Increasing lifetime and past 30-day marijuana use among middle school students regardless of recreational marijuana sales.

PURPOSE: This study investigated whether adult use marijuana sales were associated with changes in lifetime and past 30-day (P30D) marijuana use among middle school students in Nevada (NV), which had adult-use marijuana sales during the study period, compared to New Mexico (NM), which did not have adult-use marijuana sales during the study period. METHODS: Data were drawn from the middle school 2017 and 2019 NV Youth Risk Behavior and NM Youth Risk and Resiliency Surveys. Difference-in-difference analyses compare changes in lifetime and P30D marijuana use in NV (adult-use sales implemented July 2017) vs. NM (no adult-use sales during the study period). RESULTS: There was no difference in lifetime (aOR 1.11; 95% CI 0.91,1.36) and P30D (aOR 1.17; 95% CI 0.91,1.51) marijuana use by adult-use sales status. The odds of lifetime and P30D marijuana use increased in both states, particularly among students who were female, older, non-White, or attending a Title 1 school. DISCUSSION: Adult-use sales were not associated with an increase in lifetime or P30D marijuana use. State-level prevention efforts should focus on sub-populations with increasing lifetime and P30D use regardless of adult-use sales status.

Protective Environmental Factors and Opioid Use Among Sexual Minority Youth.

Objectives: Nonmedical use of prescription opioids (NMUPO) is a pressing public health concern and affects sexual minority youth (SMY) at greater rates than heterosexual youth. We investigated whether protective environmental factors-(1) Human Rights Campaign's state equality index (SEI) and (2) supportive school environments for LGBTQ youth, influenced NMUPO among SMY and non-SMY students. Methods: We combined data from the 2017-2019 Youth Risk Behavior Survey, 2016-2018 School Health Profiles, state-level socio-demographic and SEI data across 24 states (N=156,149). Generalized linear mixed models examined associations between (1) SEI and (2) supportive school environments for LGBTQ youth, with NMUPO, accounting for clustering at the school-and state-level. Results: Before adjustment, we found that youth in states with higher SEI were significantly less likely to engage in NMUPO compared to students in states with lower SEI, a relationship that became non-significant after adjustment. After adjusting for individual-and state-level indicators, SMY in states with supportive school environments for LGBTQ youth were less likely to engage in NMUPO. Conclusions: Supportive school environments for LGBTQ youth may play an important role in the health of SMY. Establishing more inclusive policies and supportive environments within schools may reduce NMUPO among SMY.

Adverse childhood experiences, antenatal stressful life events, and marijuana use during pregnancy: A population-based study.

Cumulative exposure to adverse childhood experiences (ACEs) and antenatal stressful life events (ASLEs) are independently associated with marijuana use during pregnancy. However, research has not explored how both exposures may influence marijuana use jointly. Assessing the joint associations of ACEs and recent ASLEs on marijuana use can identify people who may benefit from early intervention. Data come from the Nevada Pregnancy Risk Assessment Monitoring System, 2017-2020 (N = 2483). We assessed eight measures of ACEs before age 18 and fourteen measures of ASLEs twelve months before giving birth. Generalized estimating equations estimated the direct and joint associations (additive and multiplicative interaction) of ACEs and ASLEs on marijuana use during pregnancy. 9.8% used marijuana during the most recent pregnancy. Compared to people who reported no ACEs, those reporting 1 ACE (adjusted prevalence ratio[aPR] = 1.96, 95% confidence interval [CI] = 1.30-2.94), 3 ACEs (aPR = 3.58, 95%CI = 2.69-4.77), and 4+ ACEs (aPR = 3.67, 95%CI = 2.36-5.72) were more likely to use marijuana. Compared to people reporting no ASLEs, those reporting 4+ ASLEs (aPR = 3.12, 95% CI = 1.64-5.92) were more likely to use marijuana. There was evidence of interaction for high ACE and ASLE exposure on an additive scale. ACEs and ASLEs were independently associated with marijuana use during pregnancy, and there was evidence of additive interaction. Screening for ACEs and ASLEs during pregnancy, referrals to appropriate behavioral health services, and trauma-informed approaches are important to address marijuana use during pregnancy.

