Adolescent Health Clinic

Recent studies have indicated that sleep is fundamental for adolescents' physical and mental health. Although it is known that context influences sleep, the impact of school climate on sleep duration remains understudied. Using a large, diverse, population-based sample of adolescents attending California high schools (N = 277,954; data collection: 2018-2019) and applying two statistical methods suggested for quantitative research using an intersectionality approach (linear regressions with interaction terms and Exhaustive Chi-square Automatic Interaction Detection [ECHAID]), this study examined associations between school climate and sleep duration among adolescents at the intersection of multiple social positions. Similar proportions of participants were assigned male and female at birth. The sample was racially and ethnically diverse (54.1% Latina/x/o). The large majority of participants were straight (85.4%) and cisgender (97.7%). On average, participants slept 6.75 h/night. Positive school climate was associated with longer and adequate sleep duration; however, this association varied across social positions, such that the effects of school climate on sleep duration were attenuated among adolescents who held some minoritized social positions. ECHAID results indicated that those reporting the lowest averages of sleep duration not only perceived school climate as negative but also held multiple minoritized identities. In contrast, those who perceive their school climate as positive are overrepresented among those who reported the highest averages of sleep duration. Findings underscore the impact that schools have on adolescents' sleep health. Our study indicates that adolescents with multiple minoritized social positions face additional challenges impacting their sleep. Future interventions should focus on strategies to improve school climates, given that they would benefit a large number of students.

ABSTRACT Media is a common source of sexual health information, and scholars have lauded the popular Netflix series Sex Education for its positive approach. This qualitative study explored youth viewpoints about the series as a credible source of information. Six online focus groups were conducted in 2022–2023 (N = 22 US adolescents who had viewed at least two seasons of the show, aged 14–19, 50% cisgender female). Discussion focused on whether participants thought the situations portrayed in the series were realistic and the information provided was trustworthy. Two themes and five subthemes were identified, including 1) realism (subthemes: relatable, awkwardness, dramatised for entertainment) and 2) trustworthiness (subthemes: peer advice, professional advice). Findings indicate that Sex Education presents sexual health content that young people find realistic, relatable and informative, and is a valuable addition to the landscape of sexuality education options. Opportunities for including the show as part of a multipronged approach to sexual health education are discussed.

Insufficient physical activity (PA) is associated with obesity, cardiovascular disease, and mortality, yet only 26.1% of US high school students report meeting the 60-minute daily PA guideline. Adolescents' sleep may contribute to their activity patterns. However, findings in this area have been inconsistent, and few studies have used both objectively measured sleep and PA. Two hundred and sixty ninth-grade students (mean age = 14.7, SD = 0.5) in Minnesota wore wrist actigraphs for 7days to assess weekday and weekend sleep duration, midpoint, efficiency, latency, moderate to vigorous PA, light PA, and waking sedentary time. Multiple regression analyses, controlling for demographics, assessed whether sleep features were associated with activity levels. Weekday and weekend sedentary time decreased by 25.86 and 19.21minutes per each additional hour in weekday and weekend sleep duration, respectively. A later weekend sleep midpoint was associated with 8.09 fewer minutes of weekend sedentary time. Sleep duration related to less daily time spent in light PA (8.66 and 9.64min per every additional hour slept on weekdays and weekends, respectively). Each hour of advancement in weekday sleep midpoint was associated with 14.22 additional minutes of light PA and 3.06 more minutes of moderate to vigorous PA. For each additional percentage point in sleep efficiency, 2.11minutes less weekend light PA was observed. If sleep can influence activity, modifying sleep could be a path to promoting healthful activity levels. Further, given that PA and sleep may be mutually reinforcing, targeting both behaviors concurrently could provide comprehensive health promotion.

High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self-injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots. Using the 2013-2019 Minnesota Student Surveys, we assessed associations of student-reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety. Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures. Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated.

Limited research incorporates an intersectional approach when evaluating disordered eating behaviors among those holding minoritized social positions, such as lesbian, gay, bisexual, queer, questioning, and/or transgender/gender diverse (LGBTQ) adolescents. The current study assessed stigma experiences from peers at school, self-esteem, LGBTQ pride, and overlapping social positions as they relate to disordered eating behaviors among LGBTQ adolescents. Participants included 11,083 adolescents (Mage = 15.6, SD = 1.3; 34.8% transgender/gender diverse) from a large national survey study of LGBTQ adolescents from 2017. Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify bias-based bullying experiences (i.e., weight-based, identity-based), self-esteem, LGBTQ pride, and overlapping social positions (i.e., gender identity, sexual identity, race/ethnicity, body mass index (BMI) percentile) associated with the highest prevalence of unhealthy weight control behaviors, extreme unhealthy weight control behaviors, and past year binge eating. Adolescents in the 28 identified groups with a high prevalence of disordered eating behavior held at least one structurally marginalized social position (e.g., high BMI), bias-based bullying experience, low self-esteem, or low LGBTQ pride in addition to being LGBTQ. Weight-based bullying was a salient risk-factor for disordered eating across social positions. Among adolescents with the same social positions, levels of self-esteem, LGBTQ pride, but no bias-based bullying experience, prevalence estimates of disordered eating were, on average, 23% lower. LGBTQ adolescents with multiple marginalized social positions and related factors engage in disproportionately high prevalence disordered eating. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents. Multiply marginalized LGBTQ adolescents, most of whom also reported experiencing bias-based bullying from peers at school, reported disproportionately high prevalence disordered eating. In comparison groups of adolescents with no bias-based bullying experience, prevalence of disordered eating was, on average, 24% lower. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents.

