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OBJECTIVES: Health education programmes that utilizes multicomponent classroom teaching strategies have the potential to enhance knowledge, attitudes, and actions of adolescents concerning health risk behaviors (HRBs). This study assessed the effect of a school-based context-specific health education intervention (CsHEI) on knowledge of HRBs among in-school adolescents in public- and private-owned secondary schools in Nigeria. METHODS: In-school adolescents were recruited into this quasi-experimental study using stratified random sampling from secondary schools in Ile-Ife, Osun-State, Nigeria. Knowledge of HRBs was assessed pre- and post-implementation of a CsHEI. The intervention was a four-week instructor-led health education class on HRBs, delivered over a 2-h class activity per week. Data was summarized using descriptive statistics as well as Inferential statistics. RESULTS: With a mean age of 14.9 ± 1.56 years, a total of 145 females (54.3 %) and 122 males (45.7 %) participated in this study. Over 70 % of the participants had good knowledge of HRBs prior to the intervention with the pre-test mean general knowledge of HRB (t=-3.13, p=0.002) and knowledge of personal safety (t=-2.99, p=0.003) being significantly lower between students in public-schools compared to their private-school counterparts. Post-intervention, a significant improvement in participants' knowledge was observed in all HRB domains with over 90 % of participants having a good knowledge of HRBs. CONCLUSIONS: The CsHEI improved knowledge of in-school adolescents in public- and private-owned secondary schools in Osun state, Nigeria in all domains of HRBs. Integrating the CsHEI with other health behavioral change strategies can mitigate prevalence of HRBs among adolescents, thereby improving health-outcomes and well-being of adolescents.

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Depression is a significant public health challenge. However, limited research exists regarding the risk of sociodemographic factors, health-risk behavior, and chronic conditions in relation to the development of depression in Indonesia. This study assesses the prevalence of depressive symptoms in adolescents and adults, and identifies its potential associations with sociodemographic factors, health-risk behaviors, and chronic conditions. A national cross-sectional population-based survey was performed, using the Indonesian Family Life Survey (IFLS-5), to assess depressive symptoms in respondents aged 15 years and older. Depression was evaluated using the Center for Epidemiologic Studies-Depression (CES-D) scale, and potential associations with sociodemographic factors, health-risk behaviors, and chronic conditions were examined using logistic regression analysis. The study revealed a high prevalence of depressive symptoms, with the highest incidence observed in the age group of 25-34 years. Factors such as unmarried status, younger age, good physical activity, and having chronic conditions showed associations with depression. These findings have implications for developing public mental health strategies to reduce the prevalence of depression in Indonesia.

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INTRODUCTION: Sexually transmitted infections (STIs) are a major public health problem to which young people are highly exposed and knowledge about vulnerabilities that affect them is needed. OBJECTIVE: To evaluate the knowledge about STIs and sexual behavior of a university population in the city of Sorocaba/SP. METHODS: A descriptive, cross-sectional study was conducted with data collection realized by an online application with qualitative and quantitative characteristics. RESULTS: Four hundred and seventy-seven (477) university students from different areas of knowledge were analyzed. The majority pointed to the beginning of sexual life between 15 and 18 years old. Information about sex education was obtained mainly through parents and/ or guardians, while little additional knowledge was obtained after entering higher education. Biological and Health Sciences students achieved a higher score on the knowledge questionnaire and were less likely (0.391) to contract STIs when compared to Applied Social Sciences or Engineering students (2.8 and 2.9 more likely, respectively). CONCLUSION: Students who demonstrated greater knowledge about STIs and acquired more information on the subject during graduation were less likely to become infected, suggesting that campaigns aimed at the university public are essential for the prevention and control of these pathogens.

