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Objectives Previous research in the United States suggests contextual income mobility may play a role in explaining the disparities between life expectancy in the United States and peer countries. This article aims to extend previous research by estimating the consequences of average individual exposure to mobility regimes during childhood and adolescence on adult health. Methods This study draws its data from two longitudinal datasets that track the county of residence of respondents during childhood and adolescence, the Panel Study of Income Dynamics and the National Longitudinal Survey of Youth 1997. We implement marginal structural models to assess the association of the average exposure to county income mobility on five health outcomes and behaviors. Results The results are only partially consistent with a systematic association between exposure to income mobility and health outcomes. Evidence obtained from the National Longitudinal Survey of Youth suggests less income mobility might increase the probability of smoking by age 30. Discussion The paper provides a precise assessment of the hypothesis that childhood exposure to income mobility regimes may influence health status through behavior later in life and contribute to longevity gaps. Only partial evidence on smoking suggests an association between income mobility and health, so we discuss potential reasons for the disparities in results with previous research. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the extent that physical function discrete data elements (DDE) documented in electronic health records (EHR) are complete within pediatric rehabilitation settings. Methods: A descriptive analysis on completeness of EHR-based DDEs detailing physical functioning for children with cerebral palsy was conducted. Data from an existing pediatric rehabilitation research learning health system data network, consisting of EHR data from 20 care sites in a pediatric specialty health care system, were leveraged. Completeness was calculated for unique data elements, unique outpatient visits, and unique outpatient records. Results: Completeness of physical function DDEs was low across 5766 outpatient records (10.5%, approximately 2 DDEs documented). The DDE for Gross Motor Function Classification System level was available for 21% (n = 3746) outpatient visits and 38% of patient records. Ambulation level was the most frequently documented DDE. Intercept only mixed effects models demonstrated that 21.4% and 45% of the variance in completeness for DDEs and the Gross Motor Function Classification System, respectively, across unique patient records could be attributed to factors at the individual care site level. Conclusion: Values of physical function DDEs are missing in designated fields of the EHR infrastructure for pediatric rehabilitation providers. Although completeness appears limited for these DDEs, our observations indicate that data are not missing at random and may be influenced by system-level standards in clinical documentation practices between providers and factors specific to individual care sites. The extent of missing data has significant implications for pediatric rehabilitation quality measurement. More research is needed to understand why discrete data are missing in EHRs and to further elucidate the professional and system-level factors that influence completeness and missingness. Impact: Completeness of DDEs reported in this study is limited and presents a significant opportunity to improve documentation and standards to optimize EHR data for learning health system research and quality measurement in pediatric rehabilitation settings. [ABSTRACT FROM AUTHOR]

Background The potential for sexual health services to influence the sexual health and behaviour of school-aged young people is only likely to be realised if these services are accessed. This review and synthesis seeks to explore children and adolescents' views and experiences of school-based and school-linked sexual health services to identify barriers to and facilitators of service use. Methods The study design is a systematic review of studies focusing on the views of children and adolescents (11–18 years) about relevant services. Sixteen databases were searched, titles and abstracts were screened against the inclusion criteria, data extraction and quality assessment of included studies were performed and thematic synthesis was undertaken. Results Nineteen relevant studies were identified, but only studies from the USA and the UK satisfied the inclusion criteria. The principal themes to emerge from the analysis were awareness and need, confidentiality and disclosure, perceptions of staff, service location, physical environment, costs and types of services on offer. These findings were consistent across country and type of service. Conclusions In the view of young people, school-linked sexual health services need to guarantee and promote the ideas of privacy, confidentiality and approachability if they are to be accessed and have an impact on behaviour. [ABSTRACT FROM PUBLISHER]

Social work, along with other human services professions, is increasingly moving to establish guidelines for treatment interventions that are based on empirical knowledge about populations, needs, and treatment effectiveness. This work, however, is in the beginning stages. This article explores how substance abuse treatment providers for adolescents attempt to obtain and use information to guide a "best practices" approach to treatment. Focus group data were analyzed for themes indicating supportive attitudes toward adopting and evidence of capacity to implement an evidence-based approach. Although support was fairly strong, capacity was relatively weak. [ABSTRACT FROM AUTHOR]

