Body Image Concerns in Adolescent and Young Adult Oncology Patients within Six Months of Upfront Diagnosis.

This cross-sectional study described prevalent body image (BI) concerns among adolescents and young adults (AYAs) with neoplasms who received treatment at a quaternary care children's hospital. Thirty-two AYAs, aged 15-39 years, completed questionnaires assessing BI within six months of diagnosis. The most frequently endorsed questionnaire items included the following: desire for increased physical fitness (62.5%), self-consciousness about hair (45.2%), weight dissatisfaction (40.6%), lack of strength (37.5%), wearing loose clothing to hide one's body (37.5%), decreased agility (34.4%), shape dissatisfaction (32.2%), and self-perception of too much body fat (31.3%). Awareness of AYA BI concerns during treatment may generate early intervention targeting this complex issue.

Sociodemographic Associations With Blood Pressure in 10-14-Year-Old Adolescents.

PURPOSE: To determine the association between sociodemographic characteristics and blood pressure among a demographically diverse population-based sample of 10-14-year-old US adolescents. METHODS: We conducted cross-sectional analyses of data from the Adolescent Brain Cognitive Development Study (N = 4,466), year two (2018-2020). Logistic and linear regression models were used to determine the association between sociodemographic characteristics (sex, race/ethnicity, sexual orientation, household income, and parental education) with blood pressure among early adolescents. RESULTS: The sample was 49.3% female and 46.7% non-White. Overall, 4.1% had blood pressures in the hypertensive range. Male sex was associated with 48% higher odds of hypertensive-range blood pressures than female sex (95% confidence interval [CI], 1.02; 2.14), and Black race was associated with 85% higher odds of hypertensive-range blood pressures compared to White race (95% CI, 1.11; 3.08). Several annual household income categories less than $100,000 were associated with higher odds of hypertensive-range blood pressures compared to an annual household income greater than $200,000. We found effect modification by household income for Black adolescents; Black race (compared to White race) was more strongly associated with higher odds of hypertensive-range blood pressures in households with income greater than $75,000 (odds ratio 3.92; 95% CI, 1.95; 7.88) compared to those with income less than $75,000 (odds ratio 1.53; 95% CI, 0.80; 2.92). DISCUSSION: Sociodemographic characteristics are differentially associated with higher blood pressure in early adolescents. Future research could examine potential mediating factors (e.g., physical activity, nutrition, tobacco) linking sociodemographic characteristics and blood pressure to inform targeted interventions.

Association of cyberbullying victimization and substance initiation: The Adolescent Brain Cognitive Development (ABCD) study.

BACKGROUND: Evidence shows that cyberbullying is an important risk factor for various adverse mental health outcomes, such as substance use. However, there is limited evidence from longitudinal studies that assessed whether cyberbullying victimization is associated with substance use initiation, especially among adolescent population. METHODS: Using data from the Adolescent Brain Cognitive Development Study, we assessed the association between cyberbullying victimization and substance use initiation among adolescents. In the cross-sectional analysis at year 2, multivariable logistic regressions were used to assess the association between cyberbullying victimization history and substance use initiation. Additionally, the association between year 2 cyberbullying victimization in the past 12 months/lifetime and year 3 substance use initiation was assessed using multivariable logistic regression. RESULTS: Adjusting for sociodemographic characteristics and the presence of depression/anxiety symptoms, lifetime history of cyberbullying victimization was significantly associated with substance use initiation (OR= 2.17, 95% CI: 1.68, 2.81). Recent cyberbullying victimization in the past 12 months was associated with two-times higher odds of initiating substances (OR= 2.31, 95% CI: 1.71, 3.12). In addition, both lifetime history of cyberbullying victimization and recent cyberbullying victimization at year 2 were associated with two times increased risk in substance use initiation at year 3 (OR = 2.22, 95% CI: 1.68, 2.93; OR = 2.34, 95% CI: 1.68, 3.26). CONCLUSION: There is a significant relationship between cyberbullying victimization and substance use initiation among adolescents. Cyberbullying victims are at an increased risk of initiating substance use later in life.

Associations between muscle-building exercise and concurrent e-cigarette, cigarette, and cannabis use among U.S. adolescents.