INTRODUÇÃO: As infecções sexualmente transmissíveis (IST) são um grande problema de saúde pública, ao qual os jovens apresentam alta exposição, sendo necessário um maior conhecimento sobre as vulnerabilidades que os acometem. OBJETIVO: Avaliar o conhecimento sobre as IST e o comportamento sexual de uma população universitária na cidade de Sorocaba/SP. MÉTODOS: Realizou-se um estudo descritivo, de corte transversal, com a coleta de dados realizada por meio de aplicação online de questionário com características qualitativas e quantitativas. RESULTADOS: Quatrocentos e setenta e sete (477) universitários de diferentes áreas de conhecimento foram avaliados. A maioria dos relatos apontou para o início da vida sexual entre 15 e 18 anos. As informações sobre educação sexual foram obtidas principalmente por intermédio dos pais e/ou responsáveis, enquanto pouco conhecimento adicional foi obtido após o ingresso no Ensino Superior. Estudantes de Ciências Biológicas e da Saúde alcançaram o maior score no questionário sobre conhecimento e apresentaram chances menores (0,391) de contrair IST, quando comparados aos estudantes de Ciências Sociais Aplicadas ou Engenharias (2,8 e 2,9 mais chances, respectivamente). CONCLUSÃO: Os estudantes que demonstraram maior conhecimento sobre as IST e que adquiriram mais informações sobre o tema durante a graduação apresentaram chances menores de se infectar, o que sugere que campanhas destinadas ao público universitário são essenciais para a prevenção e o controle desses patógenos.

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BACKGROUND: Parasitic diseases pose challenges in impoverished urban settlements with limited access to clean water, proper hygiene, and sanitation (WASH). This study assesses WASH practices and risk perceptions of parasitic infections among households in the Bataan Shipyard and Engineering Corporation (BASECO) Compound in Manila, an urban poor community in the Philippines. METHODS: A cross-sectional study design was employed to collect data through a self-administered questionnaire. Descriptive statistical analysis was performed to assess the sociodemographic profile, household WASH practices, and respondents' risk perception of parasitic infections. Linear regression analysis was utilized to examine the relationship between these variables. RESULTS: A survey was conducted with 363 households, of which 237 (65.3%) used distilled and purified water from the water refilling stations in the community for drinking. Meanwhile, 120 households (33.10%) consumed tap water. Boiling water was a commonly used method (n=146; 56.60%) for treating drinking water. Most households had flush toilets with septic tanks (n=244; 67.20%), water sources for handwashing (n=307; 84.57%) and soap for handwashing (n=356; 98.10%). On average, they washed their hands 6-10 times daily (n=159; 43.80%). Most households were aware that drinking untreated water (n=318; 87.6%), improper food washing (n=309; 85.1%), using contaminated water sources (n=301; 82.9%), and consuming raw or undercooked meat (n=298; 82.1%) could lead to parasitic infections. 316 respondents (87.1%) identified diarrhea as the most common symptom of parasitic infection. Relationships were found between access to drinking water and the number of household members (B=0.191; p-value=0.001), personal hygiene and the respondents' knowledge of parasitic infections (B=0.112; p-value=0.047), and the overall WASH score with household income (B=0.105; p-value=0.045). CONCLUSIONS: The WASH conditions in BASECO, Manila need improvement. Factors associated with their WASH practices include risk perception of parasitic diseases, socioeconomic disparity, and household overcrowding. These factors play a crucial role in identifying areas for improvement and promoting health policies for urban poor communities in the Philippines.

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Objetivo: Estimar a prevalência e os fatores associados à agregação de quatro comportamentos sedentários excessivos em escolares da rede pública de ensino de Jequié-BA. Métodos: Pesquisa realizada com amostra de estudantes do ensino médio da rede estadual de ensino de uma cidade do interior da Bahia, Brasil. Os quatro comportamentos sedentários observados foram: tempo de tela assistindo televisão durante e no final de semana, tempo de tela usando computador/videogame durante e no final de semana. As variáveis ​​sociodemográficas e de estilo de vida (preditores) serviram para identificar os respectivos fatores associados à agregação dos quatro comportamentos sedentários (desfecho). A associação foi determinada pela Razão de Prevalência (RP) com intervalo de confiança (IC) de 95%. Resultados: A amostra foi composta por 972 escolares, sendo a maior proporção de adolescentes do sexo feminino 53,4% (n = 519), a maior prevalência de comportamentos sedentários excessivos foi para o tempo de tela de TV e computador/videogame, nos finais de semana (24,6% e 25,1%), conforme mostrado no. Conclusões: Houve elevado valor agregado dos quatro comportamentos sedentários. As estudantes do sexo feminino eram menos propensas a serem expostas ao resultado. Porém, aqueles que não trabalhavam, que eram considerados insuficientemente ativos e que não alcançavam consumo adequado de hortaliças, aumentaram a probabilidade de agregação dos quatro comportamentos sedentários.

