Institutional Factors Associated With Burnout Among Assistant Professors.

Phenomenon: Factors related to individual circumstance and organizational climate are contributing to a worsening burnout problem among providers in healthcare settings. In the academic health center, junior faculty may be at particular risk for burnout given intersecting responsibilities of clinical expertise, research rigor, teaching commitments, and service expectations. To date, much of the focus on preventing and mitigating burnout has been located at the individual level, addressing lifestyle modification and self-regulation skills. We sought to examine relationships between institutional context and burnout qualities as a means to identify opportunities for organizational leadership to address faculty burnout. Approach: Data are from a baseline survey of assistant professors (faculty with diverse ratios for clinical, research, and teaching responsibilities) located within a pediatrics department in an academic medical center. Pearson correlation coefficients and logistic regression models were used to examine relationships between institutional factors (mentorship, collaboration opportunities, feelings of empowerment, value, and support of well-being) and experiences of burnout as measured by the original 22-item Maslach Burnout Inventory (subscales: Emotional Exhaustion, Depersonalization, and Low Personal Accomplishment). Findings: Three perceived institutional characteristics were significantly associated with all three dimensions of burnout, particularly emotional exhaustion, which decreased with increasing perception of (a) empowerment to communicate professional needs, (b) feeling valued for contributions to the department, and (c) department commitment to support faculty well-being. In multivariate logistic regression models, adjusted for gender identity and years since training, increased positive perceptions of these three institutional characteristics were associated with significantly lower odds of burnout. For example, for each unit increase along a 5-point rating scale in feeling empowered to communicate needs and feeling valued for contributions to the department, the odds of meeting cutoff scores for burnout were reduced by 78% (p = .002) to 84% (p = .002), respectively. Insights: Although much of the focus on addressing burnout in healthcare settings has been on promoting coping skills and building resilience at the individual level, our findings add to a growing literature documenting a significant role for institutional leadership in identifying and facilitating strategies to promote faculty well-being. Findings also support leadership's role for improving institutional climate via creating opportunities to increase faculty perceptions of empowerment and value in the department.

Using Telehealth to Disseminate Primary, Secondary, and Tertiary CVD Interventions to Rural Populations.

PURPOSE OF REVIEW: This study aims to review the evidence on telehealth interventions in rural communities that use primary, secondary, or tertiary strategies for the prevention and management of cardiovascular disease (CVD). RECENT FINDINGS: Studies focused on the reduction of CVD risk factors and mitigation of disease progression among rural populations using telehealth are limited in number but appear to be increasing in the last 5 years. These studies suggest primary-, secondary-, and tertiary-level interventions can impact CVD risk and management. The current review found more studies addressing primary CVD intervention strategies, although the evidence for efficacy at all intervention levels is in the early stages. Leveraging prevention strategies via telehealth may be an effective vehicle to facilitate improved CVD outcomes among populations traditionally marginalized by geographic location.

Racial and ethnic disparities in educational achievement and aspirations: findings from a statewide survey from 1998 to 2010.

Educational achievement and attainment are associated with health outcomes across the entire life span. The objective of this study was to determine whether racial/ethnic disparities in academic achievement and educational aspirations have changed over time. The study used data from the Minnesota Student Survey (MSS) from 1998, 2001, 2004, 2007, and 2010. The MSS is administered to adolescents in public secondary schools, charter schools, and tribal schools. Measures of academic achievement and educational aspirations were examined by race/ethnicity, poverty status, and family structure. Chi square tests evaluated differences in the above proportions. The analytic sample included 351,510 adolescents (1998, N = 67,239; 2001, N = 69,177; 2004, N = 71,084; 2007, N = 72,312; and 2010, N = 71,698). Study participants ranged in age from 13 to 19 years (mean = 15.9, SD = 1.6). Most were white (81.7 %), followed by 5.4 % Asian American/Pacific Islander, 4.3 % Black/African American, 2.7 % Hispanic/Latino, 1 % American Indian, and 4.9 % mixed race. Results showed that academic achievement fluctuated amongst all the racial/ethnic groups, but there were significant race/ethnic disparities at every time point. Overall, academic aspirations increased over time among the adolescents. Poverty was associated with poorer academic indicators for white youth, but not consistently for other racial/ethnic groups of youth. Family structure, however, was significantly associated with the educational indicators across all racial and ethnic groups. Despite many efforts to improve educational outcomes, there remain significant disparities in educational achievement and aspirations related to race-ethnicity and social status. Findings have implications for efforts to improve adolescent health at both individual and community levels.

