Attention Deficit Hyperactivity Disorder Symptoms, Smoking Initiation, and Social Integration among Adolescents.

This observational, longitudinal study's purpose was to investigate whether social network integration has a moderating effect on smoking initiation among those with attention deficit hyperactivity disorder (ADHD). Data were drawn from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative longitudinal dataset. Social network and smoking data were collected in schools, with a 6-year follow-up that included ADHD symptoms and reported smoking. Social integration was measured as peer friendship nominations (degree) and the influence of an individual on the entire social network (centrality). Multilevel logistic regression found a main effect for ADHD symptoms and low numbers of friendship nominations on smoking initiation, but social network measures were not significant moderators of the relationship between ADHD symptoms and smoking initiation among adolescents. Further investigation of the drivers of smoking initiation among those with ADHD is warranted.

Methodologic Considerations for Epigenomic Investigation of Preterm Birth in African American Women.

Epigenetic modifications are chemical changes that can modify gene expression without changing the sequence of the gene. These modifications are potentially identifiable and reversible, making the epigenome an important area of research for discovering biomarkers to identify those who may be at risk and providing therapeutic interventions to prevent adverse health outcomes. African Americans bear a disproportionate risk of adverse health outcomes (e.g., hypertension, cancer). Indeed, African American women experience preterm birth (PTB; <37 completed weeks gestation) at more than twice the rate of non-Hispanic White women. Research suggests that environmental influences may play a significant role in PTB outcomes for this population. However, the biological pathways by which these influences contribute to PTB are poorly understood. This paper describes research methods and ethical considerations for the collection and analysis of biological samples based on our study examining the epigenetic regulation of stress pathways in PTB in pregnant African American women.

Racial and Economic Adversity Differences in Stress Markers and Immune Function Among Urban Adolescents.

BACKGROUND: Exposure to racism and associated adversities, such as poverty, is hypothesized to contribute to racial inequities in health via stress and immune pathways. Furthermore, the effects of adversity may be more salient during sensitive developmental periods. Our study examined racial differences in stress and immune biomarkers during adolescence and the effects of exposure to economic adversity at distinct developmental time periods and cumulatively in accounting for potential racial differences. METHODS: Secondary analysis of the Adolescent Health and Development in Context study was conducted. Data were derived from self-administered surveys; interviews; smartphone-based, geographic-explicit ecological momentary assessment; stress biomarkers (evening salivary cortisol over six nights and hair cortisol); and immune biomarkers (salivary shedding of Epstein-Barr virus [EBV] DNA among EBV-positive adolescents). Current socioeconomic status measures included annual household income and caregiver education. Caregivers also reported experiences of bankruptcy, difficulty paying bills, receipt of food stamps/Supplemental Nutrition Assistance Program/electronic benefit transfer, and job loss when the child was of ages birth-5 years, 6-10 years, and 11 years or older. An affirmative response to any item was defined as exposure to economic adversity for that developmental time period (yes/no). A cumulative economic adversity measure was calculated as the sum of exposures across developmental periods (0 = never exposed to 3 = exposed across all time periods). Descriptive and multivariable regression analyses were conducted, accounting for covariates. RESULTS: Black/African American adolescents had higher salivary cortisol concentration, higher hair cortisol concentration, and an increased odd of salivary shedding of EBV DNA compared to White adolescents. Racial differences were not attenuated by the current socioeconomic status or economic adversity (developmental period or cumulatively). DISCUSSION: Our study provides evidence that stress and immune biomarkers differ by race as early as adolescence and may be one pathway through which racism and associated adversities contribute to racial health inequities. Further research on the contribution of multiple adversities beyond poverty to racial inequities in physiological stress and health is critical for informing effective prevention and intervention efforts.

Early childhood family instability and immune system dysregulation in adolescence.

Exposure to stress is one way in which social disadvantages during childhood may alter biological and psychological systems with long-term consequences. Family social and economic conditions are critical for early childhood development and exposure to difficult family conditions may have lasting physiological effects. However, there is little research linking early childhood conditions with physiological indicators of stress and system dysregulation in adolescence. In this study, we assess how family social and economic instability that occurred in early childhood (birth to age 5) is associated with immune system dysregulation in adolescence, as indicated by DNA shedding of the Epstein-Barr virus (EBV). We utilize a biomarker of EBV obtained through saliva, a non-invasive method of collecting immune-system biomarkers, in 674 adolescents 11-17 years old. Multivariable regression results indicated that experiences of moving into a new parent/caregiver household or moving in with a grandparent during early childhood was associated with an estimated 100% increase in EBV DNA shedding among prior EBV-infected adolescents. Other measures of early childhood family instability, total number of family structure changes and economic insecurity, were marginally significant. Contemporaneous family conditions were not associated with adolescents' EBV DNA shedding.