Objetivo: Estimar a prevalência e os fatores associados à agregação de quatro comportamentos sedentários excessivos (tempo de tela TV/semana, tempo de tela TV/final de semana, tempo de tela computador/semana, tempo de tela computador/final de semana) em escolares da rede pública de Jequié-BA Métodos: Levantamento com amostra de escolares, do ensino médio, da rede estadual de ensino em uma cidade no interior da Bahia, Brasil. Os quatro comportamentos sedentários observados foram: tempo de tela assistindo televisão durante e ao final de semana, tempo de tela usando computador/videogame durante e ao final de semana. As variáveis ​​sociodemográficas e do estilo de vida (preditores) serviram para identificar os fatores relacionados à agregação dos quatro comportamentos sedentários (desfecho). A associação foi determinada pela Razão de Prevalência (RP) com intervalo de confiança (IC) de 95%. Resultados: A amostra foi composta por 972 escolares, sendo maior proporção de adolescentes do sexo feminino 53,4% (n = 519), a maior prevalência dos comportamentos sedentários excessivos foi para o tempo de tela de TV e computador/videogame, aos primeiros por semana (24,6% e 25,1%). Conclusões: Houve um elevado valor de agregação (a combinação da prevalência observada foi maior que a prevalência esperada para os quatro comportamentos sedentários excessivos). Os escolares do sexo feminino apresentavam menores probabilidades de exposição ao desfecho. No entanto, aqueles que não trabalharam, que foram considerados insuficientemente ativos e que não atingiam o consumo adequado de verduras, aumentaram a probabilidade da agregação dos quatro comportamentos sedentários.

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Background: Despite lifelong and detrimental effects, the co-occurrence of health risk behaviors (HRBs) during adolescence remains understudied in low- and middle-income countries. This study examines the co-occurrence of HRBs and its correlates among adolescents in sub-Saharan Africa, China, and India. Methods: A multi-country cross-sectional study was conducted in 2021-2022, involving 9697 adolescents (aged 10-19 years) from eight countries, namely Burkina Faso, China, Ethiopia, India, Ghana, Nigeria, Tanzania, and Uganda. A standardized questionnaire was administered to examine five types of HRBs - physical inactivity, poor dietary habits, smoking, alcohol consumption, and risky sexual behavior. Latent class analysis was employed to identify clustering patterns among the behaviors, and logistic regression was used to identify the correlates of these patterns. Findings: Three clusters of HRBs were identified, with Cluster 1 (27.73%) characterized by the absence of any specific risky behavior, Cluster 2 (68.16%) characterized by co-occurrence of physical inactivity and poor dietary habits, and Cluster 3 (4.11%) characterized by engagement in smoking, alcohol consumption, and risky sexual behavior. Relative to Cluster 1, being in Cluster 2 was associated with being female (aOR 1.20, 95% CI 1.09-1.32), not enrolled in education (aOR 0.84, 95% CI 0.71-0.99), and not engaged in paid work (aOR 1.23, 95% CI 1.08-1.41). Compared with those Cluster 1, adolescents in Cluster 3 were less likely to be female (aOR 0.41, 95% CI 0.32-0.54), be engaged in paid work (aOR 0.54, 95% CI 0.41-0.71), more likely to be older (aOR 7.56, 95% CI 5.18-11.03), not be enrolled in educational institution (aOR 1.74, 95% CI 1.27-2.38), and more likely to live with guardians other than parents (aOR 1.56, 95% CI 1.19-2.05). Interpretation: The significant clustering patterns of HRBs among adolescents in sub-Saharan Africa, China, and India highlights the urgent need for convergent approaches to improve adolescent health behaviors. Early life and school-based programs aimed at promoting healthy behaviors and preventing risky and unhealthy behaviors should be prioritized to equip adolescents with the tools and skills for lifelong well-being. Funding: Fondation Botnar (Grant #INV-037672) and Harvard T.H. Chan School of Public Health, partially funded this study.

