Gender role orientation is associated with health-related quality of life differently among African-American, Hispanic, and White youth.

PURPOSE: This study examined the association between gender role orientation (GRO) and health-related quality of life (HRQOL) in youth, and how this relationship may differ between males and females as well as among African-American, White, and Hispanic individuals. GRO has been reported to influence serious health outcomes including cancer, heart disease, mental illness, and mortality rates. However, few studies have examined the link between GRO and health outcomes for children, even though gender identity is formed in childhood. METHODS: Data were examined from 4824 participants in the Healthy Passages™ project, a population-based survey of fifth-grade children in three US metropolitan areas. Children reported their own HRQOL using the PedsQL and degree of female, male, and androgynous GRO using the Children's Sex Role Inventory. RESULTS: Based on structural equations analysis, male GRO was positively associated with HRQOL for all racial/ethnic groups, regardless of sex, whereas female GRO was associated with better HRQOL for Hispanic and White females and poorer HRQOL for Hispanic males. Androgynous GRO was associated with better HRQOL among Hispanic and White females, but not males nor African-Americans of either sex. CONCLUSIONS: Racial/ethnic differences emerged for female and androgynous, but not male, GROs. Hispanic males are the only group for which GRO (female) was associated with poorer HRQOL. Future research should find ways to help youth overcome negative effects on health from gender beliefs and behavior patterns with sensitivity to racial/ethnic membership.

Common pathways toward informing policy and environmental strategies to promote health: a study of CDC's Prevention Research Centers.

This study examined the roles academic researchers can play to inform policy and environmental strategies that promote health and prevent disease. Prevention Research Centers (PRCs) engage in academic-community partnerships to conduct applied public health research. Interviews were used to collect data on the roles played by 32 PRCs to inform policy and environmental strategies that were implemented between September 2009 and September 2010. Descriptive statistics were calculated in SAS 9.2. A difference in roles played was observed depending on whether strategies were policy or environmental. Of the policy initiatives, the most common roles were education, research, and partnership. In contrast, the most prevalent roles the PRCs played in environmental approaches were research and providing health promotion resources. Academic research centers play various roles to help inform policy and environmental strategies.

Academic-health department collaborative relationships are reciprocal and strengthen public health practice: results from a study of academic research centers.

BACKGROUND: Collaborations between academic institutions and state and local health departments have been shown to enhance the public health core functions of Assurance by improving the public health workforce's knowledge and skills. Few studies have analyzed how academic-health department collaborations enhance Assessment and Policy Development core functions. This qualitative study explores types of collaborations between health departments and Prevention Research Centers (PRCs) and how they align with the core functions. Prevention Research Centers are academic institutions funded by the Centers for Disease Control and Prevention to conduct public health research and translate research results for policies and practices. METHODS: We reviewed each PRC's annual report from fiscal year 2011 and abstracted descriptions of PRC-health department collaborations. We identified 14 themes of PRC-health department collaborations and conducted a qualitative analysis to describe the dimensions and distribution of themes. RESULTS: Of the 37 PRCs, 36 reported 215 collaborations with 19 city, 97 county, 31 state, and 46 tribal health departments. Themes of research, survey, and surveillance aligned with the Assessment core function and evaluation, strategic planning, technical assistance, and program implementation supported the Policy Development and Assurance core functions. Overall, health departments provided on-the-ground expertise to inform PRC research, ensuring its applicability to public health practice. Reciprocally, PRCs improved data quality, increased the scientific rigor of health department processes and programs, and filled knowledge gaps within health departments. Both PRCs and health departments enhanced the relevance of public health programs and practices by grounding implementation and evaluation in community needs and views. CONCLUSION: Findings from this study demonstrate that PRC-health department collaborations often enhanced multiple core functions that could lead to implementation of evidence-based interventions and continuous quality improvement of public health administration at the local, state, and tribal levels. This study highlights the value and importance of reciprocal academic-health department partnerships.

A new taxonomy for stakeholder engagement in patient-centered outcomes research.

Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach.

Association of externalizing behavior disorder symptoms and injury among fifth graders.

