focusing on SMW's nonbinary stressors; (3) formulating SMW's gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW's lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions, to best respond to the unique needs of this population.

Daily stress and eating behaviors in adolescents and young adults: Investigating the role of cortisol reactivity and eating styles

Stress-related eating has been well documented in previous literature. However, there is limited research investigating the role of cortisol reactivity in daily stress-eating associations in samples of adolescents and young adults. 123 participants completed a baseline questionnaire and the Trier Social Stress Test in groups. Four saliva samples were taken at - 10, + 00, + 10 and + 40 min during the stress-induction task. Following this, participants completed an online daily diary each evening for 14 consecutive days to record daily stress and between-meal snack consumption. Multilevel modelling indicated that daily stress was positively associated with daily snack intake, particularly for ego-threatening and work/academic stressors. Emotional and external eating styles were found to moderate the stress-snacking relationship. Cortisol reactivity also moderated stress-eating associations, such that as cortisol reactivity levels increased from lower to higher levels, the impact of stress on eating decreased. The current findings highlight the importance of cortisol reactivity status and eating styles in understanding the complex relationship between daily stress and eating behavior in adolescents and young adults. Future research should continue investigating stress-eating associations in these groups and explore the role of other aspects of hypothalamic-pituitary-adrenal axis functioning.

Diet Quality and Cardiometabolic Risk Factors in Adolescents with Down Syndrome

BACKGROUND

Youth with Down syndrome (DS) have a high prevalence of obesity and dyslipidemia. Diet quality may influence cardiometabolic risk (CMR) in youth.

OBJECTIVE

The aim of this secondary analysis was to investigate the relationship between diet quality (Healthy Eating Index [HEI-2015]) with CMR factors in youth with DS compared with age, sex, race, ethnicity, and body mass index percentile matched, typically developing controls.

DESIGN

Adolescents (aged 10 to 20 years) with DS and controls of comparable age, sex, race, ethnicity, and body mass index percentile were recruited from 2012 to 2017 for a cross-sectional study from two large children's hospitals (Children's Hospital of Philadelphia and the Children's National Health System in Washington, DC).

PARTICIPANTS AND SETTING

CMRs in 143 adolescents with DS were compared with 100 controls. Exclusion criteria consisted of major organ-system illnesses.

MAIN OUTCOME MEASURES

The average of three 24-hour dietary recalls was used to calculate the HEI-2015. Anthropometrics, blood pressure, and fasting labs were collected.

STATISTICAL ANALYSES PERFORMED

Group differences were tested using Wilcoxon rank-sum tests. Relationships of CMR factors with HEI-2015 score within DS and controls were tested using linear regression models adjusted for sex, age, race, and body mass index z score.

RESULTS

Compared with controls (n = 100, median age = 14.8 years [interquartile range = 12.2 to 17.3 years]; 41% male; 24% African American; 65% with body mass index ≥85th percentile), adolescents with DS (n = 143, median age = 14.7 years [interquartile range = 11.4 to 17.4 years]; 44% male; 18% African American; 62% with body mass index ≥85th percentile) had higher scores (more aligned with dietary recommendations) for total HEI-2015 (DS: 52.7 [interquartile range = 46.8 to 58.6] vs controls: 45.1 [interquartile range = 39.5 to 55.0]; P < 0.0001). Youth with DS also had higher HEI-2015 component scores for fruits, greens/beans, dairy, refined grains, and saturated fats, but lower whole grains and sodium scores. Within the group with DS, total HEI-2015 was not significantly associated with CMR measures. Whereas HEI-2015 in the DS group was negatively associated with fasting glucose levels, the difference did not meet the set level of statistical significance (-0.14, 95% CI -0.29 to 0.00; P = 0.053).

CONCLUSIONS

Adolescents in both the control and DS groups reported low-quality diets, although the DS group had HEI-2015 scores more closely aligned with recommendations. In the DS group, diet quality was not significantly associated with CMR factors. Although further research is needed, these results suggest that dyslipidemia in youth with DS may not be related to dietary intake.

