Parents,friends, and depression: A multi-country study of adolescents in South Asia

PurposeThis study investigates the association between social support networks, as measured by parental involvement and close friendships, and depression among adolescents in South Asia.MethodsNationally representative samples of adolescents between the ages of 12 and 16 + years (n = 16,592) from the Global School Based Health Surveys from India, Sri Lanka, Pakistan, and Myanmar were analyzed to provide prevalence rates of depression. Additionally, differences in past year depressive symptoms were compared cross-sectionally by social support from parents and friends, separately. This was done by computing prevalence ratios adjusting for potential confounders and demographic factors.ResultsOf all adolescent respondents in the study, 14.5% met the criteria to be screened for depression, while 50% reported having three or more close friends, and 80% reported having very involved parents. Adjusted prevalence ratios indicated that those with close friendships were much less likely to be screened for depressive symptoms compared to their counterparts, as were adolescents with very involved parents. However, low and moderate levels of parent involvement were not found to be significantly associated with adolescents' propensity for being screened for depressive.ConclusionSocial support is a social determinant of adolescent mental health in South Asia that has received little scholarly attention to date. This study highlights the importance of research and interventions involving parents and close friends in building programs for adolescents that target mental health.     

Self-report of health problems and health care use among maltreated and comparison adolescents

The study aims were to compare maltreated and comparison adolescents' health problems and to identify how individual, family and home characteristics and maltreatment status affect adolescents' self-report of health status and health care use. The sample was 224 maltreated adolescents (mean age = 18.3 years) and 128 comparison adolescents (mean age = 18.15 years). Comparison adolescents reported more cold and pain symptoms during the previous 30 days but no differences in other physical health problems, self-assessment of their physical and mental health or health care use compared to maltreated adolescents. Girls were more likely to have had a dental checkup, to have seen a psychological counselor, and to self-identify their physical health as poor compared to boys. Older adolescents were less likely to have had a medical checkup or seen a psychological counselor than younger adolescents. A history of maltreatment was not related to health or health care disparities for adolescents growing up in the same low-income environment as adolescents without a maltreatment report. The environmental context and geographical location in which these adolescents grew up may be the primary driver in their health behaviors and health problems and not the experience of maltreatment.     

Emergency department use for injuries by adolescents in foster care

Youth in foster care are overrepresented with respect to their utilization of emergency department (ED) services. This study examines the ED utilization patterns of adolescents in foster care and evaluates the characteristics of injury related versus non-injury related visits. We found that adolescents in foster care have high rates of ED use (1.84 visits per year (95% CI 1.59, 2.12)), with 31.2% of ED visits being injury-related. Male gender was found to be the only independent predictor of having an injury related vs. non-injury related ED visit (odds ratio 2.22 (95% CI 1.27–3.87)). Regarding the mechanisms of injury, adolescent youth in group homes were significantly more likely to present with injuries inflicted by themselves or by others in their residence (p < 0.05 for both) but less likely to present with accidental injuries or injuries sustained during recreation (p < 0.05 for both). Resources and interventions targeted at both youth and group home staff related to behavioral health assessment, post-traumatic coping skills and conflict management may have beneficial effects.     

Predictors of adverse gambling related consequences among adolescent boys

Although gambling is illegal for minors, adolescents do gamble and even higher proportions of adolescents than adults are at risk to become problem gamblers. Moreover, many adolescents suffer from a wide range of gambling related harms, and this study sought to examine what predicts different adverse consequences of adolescent gambling. Our aim was to test whether various cognitive, motivational and behavioural factors were associated with psychosocial consequences and loss of control, and with interpersonal and financial consequences of gambling, as measured by the Canadian Adolescent Gambling Inventory, the only instrument developed specifically for use on adolescents. The data was collected on a convenience sample of 1330 male Croatian students (Mage = 16.58, SDage = 1.16) from all three types of secondary education in Croatia. Results show that a high proportion of adolescents gamble, and that almost half of them are either at risk or can already be considered problem gamblers. Sport betting, VLT machines and betting on virtual horse races were the most frequent gambling activities for Croatian high-school boys. Hierarchical regression models showed that psychosocial consequences and loss of control can be predicted by higher frequency of gambling, previous experience with winning money and a specific motivation to earn money gambling, to become a better gambler and with having a drive to continue gambling after winning. On the other hand, interpersonal and financial consequences were predicted again by a higher frequency of gambling, the motive to be a better gambler and the drive to continue gambling after winning, but also by specific motivation to relax and feel better. Having more cognitive distortions, specifically having poorer understanding of chance and probabilities and more superstitious beliefs, as well as engagement in general risky and antisocial behaviour also predicted more interpersonal and financial consequences. Findings are discussed in the context of practical implications for prevention programs of adolescent gambling.     

