Sexual Orientation-Based Depression and Suicidality Health Disparities: The Protective Role of School-Based Health Centers.

This study's purpose was to examine whether school-based health centers (SBHCs) support mental health indicators among sexual minority youth (SMY). Data came from the 2015 Oregon Healthy Teens Survey with 13,608 11th graders in 137 public high schools in Oregon. Regression results revealed significant SBHC by SMY status interactions indicating relative reductions in likelihood of depressive episodes (30%), suicidal ideation (34%), and suicide attempts (43%) among SMY in schools with SBHCs. SMY students in SBHC schools reported lower likelihood of a past-year depressive episode, suicidal ideation, and suicide attempt versus those attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY by SBHC status. SBHCs may help reduce mental health disparities among SMY, a marginalized, underserved population.

Sexual Orientation-Based Alcohol, Tobacco, and Other Drug Use Disparities: The Protective Role of School-Based Health Centers.

This study investigated whether the presence of school-based health centers (SBHCs) was associated with six substance use behaviors among sexual minority youth (SMY) and their heterosexual peers. Data from the 2015 Oregon Healthy Teens Survey, including 13,608 11th graders in 137 schools (26 with SBHCs) were used in the current study. Multilevel logistic regression analyses were performed. Results revealed significant SBHC by SMY status interactions indicating a relatively lower likelihood of past 30-day alcohol use (23%), binge drinking (43%), use of e-cigarettes (22%), marijuana (44%), and unprescribed prescription drugs (28%) among SMY in SBHC schools compared with non-SMY at SBHC schools. Furthermore, SMY in SBHC schools reported lower likelihood of aforementioned substance use behaviors than SMY attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY in SBHC and non-SBHC schools. Findings from this study suggest SBHCs may help to mitigate substance use disparities among marginalized populations, such as SMY.

School-based health services and educational attainment: Findings from a national longitudinal study.

This study examined whether availability and use of different types of school-based health services (SBHS) during adolescence were associated with educational attainment in adulthood. Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed in 2018 to assess relationships between different types of SBHS provided by schools and use of SBHS among adolescents in 1995, and educational attainment in young adulthood (2001-02) and later adulthood (2008). Multi-level linear regression models included SBHS such as providing immunizations, physical exams and emotional counseling at the school level, and receiving a school-based physical exam, emotional counseling or family planning counseling at the individual level, with other school and individual characteristics included as covariates. At the school level, providing immunizations in 1995 was associated with higher educational attainment in 2001-02 and 2008. Providing physical exams and physical fitness/recreation centers also were marginally associated with higher educational attainment in 2001-02 and 2008, respectively. At the individual level, receiving a physical exam at school in 1995 was associated with higher educational attainment in 2001-02, while receiving emotional counseling at school was inversely associated with educational attainment in 2008. None of the other types of SBHS at the school or individual level were associated with later educational attainment. This study suggests that preventive SBHS such as immunizations, physical exams and physical fitness/recreation centers may contribute to academic achievement and higher educational attainment during young and later adulthood.

"It just depends on the environment": Patterns and decisions of substance use and co-use by adolescents.

This study used rich qualitative data to examine the role that social and physical contexts play in decision-making related to simultaneous use of alcohol and marijuana among adolescents. In-depth, semi-structured interviews were conducted with 13 adolescents who used alcohol and marijuana within several hours of each other. Decisions about whether to use alcohol and marijuana simultaneously as well as use patterns (e.g. the sequence in which substances were used) were informed by the context and the desired effect of the substance(s). Also, simultaneous alcohol and marijuana use was described as occurring in multiple contexts, both destination and transitional. Interventions designed to reduce simultaneous alcohol and marijuana use could benefit from paying attention to substance use contexts.

School-based mental health services, suicide risk and substance use among at-risk adolescents in Oregon.