Multilevel Risk and Protective Factors for Frequent and Nonfrequent Past-30-Day Marijuana Use: Findings From a Representative Sample of High School Youth.

OBJECTIVE: Research has identified many factors associated with past-30-day (P30D) marijuana use among youth but has not assessed factors that may differentiate youth who use frequently from youth who do not. We took a multilevel approach to identify and compare risk and protective factors associated with frequent and nonfrequent P30D marijuana use among high school students. METHOD: Individual-level data were obtained from the 2019 Nevada Youth Risk Behavior Survey (completed by 4,980 high school youth from 99 schools); school-level data were obtained from the state's Department of Education. A multinomial, multilevel model was used to estimate the association between risk and protective factors at the individual and school levels and a three-level frequency of use outcome: no P30D use (0 times), nonfrequent P30D use (1-19 times), and frequent P30D use (≥20 times). RESULTS: At the individual level, other P30D substance use, exposure to adverse childhood experiences (ACEs), perceived ease of access, and perceived risk were associated with both frequent and nonfrequent use, but the relationships were generally stronger for frequent use. P30D nonprescription drug use and school connectedness were associated with frequent use only. At the school level, number of students with individualized education programs, number of incidents involving possession of controlled substances, and school type were associated with frequent use only. CONCLUSIONS: Individual and school-based interventions designed to address the factors uniquely or strongly associated with frequent marijuana use may prevent escalation from occasional use to more frequent use among high school youth.

Associations between Circumstances Surrounding Overdose and Underlying Classes of Polysubstance Overdose Deaths.

BACKGROUND: The overdose crisis is worsening, with polysubstance overdose deaths involving psychostimulants increasing in the U.S. Substance-specific prevention and intervention activities may not be as effective for polysubstance use, so we sought to classify substances used among overdose decedents to identify unique factors related to these classes. METHODS: We used data from the Nevada State Unintentional Drug Overdose Reporting System, Jan 2019-Jun 2021, which comes from death certificates, coroner/medical examiner reports, and postmortem toxicology. Latent class analysis, multinomial logistic regression, and Chi-squared tests determined underlying drug use classes, differences in characteristics and circumstances surrounding overdose, and assessed relationships between circumstances and drug use classes. RESULTS: We identified four latent classes: (1) prescription drugs (19.1%), (2) predominately methamphetamine (31.4%), (3) multi-drug (28.9%), and (4) opioid and stimulant (20.6%). Compared to other classes, the prescription drug class had a higher percentage of female decedents, from rural counties, with mental health diagnoses, who died at home. The predominately methamphetamine class had a higher percentage of decedents experiencing homelessness. The multi-drug use class had higher percentage of younger and Hispanic decedents. Those in the opioid and stimulant class had higher odds of being recently released from an institutional setting, compared to the multi drug class. CONCLUSIONS: These underlying classes were associated with several characteristics and circumstances that can prove useful for prevention, treatment, and harm reduction agencies when designing programs and interventions to target specific groups of people at-risk for drug overdose.

Youth Assets and Initiation of Sexual Intercourse by Family Structure: A Longitudinal Cohort Study.

BACKGROUND: The purpose of this study was to assess the protective influence of individual, family, and community assets from the initiation of sexual intercourse (ISI) for adolescents living in one-parent households compared with adolescents living in two-parent households. METHODS: Five waves of data were collected annually over a 4-year period (N = 591, 52.5% female, mean age = 14.0 years) from a racially/ethnically diverse sample of adolescents. Extended Cox models were used to assess the relationship between assets and time of ISI while controlling for demographic variables. Potential interactions between adolescent's household structure and assets were examined. RESULTS: Five of 17 assets were prospectively and significantly associated with a reduced risk of ISI among adolescents living in one-parent households compared with 11 of 17 assets for adolescents living in two-parent households. Adolescents living in one-parent households who possessed any one of five assets (e.g., general aspirations for the future, relationship with mother, positive peer role models) had between a 27% and 57% lower risk of ISI, whereas adolescents living in two-parent households who possessed any of one of 11 assets (e.g., responsible choices, family communication, community involvement) had between a 20% and 42% lower risk of ISI. CONCLUSION: The results suggest that strengthening specific youth assets across multiple dimensions of behavioral influence may decrease the risk of ISI for adolescents living in both one-parent and two-parent households. Public health efforts focused on developing programs to promote asset building tailored to adolescent's family structure are warranted.