OBJECTIVE: Injury is the leading cause of death among American youth, killing more 11-year-olds than all other causes combined. Children with symptoms of externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) may have increased risk. Our aims were to determine: (1) whether increasing symptoms of ADHD and CD associate positively with injuries among a community sample of fifth graders; and (2) whether symptoms of ADHD and CD have a multiplicative rather than additive association with injuries among the sample. METHODS: Data were collected from 4745 fifth graders and their primary caregivers participating in Healthy Passages, a multisite, community-based study of pediatric health risk behaviors and health outcomes. The primary outcome was injury frequency. Primary independent variables were ADHD and CD symptoms. Additional covariates included gender, race/ethnicity, and household income. Ordinal logistic regression examined correlates of injury frequency. The interaction between ADHD and CD symptoms also was examined. RESULTS: In bivariate analyses, the odds of injury increased as ADHD symptoms (odds ratio [OR] 1.29; 95% confidence interval [95% CI] 1.18-1.41) and CD symptoms (OR 1.18; 95% CI 1.07-1.31) increased. However, in multivariate analysis, only ADHD symptoms were significantly associated with injury (OR 1.22; 95% CI 1.10-1.35). There was no statistically significant interaction between ADHD and CD symptoms. CONCLUSIONS: ADHD symptoms are associated with increased odds of injury in fifth graders. Findings have implications for potential injury prevention strategies for mental health practitioners (for example, cognitive training with at-risk youth), pediatricians (ADHD screening), and parents (improved supervision).

Training and technical assistance to enhance capacity building between prevention research centers and their partners.

INTRODUCTION: The Centers for Disease Control and Prevention has administered the Prevention Research Centers Program since 1986. We quantified the number and reach of training programs across all centers, determined whether the centers' outcomes varied by characteristics of the academic institution, and explored potential benefits of training and technical assistance for academic researchers and community partners. We characterized how these activities enhanced capacity building within Prevention Research Centers and the community. METHODS: The program office collected quantitative information on training across all 33 centers via its Internet-based system from April through December 2007. Qualitative data were collected from April through May 2007. We selected 9 centers each for 2 separate, semistructured, telephone interviews, 1 on training and 1 on technical assistance. RESULTS: Across 24 centers, 4,777 people were trained in 99 training programs in fiscal year 2007 (October 1, 2006-September 30, 2007). Nearly 30% of people trained were community members or agency representatives. Training and technical assistance activities provided opportunities to enhance community partners' capacity in areas such as conducting needs assessments and writing grants and to improve the centers' capacity for cultural competency. CONCLUSION: Both qualitative and quantitative data demonstrated that training and technical assistance activities can foster capacity building and provide a reciprocal venue to support researchers' and the community's research interests. Future evaluation could assess community and public health partners' perception of centers' training programs and technical assistance.

Association of family stressful life-change events and health-related quality of life in fifth-grade children.

OBJECTIVE: To examine the association of recent family-related stressful life-change events (SLEs) with health-related quality of life (HRQOL) in fifth graders. DESIGN: Population-based, cross-sectional survey. SETTING: Three US metropolitan areas; 2004-2006. PARTICIPANTS: A total of 5147 fifth graders and their parents. MAIN EXPOSURES: Nine recent family-related SLEs: a parent's death, another family member's death, a family member's injury/illness, a family member's alcohol/drug problems, loss of a pet, recent change of residence, addition of a new baby or child to the household, parental separation, and parental divorce. MAIN OUTCOME MEASURE: The HRQOL measured using the 23-item Pediatric Quality of Life Inventory. RESULTS: Twenty-four percent of children had no reported recent SLEs; 33% had 1, 25% had 2, 12% had 3, and 6% had 4 or more. Mean HRQOL scores (total, physical, and psychosocial scales) were lower for children with more SLEs. The mean total HRQOL score was 80.4 (95% confidence interval, 79.4-81.3) for children with no recent SLEs and 71.8 (70.2-73.5) for children with 4 or more SLEs (P < .001). In adjusted logistic regression analyses, children with more SLEs had greater odds of impaired HRQOL compared with children without any SLEs. Psychosocial HRQOL fully mediated the relationship between SLEs and physical HRQOL. CONCLUSIONS: The occurrence of multiple family-related SLEs in children is associated with less positive HRQOL. By incorporating the needs of families as part of comprehensive, high-quality care, health care professionals can identify these types of family-level needs and assist families in accessing community resources for support.

The association of activity level, parent mental distress, and parental involvement and monitoring with unintentional injury risk in fifth graders.