This study examined whether an increase in the availability of mental health services at school-based health centers (SBHCs) in Oregon public schools was associated with the likelihood of suicidal ideation, suicide attempts and substance use behaviors among adolescents who experienced a depressive episode in the past year. The study sample included 168 Oregon public middle and high schools and 9073 students who participated in the Oregon Healthy Teens Survey (OHT) in 2013 and 2015. Twenty-five schools had an SBHC, and 14 of those schools increased availability of mental health services from 2013 to 2015. The OHT included questions about having a depressive episode, suicidal ideation, attempting suicide in the past year, and substance use behaviors in the past 30days. Multi-level logistic regression analyses were conducted in 2017 to examine associations between increasing mental health services and the likelihood of these outcomes. Analysis results indicated that students at SBHC schools that increased mental health services were less likely to report any suicidal ideation [odds ratio (OR) (95% C.I.)=0.66 (0.55, 0.81)], suicide attempts [OR (95% C.I.)=0.71 (0.56, 0.89)] and cigarette smoking [OR (95% C.I.)=0.77 (0.63, 0.94)] from 2013 to 2015 compared to students in all other schools. Lower frequencies of cigarette, marijuana and unauthorized prescription drug use were also observed in SBHC schools that increased mental health services relative to other schools with SBHCs. This study suggests that mental health services provided by SBHCs may help reduce suicide risk and substance use behaviors among at-risk adolescents.

Cognitive precursors to adolescents' reproductive health: Exploring the role of school-based health services.

The goal of this study was to examine associations between the number of school-based health services (SBHS) provided and the cognitive precursors to adolescents' reproductive health, including birth control self-efficacy, motivation to use birth control, attitudes toward birth control, and contraception knowledge. Further, this study examined whether these associations varied by adolescents' age, gender, socioeconomic status (SES), and race/ethnicity. Data were drawn from two waves of Add Health, a longitudinal survey of a nationally representative sample of U.S. adolescents (1994-96). Results from hierarchical linear regression models indicated that the number of SBHS interacted with adolescents' age to predict birth control self-efficacy, such that a greater number of SBHS were associated with greater birth control self-efficacy among 15-year-old adolescents. Findings also indicated that a greater number of SBHS were associated with lower reported birth control motivation. Although access to a greater number of health services in school settings had some effect, study findings suggest that simply increasing the number or range of health services provided may not be the most effective method for supporting diverse adolescents' reproductive health. This information is important for schools as it highlights the need for SBHS to be health outcome specific and can be used to inform initiatives related to adolescents' reproductive health.

Oregon School-Based Health Centers and Sexual and Contraceptive Behaviors Among Adolescents.

This study investigated the association between school-based health centers (SBHCs) and sexual behavior and contraceptive use among 11th graders. The sample included 134 high schools (27 schools with SBHCs) and 11,840 students who participated in the 2015 Oregon Healthy Teens Survey. Multilevel logistic regressions found positive associations between SBHC presence and healthy sexual behavior ( OR = 1.23, p < .05) and contraceptive use ( OR = 1.31, p < .01). Associations were stronger at schools with at least 50% of students receiving free or reduced price lunch. Among SBHC schools, prescribing and dispensing contraceptives onsite was positively related to contraceptive use among students who had sex within the past 3 months ( OR = 1.77, p < .01). Findings suggest that exposure to SBHCs in general, and availability of specific reproductive health services, may be effective population-based strategies to support healthy sexual behaviors among youth.

Providing Culturally Competent Care for LGBTQ Youth in School-Based Health Centers: A Needs Assessment to Guide Quality of Care Improvements.

School-based health centers (SBHCs) can take specific steps to provide culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, potentially impacting well-being. A needs assessment survey was conducted among a convenience sample of SBHC administrators and medical directors to assess climates and actions supportive of LGBTQ quality medical care. Half (53%) of the SBHCs surveyed ( N = 66) reviewed print materials for negative LGBTQ stereotypes, and 27.3% conducted exhaustive materials review. Regional differences were detected: 46.2% of Southern SBHCs conducted any materials review compared to 91.3% in the West and all in the East and Midwest (χ2, p < .001). In the last academic year, 45.5% conducted no medical provider trainings, and 54.5% conducted no general staff trainings on providing care for LGBTQ youth. On intake forms, 85.4% included preferred names, but only 23.5% included preferred pronoun. There are significant gaps in the extent to which SBHCs provide culturally competent care. These findings can guide future training and advocacy.