Physical activity and team sports may be protective of substance use among adolescents, although there is mixed evidence on whether muscle-building exercise is associated with patterns of e-cigarette use (i.e., vaping), cigarette use, and cannabis use. Therefore, this study aimed to determine the association between muscle-building exercise and patterns of concurrent substance use among U.S. adolescents. Cross-sectional data from the 2019 Youth Risk Behavior Survey (N = 8,474) were analyzed in 2022. Muscle-building exercise was assessed by number of days of the behavior in the past week and categorized based on level of engagement (none, low, medium, and high). Concurrent vaping, cigarette use, and cannabis use within the past 30 days were assessed using a combined, four-category variable (no use, any single use, any dual use, and triple use). Multinomial logistic regressions, with coefficients transformed to relative risk ratios (RRR), were conducted to estimate the associations between muscle-building exercise and concurrent substance use among the overall sample, and by sex, while adjusting for relevant sociodemographic variables. Among the overall sample, high engagement (6-7 days) in muscle-building exercise was associated with greater relative risk of any single use (RRR 1.36, 95% confidence interval [CI] 1.06-1.72), any dual use (RRR 1.46, 95% CI 1.10-2.94), and triple use (RRR 1.81, 95% CI 1.05-3.12). While muscle-building exercise was associated with greater relative risk of concurrent patterns of vaping, cigarette use, and cannabis use among adolescent males, there were no significant relationships found among adolescent females. Healthcare professionals should consider this association when treating adolescent males, particularly given the high prevalence of muscle-building exercise and substance use among this group. More research is needed to understand the experiences of adolescent males who report high engagement in muscle-building exercise and substance use to uncover mechanisms of association.

Physical activity from young adulthood to middle age and premature cardiovascular disease events: a 30-year population-based cohort study.

BACKGROUND: Although physical activity is generally protective of cardiovascular disease (CVD), less is known about how young adult physical activity relates to premature CVD events. The objective of this study was to determine the association between level and change in physical activity from young adulthood to middle age and incidence of premature CVD events before age 60. METHODS: We analyzed data collected across four urban sites from nine visits over 30 years of follow-up (1985-2016) from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective community-based cohort study of 5115 Black and White women and men aged 18-30 years at baseline (1985-1986). Linear mixed models were used to develop individualized moderate-to-vigorous intensity self-reported physical activity trajectories per participant. Fatal and nonfatal coronary heart disease (CHD), heart failure, and stroke outcomes were analyzed separately and as a combined CVD event outcome. RESULTS: Overall, physical activity declined in young adults as they progressed through middle age. Lower physical activity scores (per 100 exercise units) in 18 year-olds were associated with higher odds of premature CHD (AOR 1.14, 95% CI 1.02-1.28), heart failure (AOR 1.21, 95% CI 1.05-1.38), stroke (AOR 1.20, 95% CI 1.04-1.39), and any CVD (AOR 1.15, 95% CI 1.06-1.24) events. Each additional annual 1-unit reduction in the physical activity score was associated with a higher annual odds of incident heart failure (1.07, 95% CI 1.02-1.13), stroke (1.06, 95% CI 1.00-1.13), and CVD (1.04, 95% CI 1.01-1.07) events. Meeting the minimum (AOR 0.74, 95% CI 0.0.57-0.96) and twice the minimum (AOR 0.55, 95% CI 0.34-0.91) Department of Health and Human Services physical activity guidelines through follow up was protective of premature CVD events. CONCLUSIONS: Given recent trends in declining physical activity with age and associated premature CVD events, the transition from young adult to midlife is an important time period to promote physical activity.

Weight gain attempts and substance use behaviors among adults across five countries.

Weight gain attempts are common among adolescents, yet a paucity of research has explored these behaviors among adults, particularly in relation to substance use behaviors. To address this gap in the literature, pooled data from the 2018 and 2019 International Food Policy Study (N = 42,108) were analyzed. The association of weight gain attempts in the past 12 months with four important and relatively common substance use behaviors (alcohol use, binge-drinking, cigarette smoking, marijuana use) was examined using multiple modified Poisson regression analyses that adjusted for theoretically relevant covariates. Among men and women, weight gain attempts were associated with a higher likelihood of cigarette smoking in the past 30 days, marijuana use in the past 12 months, and binge-drinking one or more times per month in the past 12 months among men only. Among women, weight gain attempts were associated with a lower likelihood of alcohol use one or more times per month in the past 12 months. Our findings contribute to the literature demonstrating that substance use behaviors are more prevalent among adults who report weight gain attempts in a large international sample.