A 28-day, 2-year study reveals that adolescents are more fatigued and distressed on days with greater NO2 and CO air pollution

This 2-year, 28-day study examined whether adolescents felt greater fatigue and emotional distress the same day and the day after air quality was worse. We linked objective daily air quality measurements to daily self-reports from 422 Mexican-American adolescents in Los Angeles County, California from 2009 to 2011 (50% girls, M_Age = 15 years). A robust, within-subject analysis of 9696 observations revealed that adolescents with ongoing physical complaints reported greater fatigue and emotional distress on days that the air contained higher levels of nitrogen dioxide (NO₂) and carbon monoxide (CO). Regardless of physical complaints, adolescents on average also reported greater fatigue the day after NO₂ levels were higher. The same-day and next-day associations between air pollution and distress were mediated via daily increases in fatigue. Results were robust when controlling for day of the week, and daily temperature and humidity. Sulfur dioxide (SO₂), ozone (O₃), PM_2.5 and PM₁₀ were not related to daily fatigue or distress.

Integrated role of lifestyle habits in cardiometabolic risk factors according to sex in adolescents

Background: A healthy lifestyle should be adopted by young people to maintain cardiometabolic health. Aim: To verify the prevalence and the integrated role of lifestyle habits in cardiometabolic risk factors according to sex in adolescents. Subjects and methods: Cross-sectional study developed with 1,502 adolescents, aged 10 to 17 years. Lifestyle habits included physical activity, screen time and sleep duration evaluated through a questionnaire. Cardiometabolic risk score (CMRS) was calculated by summing z-scores, divided by six. For statistical analyses, multivariable binary and multinomial logistic regression models were used. Results: 80.7% of the boys classified with adverse CMRS presented physical inactivity, compared to normal CMRS. In girls, 42.6% showed inadequate sleep compared to normal CMRS. Boys classified as inactive showed higher odds for obesity, as well as altered triglycerides, and systolic blood pressure, risk for cardiorespiratory fitness (CRF), high waist circumference, and CMRS, compared to the active. A prolonged screen time increased the odds for altered glucose and decreased the odds for altered triglycerides. In girls, inadequate sleep duration presented higher odds for overweight, obesity, risk for CRF, and high CMRS, compared to adequate sleep. Conclusions: Physical activity for boys and sleep duration for girls are important to maintain healthy metabolic health among youth.

Biological and socioeconomic factors as moderator in relationship between leisure-time physical activity and cardiometabolic risk in adolescents from southern Brazil

BACKGROUND

Given the important repercussions that sociodemographic factors can have on physical activity, especially in the field of leisure, and cardiometabolic risk, it seems relevant to analyze the implications of these variables on the relationship between physical activity in leisure time (LTPA) and cardiometabolic risk. In this sense, the present study aims to verify the moderating role of biologic and socioeconomic factors in the relationship between LTPA and cardiometabolic risk in adolescents in southern Brazil.

METHODS

Cross-sectional study that included 1596 adolescents selected at random (58.2% girls), aged between 10 and 17 years. LTPA, biological and socioeconomic factors were assessed using a self-reported questionnaire and the cardiometabolic risk score (total cholesterol/HDL-c ratio, triglycerides, fasting glucose, systolic blood pressure, and waist circumference, considering the participant's age and sex) was included as an outcome. Associations and moderations were tested by multiple linear regression models.

RESULTS

It was observed a positive interaction of LTPA and sex (p = 0.048) and LTPA and school system (p = 0.037), and negative interaction of LTPA and skin color (p = 0.040), indicating that these factors were moderators in the relationship between LTPA and clustered cardiometabolic risk score (cMetS) in adolescents. A reduction in cardiometabolic risk was observed according to the increase in weekly minutes of LTPA among boys, non-white adolescents, and students from municipal schools.

CONCLUSIONS

The association between LTPA and cardiometabolic risk was moderated by sex, skin color, and school system in adolescents from southern Brazil.