Perceived Access and Parental Monitoring as Moderators of Impulsivity and Marijuana Use Among Adolescents.

The social and political climate regarding marijuana use has been changing in the US over the past decade. Research suggests that many adolescents report relatively easy access to marijuana and perceptions that recreational use involves minimal harm despite a growing body of research implicating the deleterious effects of use on cognitive and psychological development. Not surprisingly, prevalence rates have been rising in recent years, making it important to identify risk and protective factors associated with adolescent marijuana use. We tested a 3-way interaction model designed to (a) examine the relationship between behavioral impulsivity and marijuana use in adolescents, and (b) evaluate the roles of perceived access and parental monitoring as moderators of this relationship. High school students (N = 498, M age  = 15.7, 53% female, 77% White) completed an anonymous self-report assessment examining substance use, perceived access, and psychosocial factors related to substance use (i.e., behavioral impulsivity and parental monitoring). Results indicated that higher levels of impulsivity, greater access, and reduced parental monitoring were related to marijuana use. Significant moderating effects were found for perceived access and parental monitoring, such that use was greater for adolescents who perceived that marijuana was easier to acquire and for those with lower levels of parental monitoring. Among individuals with greater levels of impulsivity, parental monitoring reduced the impact of perceived access. Overall, results highlight risk and protective factors related to adolescent marijuana use and indicate that parental monitoring can be an effective means for reducing consumption.

Reproductive Health Services: Barriers to Use Among College Students.

The objective of the current study was to explore demographic, financial, and psychosocial barriers associated with the use/non-use of reproductive health (RH) services. The sample included 212 college students (60 % female) aged 18-19 from a Northern California public university. In October, 2014, students took an on-line survey with questions on knowledge, access, barriers, and use of different RH services and settings. Findings indicated that college students were more likely to visit a primary care setting and/or school-based setting for their RH care. Sexual intercourse was the strongest correlate of having received RH care in the past year, followed by gender, social disapproval, and knowledge of available services. Analyses stratified by gender found a similar pattern among females. However, the only significant predictor among males was knowledge of available services. These finding highlight universities as uniquely positioned to reduce perceived barriers to accessing RH services by making use of technology, promoting health and wellness centers, and providing/adding sexual and reproductive information to general education classes.

Assessing the Impact of School-Based Health Centers on Academic Achievement and College Preparation Efforts: Using Propensity Score Matching to Assess School-Level Data in California.

This study examines the association between school-based health center (SBHC) presence and school-wide measures of academic achievement and college preparation efforts. Publicly available educational and demographic data from 810 California public high schools were linked to a list of schools with an SBHC. Propensity score matching, a method to reduce bias inherent in nonrandomized control studies, was used to select comparison schools. Regression analyses, controlling for proportion of English-language learners, were conducted for each outcome including proportion of students participating in three College Board exams, graduation rates, and meeting university graduation requirements. Findings suggest that SBHC presence is positively associated with college preparation outcomes but not with academic achievement outcomes (graduation rates or meeting state graduation requirements). Future research must examine underlying mechanisms supporting this association, such as school connectedness. Additional research should explore the role that SBHC staff could have in supporting college preparation efforts.

Adolescent Drinking Risks Associated with Specific Drinking Contexts.