OBJECTIVE: Extend findings with young children by examining the strength of association of activity level, parent mental distress, and parental involvement and monitoring with fifth graders' unintentional injuries. METHODS: Ordinal logistic regression models were used to predict unintentional injury frequency among 4745 fifth-graders. Examined predictors included demographics, parent reports of mental distress, temperamental activity level (tendency to be fidgety, restless, and constantly in motion), and parental involvement and monitoring in adolescents' lives. RESULTS: Higher levels of both activity level and parent mental distress predicted more frequent injuries. CONCLUSIONS: As has been found with younger children, unintentional injuries in fifth graders are associated with both parent and child characteristics. The result is discussed in the context of adolescent development. Implications include those for injury prevention (multi-dimensional prevention strategies that incorporate environmental modifications as well as training of youth and parents) and future research (study of potential mechanisms behind injury risk behavior via longitudinal and experimental research; study of injury risk during this phase of child development).

Factor structure and psychometric properties of the Brief Symptom Inventory-18 in women: a MACS approach to testing for invariance across racial/ethnic groups.

This study used data from 3 sites to examine the invariance and psychometric characteristics of the Brief Symptom Inventory-18 across Black, Hispanic, and White mothers of 5th graders (N = 4,711; M = 38.07 years of age, SD = 7.16). Internal consistencies were satisfactory for all subscale scores of the instrument regardless of ethnic group membership. Mean and covariance structures analysis indicated that the hypothesized 3-factor structure of the instrument was not robust across ethnic groups. It provided a reasonable approximation to the data for Black and White women but not for Hispanic women. Tests for differential item functioning (DIF) were therefore conducted for only Black and White women. Analyses revealed no more than trivial instances of nonuniform DIF but more substantial evidence of uniform DIF for 3 of the 18 items. After having established partial strong factorial invariance of the instrument, latent factor means were found to be significantly higher for Black than for White women on all 3 subscales (somatization, depression, anxiety). In conclusion, the instrument may be used for mean comparisons between Black and White women.

Findings from Project HeartBeat! Their importance for CVD prevention.

Project HeartBeat! was a longitudinal "growth" study of cardiovascular disease (CVD) risk factors and body composition in childhood and adolescence. Its findings demonstrate patterns of change from ages 8 to 18 years in anthropometric indicators of adiposity, blood lipid components, and blood pressure measurements, as well as the varying inter-relations among these patterns. Especially noteworthy are differences among associations between the two components of BMI (kg/m(2))-the lean or fat-free mass index, and the fat mass index-and each of several CVD risk factors. Policy development and public health recommendations for CVD prevention beginning in childhood have evolved over 30 years or more. A new impetus to action is the recognized increase in the prevalence of childhood overweight and obesity. Intervention to prevent obesity can have a major impact in preventing CVD risk factors more broadly. Opportunities to strengthen interventions for CVD prevention in childhood and adolescence include updated algorithms for monitoring body composition, blood lipids, and blood pressure throughout childhood and adolescence through use of the Project HeartBeat! study results.

Blood lipids in children: age-related patterns and association with body-fat indices: Project HeartBeat!

BACKGROUND: Longitudinal data on the normal development of blood lipids and its relationships with body fatness in children and adolescents are limited. Objectives of the current analysis were to estimate trajectories related to age for four blood lipid components and to examine the impact of change in body fatness on blood lipid levels, comparing estimated effects among adiposity indices, in children and adolescents. METHODS: Three cohorts, with a total of 678 children (49.1% female, 79.9% nonblack) initially aged 8, 11, and 14 years, were followed at 4-month intervals (1991-1995). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels were determined in blood samples taken following fasting. Body fatness was measured by five adiposity indices-BMI; percent body fat (PBF); abdominal circumference; and the sums of six and of two skinfold thicknesses. Trajectories of change in blood lipid levels from ages 8 to 18 years were estimated by gender and race. The impact of change in body fatness on lipid levels was evaluated for each index, adjusting for gender, race, and age. RESULTS: All lipid components varied significantly with age. Total cholesterol decreased by approximately 19 mg/dL from ages 9 to 16 years in girls and more steeply from ages 10 to 17 years in boys. LDL-C decreased monotonically, more steeply in boys than in girls. It was higher among nonblacks than among blacks. HDL-C increased monotonically in girls, mainly from ages 14 to 18 years, but fluctuated sharply among boys. Levels of HDL-C were higher among blacks than among nonblacks. The levels of triglycerides increased from ages 8 to 12 years among girls and, almost linearly, from ages 8 to 18 years among boys. The levels of triglycerides were higher among nonblacks than among blacks. Increase in body fatness was significantly associated with increases in total cholesterol, LDL-C, and triglyceride levels. Significant interactions between the adiposity indices (except for BMI) and gender indicated smaller impacts of change in body fatness on total cholesterol and LDL-C in girls than in boys. The estimated impact on triglycerides was weaker among blacks than among nonblacks, except for PBF. Change in body fatness was negatively associated with HDL-C. The results remained essentially unchanged after adjustments for energy intake, physical activity, and sexual maturation. CONCLUSIONS: Patterns of change with age in blood lipid components vary significantly among gender and racial groups. Increase in body fatness among children is consistently associated with adverse change in blood lipids. Evaluation of blood lipid level should take into account variation by age, gender, and race. Intervention through body-fat control should help prevent adverse lipid levels in children and adolescents.