Positive Outliers: A Mixed Methods Study of Resiliency to Childhood Obesity in High-Risk Neighborhoods.

OBJECTIVE: Despite the high prevalence of obesity and the clustering of risk by neighborhood, few studies have examined characteristics which promote healthy child weight in neighborhoods with high obesity risk. We aimed to identify protective factors for children living in neighborhoods with high obesity risk. METHODS: We identified neighborhoods with high obesity risk using geolocated electronic health record data with measured body mass index (BMI) from well-child visits (2012-2017). We then recruited caregivers with children aged 5 to 13 years who lived in census tracts with mean child BMI percentile ≥72 (February 2020-August 2021). We used sequential mixed methods (quantitative surveys, qualitative interviews) to compare individual, interpersonal, and perceived neighborhood factors among families with children at a healthy weight (positive outliers [PO]) versus families with ≥1 child with overweight or obesity (controls). Regression models and comparative qualitative analysis were used to identify protective characteristics. RESULTS: Seventy-three caregivers participated in the quantitative phase (41% PO; 34% preferred Spanish) and twenty in the qualitative phase (50% PO; 50% preferred Spanish). The frequency of healthy caregiver behaviors was associated with being a PO (Family Health Behavior Scale Parent Score adjusted ß 3.67; 95% CI 0.52-6.81 and qualitative data). Protective factors also included caregivers' ability to minimize the negative health influences of family members and adhere to family routines. CONCLUSIONS: There were few differences between PO and control families. Support for caregiver healthy habits and adherence to healthy family routines emerged as opportunities for childhood obesity prevention in neighborhoods with high obesity risk.

Prevalence of food insecurity among students attending four Historically Black Colleges and Universities.

Objective: This study examined the prevalence of food insecurity (FI) among students attending Historically Black Colleges and Universities (HBCUs) in the Southeastern United States. Participants: Students attending four HBCUs (N = 351) completed an anonymous Web-based survey. Methods: Food insecurity was assessed using the 2-item Hunger Vital Sign Tool. Summary statistics were used to quantify FI experiences. Logistic regression was conducted to determine if student demographic characteristics were significantly associated with FI outcomes. Results: Nearly 3 in 4 students (72.9%) reported some level of FI in the past year. Students representing all levels of postsecondary education reported FI. Meal plan participation did not prevent FI. Conclusions: Students attending HBCUs experience FI at levels that exceed estimates reported among students attending predominantly White institutions. More work is needed to understand the lived experience of food-insecure HBCU students as a means to ensure institution-level food policies support student academic success and wellbeing.

Social Support and Breastfeeding Outcomes Among a Racially and Ethnically Diverse Population.