Adolescent individual, school, and neighborhood influences on young adult hypertension risk.

BACKGROUND: Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors. This study examines the association between individual, neighborhood, and school-level influences during adolescence on young adult blood pressure. METHODS: Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (1994-1995 aged 11-18 and 2007-2008 aged 24-32). We categorized hypertension as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Secondary outcomes included continuous systolic and diastolic blood pressure. We fit a series of cross-classified multilevel models to estimate the associations between young adulthood hypertension with individual-level, school-level, and neighborhood-level factors during adolescence (i.e., fixed effects) and variance attributable to each level (i.e., random effects). Models were fit using Bayesian estimation procedures. For linear models, intra-class correlations (ICC) are reported for random effects. RESULTS: The final sample included 13,911 participants in 128 schools and 1,917 neighborhoods. Approximately 51% (7,111) young adults were hypertensive. Individual-level characteristics-particularly older ages, Non-Hispanic Black race, Asian race, male sex, BMI, and current smoking-were associated with increased hypertension. Non-Hispanic Black (OR = 1.21; 95% CI: 1.03-1.42) and Asian (OR = 1.28; 95% CI: 1.02-1.62) students had higher odds of hypertension compared to non-Hispanic White students. At the school level, hypertension was associated with the percentage of non-Hispanic White students (OR for 10% higher = 1.06; 95% CI: 1.01-1.09). Adjusting for individual, school, and neighborhood predictors attenuated the ICC for both the school (from 1.4 null to 0.9 fully-adjusted) and neighborhood (from 0.4 to 0.3). CONCLUSION: We find that adolescents' schools and individual-level factors influence young adult hypertension, more than neighborhoods. Unequal conditions in school environments for adolescents may increase the risk of hypertension later in life. Our findings merit further research to better understand the mechanisms through which adolescents' school environments contribute to adult hypertension and disparities in hypertension outcomes later in life.

Associations between Concurrent Substance Use and Anabolic-Androgenic Steroid Use among Adolescents.

BACKGROUND: Concurrent use of e-cigarettes, cigarettes, and cannabis is common among adolescents, while illicit anabolic-androgenic steroid (AAS) use has recently been on the rise. Today, no known research has investigated the patterns of concurrent substance use and AAS use among adolescents in the United States. OBJECTIVE: To determine the association between concurrent lifetime use of e-cigarettes, cigarettes, and cannabis and illicit AAS use among adolescents. METHODS: Cross-sectional data from the 2019 Youth Risk Behavior Survey (N = 13,677) were analyzed in 2021. Four mutually exclusive categories of concurrent substance use (no use, any single use, any dual use, and triple use) were constructed, along with any lifetime AAS use. One logistic regression model was estimated to determine the association between concurrent substance use and lifetime AAS use. RESULTS: Compared to no use, lifetime triple use (adjusted odds ratio 3.95, 95% confidence interval 1.73-8.95) was associated with lifetime AAS use while adjusting for potential confounders. CONCLUSIONS: Findings underscore an overlapping pattern of problematic substance use that may be harmful for adolescents. Health care professionals should be aware of these patterns to improve substance use assessment protocols.

Physical Violence Perpetration Among College Students: Prevalence and Associations With Substance Use and Mental Health Symptoms.

The aims of this study were to, first, report the prevalence of physical violence perpetration among a sample of college students and, second, to identify associations between physical violence perpetration, substance use, and mental health symptoms. We analyzed survey data from the Healthy Minds Study. We examined the 12-month prevalence of physical violence perpetration by gender identity from 2014-2019 (n = 181,056). We used multivariable logistic regression analyses to estimate associations between physical violence perpetration, substance use, and mental health symptoms from the 2018-2019 survey year (n = 43,563). Results revealed that 12-month prevalence rates of physical violence perpetration increased from 2014-2019 among male, female, and transgender/gender nonconforming college students. Results from multivariable logistic regression analyses using the 2018-2019 survey year revealed higher odds of physical violence perpetration in the previous 12 months among students who reported substance use and mental health symptoms, including vaping or e-cigarette use, illicit drug use, and nonsuicidal self-injury, among others. Our findings highlight steadily rising prevalence of physical violence perpetration from 2014-2019 among college students, indicating a growing need for more research and prevention efforts to address this problem in higher education settings. Efforts to prevent violence on college campuses should consider how to reduce substance use and improve mental health to reduce this form of violence.