Physical activity, energy intake, sedentary behavior, and adiposity in youth.

BACKGROUND: It is unclear to what extent factors affecting energy balance contribute to the development of body fatness in youth. The objective of the current study was to describe the relationship of physical activity, energy intake, and sedentary behavior to BMI, fat free-mass index (FFMI), and fat mass index (FMI) in children aged 10-18 years. METHODS: In the subsample studied, participants were 245 girls and 227 boys (aged > or =10 years at entry or during follow-up assessments, or aged 11-14 years at entry) followed for 4 years from entry at ages 8, 11, or 14 years. At baseline and anniversary examinations, trained interviewers used a questionnaire to assess time spent daily in moderate-to-vigorous physical activity (MVPA), sedentary behavior, and energy intake (kcal/day). Sexual maturation was assessed by direct observation of pubic-hair development (Tanner Stages 1-5). Triplicate recordings of height and weight were used to estimate BMI by the standard formula (kg/m(2)); bioelectric impedance was used to estimate percent body fat for calculating FFMI and FMI (kg/m(2)). Multilevel models were used to examine the association of MVPA, energy intake, and sedentary behavior with BMI, FFMI, and FMI. Data were analyzed in 2007-2008. RESULTS: Energy intake was unrelated to FMI or FFMI in models adjusted for age or sexual maturation or in any model to BMI. Sedentary behavior was unrelated to FMI in any model or to FFMI or BMI in models adjusted for age or sexual maturation. MVPA was inversely related to FMI. CONCLUSIONS: In children aged 10-18 years, MVPA was inversely associated with fat mass and with BMI. Investigations in youth of dietary intake and physical activity, including interventions to prevent or reverse overweight as represented by BMI, should address its fat and lean components and not BMI alone.

Evaluation of AAP guidelines for cholesterol screening in youth: Project HeartBeat!

BACKGROUND: The American Academy of Pediatrics (AAP) criterion for screening for hypercholesterolemia in children is family history of hypercholesterolemia or cardiovascular disease or BMI > or =85th percentile. This paper aims to determine the sensitivity, specificity, and positive predictive value (PPV) of dyslipidemia screening using AAP criteria along with either family history or BMI. METHODS: Height, weight, plasma total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and family history were obtained for 678 children aged 8, 11, and 14 years, enrolled from 1991 to 1993 in Project HeartBeat!. Sensitivity, specificity, and PPV screening of each lipid component using family history alone, BMI > or =85th percentile alone, or family history and/or BMI > or =85th percentile, were calculated using 2008 AAP criteria (total cholesterol, LDL-C, and triglycerides > or =90th percentile; HDL-C <10th percentile). RESULTS: Sensitivity of detecting abnormal total cholesterol, LDL-C, HDL-C, and triglycerides using family history alone ranged from 38% to 43% and significantly increased to 54%-66% using family history and/or BMI. Specificity significantly decreased from approximately 65% to 52%, and there were no notable changes in PPV. In black children, cholesterol screening using the BMI > or =85th percentile criterion had higher sensitivity than when using the family history criterion. In nonblacks, family history and/or BMI > or =85th percentile had greater sensitivity than family history alone. CONCLUSIONS: When the BMI screening criterion was used along with the family history criterion, sensitivity increased, specificity decreased, and PPV changed trivially for detection of dyslipidemia. Despite increased screening sensitivity by adding the BMI criterion, a clinically significant number of children still may be misclassified.