BACKGROUND: To identify drinking contexts toward which prevention efforts should be directed, associations of context-specific alcohol use (past-year frequency of drinking and heavier drinking in the context) with a range of alcohol-related problems were examined in a population sample of adolescents. METHODS: A sample of youths (ages 15 to 18) residing in 50 medium-to-large California cities (n = 473 drinkers) was obtained. Respondents provided information about 7 past-year alcohol-related problems in 3 domains (physiological consequences, alcohol-related violence, and conflict/trouble) and the number of times in the past year they used 6 distinct drinking contexts (parties, restaurants/bars, parking lots/street corners, beaches/parks, respondent's home without parents, and someone else's home without parents). Context-specific dose-response model was estimated for each context using censored Tobit models with heteroskedasticity corrections. RESULTS: Physiological problems were associated with more frequent drinking in 5 of 6 contexts. Heavier drinking in restaurants/bars/nightclubs (b = 0.22, SE = 0.10) and someone else's home without parents (b = 0.14, SE = 0.06) was associated with greater risk of violence. Conflict/trouble was associated with more frequent drinking in parking lots/street corners, declining at higher levels of drinking. CONCLUSIONS: Certain drinking contexts are related to problems among youths, some because they are associated with frequent alcohol consumption and others because they are associated with heavier drinking. Identifying which drinking contexts are related to specific alcohol-related problems and why is an essential component of developing effective preventive interventions.

Who drinks where: youth selection of drinking contexts.

BACKGROUND: Different drinkers may experience specific risks depending on where they consume alcohol. This longitudinal study examined drinking patterns, and demographic and psychosocial characteristics associated with youth drinking in different contexts. METHODS: We used survey data from 665 past-year alcohol-using youths (ages 13 to 16 at Wave 1) in 50 midsized California cities. Measures of drinking behaviors and drinking in 7 contexts were obtained at 3 annual time points. Other characteristics included gender, age, race, parental education, weekly disposable income, general deviance, and past-year cigarette smoking. RESULTS: Results of multilevel regression analyses show that more frequent past-year alcohol use was associated with an increased likelihood of drinking at parties and at someone else's home. Greater continued volumes of alcohol (i.e., heavier drinking) was associated with increased likelihood of drinking at parking lots or street corners. Deviance was positively associated with drinking in most contexts, and past-year cigarette smoking was positively associated with drinking at beaches or parks and someone else's home. Age and deviance were positively associated with drinking in a greater number of contexts. The likelihood of youth drinking at parties and someone else's home increased over time, whereas the likelihood of drinking at parking lots/street corners decreased. Also, deviant youths progress to drinking in their own home, beaches or parks, and restaurants/bars/nightclubs more rapidly. CONCLUSIONS: The contexts in which youths consume alcohol change over time. These changes vary by individual characteristics. The redistribution of drinking contexts over the early life course may contribute to specific risks associated with different drinking contexts.

Religiousness and Levels of Hazardous Alcohol Use: A Latent Profile Analysis.

Prior person-centered research has consistently identified a subgroup of highly religious participants that uses significantly less alcohol when compared to the other subgroups. The construct of religious motivation is absent from existing examinations of the nuanced combinations of religiousness dimensions within persons, and alcohol expectancy valuations have yet to be included as outcome variables. Variable-centered approaches have found religious motivation and alcohol expectancy valuations to play a protective role against individuals' hazardous alcohol use. The current study examined latent religiousness profiles and hazardous alcohol use in a large, multisite sample of ethnically diverse college students. The sample consisted of 7412 college students aged 18-25 (M age = 19.77, SD age = 1.61; 75% female; 61% European American). Three latent profiles were derived from measures of religious involvement, salience, and religious motivations: Quest-Intrinsic Religiousness (highest levels of salience, involvement, and quest and intrinsic motivations; lowest level of extrinsic motivation), Moderate Religiousness (intermediate levels of salience, involvement, and motivations) and Extrinsic Religiousness (lowest levels of salience, involvement, and quest and intrinsic motivations; highest level of extrinsic motivation). The Quest-Intrinsic Religiousness profile scored significantly lower on hazardous alcohol use, positive expectancy outcomes, positive expectancy valuations, and negative expectancy valuations, and significantly higher on negative expectancy outcomes, compared to the other two profiles. The Extrinsic and Moderate Religiousness profiles did not differ significantly on positive expectancy outcomes, negative expectancy outcomes, negative expectancy valuations, or hazardous alcohol use. The results advance existing research by demonstrating that the protective influence of religiousness on college students' hazardous alcohol use may involve high levels on both quest and intrinsic religious motivation.

Educating health care professionals on human trafficking.