Compulsive exercise and vaping among a sample of U.S. College students aged 18-26 years.

PURPOSE: To determine the association between compulsive exercise and vaping among college students aged 18-26 years, and to characterize the type of vaping used among participants who report compulsive exercise. METHODS: Cross-sectional, pooled data from two survey years (2018-2020; N = 2125) of the national (U.S.) Healthy Minds Study were analyzed. Compulsive exercise was measured based on number of occurrences in the past 28 days (analyzed continuously and among those who reported ≥ 1 and ≥ 20 occurrences). Vaping was measured based on reported use in the past 30 days. Most recent type of vaping was assessed only among participants who reported vaping. Logistic regression analyses were conducted to estimate the associations between compulsive exercise and vaping, while adjusting for covariates. RESULTS: For every additional occurrence of compulsive exercise reported by participants, their odds of also reporting vaping increased by 5% (95% CI 1.01-1.09). Participants who reported 20 or more occurrences of compulsive exercise in the past 28 days, a clinical threshold, had 3.71 (95% CI 1.28-10.76) higher odds of vaping in the past 30 days. Among participants who endorsed vaping, nicotine vaping was the most common recent type for those who reported any (76.2%) or 20 or more (50.2%) occurrences of compulsive exercise. CONCLUSION: Compulsive exercise is associated with vaping in a national, U.S. sample of college students, with nicotine vaping being the most common type used. Screening for both compulsive exercise and vaping, particularly if either is reported, among college-age young adults is necessary to implement prevention and intervention strategies. LEVEL OF EVIDENCE: V, cross-sectional descriptive study.

Clinician practices assessing hypothalamic-pituitary-gonadal axis suppression in adolescents with an eating disorder.

OBJECTIVE: Although extensive literature exists on hypothalamic-pituitary-gonadal (HPG) axis suppression in females with an eating disorder, there are few studies in males. Our study aimed to determine clinician practices for the assessment of HPG axis suppression and to identify differences in practice based on the sex of the patient. METHOD: Our 31-item survey queried clinicians about confidence level and practices for assessing HPG suppression in male compared to female patients. RESULTS: Findings showed that clinicians (n = 104) were less likely to evaluate HPG suppression in males compared to females, including assessment of sexual maturity rating (p < .050), screening of decreased libido compared to amenorrhea (p < .001) and lab assessment (luteinizing hormone and follicular-stimulating hormone: p < .001; estradiol/testosterone: p < .010; TSH: p < .050). Participants also felt less confident evaluating male patients (p < .001) and requested better screening tools for males (p < .001). DISCUSSION: Our data suggest that clinician practices differ based on patient sex and that clinicians request tools for HPG suppression assessment in males. This is the first study examining specific practices and comfort levels of clinicians when assessing HPG axis suppression. Findings suggest that more guidance on the management of male patients may be needed to standardize care and to prevent short and long-term sequela of malnutrition.

Associations between vaping and eating disorder diagnosis and risk among college students.

Vaping is common among college-age young adults. Preliminary research has shown associations between vaping and eating disorder symptoms, however, there remain gaps in this knowledge among college students. The aim of this study was to determine the associations between vaping and a self-reported lifetime eating disorder diagnosis and eating disorder risk among a large sample of college students. Cross-sectional data from the 2018-2019 national (U.S.) Healthy Minds Study (n = 51,231) were analyzed. Multiple logistic regression analyses were conducted to determine the unadjusted and adjusted associations between vaping or e-cigarette use in the past 30 days and a self-reported lifetime eating disorder diagnosis (any diagnosis, anorexia nervosa, bulimia nervosa, binge-eating disorder) and eating disorder risk (SCOFF). Among the sample, 19.0% of participants reported vaping or e-cigarette use in the past 30 days, 3.7% self-reported any lifetime eating disorder diagnosis, and 25.0% were at elevated risk for an eating disorder. Vaping or e-cigarette use was associated with higher odds of all eating disorder measures, including the self-reported lifetime eating disorder diagnosis items (any diagnosis, anorexia nervosa, bulimia nervosa, binge-eating disorder) and elevated eating disorder risk, while adjusting for demographic and confounding variables. Among a large sample of college students, vaping or e-cigarette use was associated with a self-reported lifetime eating disorder diagnosis and elevated eating disorder risk, which may exacerbate the many medical complications associated with eating disorder behaviors. Clinical professionals should screen for eating disorder behaviors among college students who report vaping or e-cigarette use to monitor symptoms and medical complications.