Longitudinal cohort study of injury type, settings, treatment and costs in British Columbia youth, 2003-2013

BACKGROUND

In 2010 in British Columbia (BC), Canada, total injury costs per capita were higher among youth aged 15-24 years than in any other age group. Injury prevention efforts have targeted injuries with high mortality (transportation injuries) or morbidity (concussions). However, the profile and health costs of common youth injuries (types, locations, treatment choices and prevention strategies) and how these change from adolescence to young adulthood is not known.

METHODS

Participants (n=662) were a randomly recruited cohort of BC youth, aged 12-18, in 2003. They were followed biennially across a decade (six assessments).

RESULTS

Serious injuries (defined as serious enough to limit normal daily activities) in the last year were reported by 27%-41% of participants at each assessment. Most common injuries were sprains or strains, broken bones, cuts, punctures or animal bites, and severe bruises. Most occurred when playing a sport or from falling. Estimated total direct cost of treatment per injury was approximately $2500. In addition, 25% experienced serious injuries at three or more assessments, indicating possible differences that warrents further investigation.

CONCLUSIONS

The occurence and health cost of common injuries to youth and young adults are underestimated in this study but are nevertheless substantial. Ongoing surveillence, awareness raising, and prevention efforts may be needed to reduce these costs.

Clustering of South Korean Adolescents' Health-Related Behaviors by Gender: Using a Latent Class Analysis

Background: Health-related behaviors during adolescence could influence adolescents’ health outcomes, leading to either advantageous or deteriorative conditions. Clustering of adolescents’ health-related behaviors by gender identifies the target groups for intervention and informs the strategies to be implemented for behavioral changes. Methods: Data from 1807 adolescents in grades 7 and 10 in a city in South Korea were used. Health-related behaviors including eating habits, physical activity, hand washing, brushing teeth, drinking alcohol, smoking, and Internet use were examined. Latent class analysis (LCA) was used to identify subgroups of adolescents with regard to their health-related behaviors. Results: A four-class model was the most adequate grouping classification across genders: adolescents with (1) healthy behaviors, (2) neither health-promoting nor health-risk behaviors, (3) good hygiene behaviors, and (4) unhealthy behaviors. The majority of both male and female adolescents were classified into the healthy group. Male adolescents belonging to the healthy group were more likely to engage in vigorous physical activities, while vigorous physical activity was not important for female adolescents. The smallest group was the unhealthy group, regardless of gender; however, the proportion of boys in the unhealthy group was almost twice that of girls. Only female adolescents engaged in excessive Internet use, especially the group with neither health-promoting nor health-risk behaviors. Conclusion: To improve adolescents’ health-related behaviors, it would be more effective to develop tailored interventions considering the behavioral profiles of the target groups.

Disease Prevention Behavior During the COVID-19 Pandemic and the Role of Self-Esteem: An Extended Parallel Process Model

Objective

The COVID-19 outbreak has become a serious public health problem worldwide. The purpose of this study was to use an extended parallel process model (EPPM) to understand factors in COVID-19 prevention behaviors.

Methods

This cross-sectional and analytical study was conducted on 1012 participants in Taiwan. A structured questionnaire and an online survey were used to collect data.

Results

The EPPM revealed that the severity of the COVID-19 threat perceived by respondents directly affected the arousal of fear in the respondents (β=0.268, t=9.007, p<0.001), but perceived efficacy did not (β=−0.019, t=−0.619, p>0.05); additionally, fear arousal was significantly associated with COVID-19 prevention behaviors (β=0.119, t=4.603, p<0.001). Regarding personal characteristics, self-esteem moderated the relationship between perceived threat and fear arousal. However, the moderating effect of self-esteem was stronger in people with low self-esteem compared to those with high self-esteem (β=0.606, −0.472; t=26.303, −17.694; p<0.001, p<0.001; respectively). The results of this study also indicated that two demographic characteristics (age and gender) affect COVID-19 prevention behaviors.