Depressive symptoms are associated with salivary shedding of Epstein-Barr virus in female adolescents: The role of sex differences.

BACKGROUND: Adolescent females have a higher prevalence of depression in comparison to their male peers - a disparity that has been increasing over the past decade. Depression is of concern as it is associated with chronic disease and to immune dysregulation, which may be one mechanism linking depression to future pathology. This study examined the extent to which sex moderated the association between depressive symptoms and immune dysregulation during adolescence using Epstein-Barr virus (EBV) reactivation, a biomarker of cellular immune response, as a model. METHODS: A representative community sample of 259 female and 279 male adolescents aged 11-17 years who were EBV IgG positive were examined. Trained interviewers collected the data during two home visits, one week apart. Depressive symptoms were measured at the first visit using the 9 item short-form of the Center for Epidemiologic Studies-Depression scale. EBV biomarkers were collected via saliva at the second visit and included a qualitative measure of EBV viral capsid antigen immunoglobulin G to assess prior EBV infection and a quantitative measure of EBV DNA to assess the number of viral copies shed in the saliva. RESULTS: In multivariable logistic regression analyses, increasing depressive symptoms were significantly associated with salivary shedding of EBV DNA for adolescent females only (logit=0.66, se=0.30, p<0.05), and the interaction between sex and depressive symptoms on salivary shedding of EBV DNA was statistically significant (logit=-1.19, se=0.42, p<0.01). Sensitivity analyses were conducted in which sex was examined as a moderator in the relationship between depressive symptoms and salivary EBV DNA quantitative copies via Tobit regression; results were consistent with the presented findings. CONCLUSIONS: Depressive symptoms are associated with EBV reactivation among EBV positive female adolescents, but not males. Future research is needed to examine EBV reactivation in female adolescents as a mechanism linking depression to future chronic disease and the role of sex hormones in explaining sex differences in the relationship between depressive symptoms and EBV reactivation.

Exposure to neighborhood immigrant concentration from adolescence to young adulthood and immune function among Latino young adults.

The immune system plays a critical role in the prevention of infectious and chronic disease. We investigate associations between exposure to neighborhood immigrant concentration across the transition from adolescence to adulthood and immune function among Latino young adults, including moderation by nativity. Data from the National Longitudinal Study of Adolescent Health (1994-2008) were analyzed. Immune function was measured via Epstein-Barr virus (EBV) antibody levels (higher levels indicate impaired immune function) among EBV-positive Latino adults (N=1130). Results indicated the averaged individual exposure to immigrant concentration (mean % of foreign-born residents in the census tract across waves 1-4) was associated with immune function for foreign-born Latinos only (b=-0.37, P<0.05). For waves of exposure, only the cumulative measure of living in an immigrant enclave (census tracts with ≥40% foreign-born residents) across all waves was associated with immune function and only for foreign-born Latinos (b=-0.22, P<0.05). Research on the mechanisms through which neighborhood immigrant concentration confers salubrious physiological outcomes for foreign-born Latinos is needed.

Effects of exposure to violence with a weapon during adolescence on adult hypertension.

OBJECTIVES: To examine the longitudinal associations between exposure to violence with a weapon during the past year among adolescents and hypertension during adulthood, including the extent to which adult cardiovascular risk factors mediated the association. METHODS: Secondary analysis of the National Longitudinal Study of Adolescent Health, 1994-2008. The sample included 3555 male and 4416 female participants who were aged 11-17 years at wave 1 (1994-1995). Participants were categorized as hypertensive if they had a mean systolic blood pressure of 140 mm Hg or higher or a mean diastolic pressure of 90 mm Hg or higher at wave 4 (2008). Witnessed violence with a weapon was defined as having seen a shooting or stabbing during the year before wave 1, whereas victim of violence with a weapon was defined as having been shot, cut, or stabbed or had a gun or knife drawn on them during the year before wave 1. Potential mediators of adult cardiovascular risk (wave 4) included body mass index, daily smoking, alcohol abuse, and depression. RESULTS: Males who witnessed violence and females who were victims of violence in the year before wave 1 had an increased odds of hypertension at wave 4 compared with their unexposed peers (adjusted odds ratio, 1.45; 95% confidence interval, 1.003-2.10 and adjusted odds ratio, 1.72; 95% confidence interval, 1.04-2.84, respectively). The hypothesized adult cardiovascular risk mediators did not significantly attenuate the associations for either the male or female samples. CONCLUSIONS: Interventions addressing prior violence exposure are needed to promote adult cardiovascular health.

