Loneliness, Discrimination, Stress, and Type 2 Diabetes Risk in Young Adults.

INTRODUCTION: The aim of this study was to determine the associations between type 2 diabetes or prediabetes and loneliness and related social experiences in young adults, a population at increasingly high risk of type 2 diabetes. METHODS: This was a cross-sectional analysis using data from adults aged 18-35 years enrolled in the All of Us Research Program. Exposures included loneliness, social support, discrimination, neighborhood social cohesion, and stress, measured by standardized surveys. The main outcome was type 2 diabetes or prediabetes by self-report or linked health record. Logistic regression determined the odds of type 2 diabetes/prediabetes for each survey measure, adjusting for age, sex, race or ethnicity, income, and family history. Latent class analysis evaluated clustering of social experiences. Data were collected from 2018 to 2022 and analyzed in May 2023-June 2024. RESULTS: The cohort included 14,217 young adults (aged 28.2 ± 4.4 years, 73.1% [n=10,391] women, 64.1% [n=9,111] White, 10.6% [n=1,506] Hispanic, 5.7% [n=806] Black, and 9.1% [n=1,299] multiracial). Overall, 5.5% (n=777) had either prediabetes or type 2 diabetes. The 2 highest loneliness quartiles were associated with increased odds of prediabetes/type 2 diabetes (Q3: OR=1.42 [95% CI=1.15, 1.76] and Q4: OR=1.78 [95% CI=1.45, 2.19]). Greater stress and discrimination and lower social support and neighborhood social cohesion were also associated with increased odds of prediabetes/type 2 diabetes. Latent class analysis revealed 3 distinct phenotypes, with elevated odds of prediabetes/type 2 diabetes in the 2 with the most adverse social profiles (OR=2.32 [95% CI=1.89, 2.84] and OR=1.28 [95% CI=1.04, 1.58]). CONCLUSIONS: Loneliness and related experiences are strongly associated with type 2 diabetes and prediabetes in young adults. Whether these factors could be leveraged to reduce type 2 diabetes risk should be investigated.

Associations Between Acculturation, Discrimination, and Adolescent Relationship Abuse: A Matched Parent-Adolescent Study of Latine Families.

Adolescent relationship abuse (ARA) is prevalent among adolescents, including those who identify as Latine. However, there is limited research that has considered the cultural and structural mechanisms that may impact ARA experiences among Latine youth. Further, although parents play a crucial role in ARA prevention, few studies have investigated how adolescent-parent differences in acculturation and discrimination are associated with ARA. The objective of this exploratory study of Latine families was to examine how acculturation, discrimination, and adolescent-parent acculturation/discrimination differences relate to ARA victimization and perpetration. Parent-adolescent dyads recruited from clinic and community-based settings in Pittsburgh and Kansas City completed matched surveys. Parent-adolescent acculturation and discrimination differences were calculated using multilevel linear models. Multivariable logistic regression was used to examine associations among ARA victimization and perpetration and adolescent-reported acculturation, adolescent-reported discrimination, and adolescent-parent acculturation and discrimination differences. One hundred eighty-two adolescents and their parent/caregiver (n = 364) completed a matched survey in English or Spanish from March 2020 to March 2021. Forty-three percent of adolescents reported that they had started dating; of these 35% and 24% reported ARA victimization and perpetration, respectively. Higher levels of adolescent-reported acculturation conflict were associated with lower ARA victimization (adjusted odds ratio [aOR]: 0.24; 95% confidence interval, CI [0.08, 0.75]); conversely, higher adolescent-reported discrimination was associated with ARA victimization (aOR: 2.50 [1.30, 4.60]) and perpetration (aOR: 2.10 [1.10, 3.90]). Wider adolescent-parent acculturation differences in Spanish language (aOR: 3.40 [1.04, 11.30]) and interpersonal discrimination (aOR: 2.40 [1.10, 5.20]) were associated with increased ARA victimization. Results underscore the importance of discrimination in understanding ARA experiences among Latine youth. Future work should consider developing culturally and linguistically affirming ARA prevention programs for Latine adolescents and parents.

Caregivers of children with asthma alarmed by climate change: a cross-sectional study.