Conclusion

When developing healthcare policies and community interventions for improving COVID-19 prevention behaviors during an outbreak, healthcare administrators should carefully consider the main constructs of the EPPM, particularly personal characteristics (ie, self-esteem) and demographic characteristics (ie, age and gender).

Physical Activity in the Daily Life of Adolescents: Factors Affecting Healthy Choices from a Discrete Choice Experiment

Physical activity improves peoples’ well-being and can help in preventing weight gain, obesity, and related non-communicable diseases. Promoting healthy behaviors in the daily travels and transport choices of adolescents is very important in early establishing healthy habits that imply routine physical activity. For designing and developing effective strategies, it is relevant to study adolescents’ preferences for physical activity and what factors in the social and environmental contexts affect their preferences. The paper investigates these aspects by means of a discrete choice experiment, using data from more than 4300 16–17 year-old adolescents in Italy. The results show that adolescents generally prefer walking for long time alone. However, females prefer cycling, while adolescents from lower educated families prefer motorized means of transport. Environmental factors affect the adolescents’ preferences: living nearby a green area is associated with more active and healthier choices in their short daily travels. Conversely, adolescents living closer to an industrial or high traffic area prefer to use motorized vehicles. Such findings have been discussed and policy implications presented, in order to support policymakers in designing cross-sectoral policies to promote healthy choices related to physical activity in adolescence.

Stopping the Drop: Examining the Impact of a Pilot Physical Literacy-Based Intervention Program on Physical Activity Behaviours and Fitness during the Transition into University

The move to university is a major life transition associated with precipitous declines in physical activity (PA). While it remains unclear how these declines can be best attenuated, the concept of physical literacy (PL) or enhancements of PL may be a promising modality to promote PA during life transitions. The purpose of the current study was to evaluate the impact of a pilot PL-based intervention on PA and fitness for students transitioning into university. Participants included 65 first-year students (Mage = 17.85 ± 0.51; n = 46 females), enrolled in a quasi-experimental study. Intervention participants (n = 26) participated in a 12-week novel movement skills program conducted in a group-based environment. Results from the 2 × 2 repeated measures ANOVA found moderate effects in the time by condition interaction F(1,56) = 2.70, p = 0.11, ηp2 = 0.08 for PA behaviors as well as for estimated cardiorespiratory fitness F(1,61) = 8.35, p = 0.005, ηp2 = 0.12. Findings from our pilot program suggest that PL may be an effective modality to help first-year university students maintain fitness and attenuate the declines in PA behaviors when transitioning into university. Similar trials with larger samples are required.

Psychosocial Risk Factors: its Relation with Social Cognition, Emotional Regulation and Well-Being

In Colombia, an increase of suicidal behavior in adolescents caused by personal and environmental factors is evidenced. This quantitative, descriptive, correlational research aimed to establish the existing relationship between social cognition, perception of the quality of relationships and emotional regulation with the variables of psychosocial risk, suicide risk and level of psychological well-being in adolescents in contexts of high socioeconomic vulnerability of Bogotá. A total of 155 adolescents were selected through non-probabilistic sampling at convenience, with ages between 13 and 17 years (M = 14.47 and DE = 1.03). The results allowed observing the existence of significant relationships between the study variables. From a linear regression analysis, the emotional bond and emotional self-regulation had a higher level of explanation about the perception of well-being and the psychosocial risk associated with suicide. Finally, the results and implications of a greater participation of the emotional bond in comparison to that of social cognition in adolescence are discussed, in order to formulate programs that promote well-being and prevent risk.