Effects of apolipoprotein E genotype on blood cholesterol in adolescent girls.

BACKGROUND: Few investigations have examined whether associations between the apolipoprotein E genotype (apo E) and total cholesterol or LDL-C are modified or explained by other characteristics. The objective of this study was to explore effects of behavioral characteristics, physical growth, body composition, sexual maturation, and endocrine function on age trajectories of total cholesterol and LDL-C by apo E in adolescent girls. METHODS: Participants were 247 Caucasian adolescent girls followed for 4 years. Apo E genotyping and plasma lipid concentrations were determined from fasting blood samples using standard enzymatic methods. Age; gender; fat-free mass (FFM); BMI; percent body fat (PBF); sexual maturation (pubic hair, Tanner Stages 1-5); estradiol concentration (EST); energy intake; and physical activity were collected or calculated with standard methods. RESULTS: In models including the proposed explanatory variables, apo E genotype remained strongly associated with total cholesterol and LDL-C. Girls with the epsilon (epsilon)3/3 and epsilon3/4 genotypes (where epsilon is the protein isoform of the apo E gene), relative to those with epsilon2/3, had total cholesterol and LDL-C values 16-23 mg/dL higher throughout adolescence. Age-apo E interaction terms remained significant. FFM, BMI, PBF, pubic-hair stage, and EST showed a significant effect on total cholesterol and LDL-C. When the combination of pubic-hair stage, EST, and one of FFM, BMI, and PBF was included in total cholesterol or LDL-C models, only EST was significant. CONCLUSIONS: Adolescent girls with epsilon3/3 and epsilon3/4 genotypes had higher total cholesterol and LDL-C and showed different patterns of change, compared to those with epsilon2/3 genotype. These apo E effects were independent of behavioral characteristics, physical growth, body composition, sexual maturation, and endocrine function. Girls with epsilon3/3 or epsilon3/4 genotypes may be at risk for elevated total cholesterol and LDL-C later in life.

Project HeartBeat! Concept, development, and design.

Major cardiovascular disease (CVD) risk factors begin development in childhood and adolescence. Project HeartBeat! studied early development of these risk factors as growth processes. Growth, body composition, sexual maturation, major CVD risk factors, and cardiac structure and function were monitored every 4 months for up to 4 years among 678 children and adolescents (49.1% girls; 20.1% blacks) aged 8, 11, or 14 years at study entry. All resided in The Woodlands or Conroe TX. Interviews were conducted at entry and annually on diet, physical activity, and health history of participants and their families. Data were collected from 1991 to 1995, and study investigators continue data analysis and reporting. Overlap in ages at examination among three cohorts (aged 8-12, 11-15, and 14-18 years at baseline) and use of multilevel modeling methods permit analysis of some 5500 observations on each principal variable for the synthetic cohort from ages 8 to 18 years. The mixed-longitudinal design provides trajectories of change with age, for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; systolic, and fourth-phase and fifth-phase diastolic blood pressure, and left ventricular mass. These trajectories are then related to concurrent measures of multiple indices of body composition and sexual maturation and adjusted for energy intake and physical activity. The data provide valuable insights into risk factor development and suggest a fresh approach to understanding influences on blood lipids, blood pressure, and left ventricular mass during the period of childhood and adolescence, a period of dynamic change in these risk factors.

Prevalence, characteristics, and associated health and health care of family homelessness among fifth-grade students.

OBJECTIVES: We describe the lifetime prevalence and associated health-related concerns of family homelessness among fifth-grade students. METHODS: We used a population-based, cross-sectional survey of 5147 fifth-grade students in 3 US cities to analyze parent-reported measures of family homelessness, child health status, health care access and use, and emotional, developmental, and behavioral health and child-reported measures of health-related quality of life and exposure to violence. RESULTS: Seven percent of parents reported that they and their child had experienced homelessness (i.e., staying in shelters, cars, or on the street). Black children and children in the poorest families had the highest prevalence of homelessness (11%). In adjusted analyses, most general health measures were similar for children who had and had not been homeless. Children who had ever experienced homelessness were more likely to have an emotional, behavioral, or developmental problem (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.1, 2.6; P = .01), to have received mental health care (OR = 2.2; 95% CI = 1.6, 3.2; P < .001), and to have witnessed serious violence with a knife (OR = 1.6; 95% CI = 1.1, 2.3; P = .007) than were children who were never homeless. CONCLUSIONS: Family homelessness affects a substantial minority of fifth-grade children and may have an impact on their emotional, developmental, and behavioral health.