Background Evidence suggests adolescent alcohol consumption has declined since the turn of the millennium in almost all high-income countries. However, differences in the timing and magnitude of the decline have not been explored across countries. Methods We examined trends in adolescent past month or monthly alcohol consumption prevalence from cross-national or national survey reports for 39 countries and four US territories. For each country, we calculated the magnitude of the decline in youth drinking as the relative change in prevalence from the peak year to the most recent year available. Heat maps were utilized to present the timing and magnitudes of these declines. Results The timing and extent of youth drinking declines have varied markedly across countries. The decline began in the USA before 1999, followed by Northern European countries in the early 2000s; Western Europe and Australasia in the mid-2000s. The steepest declines were found for Northern Europe and the UK, and the shallowest declines were observed in Eastern and Southern European countries. Conclusions Previous analyses of the decline in adolescent drinking have emphasized the wide reach of the changes and their near-coincidence in time. Our analysis points to the other side of the picture that there were limits to the wide reach, and that there was considerable variation in timing. These findings suggest that as well as broader explanations that stretch across countries, efforts to explain recent trends in adolescent drinking should also consider factors specific to countries and regions. [ABSTRACT FROM AUTHOR]

Introduction: North American Indigenous people (ie, American Indian/Alaska Native and Canadian First Nations) have the highest rates of commercial cigarette smoking, yet little is known about long-term trajectories of use among this population. The purpose of this study is to examine heterogeneous trajectories and profiles of Indigenous cigarette use frequency from early adolescence (mean age: 11.1 years) to young adulthood (mean age: 26.3 years).Aims and Methods: Data come from a nine-wave prospective longitudinal study spanning early adolescence through young adulthood among Indigenous people in the Upper Midwest of the United States and Canada (N = 706). Smoking frequency was examined at each wave, and latent class growth analysis was used to examine heterogeneous patterns. Early adolescent and young adult demographics and smoking-related characteristics were examined across these latent trajectory groups.Results: In young adulthood, 52% of participants smoked daily/near-daily, and an additional 10% smoked weekly or monthly. Four latent trajectory groups emerged: low/non-smokers (35.2%) who had low probabilities of smoking across the study; occasional smokers (17.2%) who had moderate probabilities of smoking throughout adolescence and declining probabilities of smoking into young adulthood; mid-adolescent onset smokers (21.6%) who showed patterns of smoking onset around mid-adolescence and escalated to daily use in young adulthood; and early-adolescent onset smokers (25.9%) who showed patterns of onset in early adolescence and escalated to stable daily use by late adolescence.Conclusions: The findings suggest multiple critical periods of smoking risk, as well as a general profile of diverse smoking frequency patterns, which can inform targeted intervention and treatment programming.Implications: Nearly two-thirds (62%) of this sample of Indigenous people were current smokers by early adulthood (mean age = 26.3 years), which is substantially higher than national rates in the United States and Canada. Moreover, in all but one trajectory group, smoking prevalence consistently increased over time, suggesting these rates may continue to rise into adulthood. The longitudinal mixture modeling approach used in this study shows that smoking patterns are heterogeneous, and implications for public health policy likely vary across these diverse patterns characterized by timing of onset of use, escalation in frequency of use, and stability/change over time. [ABSTRACT FROM AUTHOR]

In the United States, suicidal ideation is an issue for high school–age youths. Research supports that youths who have learning difficulties and who are at risk of high school dropout are at greater risk for suicidal ideation. Although alternative high schools address both student academics and emotional health, they are underused, nonclinical settings for understanding and addressing suicidal ideation. This study aimed to examine the impact of student identity, external stressors, and academic self-concept on suicidal ideation among sexual and ethnic minority and underserved students enrolled in an alternative education public high school. The student sample (N  =   103) completed a onetime survey comprised of the Suicidal Ideation Questionnaire-Junior, the Cultural Assessment of Risk of Suicide, the Coddington Life Events Scale for Adolescents, and the Piers Harris 2. Results of hierarchical linear regression indicated that identifying as nonheterosexual and experiencing discrimination were associated with greater student reporting of suicidal ideation. Identifying as Latino and other non-White was associated with lower reporting of suicidal ideation. Controlling for student demographics and external stressors, positive academic self-concept was associated with a lower reporting of suicidal ideation. Findings have future implications for health social work, suicide prevention and intervention, and education policy. [ABSTRACT FROM AUTHOR]