Adverse childhood experiences and past 30-day cannabis use among middle and high school students: The protective influence of families and schools.

Exposure to adverse childhood experiences (ACEs) is a risk factor for adolescent cannabis use (CU). We explored whether family communication and school connectedness can offer direct protection (the compensatory model of resiliency) or moderating protection (the protective factors model of resiliency). Using cluster random sampling, a Youth Risk Behavior Survey (YRBS) was conducted with 5,341 middle school and 4,980 high school students in 2019. Generalized estimating equations were used to estimate whether family communication and school connectedness offered independent direct protection (multiple regression) or moderating protection (multiplicative interaction) in the relationship between ACEs and past 30-day CU. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) were calculated. There was a graded relationship between ACEs and past 30-day CU for all students that was particularly strong among middle school students: 1 ACE (APR = 2.37, 95% CI = 2.16, 2.62), 2 ACEs (APR = 2.89, 95% CI = 2.60, 3.23), 3 ACEs (APR = 5.30, 95% CI = 4.75, 5.90), 4 + ACEs (APR = 7.86, 95% CI = 7.13, 8.67). Results supported the compensatory model of resiliency with both family communication (middle school APR = 0.90, 95% CI = 0.88, 0.93; high school APR = 0.90, 95% CI = 0.87, 0.93) and school connectedness (middle school APR = 0.76, 95% CI = 0.72, 0.79; high school APR = 0.72, 95% CI = 0.68, 0.77) demonstrating a direct, independent protective relationship with past 30-day CU. There was no consistent evidence supporting the protective factors resiliency model.

Attempted Suicide Among Adolescents in Military Families: The Mediating Role of Adverse Childhood Experiences.

Research has shown that adolescents in military families have higher rates of suicidal behaviors compared to their nonmilitary peers. This is typically attributed to military-specific stressors, but exposure to adverse childhood experiences (ACEs) may also play a role. Our primary research objective was to determine whether cumulative exposure to ACEs mediates the relationship between military family involvement and attempted suicide. A two-stage cluster random sampling design was used to randomly sample 5,336 students from 98 high schools. Students were asked whether a parent or other adult in their home was serving on active duty in the military and attempted suicide in the past 12 months was assessed. Six measures of childhood abuse and household dysfunction were summed, and the ACE score was categorized as 0, 1, 2, and 3-6 ACEs. Weighted logistic regression and multinomial regression were used to assess differences in ACEs and attempted suicide, controlling for sex, age, race/ethnicity, rurality, and qualification for free/reduced lunch. To investigate potential mediation effects of ACEs on the relationship between military family and attempted suicide, we conducted path analyses controlling for demographics. Compared to their peers, students in military families had higher exposure to ACEs (1 ACE: adjusted odds ratio [AOR] = 1.49, 95% confidence interval [CI] = [0.88, 2.53], 2 ACEs: AOR = 2.07, 95% CI = [1.23, 3.48], and 3-6 ACEs: AOR = 2.57, 95% CI = [1.54, 4.27]) and twice the odds of attempting suicide in the past 12 months (AOR = 2.16, 95% CI = [1.30, 3.61]). Mediation analyses showed that cumulative exposure to ACEs completely mediated the relationship between military family involvement and attempted suicide. The study results highlight the need for trauma-informed approaches to mental health promotion with military families.

Adverse Childhood Experiences and Suicidal Behaviors Among Youth: The Buffering Influence of Family Communication and School Connectedness.

PURPOSE: The main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of adverse childhood experiences (ACEs; direct protective effect) and (2) whether family communication or school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales. METHODS: Data were obtained from a western state's 2019 Youth Risk Behavior Survey that included 5,341 middle school and 4,980 high school participants. Generalized linear models were used to estimate whether family communication and school connectedness offered direct protection against suicidal behaviors or buffered the association between ACEs and suicidal behaviors using adjusted prevalence ratios and corresponding 95% confidence intervals. RESULTS: Family communication and school connectedness offered direct protection against suicidal behaviors in the presence of ACEs (a 1-unit higher score was associated with a 32%-42% lower prevalence of suicidal behaviors for middle school youth and a 27%-39% lower prevalence of suicidal behaviors for high school youth). There was evidence that family communication and school connectedness buffered the association between ACEs and suicidal behaviors on the multiplicative scale. CONCLUSIONS: The findings provide support for the development and implementation of interventions that build family communication and school connectedness to reduce suicidal behaviors. Furthermore, screening for trauma and suicidal behaviors is warranted.