Student debt and hardship: Evidence from a large sample of low- and moderate-income households

Student debt has risen in recent years as higher education costs have shifted to students and their families, particularly those with low-to-moderate incomes (LMI). Though a college degree continues to convey higher earnings, those who finance their degrees have lower net worth and greater financial difficulties than persons without student debt. We assess the relationship between student debt and material and health care hardship among a large sample (n = 5558) of LMI tax filers, using propensity score analysis to adjust for self-selection into student debt status and loan amount and monthly payment quartiles. We find that participants with student debt have a higher likelihood of hardship. Loan amounts only partially predict hardship, and borrowers making current loan payments are at lower odds for hardship than non-payers. We also find that among those with student debt, non-payers and those without college degrees have much greater social and economic disadvantages.     

Risky sexual behavior and substance use among adolescents: A meta-analysis

This study presents the results of a meta-analysis of the association between substance use and risky sexual behavior among adolescents. 87 studies fit the inclusion criteria, containing a total of 104 independent effect sizes that incorporated more than 120,000 participants. The overall effect size for the relationship between substance use and risky sexual behavior was in the small to moderate range (r = .22, CI = .18, .26). Further analyses indicated that the effect sizes did not substantially vary across the type of substance use, but did substantially vary across the type of risky sexual behavior being assessed. Specifically, mean effect sizes were the smallest for studies examining unprotected sex (r = .15, CI = .10, .20), followed by studies examining number of sexual partners (r = .25, CI = .21, .30), those examining composite measures of risky sexual behavior (r = .38, CI = .27, .48), and those examining sex with an intravenous drug user (r = .53, CI = .45, .60). Furthermore, our results revealed that the relationship between drug use and risky sexual behavior is moderated by several variables, including sex, ethnicity, sexuality, age, sample type, and level of measurement. Implications and future directions are discussed.     

Using a community-based participatory research approach to evaluate resident predictors of involuntary exit from permanent supportive housing

ObjectiveThe aim of this study was to determine an association between resident characteristics at time of entry to permanent supportive housing and exit status.MethodsA community-based participatory research (CBPR) approach was the guiding framework for the design, implementation and evaluation of this project. This retrospective observational study used an administrative data source from a local permanent supportive housing provider to compare resident characteristics among those who left housing voluntarily or involuntarily.ResultsThe population based sample (n = 407) was comprised of 51% males and 47% African-Americans with a mean age of 40 years (SD = 11.8). Involuntary exits (IEs) occurred in 40% of the sample (n = 166). IE was less likely with receipt of mainstream benefits, compared to employment income (O.R. = .546, p = .032). IE was more likely for residents self-identifying as African-American (O.R. = 1.56, p = .037) and when children resided in the household (O.R. = 2.03, p = .013).ConclusionsDespite limitations of community-derived data, findings suggest that supportive housing providers consider income source and family status when designing interventions to decrease IEs. A CBPR approach is a promising framework to guide evaluation efforts for supportive housing programs.     

The subjective well-being of adolescents in residential care compared to that of the general population

The aim of this research is to study the subjective well-being of adolescents in residential care and compare it with that of the general population of the same age in Catalonia. Two samples were used: one from the general population in the first year of secondary education (n = 491; 50% boys; mean age = 12.1 years) and another from the residential care population aged 12–13 years (n = 226; 56% boys; mean age 12.5). The questionnaire of the International Survey of Children's Well-Being (ISCWeB) was used. It includes two psychometric scales: the Personal Well-Being Index—School Children (PWI-SC7) and the Overall Life Satisfaction (OLS); the former being adapted for the in-care population. To test the validity of the factorial structure of data for the two groups, a Confirmatory Factor Analysis (CFA) of the PWI-SC7 and different multi-group structural equation models (SEMs) were conducted. The CFA of the PWI-SC7 showed a good fit with the pooled sample and good comparability of correlations and regressions between the two groups. The SEM with constrained loadings allowed us to compare the contribution of the different items on the PWI-SC7 latent variable which was higher in all cases for adolescents in care. Likewise it showed a high correlation between OLS and PWI-SC7 in both populations, being it more intense among adolescents in care. Scores on the OLS and on the PWI-SC7 are significantly lower among adolescents in care. However, according SEM results mean scores of the PWI-SC7 are not strictly comparable between groups. Results challenge public policy concerning children by increasing efforts to promote equal opportunities for the in-care community and improve satisfaction with particular life domains, such as school and residential homes.     