INTRODUCTION: Social support is a modifiable social determinant of health that shapes breastfeeding outcomes and may contribute to racial and ethnic breastfeeding disparities. This study characterizes the relationship between social support and early breastfeeding. METHODS: This is a cross-sectional analysis of baseline data collected in 2019-2021 for an RCT. Social support was measured using the Enhancing Recovery in Coronary Heart Disease Social Support Instrument. Outcomes, collected by self-report, included (1) early breastfeeding within the first 21 days of life, (2) planned breastfeeding duration, and (3) confidence in meeting breastfeeding goals. Each outcome was modeled using proportional odds regression, adjusting for covariates. Analysis was conducted in 2021-2022. RESULTS: Self-reported race and ethnicity among 883 mothers were 50% Hispanic, 17% Black, 23% White, and 10% other. A large proportion (88%) of mothers were breastfeeding. Most breastfeeding mothers (82%) planned to breastfeed for at least 6 months, with more than half (58%) planning to continue for 12 months or more. Most women (65%) were confident or very confident in meeting their breastfeeding duration goal. In adjusted models, perceived social support was associated with planned breastfeeding duration (p=0.042) but not with early breastfeeding (p=0.873) or confidence in meeting breastfeeding goals (p=0.427). Among the covariates, maternal depressive symptoms were associated with lower breastfeeding confidence (p<0.001). CONCLUSIONS: The associations between perceived social support and breastfeeding outcomes are nuanced. In this sample of racially and ethnically diverse mothers, social support was associated with longer planned breastfeeding duration but not with early breastfeeding or breastfeeding confidence.

Parent perceptions of neighborhood: relationships with US youth physical activity and weight status.

Context is important for understanding and making change to improve health outcomes. The purpose of this study was to examine the relationship between parent perceptions of neighborhood and youth aerobic physical activity and weight. This study is a secondary data analysis of 64,076 parents and guardians of children and adolescents (6-17 years) participating in the 2007 National Survey of Children's Health. Logistic regression models were used to evaluate the relationship between neighborhood characteristics, including constructs for social capital, physical condition, resource availability, and safety, and youth likelihood of meeting healthy standards for physical activity and weight. Neighborhood characteristics, including social capital, resource availability, and safety were significantly associated with increased likelihood of youth achieving healthy physical activity and normal weight parameters even with adjustment for individual and family-level demographic and behavioral characteristics. Findings support neighborhood assessment during behavioral counseling and continued exploration of neighborhood context as a means to positively impact youth physical activity and weight outcomes.

Racial and Ethnic Differences in Maternal Social Support and Relationship to Mother-Infant Health Behaviors.

OBJECTIVE: To examine racial and ethnic differences in maternal social support in infancy and the relationship between social support and mother-infant health behaviors. METHODS: Secondary analysis of baseline data from a multisite obesity prevention trial that enrolled mothers and their 2-month-old infants. Behavioral and social support data were collected via questionnaire. We used modified Poisson regression to determine association between health behaviors and financial and emotional social support, adjusted for sociodemographic characteristics. RESULTS: Eight hundred and twenty-six mother-infant dyads (27.3% non-Hispanic Black, 18.0% Non-Hispanic White, 50.1% Hispanic and 4.6% Non-Hispanic Other). Half of mothers were born in the United States; 87% were Medicaid-insured. There were no racial/ethnic differences in social support controlling for maternal nativity. US-born mothers were more likely to have emotional and financial support (rate ratio [RR] 1.14 95% confidence interval [CI]: 1.07, 1.21 and RR 1.23 95% CI: 1.11, 1.37, respectively) versus mothers born outside the United States. Mothers with financial support were less likely to exclusively feed with breast milk (RR 0.62; 95% CI: 0.45, 0.87) yet more likely to have tummy time ≥12min (RR 1.28; 95% CI: 1.02, 1.59) versus mothers without financial support. Mothers with emotional support were less likely to report feeding with breast milk (RR 0.82; 95% CI: 0.69, 0.97) versus mothers without emotional support. CONCLUSIONS: Nativity, not race or ethnicity, is a significant determinant of maternal social support. Greater social support was not universally associated with healthy behaviors. Interventions may wish to consider the complex nature of social support and population-specific social support needs.

Using geographic information systems to characterize food environments around historically black colleges and universities: Implications for nutrition interventions.