A longitudinal study of the protective influence of youth assets on juvenile arrest.

BACKGROUND: The objective of this study was to determine the separate and cumulative influence of individual, family and community assets on juvenile arrest rates in a cohort of youth. METHODS: Five waves of data were collected from 1111 youth and their parents living in randomly sampled census tracts in a Midwestern state. Computer-assisted, in-person data collection methods were used to measure assets within individual (six assets), family (four assets) and community (six assets) domains. Extended Cox models were used to assess the relationship between the number of assets and time to first juvenile arrest, while controlling for known confounders. RESULTS: Nine of 16 assets across individual, family and community domains were prospectively associated with a reduction in arrest rates. There was a relationship between the number of assets youth possess within individual, family and community domains and rates of arrest. For example, compared to youth with zero to one community assets, those with three [adjusted hazard ratio (AHR): 0.52; 95% confidence interval (CI): 0.30-0.88], four [AHR: 0.57; 95% CI: 0.34-0.97] or five to six [AHR: 0.45; 95% CI: 0.25-0.82] community assets had lower risk of arrest. CONCLUSIONS: Public health efforts focused on developing policies and programs to promote asset building across multiple domains of influence are warranted.

Cannabis use and driving under the influence: Behaviors and attitudes by state-level legal sale of recreational cannabis.

BACKGROUND: As states continue to legalize the sale of recreational cannabis, there is a need to study attitudes and behaviors regarding driving after cannabis use. The purpose of this study was to describe US adults' attitudes and behaviors regarding driving after cannabis use by state-level legal sale of recreational cannabis, and to determine whether these associations differ by frequency of cannabis use. METHODS: Data were collected from a national sample of 17,112 adults in the United States. Weighted adjusted prevalence ratios and 95% confidence intervals were used to compare the prevalence of behaviors and attitudes by state-level legal sale of recreational cannabis. Analyses were repeated among recent cannabis users, stratifying by cannabis use status. RESULTS: Driving after cannabis use was more prevalent in legal cannabis sales states; however, so were potentially protective attitudes related to cannabis use and driving. After stratifying by frequency of use, daily/almost daily, weekly/monthly, and past 12-month users from states with legal recreational cannabis sales had significantly lower prevalence of driving after cannabis use and higher prevalence of protective attitudes compared to those from states without legal recreational sales. Risk perceptions were lower for cannabis than alcohol. CONCLUSIONS: Public health messaging campaigns to reduce driving and riding after cannabis use and to improve attitudes regarding driving after cannabis use are warranted across all U.S. states, regardless of legalization status.

Prospective relationships between youth assets, negative life events, and binge drinking in a longitudinal cohort of the youth.

PURPOSE: The purpose of this study was to investigate whether individual, family, and community assets can 1) protect youth from binge drinking in the face of negative life events and 2) modify the relationship between negative life events and binge drinking. METHODS: Data from waves 2-5 of the Youth Asset Study were analyzed. Generalized estimating equations were used to assess the relationship between negative life events, assets, and binge drinking. Multiplicative and additive interaction between negative life events and assets was evaluated. RESULTS: When included in the same model as negative life events, individual, family, and community assets had a graded, protective relationship with binge drinking, with strongest protection for those with the greatest number of assets. For example, youth with 3 [adjusted odds ratio (AOR):0.78, 95% confidence interval (CI): 0.65-0.93], 4 [AOR: 0.60, 95% CI: 0.49-0.73], 5 [AOR: 0.53, 95% CI: 0.41-0.69], and 6 [AOR: 0.42, 95% CI: 0.28-0.63] assets within the community domain had a significantly lower odds of binge drinking than youth with 0-2 community assets. No significant interactions were observed. CONCLUSIONS: The findings suggest that while youth who are exposed to negative life events are at risk for binge drinking, building assets across individual, family, and community domains can have a protective influence.