Food insecurity risk and alcohol use disorder in US young adults: Findings from the National Longitudinal Study of Adolescent to Adult Health.

BACKGROUND AND OBJECTIVES: The relationship between food insecurity and alcohol use disorder remains unknown. The aim of this study was to determine the association between food insecurity risk and alcohol use disorder in a nationally representative sample of young adults. METHODS: Cross-sectional nationally representative data of 14,786 US young adults aged 24-32 years old from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed to assess a single-item measure of food insecurity risk and Diagnostic and Statistical Manual, 5th Edition (DSM-5) alcohol use disorder. RESULTS: Among young adults, 12% were found to be at risk for food insecurity. Young adults with food insecurity risk had greater odds of moderate (adjusted odds ratio [AOR]: 1.34, 95% confidence interval [CI]: 1.13-1.58) and severe (AOR: 1.67, 95% CI: 1.34-2.07) threshold alcohol use disorder than food-secure young adults, adjusting for age, sex, race/ethnicity, education, income, receipt of public assistance, household size, and smoking. Food insecurity risk was also associated with a 23% higher (95% CI: 11%-37%) number of problematic alcohol use behaviors (e.g., risky behaviors, continued alcohol use despite emotional or physical health problems). DISCUSSION AND CONCLUSIONS: Food insecurity risk is associated with problematic patterns of alcohol use. Health care providers should screen for food insecurity and problematic alcohol use in young adults and provide referrals for further resources and treatment when appropriate. SCIENTIFIC SIGNIFICANCE: This nationally representative study of US young adults is the first to find an association between food insecurity risk and alcohol use disorder using DSM-5 criteria.

Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students.

BACKGROUND: Fasting is an unhealthy behavior that has been frequently used as part of weight loss attempts. To date, little research has been conducted to determine the prevalence and substance use and mental health correlates of fasting among college students. Therefore, the aim of this study was to estimate the prevalence and associations between any (≥ 1 time) and regular (≥ 13 times) occurrences of fasting in the past 4 weeks and substance use and mental health correlates among a large sample of college students from 2016 to 2020. METHODS: Data from four academic survey years (2016-2020; N = 8255) of the national (USA) Healthy Minds Study were analyzed. Unadjusted prevalence of any and regular fasting by survey year and gender was estimated. Multiple logistic regression analyses were conducted to estimate the associations between any and regular fasting and the demographic (age, body mass index, race/ethnicity, sexual orientation, highest parental education), substance use (cigarette use, marijuana use, other illicit drug use, alcohol use), and mental health (depression, anxiety, eating disorder symptoms, suicidal ideation, non-suicidal self-injury) correlates. RESULTS: Any fasting in the past 4 weeks was common among both men (14.77%) and women (18.12%) and significantly increased from 2016 (10.30%) to 2020 (19.81%) only among men. Regular fasting significantly increased among both men and women from 2016 (men: 1.46%; women: 1.79%) to 2020 (men: 3.53%; women: 6.19%). Among men and women, both any and regular fasting in the past 4 weeks were associated with higher odds of all mental health symptoms, including a positive depression, anxiety, and eating disorder screen, suicidal ideation, and non-suicidal self-injury. Among women, but not men, any and regular fasting in the past 4 weeks were associated with higher odds of marijuana use and other illicit drug use (e.g., cocaine, ecstasy). CONCLUSIONS: The results from this study underscore both the high and increasing prevalence of fasting among a national sample of college students, as well as the substance use and mental health symptoms associated with this behavior. Healthcare professionals both on and off campus should consider screening for fasting behaviors among college students and provide appropriate intervention when needed.