Programmatic effects to modify sources of financial support among Hispanic teenage mothers

This study evaluates whether a randomized school-based intervention for adolescent teenage mothers successfully helped participants achieve better financial independence and economic prospects. Project Mothers and Schools (PMAS) is an initiative intended to modify attitudes and beliefs related to self-sufficiency, parenting, educational goals and achievement, career goals, health behaviors, and interpersonal relationships with family members. PMAS participants were surveyed at baseline and 12 months after intervention enrollment to evaluate the receipt of financial support from 11 sources. The 48 “core group” participants received a basic level of services, whereas the 43 “core-plus group” participants received the same basic services and additional enhanced services. Wilcoxon signed-rank tests were used to identify statistically significant changes in participant responses from baseline to 12 months post-intervention. Both groups reported higher levels of employment 12 months post-intervention compared to baseline (z = − 3.162, p = 0.002 and z = − 2.646, p = 0.008, respectively). The core-plus group used more Food Stamps (z = − 2.673, p = 0.008) and reported receiving more child support (z = 2.236, p = 0.025) 12 months post-intervention versus baseline. PMAS benefited all participants by promoting employment 12 months post-intervention versus baseline. The enhanced services offered to the core-plus group appeared to also increase participant access to Food Stamps and child support, sources which assist participants down the path toward eventual financial independence.     

I would like them to get where I never got to: Nonresident fathers' presence in the educational lives of their children

Through the lens of social role theory, provider role strain and father ‘presence’, a qualitative design was used to explore nonresident fathers' perceptions of their role in their children's education and the ways in which they are actively engaged in their children's educational lives. Findings revealed that nonresident fathers with diverse racial, educational and occupational backgrounds (N = 39, mean age = 35) experienced regret over not meeting their own educational goals and they attributed their inability to consistently support their children financially to their educational failures. These low to moderate income fathers hoped to prevent their children from experiencing the same disappointments and financial hardships that they did and consequently emphasized the importance of education to their children. Fathers reported being present in their children's educational lives as advisors, teachers and/or investors. As advisors, fathers encouraged their children to stay in school and to not make mistakes that might derail them from their educational goals. As teachers, fathers provided cognitive support. Finally, fathers aimed to invest in their children's education by saving money for their educational futures. Programs and policies that promote educational presence are likely to influence the educational outcomes of children with nonresident fathers. Recommendations includ educational savings accounts and an emphasis on educational engagement in responsible fatherhood policies and programs.     

Racial disparities in education debt burden among low- and moderate-income households

Evidence now demonstrates significant variation in education-debt levels by race and household income, with Black and lower-income students accumulating higher levels of education debt compared to their White and upper-income peers. This study is one of the first to evaluate whether racial disparities in education debt extend to a low- and moderate-income (LMI) population. With data from a national sample of LMI households in the Refund to Savings study (N = 17.684), we employ a two-part modeling approach with a matching-estimator robustness check to estimate racial and ethnic variation in education debt. We find that significant disparities in education debt remain: the odds of student loan indebtedness are twice as high for LMI Black students as for White counterparts. In all, LMI Black students are estimated to incur $7721 more in education debt than LMI Whites, with disparities persisting after graduation. These findings suggest that LMI Black and White students, who face similar liquidity constraints and borrowing risks, are at unequal risk of accumulating education debt. We conclude by discussing the implications of this research for asset-building policies and student loan repayment efforts, both of which offer promise in bolstering college affordability and easing the burden of education debt.     

Cigarette,alcohol, and marijuana use among adolescents in foster family homes

Data from a cross-sectional study conducted in a random sample of children who were placed in foster family homes were used to examine the prevalence and associated factors of substance use (i.e., cigarette, alcohol, and marijuana), and to explore if adolescents in foster family homes had different rates of substance use than those in the general population matched on age, gender and race/ethnicity. Logistic regression models were used to determine factors associated with substance use and McNemar tests were used to compare prevalence rates of substance use. Substance use was common among adolescents in foster family homes. A higher number of placement settings were significantly associated with current cigarette use (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.09–1.60), and being placed in special study homes (i.e., fictive kin) was significantly associated with current marijuana use (OR, 6.43; 95% CI, 1.40–29.52). Compared to adolescents in the general population, those in foster family homes had lower rates of current alcohol (9.1% vs. 38.3%, p < 0.0001) and marijuana (13.6% vs. 29.7%, p = 0.005) use. No significant difference was observed for current cigarette use (18.2% vs. 11.5%, p = 0.08). More research is needed to confirm the lower rate of current substance use in foster family homes than those matched in the general population, and to explore why adolescents in special study homes were more vulnerable to marijuana use.     