Young people transitioning from out-of-home care (generally called care leavers) are recognised globally as a vulnerable group. In the last eighteen months, four Australian jurisdictions have extended state care till twenty-one years in an attempt to advance the life opportunities of this cohort. These initiatives are strongly influenced by extended care programmes in the USA and England, which have reported improved outcomes for care leavers. This article interrogates formal public evaluations of these extended care programmes with a particular focus on their eligibility criteria that have determined which groups of care leavers are included or alternatively excluded and the identified strengths and limitations of the programmes. Additionally, we consider cross-cultural differences in leaving care populations and variations within the broader social policy context of these jurisdictions, which may also impact on the effectiveness of policy transfer. Some conclusions are drawn about key factors that may enhance the success of extended care programmes. [ABSTRACT FROM AUTHOR]

The study reported in this article assessed prevalence and demographic correlates of sex trafficking in a purposive sample of 270 young people experiencing homelessness in three U.S. cities (Philadelphia; Phoenix; and Washington, DC) and at five host agencies. Participants were 57% male, 38% female, 4% transgender, and 1% other. The average age of participants was 20.7 years (SD = 2.0 years). The majority of the participants were African American (56%), followed by white (14%) and multiracial (14%). The Human Trafficking Interview and Assessment Measure detected that nearly one in five young people were victims of sex trafficking, either due to force, fraud, or coercion (FFC); age; or both. Those who were sex trafficked were more likely than those who were not sex trafficked to be female, sexual minorities, or Latino and to have either dropped out of high school or obtained a GED. Differences between being trafficked due to FFC and being trafficked due to age were also investigated. Findings support the need for development of targeted prevention and intervention efforts for young people experiencing homelessness that address sex trafficking victimization and related risk factors. [ABSTRACT FROM AUTHOR]

Background. Much has been written about the impact of human immunodeficiency virus (HIV) among young (13-24) sexual minority men (SMM). Evidence for concern is substantial for emerging adult (18-24 years) SMM. Data documenting the burden and associated risk factors of HIV among adolescent SMM (<18 years) remain limited. Methods. Adolescent SMM aged 13-18 years were recruited in 3 cities (Chicago, New York City, and Philadelphia) for interview and HIV testing. We used χ² tests for percentages of binary variables and 1-way analysis of variance for means of continuous variables to assess differences by race/ethnicity in behaviors. We calculated estimated annual HIV incidence density (number of HIV infections per 100 person-years [PY] at risk). We computed Fisher's exact tests to determine differences in HIV prevalence by selected characteristics. Results. Of 415 sexually active adolescent SMM with a valid HIV test result, 25 (6%) had a positive test. Estimated annual HIV incidence density was 3.4/100 PY; incidence density was highest for blacks, followed by Hispanics, then whites (4.1, 3.2, and 1.1/100 PY, respectively). Factors associated with higher HIV prevalence included black race; ≥4 male partners, condomless anal sex, and exchange sex in the past 12 months; and a recent partner who was older, black, HIV-infected, or had ever been in jail or prison (P < .05). Conclusions. HIV-related risk behaviors, prevalence, and estimated incidence density for adolescent SMM were high, especially for minority SMM. Our findings suggest that initiating intervention efforts early may be helpful in combating these trends. [ABSTRACT FROM AUTHOR]

Although smoking declines in the United States, the prevalence of male adolescent smokeless tobacco (ST; moist snuff and chewing tobacco) use remains unchanged. ST product characteristics, such as flavoring, packaging, and branding, could influence adolescents' ST initiation and continued use. This qualitative study examines the potential role of product characteristics in shaping STrelated perceptions and behaviors among rural adolescent males. Semi-structured individual interviews were conducted at three California rural high schools. ST users were asked about their experiences and perceptions related to product characteristics. Interviews were transcribed, coded, and analyzed using a general inductive approach. Participants associated flavored ST with appealing non-tobacco products, such as chewing gum and alcohol. Availability of different varieties and flavors stimulated interest and curiosity in sampling or switching between ST products. Time-limited promotional flavors and packaging also enhanced product appeal. Adolescent ST users preferred certain brands based on perceived brand features and perceived nicotine content, associating higher-strength brands as better suited for experienced ST users. Brand preferences frequently reflected perceived ST brand popularity within peer groups. Based on these observations, potential ST regulation and health education campaigns to address misconceptions about ST characteristics could influence adolescents' ST-related perceptions and reduce ST use among this vulnerable population. [ABSTRACT FROM AUTHOR]

The Children's Safety Network has identified teenage dating violence (TDV) as a public health problem and called for effective prevention programs to address the issue. This study used resource dependence theory to examine factors that relate to domestic violence shelters' in-school efforts to prevent TDV. A national survey was sent to domestic violence shelters asking them to provide information on their TDV prevention efforts in schools. Seventy-seven percent of agencies indicated that they provide TDV programming within schools. Shelters' engagement in community awareness campaigns predicted their TDV prevention efforts in schools. Shelters' advocacy efforts, shelter size, and state law requiring TDV programming in the schools did not predict shelters' TDV prevention efforts in schools. The article concludes with a discussion of the implications for school-based practitioners. [ABSTRACT FROM AUTHOR]