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Background: Alcohol misuse is one of the most important preventable public health risk factors. Empirical research shows that alcohol misuse is related to social and economic losses. Both theoretical and empirical evidence suggests that neighborhood disorder impacts alcohol-related behavior. However, there is limited literature in the context of developing countries. Objectives: The aim of this research is to estimate the association between perceived neighborhood disorder and (1) alcohol-related behavior and (2) alcohol-related problems in the context of the Chilean population. Our contribution focuses on the examination of the perception of disorder in urban neighborhoods and alcohol use patterns in a wide age range and sample of Chilean cities. Results: High levels of neighbor disorder perception are associated with higher levels of drinking and hazardous alcohol use. In addition, perceived neighborhood disorder is directly associated with probability of alcohol-related problems (ranging from 2% to 11%). Conclusions/Importance: The results are consistent with empirical and theoretical frameworks. This research could be used to better guide place-based policies in emerging countries with high levels of alcohol consumption to prevent alcohol risk behaviors and alcohol-related problems.

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OBJECTIVES: To explore the relationship between cumulative ecological risk and individual risky behavior and multiple forms of aggregated behaviors among adolescents, and examine the gender differences. METHODS: A large-scale, nationally representative, and students-based investigation was conducted in rural and urban areas of eight provinces in China from October to December 2021. A total of 22 868 adolescents with an average age of 14.64 years completely standardized questionnaire in which the sociodemographic characteristics, socio-ecological risk factors and risky behaviors were used to analyze. RESULTS: Of included students, 48.4% encountered the high level of social-ecological risk. The prevalence of breakfast intake not daily, alcohol use (AU), smoking, physical inactivity, prolonged screen time (ST) on weekdays and weekends, suicidal ideation, suicidal plan, suicidal attempt, and non-suicidal self-injury (NSSI) was 41.0%, 11.9%, 3.4%, 61.9%, 15.1%, 51.1%, 27.7%, 13.9%, 6.5% and 27.0% respectively. 22.2% of participants engaged in high-risk behaviors. All were significantly influences of increased cumulative ecological risk on individual behavior and low-risk clustering behaviors separately. The odds ratio of breakfast intake not daily, AU, smoking, physical inactivity, prolonged ST in weekday and weekend, suicidal ideation, suicidal plan, suicidal attempt, and NSSI for the adjusted model in low versus high level of cumulative ecological risk was respectively significant in both boy and girls, and the ratio of odds ratios (ROR) was separately 0.95 (p = 0.228), 0.67 (p < 0.001), 0.44 (p < 0.001), 0.60 (p < 0.001), 0.78 (p = 0.001), 0.83 (p = 0.001), 0.80 (p = 0.001), 0.83 (p = 0.022), 0.71 (p = 0.005), 0.75 (p = 0.001). Girls encountering a high level of cumulative ecological risk were more likely to engage in multiple forms of clustering risky behaviors than boys (RORs: 0.77, p = 0.001). CONCLUSIONS: Research and effective inventions at the social-ecological environment, based on the view of cumulative risk, are needed to promote the healthy development of behaviors in adolescence, and pay more attention to decreasing the occurrence of risky behaviours in girls than boys.

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Objective@#To analyze the association between latent class of health-risk behaviors and depressive symptoms among middle school students, so as to provide the evidence for the prevention and intervention of depressive symptoms among middle school students.@*Methods@#Students in two junior high schools, two senior high schools and one vocational high school in Yinzhou District, Ningbo City, Zhejiang Province, were selected using a stratified multi-stage cluster sampling method. Demography and health-risk behaviors were collected using questionnaire surveys, depressive symptoms were investigated using the Center for Epidemiological Studies Depression-10 Scale, and latent class analysis was conducted for health-risk behaviors. The association between different latent classes and depressive symptoms was analyzed using a multivariable logistic regression model.@*Results@#A total of 1 247 students were surveyed, including 641 boys (51.40%) and 606 girls (48.60%). There were 452 junior high school students (36.25%), 532 high school students (42.66%) and 263 vocational high school students (21.09%). Latent class analysis showed that health-risk behaviors in students were classified into three groups, namely healthy behavior group (52.93%), poor diet group (39.94%) and high-risk behavior group (7.14%), and the detection rates of depressive symptoms were 7.12%, 18.88% and 52.81%, respectively, with a statistically significant difference between groups (P<0.05). Multivariable logistic regression analysis showed that after adjusting for age, gender, native place, only child and living on campus, the poor diet group (OR=3.107, 95%CI: 2.086-4.627) and high-risk behavior group (OR=15.401, 95%CI: 9.031-26.262) had higher risks of depressive symptoms compared with the healthy behavior group.@*Conclusion@#Having high-risk behaviors and poor diet may increase the risk of developing depressive symptoms among middle school students.