BACKGROUND: Climate change poses significant health risks, with children being particularly vulnerable to its adverse health effects. Children with asthma are expected to have worsening disease due to increased exposure to heat, air pollution, mold from flooding, and pollen. Understanding caregiver perspectives on these health harms is crucial for informing public health policy and education. Therefore, we aimed to explore caregiver perceptions of climate change-related health risks to children with asthma. METHODS: In this cross-sectional study, a survey instrument was created and distributed to caregivers of children with asthma during their visits to pulmonology clinics located in an urban northeastern US setting and via email. RESULTS: Among 198 completed surveys, 78% of participants reported high levels of concern about climate change, with most respondents agreeing that climate change has already impacted their child's health. Examples provided by respondents included worsening asthma control due to air pollution, wildfire events, pollen exposure, and rapid changes in weather. Respondents who self-identified as female had greater concern. Most respondents agreed that these topics should be further discussed with their child's doctor. Although, barriers to such discussions were noted by the respondents. CONCLUSION: Caregivers of children with asthma have high levels of concern regarding climate change and report adverse impacts on their child's asthma. Clinicians caring for children with asthma should consider discussing the respiratory health impacts of climate change with caregivers. However, barriers to these discussions need further examination.

Perinatal Economic Abuse: Experiences, Impacts, and Needed Resources.

Introduction: Economic abuse is one form of intimate partner violence (IPV) intended to control a survivor's ability to make, save, or spend money to gain power over them. Perinatal people may be more vulnerable to economic abuse due to changes in employment and finances. This study's aims were to explore how economic abuse manifests among pregnant and parenting survivors and how best to support pregnant and parenting survivors of economic abuse. Methods: We conducted virtual semistructured interviews with IPV survivors and IPV advocates. Participants were recruited through an online recruitment registry, national IPV organizations, and local domestic violence agencies. Interview audiorecordings were transcribed. We used a deductive-inductive thematic analysis approach. Two research team members individually coded each transcript and met to resolve discrepancies in coding. Results: We completed interviews with 18 advocates and 20 survivors. Participants described experiences of financial control, exploitation, and employment sabotage. Partners leveraged the criminal-legal, child welfare, and health care systems and cultural norms about pregnancy, including those related to gender and religion to financially harm survivors. Advocates described how economic abuse impacts marginalized survivors. Dream resources described include cash assistance, healthy relationship and financial education, and employer policies. Discussion: Survivors and advocates reported a variety of experiences with economic abuse during the perinatal period. Future interventions should focus on providing unrestricted cash transfers to survivors, developing education on economic abuse, and creating supportive policies in health care and employment settings. This study highlights the ways that economic abuse specifically impacts perinatal survivors and their children.

Online Human-Centered Design Methods are Acceptable, Appropriate, and Feasible for Generating Adolescent Relationship Abuse Intervention Ideas With Sexual and Gender Diverse Youth.

PURPOSE: Sexual and gender diverse youth (SGDY) are at greater risk for adolescent relationship abuse (ARA) than cisgender heterosexual youth, but there are not enough evidence-based interventions for reducing ARA among SGDY. We piloted online human-centered design (HCD) methodology to engage SGDY in generating ARA intervention ideas. This study evaluated the acceptability, appropriateness, and feasibility of the online methods and identified SGDY-derived intervention ideas for reducing ARA. METHODS: From August 2020 through March 2021, we conducted a longitudinal online HCD study with 46 SGDY (aged 14-18 years) recruited via social media from across the United States. SGDY completed HCD activities using MURAL (collaborative digital whiteboard) in four group-based sessions (1.5 hours each) and a follow-up survey with validated measures of acceptability, appropriateness, and feasibility (a priori success benchmarks: means > 3.75 on each five-point scale). RESULTS: SGDY in the sample were 41% racial/ethnic minorities. SGDY rated the online HCD methods as highly acceptable, appropriate, and feasible (means ≥ 4.29). SGDY co-created a breadth of ARA intervention concepts across all social-ecological levels, including commonplace ideas (e.g., curriculum for schools) and novel ideas, such as social media-based interventions to foster healthy relationships, incentivization interventions for performing social justice work, and school plays with SGDY storylines. DISCUSSION: Online HCD methods are acceptable, appropriate, and feasible for designing ARA intervention ideas. The intervention ideas generated in this study can help catalyze ARA intervention research for SGDY. Our method can be transported to other populations and health topics to help advance adolescent health and equity.