Patterns of marijuana use and physical health indicators among Canadian youth

We examine how trajectories of marijuana use in Canadian youth (ages 15 to 28) are related to physical health indicators in adolescence and young adulthood. Youth were initially recruited in 2003 (N = 662; 48% male; ages 12 to 18) and followed for six waves. Five trajectories of marijuana use (Abstainers-29%, Occasional users-27%, Decreasers-14%, Increasers-20% and Chronic users-11%) were identified. Chronic users reported more physical symptoms, poorer physical self-concept, less physical activity, poorer eating practices, less sleep, and higher number of sexual partners during adolescence than other classes. Decreasers also reported poorer physical self-concept and poorer eating practices than abstainers. Other trajectory classes showed few significant health problems. Chronic users also reported more acute health problems (i.e. serious injuries, early sexual debut, higher number of sexual partners, greater likelihood of having a STI) in young adulthood than all other classes contributing to costs of healthcare. Youth who engage in early, frequent and continued use of marijuana from adolescence to young adulthood are at-risk of physical health problems in adolescence and young adulthood.

Depressive symptom trajectories and physical health: Persistence of problems from adolescence to young adulthood

BACKGROUND

We examine how depressive symptom trajectories are related to adolescent and young adult subjective health, health-promoting, health-risk, and sexual risk behaviors, as well as cardiometabolic risks.

METHOD

Data came from a community-based sample of youth (N = 662; 52% female) followed biannually, six times across 10 years. Latent class growth analysis identified four depressive symptom trajectories which were compared on adolescent (T1; ages 12-18) and young adult (T6; ages 22-29) health indicators.

RESULTS

The Low stable trajectory (49%) showed the fewest health risks. The Persistent high trajectory (9%) reported higher physical symptoms, lower physical self-concept, less physical activity and sleep, and higher rates of smoking and sexual risk behaviors than the Low stable trajectory and risks for physical symptoms, physical self-concept, and physical activity worsened in young adulthood. Increasers (21%) showed risks for physical symptoms, physical activity, and sleep in adolescence and problems for physical symptoms and physical self-concept persisted in young adulthood. Decreasers (22%) showed risks for physical symptoms, physical self-concept, physical activity, and sleep in adolescence but these risks resolved into young adulthood.

LIMITATIONS

Findings may not generalize to ethnic minorities. Sex differences were not examined due to sample size limitations and most variables, except cardiometabolic risks, were self-reported.

CONCLUSIONS

Findings suggest early treatment of depressive symptoms that includes strategies addressing physical symptoms, physical self-concept, and physical activity may prove beneficial. Screening youth for physical symptoms and declines in health-promoting behaviors may also identify youth at risk of depression onset and progression.

The NBA and Youth Basketball: Recommendations for Promoting a Healthy and Positive Experience

Participation in sports offers both short-term and long-term physical and psychosocial benefits for children and adolescents. However, an overemphasis on competitive success in youth sports may limit the benefits of participation, and could increase the risk of injury, burnout, and disengagement from physical activity. The National Basketball Association and USA Basketball recently assembled a group of leading experts to share their applied research and practices to address these issues. This review includes the group's analysis of the existing body of research regarding youth sports participation and the related health, performance, and psychosocial outcomes. Based upon this, age-specific recommendations for basketball participation are provided that aim to promote a healthy and positive experience for youth basketball players.

Wide educational disparities in young adult cardiovascular health

Widening educational differences in overall health and recent stagnation in cardiovascular disease mortality rates highlight the critical need to describe and understand educational disparities in cardiovascular health (CVH) among U.S. young adults. We use two data sets representative of the U.S. population to examine educational disparities in CVH among young adults (24-34) coming of age in the 21st century: the National Health and Nutrition Examination Survey (2005-2010; N= 689) and the National Longitudinal Study of Adolescent to Adult Health (2007-2008; N=11,200). We employ descriptive statistics and regression analysis. The results show that fewer than one in four young adults had good CVH (at least 5 out of 7 ideal cardiovascular indicators). Young adults who had not attained a college degree demonstrate particularly disadvantaged CVH compared with their college-educated peers. Such educational disparities persist after accounting for a range of confounders, including individuals' genetic propensity to develop coronary artery disease. The results indicate that the CVH of today's young adults is troubling and especially compromised for individuals with lower levels of educational attainment. These results generate substantial concern about the future CVH of the US population, particularly for young adults with a low level of education.