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OBJECTIVES: The aim of this study is to report on the frequency of serious physical injuries (SPI) among adolescents in Central America during the previous decade, 2009-2018. METHODS: In total, 15,807 school adolescents (14.4 years mean age; SD=1.4) from six Central American countries participated in cross-sectional Global School-based Student Health Surveys in 2009-2018 (ranging from 1,779 students in Honduras in 2012 to 4,374 students in Guatemala in 2015). RESULTS: The prevalence of SPI was 33.8 % (22.9 % once, 7.4 % 2 or 3 times and 3.6 % 4 or more times), ranging from 31.8 % in Guatemala to 45.0 % in Belize and 45.6 % in Panama. The most frequent causes of SPI included fall (11.4 %, ranging from 6.9 % in Costa Rica to 15.6 % in Panama), and the type of SPI was fracture/dislocation (5.7 %, ranging from 4.3 % in Costa Rica to 6.7 % in Panama). In adjusted Poisson regression, male sex, food insecurity, a history of alcohol intoxication, soft drink consumption, fast food intake, truancy, multiple sexual partners, psychological distress, physical fight, physically attacked, bullied, and suicide attempt were significantly associated with a higher number of injury event counts. CONCLUSIONS: Overall, about one in three adolescents in Central America had sustained unintentional injuries in the past 12 months and several contributing factors were identified which if addressed could aid injury prevention among adolescents.

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BACKGROUND: Air pollution is a major health risk contributing to global morbidity and mortality, yet clinicians do not routinely engage in counseling patients on this topic. Clinicians cite their lack of education as a common barrier. We developed a two-minute animated video on mitigating air pollution health risks and evaluated the efficacy of this video as an educational tool. METHODS: In March-June 2021, a convenience sample of Minnesota interprofessional health learners and clinicians viewed the video and completed an electronic survey that assessed pre-/post-video intervention changes in (a) didactic and clinically applied knowledge on health impacts of air pollution, (b) perceived comfort in identifying at-risk patients and counseling them on relevant preventive health behaviors, (c) intentions/barriers to counseling patients, (d) beliefs and attitudes related to the health harms of air pollution, and (e) perceptions of the overall acceptability of the intervention. RESULTS: The 218 participants included learners and clinicians in medicine, nursing, and advanced practice provision. Respondents' knowledge scores and self-reported level of comfort in identifying high-risk patients and counseling them on preventative health behaviors increased significantly pre-/post-intervention. The video also effectively altered participants' misperceptions about the health impacts of air pollution. While less than half of participants (43.6%) reported they intended to engage in counseling patients as a result of watching the video, 52.3% indicated they might do so. Lack of time during clinical encounters and lack of training were reported as persistent barriers to engaging in this counseling. Overall, participants found the video to be an effective educational tool, indicating that they wanted their colleagues and patients to watch the video and would like to see further short, animated videos on other environmental health topics. CONCLUSIONS: A two-minute animated educational video significantly improved knowledge of inequitable health impacts of air pollution and improved perceived comfort in identifying and counseling at-risk patients among health professional learners and clinicians regardless of profession, level of training, or pre-intervention knowledge level. Academic health professional training programs and health systems should consider adopting this modality as a tool for educating learners, clinicians, and patients on environmental health risks.