Supporting Youth Exposed to Violence in the Post-Pandemic: Prevention and Intervention Strategies.

The coronavirus disease 2019 pandemic was a public health emergency that impacted adolescents across the United States and disproportionately affected youth experiencing marginalization due to less access to resources and supports. This study reviews the increases in intimate partner and youth violence during the pandemic, mechanisms contributing to these increases, and the overarching health impacts on adolescents. Pediatric health professionals have a vital role to play in implementing healing-centered practices and prevention efforts that mitigate impacts of trauma and violence and that support youth and families in pathways to healing and recovery.

Primary care perspectives on prescribing anti-obesity medication for adolescents.

BACKGROUND: Recent pediatric guidelines recommend clinicians offer anti-obesity medication (AOM) as an adjunct to intensive lifestyle intervention. OBJECTIVE: To investigate pediatricians' perspectives about prescribing AOM, including barriers and facilitators. METHODS: An investigator-developed survey was emailed to primary care pediatric physicians (n = 187) and advanced practice providers (n = 190) within an academic-affiliated network. The survey evaluated how willing clinicians were to prescribe AOM and their agreement with 25 statements about barriers and facilitators. Three vignettes explored AOM decision-making. Multinomial logistic regression was used to determine relative risk ratios for willingness to prescribe by agreement with each statement. RESULTS: Among 74 respondents (20% response rate), 24% were willing, 42% uncertain and 34% unwilling to prescribe. Most (64%) agreed that AOM should be managed only by specialists. Willingness to prescribe was associated with clinician motivation and belief in guideline practicality and applicability. Unwillingness was associated with beliefs that patients would not continue AOM long enough for benefit and that there was insufficient time or resources to implement. In vignettes, 52% were willing to prescribe AOM for a patient with severe obesity and metabolic complications, versus 11% for a patient with obesity and possible disordered eating. CONCLUSIONS: Willingness to prescribe AOM was low and was associated with perceived practicality and appropriateness for patients.

Prediabetes Prevalence by Adverse Social Determinants of Health in Adolescents.

Importance: Several clinical practice guidelines advise race- and ethnicity-based screening for youth-onset type 2 diabetes (T2D) due to a higher prevalence among American Indian and Alaska Native, Asian, Black, and Hispanic youths compared with White youths. However, rather than a biological risk, this disparity likely reflects the inequitable distribution of adverse social determinants of health (SDOH), a product of interpersonal and structural racism. Objective: To evaluate prediabetes prevalence by presence or absence of adverse SDOH in adolescents eligible for T2D screening based on weight status. Design, Setting, and Participants: This cross-sectional study and analysis used data from the 2011 to 2018 cycles of the National Health and Nutrition Examination Survey. Data were analyzed from June 1, 2023, to April 5, 2024. Participants included youths aged 12 to 18 years with body mass index (BMI) at or above the 85th percentile without known diabetes. Main Outcomes and Measures: The main outcome consisted of an elevated hemoglobin A1c (HbA1c) level greater than or equal to 5.7% (prediabetes or undiagnosed presumed T2D). Independent variables included race, ethnicity, and adverse SDOH (food insecurity, nonprivate health insurance, and household income <130% of federal poverty level). Survey-weighted logistic regression was used to adjust for confounders of age, sex, and BMI z score and to determine adjusted marginal prediabetes prevalence by race, ethnicity, and adverse SDOH. Results: The sample included 1563 individuals representing 10 178 400 US youths aged 12 to 18 years (mean age, 15.5 [95% CI, 15.3-15.6] years; 50.5% [95% CI, 47.1%-53.9%] female; Asian, 3.0% [95% CI, 2.2%-3.9%]; Black, 14.9% [95% CI, 11.6%-19.1%]; Mexican American, 18.8% [95% CI, 15.4%-22.9%]; Other Hispanic, 8.1% [95% CI, 6.5%-10.1%]; White, 49.1% [95% CI, 43.2%-55.0%]; and >1 or other race, 6.1% [95% CI, 4.6%-8.0%]). Food insecurity (4.1% [95% CI, 0.7%-7.5%]), public insurance (5.3% [95% CI, 1.6%-9.1%]), and low income (5.7% [95% CI, 3.0%-8.3%]) were each independently associated with higher prediabetes prevalence after adjustment for race, ethnicity, and BMI z score. While Asian, Black, and Hispanic youths had higher prediabetes prevalence overall, increasing number of adverse SDOH was associated with higher prevalence among White youths (8.3% [95% CI, 4.9%-11.8%] for 3 vs 0.6% [95% CI, -0.7% to 2.0%] for 0 adverse SDOH). Conclusions and Relevance: Adverse SDOH were associated with higher prediabetes prevalence, across and within racial and ethnic categories. Consideration of adverse SDOH may offer a more actionable alternative to race- and ethnicity-based screening to evaluate T2D risk in youth.