ObjectiveTo understand the distribution of healthy and unhealthy food stores near historically black colleges and universities (HBCUs). Participants and methods: Using ArcGIS Pro's network analysis tools and ReferenceUSA database, this study characterized the healthy (favorable) and unhealthy (unfavorable) retail food stores within a 5-mile radius, 15-min driving, and 15-min walking distance from each HBCU in North Carolina. Results: Most retail food stores within a 5-mile buffer radius of the 10 HBCUs in North Carolina were unfavorable. Within 15-min driving from each HBCU, 1082 stores (76.0%) were unfavorable food stores, while 332 (24.0%) were favorable. Additionally, there were four favorable and 35 unfavorable retail food stores within the 15-min walking distance of each HBCU. Conclusions: Favorable food retail stores around HBCUs in North Carolina are limited. Researchers, policy makers, and community stakeholders should work together to improve food environments surrounding HBCUs.

Food insecurity among university students in the United States amidst the COVID-19 pandemic.

OBJECTIVE: This study reports on food insecurity (FI) amidst the COVID-19 pandemic. PARTICIPANTS AND METHODS: College students in four regions of the US completed the two-item validated Hunger Vital Sign™ screening tool on Qualtrics. RESULTS: FI increased significantly after March 2020 among US students (worry about food running out: 25% to 35%; food did not last: 17% to 21%) with significant regional increase in the Midwest and South. An adjusted multivariable logistic regression model indicated students that ran out of food were significantly at greater odds of experiencing hardship with paying bills (AOR: 5.59, 95% CI =3.90-8.06). CONCLUSIONS: The findings identified an increase in the prevalence of FI among college students during the pandemic. Suggestions of how to address FI are discussed.

Adolescent condom use consistency over time: global versus partner-specific measures.

BACKGROUND: The conundrum of measuring condom use consistency, particularly with adolescents, has left researchers with a cacophony of strategies, thereby limiting comparability and interpretation. OBJECTIVE: The aim of this analysis was to compare and contrast two measures of condom use consistency, global versus partner specific, and their relationships with key covariates, using trajectory groups differentiated by stability of condom use consistency over three time points. METHOD: Using self-report data from sexually active girls (aged 13-17 years) in a clinic-based intervention study aimed at lowering risk for early pregnancy, this analysis compared two measures of self-reported condom use consistency: (a) a global measure: overall condom use consistency in the past 6 months and (b) a partner-specific measure: condom use consistency with the most recent sex partner in the last 6 months. Using a subjective rule-based approach, the adolescent girls in the study (n = 151) were classified into trajectory groups representing their condom use consistency at three time points (baseline and 6 and 12 months). Then, using bivariate methods, trajectory groups were compared on four baseline covariates (age, treatment condition, hormonal use in the last 6 months, and number of sex partners in the last 6 months) and three time-varying covariates measured at baseline and at 6 and 12 months (hormonal use stability, stability of primary sex partner, and stability of number of sex partners). RESULTS: For the trajectory groups formed using the global measure of condom use consistency, stability of the primary sex partner differed significantly between trajectory groups. For the partner-specific trajectory groups, two baseline and one time-varying covariate relationships were significant: hormonal use in the 6 months prior to baseline, number of sex partners in the past 6 months (baseline), and stability of the primary sex partner (time varying), with hormonal use stability (time varying) trending toward significance. DISCUSSION: The larger number of significant covariate relationships with the partner-specific trajectory groups suggests greater utility in assessing partner-linked behavior rather than a global measure. Despite limitations of the analytic strategy, this study sheds light on a measurement conundrum that has been an obstacle to comparing and contrasting indicators of condom use consistency during adolescence.

Adult care transitioning for adolescents with special health care needs: a pivotal role for family centered care.