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BACKGROUND: Using existing models of behavioral health promotion, specifically the Extended Parallel Process Model, previous research has identified factors that may impact engagement in preventive health behaviors during the COVID-19 pandemic such as perceived threat, perceived susceptibility to the threat, perceived severity, and perceived efficacy. OBJECTIVE: This study aims to examine the role of perceived effectiveness of COVID-19 preventive behaviors, perceived susceptibility, perceived threat, and perceived severity of COVID-19 in participants' intentions to engage in Centers for Disease Control (CDC)-recommended individual health behaviors in the first year of the pandemic. METHODS: In October 2020, a representative sample of 506 US adults completed a web-based survey through the RAND American Life Panel. RESULTS: The study primarily found that participants who perceived that CDC-recommended health practices were effective had stronger intentions to engage in those practices. The second strongest correlate was participants' perceived severity of COVID-19 across the United States. Perceived effectiveness of recommended practices accounted for the largest variance in behavioral intention. However, analysis of individual behaviors indicated a mismatch in the behaviors perceived to be the most effective (avoiding sick people and mask-wearing) and those participants indicated intention to engage in (throwing away used tissues, avoiding sick people, and coughing into their elbows) in the next 30 days. CONCLUSIONS: The authors recommend tailoring public health messaging to address the perceived threat of COVID-19 and self-efficacy. Thus, health promotion efforts should emphasize the effectiveness of CDC-recommended practices while highlighting the pandemic's severity. Additionally, rebuilding trust in public health messaging and messengers is necessary to increase perceived self-efficacy. As the COVID-19 pandemic continues, health messaging must continue to promote and build trust in CDC-recommended health practices and educate regarding the efficacy of vaccination and other preventive behaviors.

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BACKGROUND: Adolescents frequently engage in risky behaviors that negatively influence their health and pose a serious public health concern. This study aimed to examine the clustering pattern of health risk behaviors among school-going adolescents in Bangladesh. METHODS: A cross-sectional study was conducted from 15 April to 27 June 2022 among 412 school-going adolescents in Mymensingh district of Bangladesh through a convenience sampling technique. Data were collected via face-to-face interviews using a modified Global School-Based Student Health Survey (GSHS) 2021 questionnaire. Cluster membership was identified using the k-means clustering algorithm. The chi-square test was adopted to explore the association between sociodemographic variables and each cluster membership. The ordinal logistic regression model was employed to examine the predictors associated with cluster membership. RESULTS: Most of the respondents were female (55.3%) and belonged to the 16-19 years (74.5%) age group. Three behavioral clusters were identified, including Cluster 1: Low-risk taker (50.2%), Cluster 2: Moderate risk taker (39.6%), and Cluster 3: High-risk taker (10.2%). Influential factors of high-risk behavior among adolescents were significantly associated with their age (p = 0.03), father's education who were illiterate (p = 0.02), monthly family income >30000 BDT (p = 0.04), parent's those were understanding their child's problems in most of the time (p = 0.001). CONCLUSIONS: The study found that high-risk behaviors are significantly higher among late adolescents, those whose fathers are illiterate, whose monthly income is higher, those whose parents or guardians never realize their child's complications and worries, and those whose parents or guardians never recognize what they did in their leisure time. These findings will help to develop intervention programs, policies, strategies, and curricula in school by the experts following the necessity to adopt the adolescent toward healthy behavior and help to reduce the prevalence of health risk behavior.

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OBJECTIVE: To verify the association between exercise and free time sport types and binge drinking in a large sample of adults. METHODS: Data of 718,147 adults from the "Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey" were used. We described the demographic and behavioral variables, and negative binomial regression analyzed the association between exercise and free time sport types and binge drinking adjusted by demographics variables, body mass index status, and television time. RESULTS: Outdoor walking/running was the most common exercise reported (20.0%, 95% confidence interval [CI], 19.8%-20.2%), followed by team sports (8.1%; 95% CI, 8.0%-8.2%) and strengthening (8.0%; 95% CI, 7.9%-8.1%). The prevalence of binge drinking for each exercise and free time sport type ranged from 6.9% (water aerobics) to 31.9% (team sports). Participants engaging in strengthening (prevalence ratio = 1.12; 95% CI, 1.04-1.21, P = .002) and team sports (prevalence ratio = 1.11; 95% CI, 1.07-1.17, P < .001) were more likely to binge drink more frequently in the past 30 days than inactive participants. CONCLUSIONS: It appears that the participants' profile plays an important role in the underlying social context of this association. Participants with more frequent strengthening and less frequent team sports practice, who were primarily younger and single, were more likely to binge drink frequently.