The Tips From Former Smokers ("Tips") campaign in the United States primarily targets adult smokers, but considers adolescents an important secondary audience. This study examines the association between exposure to Tips and smoking outcomes in the adolescent population in the United States. We analyzed data from the 2013 National Youth Tobacco Survey, a nationally representative, cross-sectional survey of middleand high-school students in the United States (n=18 406). Multivariate logistic regression was used to assess the relationships between exposure to Tips advertisements and quitting intentions among current smokers and smoking susceptibility among experimenters and never smokers. Among current smokers, exposure to one Tips ad (versus no exposure) was positively associated with intending to quit. Similar associations also emerged for higher levels of exposure but did not reach significance. Among never smokers, exposure to four and more ads (versus no exposure) was associated with lower smoking susceptibility. Exposure to Tips ads was unrelated to smoking susceptibility among experimenters. The associations observed in the study suggest an intricate, and generally favorable, relationship between campaign exposure and smoking-related outcomes among current smokers and never smokers. Close monitoring of the Tips' impact on the adolescent population is needed. [ABSTRACT FROM AUTHOR]

The author discusses studies, practice, and policy strategies to ensure healthy development for all youths. The author said that new studies that shows long-term financial benefits of primary prevention and intervention efforts are needed. Administrative tasks on an organizational level involve embracing and espousing the use of evidence-based initiatives. Expertise in understanding unique community contexts and needs is considered integral to capacity-building activities.

Keystone virus, a California-serogroup orthobunyavirus, was first isolated in 1964 from mosquitoes in Keystone, Florida. There were no prior reports of isolation from humans, despite studies suggesting that ~20% of persons living in the region are seropositive. We report virus isolation from a Florida teenager with a rash and fever. [ABSTRACT FROM AUTHOR]

Concerns about potential dangers from energy drink consumption by youth have been raised by health experts, whereas energy drink manufacturers claim these products are safe and suitable for marketing to teens. This review summarizes the evidence used to support both sides of the debate. Unlike most beverage categories, sales of energy drinks and other highly caffeinated products continue to grow, and marketing is often targeted to youth under the age of 18 years. These products pose a risk of caffeine toxicity when consumed by some young people, and there is evidence of other troubling physiological and behavioral effects associated with their consumption by youth. The US Food and Drug Administration has indicated it will reexamine the safety of caffeine in the food supply; however, more research is needed to better understand youth consumption of energy drinks and caffeine in general, as well as the long-term effects on health. Meanwhile, policymakers and physician groups have called on energy drink manufacturers to take voluntary action to reduce the potential harm of their products, including placing restrictions on marketing to youth under the age of 18 years. Additional regulatory and legislative options are also being discussed. [ABSTRACT FROM AUTHOR]

Lower English literacy achievement of deaf students is often hypothesized to be an impediment for successful adult life experiences. Yet, literacy practices that individuals engage in throughout their daily lives are much more complex than what school-based measures of English can capture and particularly so for deaf individuals. A national large-scale data set with a sample of over 1,000 deaf youths was used to assess what, precisely, standardized measures of literacy may predict in terms of postschool outcomes in three domains: life, employment, and education. Regression analyses indicate that these measures predicted some postschool outcomes, but not all, and if significant, only a small amount of variation in the outcomes was explained. Findings suggest that English literacy, particularly the narrow conceptualization of English literacy skills that are measured through school-based assessments, may not play a significant role in the lives of deaf individuals, contrary to expectations. [ABSTRACT FROM PUBLISHER]

The difficulties that adolescents encounter as they age out of the foster care system are numerous and fairly well documented. Such difficulties include poor health, lack of affordable housing, low-wage employment, limited educational opportunities, and unreliable or nonexistent familial support. These difficulties often increase the likelihood of a wide variety of negative outcomes. One such outcome is involvement with juvenile justice and adult corrections. Adolescents aging out of foster care are at an increased risk of engaging in delinquency and crime. Unfortunately, little is known about the developmental trajectories of such juvenile and adult offending for the foster care population. The present study addresses this gap in the literature. Using a semiparametric group-based modeling approach, the authors identify three unique offending trajectories among 294 male adolescents leaving a large midwestern foster care agency: nonoffenders, early onset desisters, and chronic offenders. Using multinomial logistic regression, they then identify a variety of risk and protective factors associated with each development trajectory. Placement stability and school enrollment emerge as two of the most important predictors. [ABSTRACT FROM AUTHOR]