To examine the relationship between having a usual source of care, family centered care, and transition counseling for adolescents with special health care needs. Data are from 18,198 parents/guardians, of youth aged 12-17 years, who participated in the 2005-2006 National Survey of Children With Special Health Care Needs. Linear and logistic regression models were used to define relationships between parent report of identification of a usual place and provider of medical care for their child and counseling on four transition issues: transfer to adult providers, review of future health needs, maintaining health insurance in adulthood, and youth taking responsibility for care. The direct mediating effect of family centered care was evaluated. Youth having a usual source of care (vs. not) were more likely to receive counseling on future health needs (47.4 vs. 33.6%, P < 0.001) and taking responsibility for their own care (79.3 vs. 64.4%, P < 0.001). Having a high level of family centered care (vs. low) was also associated with high rates of discussing future health needs (56.3 vs. 39.6%, P < 0.001) and encouragement to take responsibility for care (91.2 vs. 70.3%, P < 0.001). Family centered care mediated 39.1% of the effect of a usual source of care on discussion of future health needs and 94.9% of the effect of a usual source of care on encouragement to take responsibility for care. Study findings support the development of health care delivery models focusing on family centered care to the same degree as other health care access issues.

Examining youth hopelessness as an independent risk correlate for adolescent delinquency and violence.

Prior research has identified a relationship between youth hopelessness and violence perpetration within specific groups of young people. The purpose of this study was to evaluate the relationship between youth hopelessness and violence perpetration in a population-based sample of adolescents. This study is a cross-sectional analysis of data from 136,549 students in the 6th, 9th, and 12th grades responding to the 2007 Minnesota Student Survey. Logistic regression models were used to evaluate the relationship between hopelessness and youth violence perpetration, including comparison analyses for gender and race/ethnic subgroups as well as adjustment for a measure of poor-low affect. One in four youth (25.1%) reported levels of hopelessness at least enough to bother them in the previous month. Moderate-high levels of hopelessness exhibited a statistically significant independent relationship with a range of violence-related outcomes for youth subgroups: delinquent behavior, weapon carrying on school property, and all forms of self-directed violence. Relationships between hopelessness and interpersonal and intimate partner violence suggest a greater contribution by poor affective functioning for some groups. Interventions designed to reduce youth violence perpetration may benefit from increased strategies to address youth hopelessness as well as youth mental health in general.

Food Insecurity and Prediabetes among Adolescents Taking a School-based Survey.

Objectives: Food insecurity (FI) is a correlate of poor health throughout the life course. This study examines relationships between FI and reported prediabetes among middle-high school students taking a school-based survey. Methods: Data are from the 2019 Minnesota Student Survey (N = 125,375). Logistic regression was used to examine relationships between youth past month FI and reported prediabetes in analyses adjusting for demographics, low quality dietary intake (fast food and sugar sweetened beverage), and cardiometabolic indicators (physical activity, sleep duration, body mass index). Analyses were stratified by youth race-ethnic identification. Results: Almost one in 20 youth reported past month FI. In fully adjusted models, the associations between youth FI and prediabetes differed by race-ethnic identification, and were robust to sociodemographic, diet, and cardiometabolic correlates for some groups (eg, NH black, African, African-American students [AOR: 1.88, 95% CI: 1.12-3.14]; Hispanic, Latino/a students [AOR: 1.84, 95% CI: 1.14-2.97]; and NH white students [AOR: 2.83, 95% CI: 2.14-3.73]). Conclusions: FI was associated with race-ethnic disparities in youth prediabetes. Tailored approaches to address food quality, access and other social drivers may reduce youth risk of prediabetes.

Youth Beverage Intake and Reported Prediabetes: Choice and Frequency Matter.

INTRODUCTION: Sugar sweetened beverage (SSB) consumption among U.S. adolescents exceeds current recommendations. This study examines relationships between SSB intake and reported prediabetes. METHOD: Data are from the 2019 Minnesota Student Survey (N = 125,375). Logistic regression was used to examine relationships between frequencies for SSB intake and youth reported prediabetes in analytic models adjusting for demographic and other cardiometabolic indicators. Additional analyses examined relationships between consumption of fruit juice, milk, and water, and prediabetes. RESULTS: One in four youth reported consumption of at least one SSB daily. In fully adjusted models, a range of SSB intake frequencies were significantly associated with increased odds of reported prediabetes. All intake frequencies for water were associated with reduced odds of prediabetes. DISCUSSION: Efforts to reduce SSB intake among adolescents are warranted to support cardiometabolic health. Study findings are consistent with current guidance identifying water as the preferred drink for adolescents' hydration needs.