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BACKGROUND: Health risk behaviors (HRBs) is a kind of phenomenon behavior that often occurs in adolescence, and also often appears in clusters. Previous studies suggested an association between social ecological risk factors (SERFs) and HRBs. This study explored 1) whether chronotype moderates the risk of HRBs associated with SERFs and 2) whether mental health is a mediator in this relationship. METHODS: Adolescents were recruited from 39 junior or senior schools (three cities, 13 schools per city) using a multistage cluster sampling method conducted between October, 2020 and June, 2021. The Social Ecological System, Morningness-Eveningness Questionnaire, Brief Instrument on Psychological Health Youths, and Youth Risk Behavior Surveillance questionnaires were used to measure the SERFs, chronotype, mental health and HRBs. Latent category analysis was used to explore the clustering mode of HRBs. The primary exposure was SERFs, and the primary outcome was HRBs; chronotype was a moderator, and mental health was a mediator. The multivariable logistic regression model was used to determine the relationship between SERFs and chronotype and mental behavioral health status. Mediation moderate analysis using the PROCESS method was used to explore the relationship between these variables. Sensitivity analysis was conducted to evaluate the robustness of the model. RESULTS: In total, 17,800 individuals were initially enrolled. After excluding 947 individuals with invalid questionnaires, 16,853 participants were finally included in the analysis. The mean age of participants was 15.33 ± 1.08 years. After adjusting for covariates, multivariable logistic regression found that high levels of SERFs (odds ratio [OR] = 10.10, 95% confidence interval [CI]: 8.88-11.43, P < 0.01), intermediate chronotype (OR = 5.24, 95% CI: 4.57-6.01, P < 0.01), and eveningness (OR = 1.83, 95% CI: 1.64-2.05, P < 0.01) were associated with higher HRBs frequency. This study also assessed the interaction between chronotype, SERFs and HRBs (OR = 27.84, 95% CI: 22.03-35.19, P < 0.01) and mental health (OR = 18.46, 95% CI: 13.16-25.88, P < 0.01). The moderated mediation analyses examined the relationship between chronotype, SERFs, mental health and HRBs. CONCLUSIONS: SERFs may be important variables in measuring the effect of the adolescent psychosocial environment on HRBs; this effect is mediated by mental health and moderated by chronotype.

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During adolescence, interactions with peers influence a teen's attitudes and behaviors. Adolescents seek for peer approval and acceptance, which may bring them to engage in health-risky behaviors such as smoking and drinking. In this study, we estimate the impact of peers on the drug use of Spanish students aged 14 to 18. We focus on the consumption of alcohol and tobacco, the most prevalent substances used at those ages. We estimate the effect of the average classmates' consumption-the measure of peers' use-on individual consumption. Since peers' use affects individual use and vice versa, we correct for this bias using instrumental variables. Results show that peers' consumption increases substantially the probability of using alcohol, while it does not significantly affect tobacco consumption. Our results are not sensitive to using different time spans of consumption. This study shows also novel evidence indicating that the higher the proportion of grade-retained students in the class, the stronger the peer effects, especially for alcohol. This suggests that future reforms of the grade retention policy should also consider the negative effects on non-academic outcomes, such as substance use.

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There is increased acceptance that social and behavioral determinants of health (SBDH) impact health outcomes, but electronic health records (EHRs) are not always set up to capture the full range of SBDH variables in a systematic manner. The purpose of this study was to explore rates and trends of social history (SH) data collection-1 element of SBDH-in a structured portion of an EHR within a large academic integrated delivery system. EHR data for individuals with at least 1 visit in 2017 were included in this study. Completeness rates were calculated for how often SBDH variable was assessed and documented. Logistic regressions identified factors associated with assessment rates for each variable. A total of 44,166 study patients had at least 1 SH variable present. Tobacco use and alcohol use were the most frequently captured SH variables. Black individuals were more likely to have their alcohol use assessed (odds ratio [OR] 1.21) compared with White individuals, whereas White individuals were more likely to have their "smokeless tobacco use" assessed (OR 0.92). There were also differences between insurance types. Drug use was more likely to be assessed in the Medicaid population for individuals who were single (OR 0.95) compared with the commercial population (OR 1.05). SH variable assessment is inconsistent, which makes use of EHR data difficult to gain better understanding of the impact of SBDH on health outcomes. Standards and guidelines on how and why to collect SBDH information within the EHR are needed.