Associations Among Plurisexual Identity, Intimate Partner Violence, Reproductive Coercion, and Parental Monitoring in a Sample of Adolescent and Young Adult Pregnant People.

Purpose: The goal of this study was to examine plurisexual identity, intimate partner violence (IPV), reproductive coercion, and parental monitoring among pregnant 13-21-year-olds. Methods: We conducted a cross-sectional analysis of data collected from a cohort of pregnant adolescents and young adults between October 2019 and May 2023 (n = 398). Logistic regression was completed to assess IPV and reproductive coercion as a function of plurisexual identity. Next, we assessed potential interactions between parental monitoring and plurisexual identity and examined IPV and reproductive coercion as a function of parental monitoring for the full sample and stratified by plurisexuality. Results: Plurisexual identity was associated with IPV (adjusted odds ratio [aOR] = 2.3; confidence interval [CI]: 1.4-4.0). IPV was inversely related to parental monitoring among plurisexual participants (aOR: 0.51; CI: 0.32-0.82), but this association was not significant for heterosexual participants (aOR: 1.1; CI: 0.75-1.6). Conclusions: This work demonstrates the importance of parental monitoring in supporting young plurisexual pregnant people.

"How Fluent Do I Need to Be to Say I'm Fluent?" Research Experiences of Communities that Speak Languages Other than English.

OBJECTIVE: The goal of this study was to partner with community organizations to understand the research experiences of communities who speak languages other than English (LOE). METHODS: We conducted semi-structured qualitative interviews in Spanish, Nepali, Mandarin, French, or Kizigua with LOE community members and community leaders who completed recruitment and data collection. Audio-recordings of the interviews were transcribed and translated. We conducted qualitative coding using a mixed deductive-inductive analysis approach and thematic analyses using three rounds of affinity clustering. This study occurred in partnership with an established community-academic collaboration. RESULTS: Thirty community members and six community leaders were interviewed. 83% of LOE participants were born outside of the US and most participants (63%) had never participated in a prior research study. Six themes emerged from this work. Many participants did not understand the concept of research, but those that did thought that inclusion of LOE communities is critical for equity. Even when research was understood as a concept, it was often inaccessible to LOE individuals, particularly because of the lack of language services. When LOE participants engaged in research, they did not always understand their participation. Participants thought that improving research trust was essential and recommended partnering with community organizations and disseminating research results to the community. CONCLUSION: This study's results can serve as an important foundation for researchers seeking to include LOE communities in future research to be more inclusive and scientifically rigorous.

Applying a Language Justice Framework in Research: A Step Toward Achieving Health Equity.

People who use languages other than English (LOE) are rarely included in research in the United States. LOE communities face numerous health disparities that are rooted in language injustice and other intersecting oppressions including racism and xenophobia. Equitable inclusion of LOE communities in research is an important step to disrupt health disparities. We propose a new conceptual framework on language justice in research to support researchers in conducting equitable multilingual research. This language justice in research framework comprises six core pillars of best practices required for achieving language justice during all the stages of the research process including conceptualization, budgeting, data collection and analysis, and dissemination. We also present key definitions, examples of how core pillars can be applied, and structural solutions to achieving language justice. The application of the language justice in research framework is designed: (a) to achieve health equity, data equity, and antiracism across the research continuum and (b) to disrupt health disparities in systems and institutions that are disproportionately impacting LOE communities.