Fasting has recently garnered public attention given its purported benefits, including weight loss and improved physical functioning. To date, little research has been conducted to determine the prevalence of this behavior among college students, as well as what demographic characteristics, substance use behaviors, and mental health symptoms are associated with this behavior. Results from a sample of over 8000 college students from four survey years of the Healthy Minds Study show that fasting is common among college men and women and has increased in prevalence from 2016 to 2020. Fasting is associated with indicators of poor mental health including depression, anxiety, eating disorder symptoms, suicidal ideation, and non-suicidal self-injury (e.g., cutting, burning), among both college men and women. Fasting is associated with substance use behaviors, including marijuana use and other illicit drug use (e.g., cocaine, ecstasy), among college women. These results highlight the adverse correlates of this common weight loss and compensatory behavior among college students.

Performance-enhancing substance use and criminal offending: A 15-year prospective cohort study.

BACKGROUND: Research has documented an association between anabolic-androgenic steroid (AAS) use and criminal offending. Still, whether legal performance-enhancing substance (e.g., creatine; PES) use is similarly associated with criminal offending is unknown. The aim of the present study was to determine the prospective associations between legal PES use and AAS use and criminal offending among U.S. adults. METHODS: Data from three waves over 15 years of the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study, were analyzed. Legal PES use and AAS use were assessed at Wave III (ages 18-26) and criminal offending was assessed at Wave IV (ages 24-32; N = 10,861) and Wave V (ages 33-43; N = 9,451). Criminal offending was measured using a summed score of six items (range 0-6). Multiple negative binominal regressions were conducted, transformed to incident rate ratios (IRR), adjusting for biological sex, age, race/ethnicity, household income, body mass index, depression, smoking, alcohol, and prior victimization and offending. MAIN FINDINGS: Among the sample (51.3 % male; 68.8 % White), legal PES use (Wave IV: IRR 1.46, 95 % confidence interval [CI] 1.15-1.85; Wave V: IRR 1.52, 95 % CI 1.02-2.27) and AAS use (Wave IV: IRR 1.73, 95 % CI 1.09-2.76; Wave V: IRR 2.36, 95 % CI 1.33-4.19) were prospectively associated with criminal offending during young and middle adulthood, while adjusting for demographic and behavioral factors. CONCLUSIONS: These results confirm and expand upon prior research by describing the prospective associations between both legal PES use and AAS use and criminal offending among a nationally representative sample of U.S. adults.

Legal Performance-Enhancing Substances and Substance Use Problems Among Young Adults.

BACKGROUND: Legal performance-enhancing substance(s) (PES) (eg, creatine) are widely used among adolescent boys and young men; however, little is known about their temporal associations with substance use behaviors. METHODS: We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I to IV (1994-2008). Logistic regressions were used to first assess adolescent substance use (Wave I) and use of legal PES (Wave III) and second to assess use of legal PES (Wave III) and subsequent substance use-associated risk behaviors (Wave IV), adjusting for potential confounders. RESULTS: Among the sample of 12 133 young adults aged 18 to 26 years, 16.1% of young men and 1.2% of young women reported using legal PES in the past year. Adolescent alcohol use was prospectively associated with legal PES use in young men (odds ratio 1.39; 95% confidence interval [CI] 1.13-1.70). Among young men, legal PES use was prospectively associated with higher odds of problematic alcohol use and drinking-related risk behaviors, including binge drinking (adjusted odds ratio [aOR] 1.35; 95% CI 1.07-1.71), injurious and risky behaviors (aOR 1.78; 95% CI 1.43-2.21), legal problems (aOR 1.52; 95% CI 1.08-2.13), cutting down on activities and socialization (aOR 1.91; 95% CI 1.36-2.78), and emotional or physical health problems (aOR 1.44; 95% CI 1.04-1.99). Among young women, legal PES use was prospectively associated with higher odds of emotional or physical health problems (aOR 3.00; 95% CI 1.20-7.44). CONCLUSIONS: Use of legal PES should be considered a gateway to future problematic alcohol use and drinking-related risk behaviors, particularly among young men.

Gender Norms and Weight Control Behaviors in U.S. Adolescents: A Prospective Cohort Study (1994-2002).