BACKGROUND: The US Department of State estimates that there are between 4 and 27 million individuals worldwide in some form of modern slavery. Recent studies have demonstrated that 28% to 50% of trafficking victims in the United States encountered health care professionals while in captivity, but were not identified and recognized. This study aimed to determine whether an educational presentation increased emergency department (ED) providers' recognition of human trafficking (HT) victims and knowledge of resources to manage cases of HT. METHODS: The 20 largest San Francisco Bay Area EDs were randomized into intervention (10 EDs) or delayed intervention comparison groups (10 EDs) to receive a standardized educational presentation containing the following: background about HT, relevance of HT to health care, clinical signs in potential victims, and referral options for potential victims. Participants in the delayed intervention group completed a pretest in the period the immediate intervention group received the educational presentation, and all participants were assessed immediately before (pretest) and after (posttest) the intervention. The intervention effect was tested by comparing the pre-post change in the intervention group to the change in 2 pretests in the delayed intervention group adjusted for the effect of clustering within EDs. The 4 primary outcomes were importance of knowledge of HT to the participant's profession (5-point Likert scale), self-rated knowledge of HT (5-point Likert scale), knowledge of who to call for potential HT victims (yes/no), and suspecting that a patient was a victim of HT (yes/no). FINDINGS: There were 258 study participants from 14 EDs; 141 from 8 EDs in the intervention group and 117 from 7 EDs in the delayed intervention comparison group, of which 20 served as the delayed intervention comparison group. Participants in the intervention group reported greater increases in their level of knowledge about HT versus those in the delayed intervention comparison group (1.42 vs -0.15; adjusted difference = 1.57 [95% confidence interval, 1.02-2.12]; P < 0.001). Pretest ratings of the importance of knowledge about HT to the participant's profession were high in both groups and there was no intervention effect (0.31 vs 0.55; -0.24 [-0.90-0.42], P = 0.49). Knowing who to call for potential HT victims increased from 7.2% to 59% in the intervention group and was unchanged (15%) in the delayed intervention comparison group (61.4% [28.5%-94.4%]; P < 0.01). The proportion of participants who suspected their patient was a victim of HT increased from 17% to 38% in the intervention group and remained unchanged (10%) in the delayed intervention comparison group (20.9 [8.6%-33.1%]; P < 0.01). INTERPRETATION: A brief educational intervention increased ED provider knowledge and self-reported recognition of HT victims.

Knowing where they're going: destination-specific pregaming behaviors in a multiethnic sample of college students.

OBJECTIVES: To examine how legal age status, gender, and self-reported reasons for pregaming are linked to pregaming for two common drinking contexts: a bar and a Greek party. METHOD: Participants who reported pregaming at least once a month (n = 2888 students aged 18-25 years) were recruited from 30 colleges/universities across the United States. RESULTS: Many students pregame for social reasons regardless of pregaming destination. Multivariate analyses indicated that legal age students were more likely than underage students to pregame before going to a bar, whereas the opposite was true with respect to pregaming for a Greek party. Women were more likely than men to pregame before going to a bar or a Greek party, whereas men reported higher levels of consumption while pregaming for these destinations compared with women. CONCLUSIONS: The present findings suggest areas for targeted intervention efforts and promising avenues for research on context-specific pregaming behaviors among college students.

Acculturation and well-being among college students from immigrant families.

OBJECTIVE: The present study was designed to ascertain the associations between acculturation and well-being in first-generation and second-generation immigrant college students. Acculturation was operationalized as a multidimensional construct comprised of heritage and American cultural practices, values (individualism and collectivism), and identifications, and well-being was operationalized in terms of subjective, psychological, and eudaimonic components. METHOD: Participants were 2,774 first-generation and second-generation immigrant students (70% women), from 6 ethnic groups and from 30 colleges and universities around the United States. Participants completed measures of heritage and American cultural practices, values, and identifications, as well as of subjective, psychological, and eudaimonic well-being. RESULTS: Findings indicated that individualistic values were positively related to psychological and eudaimonic well-being, and positively, although somewhat less strongly, linked with subjective well-being. American and heritage identifications were both modestly related to psychological and eudaimonic well-being. These findings were consistent across gender, immigrant generation (first versus second), and ethnicity. CONCLUSIONS: Psychological and eudaimonic well-being appear to be inherently individualistic conceptions of happiness, and endorsement of individualistic values appears linked with these forms of well-being. Attachments to a cultural group-the United States, one's country of origin, or both-appear to promote psychological and eudaimonic well-being as well. The present findings suggest that similar strategies can be used to promote well-being for both male and female students, for students from various ethnic backgrounds, and for both first-generation and second-generation immigrant students.