The Role of Family Health History in Predicting Midlife Chronic Disease Outcomes.

INTRODUCTION: The generational relevance for determining disease risk for the leading causes of morbidity and mortality for U.S. adults is a source of debate. METHODS: Data on 12,300 adults (Add Health Study Members) participating in Wave V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (also known as Add Health) were merged with data from respondents' parents (n=2,013) participating in the Add Health Parent Study (2015-2017). Analyses beginning in January 2020 examined the concordance in lifetime occurrence of chronic conditions across 4 generations, including cardiovascular disease, diabetes, hypertension, hyperlipidemia, obesity, cancer, and depression and examined the associations between individual disease history and ones' family health history for the same condition. RESULTS: Mean ages were 37.4 years for Add Health Study Members and 62.9 years for Add Health Parent Study mothers. The histories of mothers from the Add Health Parent Study on hyperlipidemia (AOR=1.61, 95% CI=1.04, 2.48), obesity (AOR=1.77, 95% CI=1.27, 2.48), and depression (AOR=1.87, 95% CI=1.19, 2.95) were significantly associated with increased odds of Add Health Study Member report of these conditions. Maternal great grandparent hyperlipidemia history was significantly associated with the Add Health Study Member hyperlipidemia (AOR=2.81, 95% CI=1.51, 5.21). Histories of diabetes in maternal grandfather (AOR=2.41, 95% CI=1.24, 4.69) and maternal great grandparent (AOR=3.05, 95% CI=1.45, 6.43) were significantly associated with Add Health Study Member diabetes. Each additional point in the Add Health Parent Study mothers' cardiometabolic risk factor index was associated with an 11% increase (incidence rate ratio=1.11, 95% CI=1.04, 1.19) in the expected count of cardiometabolic risk conditions for the Add Health Study Members. CONCLUSIONS: Multigenerational health histories have value for quantifying the probability of diabetes, obesity, depression, and hyperlipidemia in early mid-adulthood. Family health history knowledge is relevant for health promotion and disease prevention strategies.

Like Parent, Like Child: Intergenerational Patterns of Cardiovascular Risk Factors at Midlife.

PURPOSE: We aimed to assess the prevalence of four cardiovascular risk factors (obesity, diabetes, excessive alcohol intake, and cigarette smoking) for parents and their adult children at the same approximate midlife age. We also evaluated associations of parents' cardiovascular risk factors, childhood health exposures, and social contexts (i.e., family, school, and neighborhood) during adolescence with adult children's cardiovascular health at midlife. METHODS: We used data from respondents at Wave V of the National Longitudinal Study of Adolescent to Adult Health who had corresponding parent (mostly mothers) data from Wave I. The final sample included 10,466 adult children with a mean age of 37.8 years. Descriptive statistics and logistic regression models were estimated, accounting for the National Longitudinal Study of Adolescent to Adult Health sampling design. RESULTS: At similar ages (i.e., 35-45 years) to their parents, adult children had higher rates of excessive drinking and obesity than their parents, lower rates of diabetes, and similar rates of smoking. Adult children's health largely converged and correlated with their parents' health at similar ages. Cardiovascular risks for adult children were also significantly associated with their childhood health exposures and social contexts during adolescence. Some associations varied with respect to the health status of parents at Wave I. CONCLUSIONS: The cardiovascular risk of parents at midlife is strongly associated with the cardiovascular risk of their adult children at midlife. The status of parents' health during adolescence can also modify the significance and magnitude of associations between childhood health exposures or adolescent social contexts and adult children's cardiovascular risk factors.

Adolescent Bariatric Surgery: Racial Disparities in 30-Day Outcomes Using the MBSAQIP from 2015 to 2018.