Exposure to adverse childhood experiences and early initiation of electronic vapor product use among middle school students in Nevada.

INTRODUCTION: The use of electronic vapor products (EVPs) among youth has increased significantly in recent years, yet little is known about factors associated with initiation of EVPs during early adolescence. The purpose of this study was to explore the relationship between chronic exposure to adverse childhood experiences (ACEs) and early initiation of EVPs in a representative sample of middle school students. METHODS: 5,464 students from 113 middle schools (grades 6-8) completed the Nevada Youth Risk Behavior Survey (YRBS) in the spring of 2017. Six abuse and household dysfunction measures were used to calculate a cumulative ACE score (range 0-6). Initiation of EVPs (e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs, and hookah pens) before age 11 was considered early initiation. Weighted logistic regression was used to assess the relationship between cumulative ACE exposure and early initiation of EVPs after controlling for sex, age, race/ethnicity, rurality, free or reduced lunch status, and military family involvement. RESULTS: Nearly 1 in 5 middle school students (18.6%) reported using EVPs, 6.7% had used EVPs during the past 30 days, and 5.1% started using EVPs before age 11. After controlling for sociodemographics, a strong graded relationship between cumulative ACE exposure and early initiation of EVPs was observed: 1 ACE (AOR = 1.60; 95% CI = 0.99-2.59), 2 ACEs (AOR = 2.29; 95% CI = 1.33-3.93), and 3-6 ACEs (AOR = 3.43, 95% CI = 2.20-5.36) compared to no ACEs. CONCLUSIONS: Screening for ACEs in school-based settings may be a feasible approach for identifying students who may be at-risk for early initiation of EVPs.

Youth assets and alcohol-related problems among male and female youth: Results from a longitudinal cohort study.

Youth who experience alcohol-related problems are at increased risk for developing alcohol dependence. Identifying factors associated with adolescent alcohol-related problems is essential, but most studies have focused on risk factors or a limited number of protective factors, with little attention to sex differences. We assessed the prospective association between 17 assets and alcohol-related problems among male and female youth. A 4-year cohort study with 1, 111 youth living in randomly-selected census tracts in the Oklahoma City Metropolitan Area was conducted. Follow-up for the current study began at wave 2 (2004/2005; N = 1079). Seventeen assets at the individual-, family-, and community-levels were measured. Five questions documented alcohol-related problems in the past 12 months. Generalized linear mixed models evaluated the prospective influence of assets on alcohol-related problems, separately for males and females. Models controlled for age, race/ethnicity, family structure, and parental income. Overall, females had more assets than males, but the protective influence of assets on alcohol-related problems over time was stronger for males. Six assets uniquely protected males (responsible choices [AOR = 0.58, 95% CI = 0.36-0.94], educational aspirations [AOR = 0.54, 95% CI = 0.31-0.93], parental monitoring [AOR = 0.41, 95% CI = 0.27-0.64], community involvement [AOR = 0.57, 95% CI = 0.34-0.97], use of time for groups/sports [AOR = 0.64, 95% CI = 0.42-0.97], and school connectedness [AOR = 0.51, 95% CI = 0.34-0.77]), and 3 uniquely protected females (general self-confidence [AOR = 0.62, 95% CI = 0.40-0.96], good health practices [AOR = 0.67, 95% CI = 0.47-0.95], and relationship with mother [AOR = 0.53, 95% CI = 0.36-0.80]). Strengthening youth assets across multiple domains may decrease alcohol-related problems for both males and females; however, gender-specific approaches to asset building are also warranted.

Adolescent Concussion and Mental Health Outcomes: A Population-based Study.