PURPOSE: The aim of this article was to determine the relationship between gender norms and weight control behaviors in U.S. adolescents. METHODS: We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health (N = 9,861), at baseline in 1994-1995 (ages 11-18 years, Wave I), 1-year follow-up (ages 12-19 years, Wave II), and 7-year follow-up (ages 18-26 years, Wave III). The primary exposure variable was a measure of one's gender normativity based on the degree to which males and females behave in ways that are similar to the behaviors of their same-gender peers. The outcome variable was an individual's weight control attempts (trying to lose or gain weight) and behaviors (dieting, fasting/skipping meals, vomiting, or weight-loss pills/laxatives/diuretics to lose weight or ate different/more foods than usual or taking supplements to gain weight). RESULTS: In logistic regression analyses controlling for potential confounders, a higher baseline individual gender normativity score (higher femininity in females and higher masculinity in males) was associated with weight loss attempts (ß = .10; p = .01) and weight loss behaviors (ß = .18; p < .001) in girls but was associated with weight gain attempts (ß = .18; p < .001) and behaviors (ß = .16; p < .001) in boys at 1-year follow-up. Higher individual gender normativity score was protective of weight loss attempts (ß = -.15; p < .001) and weight loss behaviors (ß = -.17; p < .001) in males but not females at 7-year follow-up. Loess plots provided visualizations of significant relationships. CONCLUSIONS: Gender norms may reinforce a thinner body ideal for girls but a larger ideal for boys.

Adolescent gender norms and adult health outcomes in the USA: a prospective cohort study.

BACKGROUND: Previous research has documented differences in health behaviours between men and women, with differential risks and health outcomes between the sexes. Although some sex-specific differences in health outcomes are caused by biological factors, many others are socially driven through gender norms. We therefore aimed to assess whether gender expression as an adolescent, determined by the degree to which an individual's behvaiours were typical of their gender, were associated with health behaviours and outcomes in adulthood. METHODS: In this prospective cohort study, we used data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of US adolescents from whom data were collected during adolescence (ages 11-18 years) and adulthood (ages 24-32 years). We created a measure of gender expression that was based on the degree to which male and female adolescents and adults behave in stereotypically masculine (for men) or feminine (for women) ways relative to their same-gender peers. Adolescents were assessed for baseline sociodemographic characteristics and gender expression, and these participants were later assessed, during adulthood, for their gender expression and health behaviours and outcomes, which included depression, self-rated health, drug and alcohol use, cardiovascular risk factors, experience of sexual violence, diet, and obesity. These data were collected via surveys, except for body-mass index, cholesterol, and blood pressure, which were collected as biomarkers. FINDINGS: Between April and December, 1995, self-reported data were collected from 10 480 female and 10 263 male adolescents; similar data were subsequently collected in several waves in this cohort, with a final collection between January, 2008, and February, 2009, when participants were aged 24-32 years. We used data from this final wave and from baseline, and our study represents a secondary analysis of these data. Of these participants, complete follow-up data from 6721 (80%) adult women and 5885 (80%) adult men were available. Gender expression was stable for men and women from adolescence to adulthood. High masculinity (vs low masculinity) in adolescent and adult men was positively associated with smoking in the past month, use of marijuana and recreational drugs, prescription drug misuse (adult gender expression only), and consumption of fast food and soda (adolescent gender expression only) in the past week. However, higher masculine gender expression in adult men was negatively associated with diagnosed depression and high cholesterol in adulthood, and masculine gender expression in adolescent and adult men was negatively associated with high blood pressure in adults. High femininity (vs low femininity) in adolescent or adult women was positively associated with high cholesterol and blood pressure (both adult gender expression only), depression, migraines (adult gender expression only), and physical limitations (ie, health problems that limited their daily activities). However, higher femininity in adolescence was negatively associated with self-rated good health in adulthood. Although feminine gender expression in adolescents was predictive of adult recreational and prescription drug and marijuana use and experience of sexual violence, feminine gender expression in adulthood was negatively associated with adult substance use and experience of sexual violence, suggesting that expressions of femininity typical of adolescents impart risks that expression of femininity as an adult does not. Individuals who are highly masculine or feminine seem to be at greatest risk of adverse health outcomes and behaviours. INTERPRETATION: We found compelling evidence that adolescent gender expression is correlated with health in adulthood independently of gender expression as an adult. Although more research is needed to identify causal mechanisms, our results suggest that those designing health behaviour interventions should carefully consider integrating gender transformative components into interventions. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Gender Equality, Integrated Delivery, HIV, Nutrition, Family Planning, and Water Sanitation and Hygiene Program Strategy Teams (Bill and Melinda Gates Foundation).