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PURPOSE: School social support is associated with improved adolescent wellbeing. However, positive school relationships were potentially disrupted when schools transitioned to distance learning in 2020 to mitigate the spread of COVID-19. This study investigated associations among perceived distance learning school support, mental health, social-emotional wellbeing, substance use, and delinquency among low-income, public high school students. METHODS: We analyzed longitudinal survey data, collected between June 2020 and June 2021, from 372 students attending five large urban public high schools. Mixed-effects regression models examined associations among changes in distance learning support and changes in mental health, social-emotional wellbeing, substance use, and delinquency, controlling for time, social-demographics, and baseline health. RESULTS: In this predominantly Latinx (83%) sample, within-person increases in perceived distance learning support were associated with improved mental health, increased grit, increased self-efficacy, and decreased stress. Between-person differences in distance learning support indicated that students reporting greater support had improved mental and social-emotional outcomes. Although there were no within-person associations among distance learning support and hopelessness or delinquency, students with greater distance learning support (between-person) had lower levels of hopelessness and lower odds of engaging in any delinquent behavior. There were no associations between distance learning support and 30-day substance use. DISCUSSION: School social support, even without students physically on campus, may be critical to adolescent health behaviors and social-emotional outcomes.

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OBJECTIVE: Health-risk behaviors have an unclear etiology and college students have elevated risk for engagement. Emotion dysregulation and several personality dimensions have been implicated in health-risk behaviors, but these constructs have rarely been studied together. Further, it is unknown if different types of health-risk behaviors have distinct etiologies. PARTICIPANTS: 2077 college students completed a cross-sectional survey. METHODS: Latent profile analysis discerned classes of participants from emotion dysregulation and personality dimensions. Differential engagement in self-injury, suicidality, disordered eating, substance misuse, and unprotected sex was evaluated across classes. RESULTS: Three classes were identified, which were primarily distinguished by emotion dysregulation, urgency, and neuroticism. Health-risk behaviors generally increased across classes with increasing emotion-related constructs. Self-injury and suicidality demonstrated different patterns than other health-risk behaviors. CONCLUSIONS: Results elucidate heterogeneity in health-risk behavior engagement. Focusing on emotional difficulties may be more important for reducing self-injury and suicidality than disordered eating, substance misuse, and risky sex.

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BACKGROUND: Children with disabilities may be at increased risk for engaging in health risk behaviors compared to their peers without disabilities. OBJECTIVE: This secondary analysis aims to assess if Individualized Education Program (IEP) status, a proxy for having a disability, is a risk factor for youth to engage in health risk behaviors such as alcohol use, marijuana use, other substance use, bullying or cyberbullying victimization, and sexual activity. METHODS: Data from Connecticut Youth Risk Behavior Surveillance System (YRBSS) 2013, 2015, 2017, and 2019 were combined for a representative sample of 9243 students, 850 reporting having an IEP. Having a disability was measured by an item that asked if participants received special education services as part of an IEP. Logistic regression that accounted for the YRBSS sample design was used to assess main effects. RESULTS: Having an IEP significantly predicted the likelihood of being bullied (OR = 1.81), cyberbullied (OR = 1.49), and other drug use (OR = 1.65), but did not predict engaging in sexual activity. CONCLUSIONS: Students with disabilities in CT, as defined by the receipt of special education services as specified on an IEP, are at increased risk to engage in health risk behaviors than are students without disabilities during their high school years. Further analyses and comparisons across sites, years, and type of disability are limited as there is no current item on the national YRBSS questionnaire that measures a participant's special education status or disability status.

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