Racial-ethnic differences in Epstein-Barr virus antibody titers among U.S. children and adolescents.

PURPOSE: To examine racial-ethnic differences in Epstein-Barr virus (EBV) antibody levels among U.S. children and adolescents. Elevated titers among seropositive youth can indicate viral reactivation-an indirect measure of impaired cell-mediated immunity. METHODS: Data from the 2003-2010 National Health and Nutrition Examination Survey were analyzed using multivariable linear regression accounting for the complex survey design and potential confounders. The sample comprised 4663 black-African American, Mexican American, and white youth aged 6-17 years who were EBV seropositive. RESULTS: EBV antibody levels were significantly higher for black-African American youth compared with their white peers (b = 0.343, P < .0001). Gender-stratified models were consistent with the total sample except differences in EBV antibody levels were greater between black-African American and white males (b = 0.525, P < .0001) than between black-African American and white females (b = 0.169, P = .0185). Differences in EBV antibody levels between Mexican American and white youth were only marginally significant in the total and the gender-stratified samples. CONCLUSIONS: Black-white differences in EBV antibody levels were found suggesting EBV reactivation and potential disparities in immune function among minority youth. Research on multilevel factors contributing to the disparities is needed, including potential health implications over the life course for minority youth.

Racial and ethnic disparities in human papillomavirus awareness and vaccination among young adult women.

OBJECTIVE: To examine racial and ethnic disparities in human papillomavirus (HPV) awareness and vaccination among young adult females aged 18-24 years. DESIGN AND SAMPLE: Descriptive correlational study. One thousand nineteen women aged 18-24 years who self-identified as Hispanic, non-Hispanic Black, or non-Hispanic White. MEASURES: Descriptive and multivariate logistic regression analyses using data from the 2007-2008 National Survey of Family Growth. RESULTS: Approximately 90% of non-Hispanic White women, 80% of non-Hispanic Black women, and 56-60% of Hispanic women reported an awareness of HPV infection and vaccination, and yet, vaccine receipt across racial and ethnic groups was 23%, 8%, and 6%, respectively. In multivariate analyses, Hispanic and non-Hispanic Black women were less aware than non-Hispanic White women of HPV infection (OR=0.10, 95% CI=0.05, 0.19; OR=0.23, 95% CI=0.13, 0.40) and vaccination (OR=0.13, 95% CI=0.07, 0.27; OR=0.27, 95% CI=0.14, 0.52) and also less likely to report vaccine receipt (OR=0.44, 95% CI=0.21, 0.90; OR=0.16, 95% CI=0.07, 0.35). CONCLUSIONS: Despite moderate to high levels of awareness, HPV vaccination rates were low among this national population of young adult women. Continued surveillance is imperative to monitor vaccine uptake, including racial and ethnic disparities. Further research exploring HPV knowledge and vaccination barriers across diverse cultural groups is needed to inform the development of more effective public health interventions.

Neighborhood social disorganization and the acquisition of trichomoniasis among young adults in the United States.

OBJECTIVES: We examined relationships between neighborhood social disorganization and trichomoniasis among young US adults. METHODS: We employed multilevel logistic regression modeling with secondary data from wave III of the National Longitudinal Study of Adolescent Health (2001-2002). The dependent variable-trichomoniasis-was measured via urine testing. The measures for neighborhood social disorganization were derived from the 2000 US Census-racial and ethnic composition, concentrated poverty, and residential instability. The sample comprised 11 370 individuals across 4912 neighborhoods. RESULTS: Trichomoniasis was more likely in neighborhoods with higher concentrations of Black residents (adjusted odds ratio [AOR] = 1.16; 95% confidence interval [CI] = 1.03, 1.30). However, this association was mediated by neighborhood concentrated poverty. Furthermore, young adults who lived in neighborhoods with higher concentrations of poverty were significantly more likely to have trichomoniasis (AOR = 1.25; 95% CI = 1.07, 1.46). Neither immigrant concentration nor residential instability was significantly associated with trichomoniasis. CONCLUSIONS: These findings strengthen the evidence that neighborhood structural conditions are associated with individual sexually transmitted infection (STI) acquisition. Research is needed to explore the mechanisms through which these conditions influence STI. In addition, STI-prevention programs that include structural interventions targeting neighborhood disadvantage are needed.