INTRODUCTION: Racial disparities exist in obesity prevalence and obesity-related comorbid conditions among youth. We hypothesized that non-White adolescents would have poorer 30-day outcomes after adolescent bariatric surgery. METHODS: Adolescent patients 19 years or younger who had bariatric surgery from January 2015 to December 2018 were identified in the Metabolic and Bariatric Surgery Accreditation and Quality Initiative Program datafiles. Patient characteristics and 30-day perioperative outcomes were compared across racial groups. Trends in utilization of adolescent bariatric surgery were evaluated by race and procedure. RESULTS: Bariatric surgery was performed in 3177 adolescents with a mean age of 17.9 years [standard deviation (SD) 1.1 years]. The majority of patients were White 71.5% (2,271), while only 16.4% (520) were Black, and 12.1% (386) were other. Black adolescents 42.7% (222) more commonly presented with a BMI >50kg/m2 compared to 28.4% (645) White and 27.2% (105) other. Baseline hypertension and sleep apnea were more common among Black adolescents than other racial groups (P< 0.05). Black adolescents with LRYGB comprised 4.6% (48) of procedures in 2015 and only 1.5% (11) in 2018. Clavien-Dindo complications and all-cause readmission rates were similar among racial groups. Mean BMI decrease after 30 days was greatest for Black patients after Roux-en-Y gastric bypass, with a loss of 3.1 BMI points (SD 1.5). CONCLUSIONS: Despite similar short-term outcomes, significant disparities exist for Black adolescents who qualify for bariatric surgery. Further investigation is warranted to better understand the racial differences that limit access and utilization of this safe and effective intervention.

Adolescent Adversity, School Attendance and Academic Achievement: School Connection and the Potential for Mitigating Risk.

BACKGROUND: Adverse childhood experiences (ACEs) may be particularly impactful for the learning environment. The purpose of this study was to examine relationships between ACEs and 3 education-related outcomes, no plan to graduate, past month unexcused absences, and low academic achievement, outcomes linked to poor prospects for future social status attainment and by extension, health. METHODS: Data are from 9th and 11th grade participants in the 2016 Minnesota Student Survey (N = 81,885). Logistic regression was used to determine if individual and cumulative measures for 10 types of ACEs were significantly associated with education-related outcomes in analytic models adjusting for demographic and individual factors. Final analytic models tested for moderation of relationships between ACEs and adverse education outcomes by student school connection. Analyses were stratified by sex. RESULTS: Multiple types of ACEs were significantly associated with each adverse education outcome. Relationships between some types of ACEs and education outcomes were marginally attenuated by school connection. CONCLUSIONS: Among high school students, experiences of adversity were significantly associated with scholastic outcomes that portend limited prospects for health and status attainment in adulthood. Strategies for strengthening student school connection may be relevant for supporting youth resilience, and the potential for better stability in adulthood.

Expanding Concepts of Youth Adversity: Relationships With a Positive Patient Health Questionnaire-2.

INTRODUCTION: Research suggests that diverse examples of adverse childhood experiences (ACEs) may link to health. This study examines relationships between conventional (abuse, neglect, household dysfunction) and expanded examples (bullying, safety perceptions) of ACEs and adolescent mental health among youth participating in a statewide school-based survey. METHODS: Logistic regression was used to determine whether 10 types of conventional ACEs and 11 types of additional ACEs were associated with the odds of youth meeting cutoff scores for a positive Patient Health Questionnaire-2 (PHQ-2) after adjustment for demographic covariates and known mental health problems. RESULTS: Individual and cumulative measures for conventional and expanded ACEs were significantly associated with youth odds of meeting criteria for a positive PHQ-2. Increasing frequency of bullying harassment was associated with a 1.5- to 5-fold increase in the odds of a positive PHQ-2. DISCUSSION: Findings support consideration of broad concepts for adversity as relevant for youth mental health.