Perceived racial/ethnic discrimination among fifth-grade students and its association with mental health.

OBJECTIVES: We sought to describe the prevalence, characteristics, and mental health problems of children who experience perceived racial/ethnic discrimination. METHODS: We analyzed cross-sectional data from a study of 5147 fifth-grade students and their parents from public schools in 3 US metropolitan areas. We used multivariate logistic regression (overall and stratified by race/ethnicity) to examine the associations of sociodemographic factors and mental health problems with perceived racial/ethnic discrimination. RESULTS: Fifteen percent of children reported perceived racial/ethnic discrimination, with 80% reporting that discrimination occurred at school. A greater percentage of Black (20%), Hispanic (15%), and other (16%) children reported perceived racial/ethnic discrimination compared with White (7%) children. Children who reported perceived racial/ethnic discrimination were more likely to have symptoms of each of the 4 mental health conditions included in the analysis: depression, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. An association between perceived racial/ethnic discrimination and depressive symptoms was found for Black, Hispanic, and other children but not for White children. CONCLUSIONS: Perceived racial/ethnic discrimination is not an uncommon experience among fifth-grade students and may be associated with a variety of mental health disorders.

Racial/Ethnic disparities in the mental health care utilization of fifth grade children.

OBJECTIVE: The aim of this study was to examine racial/ethnic differences in fifth grade children's mental health care utilization. METHODS: We analyzed cross-sectional data from a study of 5147 fifth graders and their parents in 3 US metropolitan areas from 2004-06. Multivariate logistic regression was used to examine racial/ethnic differences in mental health care utilization. RESULTS: Nine percent of parents reported that their child had ever used mental health care services; fewer black (6%) and Hispanic (8%) children had used services than white children (14%). Fewer black and Hispanic children with recent symptoms of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder, and fewer black children with symptoms of depression had ever utilized services compared with white children. In multivariate analyses controlling for demographic factors, parental mental health, social support, and symptoms of the 4 mental health conditions, we found that black children were less likely than white children to have ever used services (Odds ratio [OR] 0.3, 95% confidence interval [95% CI], 0.2-0.4, P < .001). The odds ratio for black children remained virtually unchanged when the analysis was restricted to children with symptoms of >/=1 mental health condition, and when the analysis was stratified by mental health condition. The difference in utilization for Hispanic compared with white children was fully explained by sociodemographics in all multivariate models. CONCLUSIONS: Disparities exist in mental health care utilization for black and Hispanic children; the disparity for black children is independent of sociodemographics and child mental health need. Efforts to reduce this disparity may benefit from addressing not only access and diagnosis issues, but also parents' help-seeking preferences for mental health care for their children.

Substance use and delinquency among fifth graders who have jobs.

BACKGROUND: Working for pay is associated with substance use and delinquency among older adolescents, although information is scant about younger youth who work. This study investigates associations between self-reports of having a job and substance use and delinquent behaviors in a sample of U.S. 5th graders. METHODS: A total of 5147 5th graders and their parents from three large metropolitan areas were assessed in a cross-sectional survey between Fall 2004 and Summer 2006. Multivariate regression was used to estimate associations between having a job and substance use and delinquency. Analyses were conducted in Fall 2007. RESULTS: Twenty-one percent of 5th graders reported having a job, with most working <5 hours per week. Typical jobs included yard work, babysitting, and cleaning. In multivariate models that controlled for demographic characteristics, household composition, and household income, having a job was significantly associated with past-30-day use of tobacco (OR=2.2), alcohol (OR=1.7), and marijuana (OR=3.1). Having a job was also significantly associated with ever being in a fight (OR=1.5) and with running away from home (OR=1.8). Further analyses indicated that the associations between holding a job and delinquency outcomes were driven largely by young workers who worked >2 hours per week. CONCLUSIONS: Among 5th graders, having a job was associated with substance-using behaviors and delinquency. Clinicians should consider asking young patients whether they work, and stress to parents the importance of monitoring the work activities, workplaces, and associates of their children.