Acculturation and Well-Being Among College Students From Immigrant Families.

OBJECTIVE: The present study was designed to ascertain the associations between acculturation and well-being in first-generation and second-generation immigrant college students. Acculturation was operationalized as a multidimensional construct comprised of heritage and American cultural practices, values (individualism and collectivism), and identifications, and well-being was operationalized in terms of subjective, psychological, and eudaimonic components. METHOD: Participants were 2,774 first-generation and second-generation immigrant students (70% women), from 6 ethnic groups and from 30 colleges and universities around the United States. Participants completed measures of heritage and American cultural practices, values, and identifications, as well as of subjective, psychological, and eudaimonic well-being. RESULTS: Findings indicated that individualistic values were positively related to psychological and eudaimonic well-being, and positively, although somewhat less strongly, linked with subjective well-being. American and heritage identifications were both modestly related to psychological and eudaimonic well-being. These findings were consistent across gender, immigrant generation (first versus second), and ethnicity. CONCLUSIONS: Psychological and eudaimonic well-being appear to be inherently individualistic conceptions of happiness, and endorsement of individualistic values appears linked with these forms of well-being. Attachments to a cultural group-the United States, one's country of origin, or both-appear to promote psychological and eudaimonic well-being as well. The present findings suggest that similar strategies can be used to promote well-being for both male and female students, for students from various ethnic backgrounds, and for both first-generation and second-generation immigrant students. © 2012 Wiley Periodicals, Inc. J. Clin. Psychol. 00:1-21, 2012.

Does distance matter? Access to family planning clinics and adolescent sexual behaviors.

UNLABELLED: The study examines the relationship between adolescent geographic access (distance, travel time, density) to Family Planning Clinics and adolescent sexual behaviors, including sexual initiation, number of partners and condom use. This cross-sectional study, conducted in 2005 in 10 California counties, utilized data from NICHD-funded study on adolescent sexual behavior (n = 921), geospatial coordinates of publicly-funded FPCs, and neighborhood characteristics. A series of regression models were used to assess the relationship between FPC distance, and density (number of FPCs within 1- and 3- mile radii of each adolescent's home), and adolescent sexual behaviors. Significant main effects between access measures of FPC and sexual behavior did not emerge. However, among older youth a significant inverse relationship emerged between number of FPCs within a 1-mile radius and initiating sexual intercourse. While not significant at α = .10, the results also indicate a negative relationship between density of FPCs and sexual partners (b = -.22, p < .15) among older youth. Access to FPCs was not associated with condom use. CONCLUSIONS: Results suggest that increased options for family planning services may lead to less risky sexual behaviors among older youth. This finding has significant implications with regards to making family planning resources more readily available to older adolescents.

Cultural influences for college student language brokers.

Children from immigrant families often translate communication for parents, a process known as language brokering (LB). LB begins in childhood, but may continue through emerging adulthood, even when individuals are in college. We surveyed 1,222 university students with two immigrant parents and compared non-language brokers, infrequent language brokers, and frequent language brokers on a variety of ethnic, cultural, and identity measures. Significant differences emerged for cultural heritage value orientation, ethnic identity, and dimensions of acculturation with frequent language brokers scoring highest, infrequent language brokers scoring in the middle, and non-language brokers scoring the lowest on these measures. There were no significant differences on acculturative stress among these three groups. These results suggest that LB experiences may contribute to the development of psychological assets for ethnic minority, emerging adults from immigrant families.