Objectives: Population-based research on the relationship between concussions and self-harm, depression, and suicidal behaviors among adolescents is limited. Methods: A statewide Youth Risk Behavior Surveillance Survey (YRBSS) was conducted among students from 98 high schools in Nevada in 2017. Students were asked if they had a concussion from playing a sport as well as their mental health outcomes 12 months before the survey. Weighted multiple logistic regression was used to assess the relationship between experiencing a concussion and adverse mental health outcomes. Results: Among 3427 students who were physically active at least 60 minutes per day on 5 or more days per week, or played on at least one sport team, 19.5% (95% CI: 17.31%-21.60%) reported they had a concussion during the past 12 months. After controlling for sex, age, race/ethnicity, and academic performance, students who had a concussion had higher odds of: self-harm [aOR = 1.59 (1.16-2.17), p = .003], depressive symptoms [aOR = 1.48 (1.12-1.94), p = .006], attempted suicide [aOR = 3.10 (2.12-4.53), p < .001] and injury from attempted suicide [aOR = 2.61 (1.31-5.20, p = .006]. Conclusions: Students who experience a concussion may be at increased risk for poor mental health outcomes, including suicide attempts. Psychological evaluation following a concussion should complement medical evaluation and treatment..

The Revised Youth Asset Survey (YAS-R).

PURPOSE: The study's purpose was to improve the psychometric properties of the Youth Asset Survey (YAS). DESIGN: Longitudinal cohort study with youth and parents recruited via door-to-door canvassing to participate in a 5-wave, 4-year study that assessed prospective associations among youth assets and youth health-related behaviors. Additional test items were added in the last 2 waves of a study to improve the YAS. SETTING: Households in randomly selected census tracts located in the Oklahoma City metropolitan area. PARTICIPANTS: Youth and their parents (N = 1111 parent/child dyads). Youth demographic characteristics at wave 4 were mean age = 17.3 (standard deviation = 1.62) years; 53% female, 41% white, 28% Hispanic, 24% African American, and 6% other. MEASURES: Sixty-eight items assessing 17 youth asset constructs and 8 single items assessing youth risk behaviors. ANALYSIS: Confirmatory factor analysis and generalized linear models were conducted to assess construct reliability and predictive validity, respectively. RESULTS: Cronbach α for the revised asset constructs ranged from .72 to .82, predictive validity was strong, and all revised asset constructs were assessed via 4 items. CONCLUSIONS: Researchers and practitioners have an improved 68-item YAS-Revised, freely available for their use, which measures 17 youth assets with good reliability, validity, and functionality.

Adverse Childhood Experiences and Psychological Distress in Juvenile Offenders: The Protective Influence of Resilience and Youth Assets.

PURPOSE: To examine whether internal resiliency and external assets directly protect juvenile offenders exposed to adverse childhood experiences (ACEs) from psychological distress and moderate the relationship between ACE exposure and psychological distress. METHODS: A total of 429 male and female adolescents involved with juvenile justice systems in a Western state completed an audio computer-assisted self-interview. Validated measures assessed ACEs, psychological distress, internal resiliency, and external youth assets. Hierarchical linear regression was used to assess the direct and moderating protective effects of internal resilience, family communication, school connectedness, peer role models, and nonparental role models on psychological distress. All models controlled for age, sex, race/ethnicity, free/reduced lunch qualification, current custody, supervision status, detention, and site. RESULTS: The mean ACE score among participants was 3.7 (standard deviation = 2.2) and 52.8% reported four or more ACEs. Participants with 4-5 ACEs (ß = .37, p < .001) and 6-8 ACEs (ß = .49, p < .001) were at increased risk for psychological distress. High internal resilience (ß = -.20, p < .001), family communication (ß = -.19, p < .001), school connectedness (ß = -.14, p < .01), and peer role models (ß = -.09, p < .05) were associated with a reduction in psychological distress in the presence of high ACE exposure. In the interaction models, having a high number of ACEs remained strongly associated with increased psychological distress. However, internal resilience (ß = -.24, p < .01) and school connectedness (ß = -.18, p < .05) significantly moderated (reduced) the relationship between high ACE exposure and psychological distress. CONCLUSIONS: Our findings suggest that programs and policies that promote internal resilience and protective factors across multiple levels of influence may protect juvenile offenders exposed to childhood trauma from psychological distress.

Prospective impact of individual, family and community youth assets on adolescent suicide ideation.