This study examined adolescent risk factors for late-onset cigarette smoking among African American males. Data came from the Pittsburgh Youth Study, a longitudinal study of young men followed from age 13 to age 25. Individuals who began smoking at age 17 or older were compared with those who began smoking by age 16 and with those who never smoked in terms of risk factors measured in middle (at age 16) and late adolescence (from age 17 to 19). The study included 281 African American young men. A total of 18 psychological, behavioral, and environmental risk factors were measured at age 16, and 19 risk factors were measured between ages 17 and 19. Several risk factors at age 16 differed between early-onset and late-onset smokers or nonsmokers; however, in multivariate analyses, only peer drug use and truancy were significant. Among the age 16 risk factors, only truancy differentiated late-onset smokers from nonsmokers. Late adolescence behavioral risk factors were significantly related to late-onset smoking. However, only smoking marijuana and highest grade completed differentiated late-onset smokers from nonsmokers in multivariate analyses. Well-established predictors of cigarette smoking assessed in middle adolescence could identify individuals who already smoked but could not distinguish between those who would and would not begin smoking later. Late adolescence life transitions were not related to late-onset smoking. More research is needed to examine contextual factors in late adolescence and early adulthood that protect against and precipitate late-onset of smoking for African Americans. [ABSTRACT FROM AUTHOR]

In 1918, the United States Public Health Service (PHS) launched a sex education campaign intended to educate Americans, young and old, male and female, on the perils of venereal disease (VD). As 'the guardians of the community's health', women were central to this effort and the PHS aggressively called upon these newly-enfranchised citizens to provide comprehensive sex education in their homes, schools, churches, and community settings. But even as the PHS called upon women to spearhead local and community efforts against VD, they used highly stereotyped images to endorse and advocate passive images of women and female sexuality. An analysis of this campaign and its failure provides insight into the ways in which the federal government attempted to use the forum of public health, both to re-shape the family and transform existing patterns of sexual behaviour during the 1920s. The failure of these attempts also provides a new understanding into the question of why federally-funded sex education programmes have generally been so unsuccessful in the USA. [ABSTRACT FROM AUTHOR]

U.S. youths continue to use alcohol, tobacco, and other drugs at alarmingly high rates despite a temporary downward trend in the 1980s. Among an average 500,000 individuals affected annually by substance use, youths (ages 12 to 18) rank as one of the highest groups in morbidity and mortality rates, resulting in many negative consequences. As a result the effectiveness of many prevention strategies has been called into question. This article reviews the extent and social cost of adolescent substance use; standard prevention strategies; prevention under criticism; and salient aspects of successful prevention strategies. Special attention is given to the social influence model of prevention as an effective and amenable model for social work professionals. [ABSTRACT FROM AUTHOR]

This study investigates the extent to which attitudes, family, and environmental correlates are associated with the escalation from nonviolent to violent offending among incarcerated youths. Escalation was defined as an adjudicated violent offense only after arrests and adjudications exclusively for nonviolent offenses. Data were collected from 50 respondents (25 escalators and 25 maintainers of nonviolent offending) incarcerated in a secure facility in the midwestern United States. Beliefs that power equates safety and a violent home environment were salient in understanding escalation in offending behavior, and prior criminal victimization was moderately significant. Implications for individual and family preventive interventions and delinquency theories are discussed. [ABSTRACT FROM AUTHOR]

In 1918, the U.S. Public Health Service (PHS) told American parents that “it is no longer possible for you to choose whether your child will learn about sex or not.” According to the PHS, most American boys learned about sex from “improper sources” by the age of nine. The “unfortunate effect of these early impressions” had, PHS warned, not only resulted in a gross misunderstanding of sex, but also been a major factor in the spread of venereal disease (The Parents' Part [the U.S. Public Health Service, 1918], p. 5). To counter and correct this miseducation, PHS joined with the Young Men's Christian Association (YMCA) to create a sex education program aimed at adolescent boys. Officially launched in the spring of 1919, the “Keeping Fit” campaign provides a unique insight into the federal government's attempt to medicalize and regulate American sexuality through the forum of public health. [ABSTRACT FROM PUBLISHER]