Services use by children and parents in multiproblem families

BackgroundMultiproblem families are multi-users of psychosocial and health care services, but little is known about factors associated with their care utilization in the general population. The aim of this study was to assess which factors were associated with the overall and psychosocial care use of two members—i.e., child and parent—of each multiproblem family.MethodsDuring well-child visits or psychosocial care, we identified 354 children and their parents who had problems in several life domains (response 69.1%). We used multivariate stepwise backward logistic regression analyses to identify the factors related to their use of overall and psychosocial care.ResultsA child's overall care use was associated with greater social support from family and friends (odds ratio, OR, 95% confidence interval, CI; OR = 1.05, CI = 1.01–1.08) compared to less perceived social support; and with more psychosocial problems in the child (OR = 1.84, CI = 1.04–3.24). Child's psychosocial care use was more likely among older children (OR = 1.94, CI = 1.20–3.15); greater social support by family and friend (OR = 1.03, CI = 1.00–1.06); more psychosocial problems (OR = 1.75, CI = 1.04–2.97); and when there were more parenting concerns (OR = 1.19, CI = 1.06–1.33). Parental overall and psychosocial care use was more likely when the family experienced a higher number of life events (OR = 1.27, CI = 1.17–1.38, and OR = 1.39, CI = 1.25–1.55).ConclusionsCare use in multiproblem families is related to family factors as well as psychosocial problems. It may be possible to use these family risk factors to identify such families early, whose intensive care use is possibly explained by the relationship with inadequate use of social support.     

Improving HIV testing amongst adolescents through an integrated Youth Centre rewards program: Insights from South Africa

Despite high HIV prevalence the uptake of HIV counseling and testing (HCT) has been low in South African adolescents, in particular among boys. We designed and implemented an integrated Youth Centre (YC), which included a health clinic and a points based rewards program to incentivize YC services, adjacent to a peri-urban community in Cape Town. We compared 12 month age and gender specific HCT rates for 12–22 year olds between the YC and the single local community clinic in the adjacent community prospectively and for the 12 months prior to YC implementation. Local clinic data were collected through the HCT register. At the YC demographic, attendance, incentives and HIV testing data were prospectively collected via a biometric data collection system. 1187 12–22 year olds attended the YC in the 12 month period. Within the 12–15 year old age group, 12.7% more individuals tested at the YC compared to the clinic in 2011–2012; this difference was greater in males than females. In the 16–22 year category, significantly more individuals tested at the clinic compared to the YC. The use of the YC reward program was associated with undergoing an HIV test. Understanding the specific programmatic factors that led to increased testing behaviour including the role of incentives at the YC warrants further attention.     

Associations between discussions of racial and ethnic differences in internationally adoptive families and delinquent behavior among Korean adopted adolescents

Internationally adopted adolescents may have more delinquent behavior than non-adopted adolescents. One explanation is that these adolescents experience discrimination and loss of culture, and adoptive parents are not adequately addressing these experiences. However, studies have not examined the effects of family discussions of racial and ethnic differences within adoptive families on adopted adolescents' delinquent behavior. To test this relationship, this study utilized data from 111 U.S. internationally adoptive families with 185 South Korean adopted adolescents (55% female, M age = 17.75). During an observational assessment, families discussed the importance of their racial and ethnic differences, and adolescents completed a delinquent behavior questionnaire. Analysis of covariance showed differences in adolescent delinquent behavior across three ways adoptive families discussed racial and ethnic differences; adolescents whose families acknowledged differences had the fewest mean delinquent behaviors. There were no significant differences in delinquent behavior between adolescents whose families acknowledged or rejected the importance of racial and ethnic differences. However, adopted adolescents whose families held discrepant views of differences had significantly more problem behavior than adolescents whose families either acknowledged or rejected the importance of racial and ethnic differences. Clinicians, adoption professionals, and other parenting specialists should focus on building cohesive family identities about racial and ethnic differences, as discrepant views of differences are associated with the most adoptee delinquent behavior.     