BACKGROUND: Studies have found that youth assets have a protective influence on many risk behaviours. However, the relationship between youth assets and adolescent suicide ideation is poorly understood. The purpose of this study was to determine if youth assets were prospectively associated with suicide ideation. METHODS: Four waves of data were collected from 1111 youth and their parents living in randomly sampled census tracts that were stratified by income and race/ethnicity using census data. Computer-assisted, in-person data collection methods were used to measure assets at the individual (6 assets), family (4 assets) and community (6 assets) levels. Generalised linear mixed models were used to prospectively assess the relationship between the number of individual-level, family-level and community-level assets and suicide ideation, while controlling for known confounders. RESULTS: About half of the sample was female (53%). Participants were racially/ethnically diverse (white (41%), Hispanic (29%) and black (24%)). Eleven of the 16 assets were associated with reduced odds of suicide ideation. In addition, there was a graded relationship between the number of assets at each level (individual, family and community) and the odds of suicide ideation. For example, compared with youth with 0-2 family assets, those with 3 (OR 0.61; 95% CI 0.42 to 0.90) or 4 (OR 0.32; 95% CI 0.21 to 0.51) family assets had lower odds of suicide ideation. CONCLUSIONS: This prospective analysis showed a protective relationship between youth assets and suicide ideation, with the greatest protection among youth with the most assets. Interventions designed to build youth assets may be a useful strategy for reducing adolescent suicide ideation.

Physical Fighting Among Male and Female Adolescents of Military Families: Results From a Representative Sample of High School Students.

The impact of family military involvement on adolescent mental health and substance abuse is well established, but little is known about other behavioral health outcomes such as physical fighting. We assessed the relationship between family military involvement and physical fighting in a representative sample of 3,928 high school students. Weighted logistic regression was used to determine whether adolescents from military families had higher odds of fighting and fighting on school property compared with adolescents of non-military families after controlling for demographics, substance use, depressive symptoms, and bullying victimization. We also assessed the cumulative impact of multiple risk factors on fighting outcomes. Overall, 23.5% of high school students reported physical fighting and 7.0% reported physical fighting at school. Youth from military families had higher odds of physical fighting (adjusted odds ratios [AOR] = 1.69; 95% confidence interval [CI] = [1.27, 2.25]) and physical fighting on school property (AOR = 1.98; 95% CI = [1.16, 3.39]). In models stratified by gender, family military involvement remained independently associated with physical fighting and physical fighting at school for males (AOR = 1.74; 95% CI = [1.15, 2.65] and AOR = 2.21; 95% CI = [1.03, 4.74]) and females (AOR = 1.65; 95% CI = [1.11, 2.45] and AOR = 1.88; 95% CI = [1.01, 3.50]). The odds of engaging in each physical fighting outcome increased as the cumulative number of risk factors increased. School-based interventions aimed at addressing fighting should be tailored to fit the unique needs of adolescents in military families, particularly those with additional risk factors.

Relationships among physical activity, sleep duration, diet, and academic achievement in a sample of adolescents.

The purpose of this study was to examine the relationships among physical activity, sleep duration, diet, and academic achievement in a sample of adolescents from the US state of Nevada. A two-stage cluster random sampling method was used to recruit Nevadan adolescents (N = 4625). The 2015 Youth Risk Behavior Survey was administered to students within public, private, and charter schools. Weighted multilevel generalized linear mixed effects models were employed to examine the relationships among physical activity, sleep duration, diet, and academic achievement. Additional analyses were run to examine the relationship between meeting multiple health behavior criteria with academic achievement. Data were collected in the US state of Nevada in 2015 and analyzed in the US state of Nevada in 2018. Adolescents who participated in at least of 60 min of physical activity per day had significantly higher odds of achieving mostly A's and B's (adjusted OR = 1.18; 95% C.I.: 1.02, 1.38; p = 0.029). Additionally, adolescents who consumed salad weekly (adjusted OR = 1.24; 95% C.I.: 1.06, 1.46; p = 0.007) and who consumed breakfast everyday (adjusted OR = 1.72; 95% C.I.: 1.48, 2.00; p < 0.001) had higher odds of achieving mostly A's and B's. Finally, adolescents who reported meeting 3 or more health behavior criteria had significantly higher odds of achieving mostly A's and B's compared to adolescents meeting only 0-2 health behaviors (adjusted OR = 1.66; 95% C.I.: 1.44, 1.92; p < 0.001). Self-reported physical activity, specific dietary behaviors, and meeting multiple health behavior criteria significantly related to academic achievement in adolescents.