This article suggests that it is primarily the Huck Finns, not the thrill‐seeking Tom Sawyers, who often find themselves in runaway shelters and in need of crisis intervention and other services. Accordingly, this article is intended to serve as an overview of the runaway crisis. A review of relevant literature on runaway youth is provided; this review includes a synthesis of the key characteristics of runaway youth that have been addressed in the literature to date. Additionally, the Life Model is presented as a suggested lens through which to view the runaway crisis. Runaway shelters, as one means of responding to the runaway crisis, are briefly discussed, along with recommendations for assessment and treatment with youth in these settings. Implications for practice, research, and policy related to runaways are provided. [ABSTRACT FROM PUBLISHER]

The validity of self-report of drug use has been found to vary widely. Moreover, previous research has focused on samples of adults. In 1996–1998, human immunodeficiency virus (HIV)-infected adolescents and high-risk, noninfected adolescents (n = 182) were recruited at 16 locations in 13 US cities into the Reaching for Excellence in Adolescent Care and Health (REACH) project, to the authors' knowledge, the first national study of disease progression among HIV-positive adolescents who were infected through sexual behavior or injection drug use. Self-report of marijuana use was assessed through audio computer-assisted self-administered interviewing (ACASI). Urines were tested for marijuana at a certified laboratory by using the enzyme-multiplied immunoassay technique. Conditional kappas for 2-, 5-, and 7-day self-reports were 0.57, 0.71, and 0.69, respectively. Maximum sensitivity was obtained from a combination of ACASI and urine drug testing. Contrary to previous studies, the data suggest that if a single evaluative instrument is to be used for prevalence, ACASI is more sensitive than urine drug testing for marijuana overall, but particularly for HIV-infected adolescents. Am J Epidemiol 2000;152:805–13. [ABSTRACT FROM PUBLISHER]

The article reports on adolescent health being made as a national priority with the efforts of the Maternal and Child Health Bureau (MCHB). Statistics suggest an increase in cigarette smoking, alcohol consumption and drug abuse among children in the United States. MCHB has launched interdisciplinary training programs in adolescent health, sponsored national and regional conferences on the topic, and published a plethora of reports and informational packets on adolescent healthcare in order to create awareness about their well-being. A major initiative in the form of the Partners in Program Planning for Adolescent Health (PIPPAH) has been taken. The goal of PIPPAH is to promote an adolescent health agenda among professional disciplines through their large, national membership organizations. Adolescent health and school health are inextricably linked. Adolescent youths who use drugs, alcohol, and tobacco have higher rates of absenteeism and lower grades. The approach currently receiving the most attention is school-based health centers.

The article focuses on the development of aggressive behavior in childhood and early adolescence in the United States. The article discusses implications for preventing youth violence. Violence is a major social and health problem that affects large numbers of children and families. Teenagers account for only 10 percent of the population, but they are victims in nearly 25 percent of all violent crimes. The article manifests light on street crime, a type of violence that includes fighting; use of handguns or other weapons to resolve disputes; murder; and predatory acts such as aggravated assault, rape, and robbery. Youth violence can be seen as the result of an impoverished opportunity structure, inadequate training in critical social and cognitive skills, the perception that there is social and concrete utility in aggressive behavior, and the lack of indigenous rewards for prosocial activities in the social environment. The article finds that in contrast to aggressive behavior that emerges early in childhood, aggressive behavior that begins in early or middle adolescence appears to have somewhat more diverse roots.

The authors examined the impact of cumulative neighborhood risk of psychosocial stress on allostatic load (AL) among adolescents as a mechanism through which life stress, including neighborhood conditions, may affect health and health inequities. They conducted multilevel analyses, weighted for sampling and propensity score-matched, among adolescents aged 12–20 years in the National Health and Nutrition Examination Survey (1999–2006). Individuals (first level, n = 11,886) were nested within families/households (second level, n = 6,696) and then census tracts (third level, n = 2,191) for examination of the contextual effect of cumulative neighborhood risk environment on AL. Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. The likelihood of having a high AL was approximately 10% higher for adolescents living in medium-cumulative-risk neighborhoods (adjusted odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.08, 1.09), 28% higher for those living in high-risk neighborhoods (adjusted OR = 1.28, 95% CI: 1.27, 1.30), and 69% higher for those living in very-high-risk neighborhoods (adjusted OR = 1.69, 95% CI: 1.68, 1.70) as compared with adolescents living in low-risk areas. Effect modification was observed by both individual- and neighborhood-level sociodemographic factors. These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically mediated negative health outcomes detectable in adolescents. [ABSTRACT FROM PUBLISHER]