An investigation of problematic internet use among adolescents in terms of self-injurious and risk-taking behavior

The purpose of this study was to examine problematic internet use in terms of self-injurious behavior and risk-taking behavior. This study was performed with 736 high school students, 328 females and 408 males studying at various high schools in Trabzon (in Turkey). The Problematic Internet Use Scale was used to measure students' problematic internet use levels, the inventory of statements about self injury to measure self-injurious behavior and the Adolescent Risk-Taking Questionnaire to measure risk-taking behavior. According to the results of the study, a positive and significant relationship was found between risk-taking behavior and problematic internet use (r = .39, p < 0.01), and it was determined that self-injurious behavior and risk-taking behavior significantly predict problematic internet use (F = 86.94, p < 0.01). Furthermore, it was found that problematic internet use displays variation according to self-injurious behavior (F_{(1, 732)} = 32.32, p < 0.01). The findings have been discussed in relation to the existing literature.     

Differences between risk factors for truancy and delinquency in Dutch adolescents

The present study examined differences in risk factors for truancy and delinquency. Research questions were: (1) Which risk factors are significantly different between truants and delinquents? (2) Which risk factors make the strongest distinction between truancy and delinquency? Participants were Dutch adolescents (N = 365) who received a penal sanction in the Netherlands. 83% (n = 304) of them had violated the penal law, and 17% (n = 62) received the penalty for truancy. Differences in risk factors for truancy and delinquency were found for age and parental punishment. Binary logistic regression showed that only parental punishment retained its predictive effects when controlling for other differences. Truants experienced more parental punishment than delinquent adolescents. The present study shows that addressing dysfunctional home circumstances could be more important for truants, indicating that existing interventions do not differentiate enough between truants and delinquents.     

Concurrent alcohol and cigarette use among school-going adolescents in Korea

BackgroundConrurrent alcohol and tobacco use may increase the risk for substance abuse in adolescents. The aim of this study was to investigate concurrent alcohol and cigarette use and the co-occurrence risks of each substance in school-going adolescents in Korea.MethodsIn a cross-sectional nationally representative survey in 2016, 65,528 students (Mean age = 15.1 years, SE = 0.02) responded to a questionnaire that included measures of substance use and substance use exposure.ResultsIn all, 13.3% of the students were concurrent lifetime smokers and drinkers (19.3% among boys and 6.7% among girls), 25.5% lifetime alcohol users only (24.2% among boys and 26.9% among girls), 3.0% lifetime smokers only (4.7% among boys and 1.1% among girls) and 58.3% never smoked and never used alcohol (52.2% among boys and 47.8% among girls). All measures of more intensive smoking pattern and smoking exposure and more intensive drinking pattern and drinking exposures, respectively, were associated with consistently increased risk of lifetime alcohol use and lifetime smoking, respectively, compared to lifetime never smokers and abstainers. In multinomial logistic regression, compared to students who neither had used alcohol nor tobacco, concurrent lifetime smokers and drinkers were more likely to be male, mixed or boys school, higher school grade, lower paternal and maternal educational level, perceived lower socio-economic status, ever drug user, perceived stress above average, depressive mood, experience of violence victimization, and living in a rural area or medium sized city.ConclusionPrevention and treatment strategies should better incorporate the comorbidity of cigarette smoking and alcohol use in their intervention programmes.     

Internalizing symptoms and safe sex intentions among adolescents in mental health treatment: Personal factors as mediators

Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N = 893, M age = 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according to sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.     

Bullying among urban Mexican-heritage youth: Exploring risk for substance use by status as a bully,victim, and bully-victim

Little is known about adolescent bullying behavior and its relationship to substance use in ethnic minority populations. In a sample of youth of Mexican heritage, the current study aimed to examine the prevalence of bullying behavior subtypes and its co-occurrence with recent alcohol, cigarette, and inhalant use. Data come from a school-based substance use prevention study in the Southwestern U.S. (n = 809). We explored the prevalence of bullying behavior by status among youth classified as bullies, victims, bully-victims, and rarely-involved bully-victims in an urban context. We also investigated risk of past 30-day use of alcohol, cigarettes, and inhalants by bullying behavior status. Compared to non-involved youth, rarely-involved bully-victims were more likely to use alcohol, bullies were more likely to engage in alcohol and cigarette use, and bully-victims were more likely to use alcohol, cigarettes, and inhalants. In contrast, victims were not significantly at risk of substance use compared to non-involved youth. Chronic bullies and bully-victims are particularly at risk for substance use, with chronic bully-victims reflecting the greatest risk of using multiple substances. Prevention and early intervention programs aimed to reduce bullying can also work to decrease other risky behaviors, such as substance use, and should attend to the growing ethnic diversity among youth.