Parental incarceration (PI) is both an adverse childhood experience (ACE) and an influencer of pediatric health. Despite evidence that rural America sees the highest incarceration rates and substantial inequities in pediatric health care access and services, it is unclear how the prevalence of PI and associated sociodemographic factors vary across urban, suburban, and rural regions of the United States. This study used data from the National Survey of Children's Health (2016-2021; N = 145 281). Based on proximity and population, households were categorized as urban, suburban, or rural. Caregivers reported on household income, race/ethnicity, and living arrangements as well as children's exposure to ACEs, including PI. Chi-squared and t-tests compared the prevalence of PI across communities and assessed regional differences in ACEs and sociodemographic characteristics in the context of PI. PI was most common in rural (12%) versus urban (8%) and suburban (6%) areas. ACEs were more prevalent among PI children compared with non-PI peers across regions, with slight differences between PI children across locales. Within all regions, PI was highest for Black, Latinx, Native, and multiracial children; those in poverty; and those in nonparent caregiver placements. However, these prevalences were consistently highest among rural children. This study points to high rates of adversity and concern racial, economic, and residential disparities for PI children, particularly those in rural communities. Evidence from this study can be used as a foundation for future prevention and intervention pediatric health responses that address inequities and unmet needs for rural populations.

Palliative care is a critical component of pediatric oncology care. Embedded pediatric palliative care (PPC) is relatively new in pediatric hematology/oncology (PHO) and may improve access, utilization, and quality of PPC. In June 2020, the Mayo Clinic PPC service transitioned from an afternoon, physically independent clinic to an all-day clinic embedded within PHO. Retrospective chart review was used to quantify consultation rates from PHO to PPC in 12-month study periods before and after establishment of an embedded clinic. Changes in descriptive statistics and consult patterns were calculated. Study periods were compared using either chi-square or Fisher's exact tests for categorical variables and Wilcox rank sum tests for continuous variables. There was an 89% increase in consultations from PHO to PPC after initiation of an embedded clinic (n=20 vs. n=38 per 12months). The absolute number of completed outpatient consults increased from three (15% of visits) pre-embedment to fourteen (37%) post-embedment (p=.082). The median number of days from first oncology visit to PPC assessment was unchanged after embedment (36 vs. 47days, p=.98). Consults for solid tumors increased from 22% (n=4) pre-embedment to 60% (n=18) post-embedment (p<.05). Consults for symptom management increased from 60% (n=12) to 87% (n=33) (p<.05). Embedment of PPC into a PHO workspace was associated with an increased number of total consults, outpatient consults, solid tumor consults, and consults for symptom management. Our "partial-PPO" model allowed for provision of PPC in the outpatient oncology setting in a clinic where there is not enough volume to support a full-time oncology-focused clinician team.

Urban racial arrest disparities are well known. Emerging evidence suggests that rural policing shares similar patterns as urban policing in the USA, but without receiving the same public scrutiny, raising the risk of biased rural policing going unnoticed. We estimated adult and adolescent arrest rates and rate ratios (RR) by race, rural-urban status, and US region based on 2016 Uniform Crime Reporting Program arrest and US Census population counts using general estimating equation Poisson regression models with a 4-way interaction between race, region, age group, and urbanicity. With few exceptions, arrest rates were highest in small towns and rural areas, especially among Black and American Indian populations. Arrest rates differed between US regions with highest rates and racial disparities in the Midwest. For example, arrest rates among Black adults in the rural Midwest were 148.6 arrests [per 1000 population], 95% CI131.4-168.0, versus 94.4 arrests, 95% CI 77.2-115.4 in the urban Midwest; and versus corresponding rural Midwest arrests among white adults, 32.7 arrests, 95% CI 30.8-34.8, Black versus white rural RR 4.54, 95% CI 4.09-5.04. Racial arrest disparities in the South were lower but still high, e.g., rural South, Black versus White adults, RR 1.86, 95% CI 1.71-2.03. Rural areas and small towns are potential hotspots of racial arrest disparities across the USA, especially in the Midwest. Approaches to overcoming structural racism in policing must include strategies targeted at rural/small town communities. Our findings underscore the importance of dismantling racist policing in all US communities.

Purpose: The current study extends the limited body of intersectional research on adolescents' sexual health by examining experiences of bias-based bullying and multiple intersecting social positions associated with engagement in sexual risk behaviors. Methods: Participants were 14,968 sexually active 9th and 11th grade students surveyed as part of the 2019 Minnesota Student Survey (15% lesbian/gay/bisexual/queer/pansexual/questioning [LGBQ] and/or transgender/gender diverse [TGD] or gender questioning). Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify experiences (i.e., bias-based bullying victimization) and intersecting social positions (i.e., sexual orientation identity; gender identity/modality; race/ethnicity; physical disabilities/chronic illness; mental health/behavioral/emotional problems) associated with the highest prevalence of three sexual risk behaviors. Results: Overall, 18% of adolescents reported 3+ sex partners in the last year, 14% reported drug/alcohol use before last sex, and 36% reported not discussing protection from sexually transmitted infections with new sexual partners. Adolescents with 2+ marginalized social positions, some of whom also experienced bias-based bullying, were part of 53% of the highest prevalence risk groups. For example, 42% of Multiracial or Latina/x/o gender questioning adolescents who identified as LGBQ reported 3+ sex partners in the last year-twice the sample average. Adolescents who were Black, American Indian/Alaska Native, Latina/x/o, Multiracial, TGD, or gender questioning were in the highest prevalence nodes across all outcomes. Conclusion: Adolescents with multiple marginalized social positions and who experience bias-based bullying engage in high-risk sexual behaviors at higher-than-average rates. Findings underscore the importance of addressing intersecting experiences of stigma to reduce high-risk sex behaviors and promote health equity among adolescents.