Projected impact of anti-obesity pharmacotherapy use on racial and ethnic disparities in adolescent obesity.

BACKGROUND: Paediatric obesity disproportionately impacts individuals from minoritized racial and ethnic backgrounds. Recent guidelines support use of anti-obesity pharmacotherapy for adolescents with obesity, but the potential impact on disparities in obesity prevalence has not been evaluated. OBJECTIVES: To model changes in obesity prevalence with increasing utilization of anti-obesity pharmacotherapy among adolescents. METHODS: Data representative of American adolescents ages 12-17 years were obtained from the National Health and Nutrition Examination Survey, cycles 2011 through pre-pandemic 2020. A body mass index (BMI) reduction of 16.7% was applied to each participant based on clinical trial results of weekly subcutaneous semaglutide 2.4 mg among adolescents. Utilization disparities were based on utilization of the same medication class among adults. Obesity prevalence was calculated assuming utilization of 10%-100%, stratified by race and ethnicity. RESULTS: Among 4442 adolescents representing 26 247 384 American adolescents, projected overall obesity prevalence decreased from 22.2% to 8.4% with 100% utilization. However, disparities increased relative to Non-Hispanic White youth, with prevalence among Non-Hispanic Black and Mexican American youth ranging from 40%-60% higher to 90%-120% higher, respectively. CONCLUSIONS: Increasing utilization of anti-obesity pharmacotherapy may widen relative disparities in obesity, particularly if utilization is unequal. Advocacy for equitable access is needed to minimize worsening of obesity-related disparities.

Economic Abuse and Help-Seeking Intentions Among Adolescents.

Economic adolescent relationship abuse (ARA) includes coercive behaviors leading to interference with education, employment, and finances. To date, no study has examined help seeking among adolescents and young adults if they were to experience economic ARA. The goals of this article include examining: (a) help-seeking intentions of adolescents regarding economic ARA; (b) help-seeking sources and reasons for not seeking help; and (c) differences in help-seeking intentions based on age, race/ethnicity, gender identity, and experiences of economic ARA. We conducted a cross-sectional survey of adolescents ages 13-19 focused on economic ARA experiences and help seeking. We performed descriptive statistics of help-seeking intentions, sources, and barriers. We utilized logistic regression, adjusted for age, race/ethnicity, and gender identity, to explore associations between economic ARA victimization and help-seeking intentions. Of 2,852 participants, 56% said they would seek help for economic ARA. Adolescents with positive help-seeking intentions shared that they would seek help from their parents (43%) or friends (35%). Those less likely to seek help were concerned about others finding out (32%), not being believed (31%), or authority figures being notified (31%). Help-seeking intentions were lower among Black/African American adolescents (aOR = 0.55, CI [0.43, 0.70]) and Multiracial adolescents (aOR = 0.26, CI [0.16, 0.42]) compared to White adolescents. Help-seeking intentions were higher among gender diverse adolescents (aOR = 5.78, CI [2.98, 11.22]) and those ages 15-17 years (aOR = 1.84, CI [1.36, 2.47]) compared to those identifying as female and ages 18-19 years. Help-seeking intentions were lower among adolescents who experienced economic ARA (aOR = 0.61, CI [0.51, 0.72]). While the majority of adolescents reported that they would seek help if they experienced economic ARA, those who had experienced economic ARA were less likely to report intentions to seek help. Supportive interventions for adolescents experiencing economic ARA are needed.

Supporting Intimate Partner Violence Survivors and Their Children in Pediatric Healthcare Settings.

Intimate partner violence (IPV) is a pervasive public health epidemic that influences child health and thriving. In this article, we discuss how pediatric healthcare providers and systems can create healing-centered spaces to support IPV survivors and their children. We review the use of universal education and resource provision to share information about IPV during all clinical encounters as a healing-centered alternative to screening. We also review how to support survivors who may share experiences of IPV, focused on validation, affirmation, and connection to resources. Clinicians are provided key action items to implement in their clinical settings.