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Purpose: Black adolescents in the United States face disproportionate poor nutrition and obesity risk due to racism. Intersections of larger structural contexts that pose differential access to Black adolescents' health resources, such as state-level racism and neighborhood-level disadvantage, may govern these risks. The purpose of this correlational study was to examine the associations between state-level racism, neighborhood disadvantage, and their intersection with nutrition and obesity for Black adolescents in a longitudinal study., Methods: Publicly available administrative data measuring state-level racism was linked to 2 waves (collected 2016-2018) of individual-level demographic, health, and neighborhood data from 1,530 Black adolescents (M age at baseline  = 9.46; 47.70% female) from the Adolescent Brain and Cognitive Development Study. Neighborhood deprivation scores were calculated from American Community Survey data. Caregivers reported adolescents' nutrition and demographics. Adolescent waist circumference and height and weight (converted to body mass index) were measured., Results: Residing in a state higher in racism was associated with greater body mass index for adolescents 1 year later (B = 0.29, p = .001), and residing in a neighborhood higher in area deprivation was associated with worse nutrition 1 year later (B = -0.02, p = .001)., Discussion: Both state-level racism and neighborhood disadvantage exert separate negative influences on health outcomes. Targeting separate state- and neighborhood-level social policies for obesity and nutrition risk may be crucial to bolster the health of Black adolescents., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the relationship between sexual orientation and police contact-including police contact with intrusion (i.e., use of intrusive verbal or physical force) and police contact with harassment (i.e., actions making one feel inferior based on appearance, identity, or demographic background)-among a national sample in Canada., Methods: Logistic and multinomial logistic regression were used to assess the association between sexual orientation and experiences with police contact among a sample of 940 persons ages 16-30 across Canada., Results: Compared to heterosexual participants, persons identifying as bisexual were significantly more likely to report having any police contact in the past 12 months (OR = 1.72, 95% CI = 1.09, 2.70). Bisexual (RRR = 3.45, 95% CI = 1. 83, 6.50) and queer, questioning, and other (RRR = 2.33, 95% CI = 1.15, 4.73) identifying participants were more likely to report having experienced police contact with harassment relative to no police contact, compared to heterosexual individuals., Conclusions: The current study provides the first analysis of the relationship between sexual minority identity and experiences with adverse police contact in Canada, revealing higher levels of police contact and police contact with harassment, especially among bisexual and queer, questioning, other individuals. Findings suggest that sexual minority persons in Canada experience potentially harmful police contact at elevated rates, which may have significant ramifications for health and traumatic stress responses., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Alexander Testa serves on the editorial board at the Annals of Epidemiology., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To determine whether rates of online racial discrimination changed over the course of 2020 and their longitudinal effects on Black youths' mental health., Method: This longitudinal study collected 18,454 daily assessments from a nationally representative sample of 602 Black and White adolescents in the United States (58% Black, 42% White; mean age = 15.09 years, SD = 1.56 years) across 58 days during the heightened racial tensions between March and November 2020., Results: Black youths experienced increases in online racial discrimination, and these increases were not fully explained by time spent online or by general cybervictimization experiences. Online racial discrimination predicted poorer same-day and next-day mental health among Black youths but not among White youths. Black youths' mental health did not predict their online racial discrimination experiences., Conclusion: Online racial discrimination has implications for shaping mental health disparities that disadvantage Black youths relative to their White peers. Programs can be implemented to decrease online hate crimes, and health providers (eg, pediatricians, psychiatrists) should develop procedures that mitigate the negative mental health effects following online racial discrimination experiences., (Copyright © 2022 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: Ethnic/racial minority children in the United States are more likely to experience father loss to incarceration than White children, and limited research has examined the health implications of these ethnic/racial disparities. Telomere length is a biomarker of chronic stress that is predictive of adverse health outcomes. This study examined whether paternal incarceration predicted telomere length shortening among offspring from childhood to adolescence, whether maternal depression mediated the link, and whether ethnicity/race moderated results., Method: Research participants included 2,395 families in the Fragile Families and Child Wellbeing study, a national and longitudinal cohort study of primarily low-income families from 20 large cities in the United States. Key constructs were measured when children were on average ages 9 (2007-2010) and 15 (2014-2017)., Results: Children who experienced paternal incarceration exhibited shorter telomere lengths between ages 9 and 15, and changes in maternal depression mediated this finding. Specifically, mothers who experienced a partner's incarceration were more likely to have depression between children's ages 9 and 15. In turn, increases in maternal depression between children's ages 9 and 15 predicted more accelerated telomere length shortening among children during this period. Paternal incarceration was more prevalent and frequent for ethnic/racial minority youth than for White youth., Conclusion: Paternal incarceration is associated with a biomarker of chronic stress among children in low-income families. Rates of paternal incarceration were more prevalent and frequent among Black American and multiethnic/multiracial families than among White Americans. As a result, the mass incarceration crisis of the criminal justice system is likely shaping intergenerational ethnic/racial health disparities., (Copyright © 2021 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Purpose: COVID-19 has led to soaring unemployment rates and the widespread adoption of working-from-home (WFH) arrangements that have disrupted family relationships and adolescent psychological well-being. This longitudinal study investigated how parental employment status (i.e., job loss and WFH) influenced adolescents' daily affect indirectly through family functioning (i.e., parent-adolescent conflict and parental warmth) and whether these links varied by family's socioeconomic status., Methods: Daily-diary approaches were used to collect dyadic parent-adolescent data from a nationwide American sample (6,524 daily assessments from 447 parent-adolescent dyads; 45% black, 36% white, 10% Latinx, 7% Asian American, 2% Native American) over the course of 15 consecutive days at the onset of the COVID-19 pandemic., Results: Parents who experienced job loss demonstrated increases in parent-child conflict, which in turn predicted decreases in child positive affect and increases in child negative affect. Furthermore, parents' WFH status predicted increases in parental warmth, which in turn predicted increases in child positive affect and decreases in child negative affect. Parents of low-income families were more likely to experience job loss (24% vs. 13%) and less likely to WFH (44% vs. 73%) than middle-high income parents., Conclusions: Adolescents from families facing economic hardship and employment shifts during COVID-19 experienced changes in parent-child relational dynamics that influenced their emotional well-being. Recognizing these shifts in family ecology is critical to health providers' ability to screen for mental health, assess existing family supports, and provide timely, targeted information about stress management and contending with family conflict., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aimed to investigate racial/ethnic disparities in emotional distress during witnessed police stops among a national sample of urban-born youth., Methods: A national sample of urban-born youth in the U.S. from the most recent wave (2014-2017) of the Fragile Families & Child Wellbeing Study was used in the present study, with a particular focus on youth who report having witnessed police stops, despite not being directly stopped by the police (N = 1,488)., Results: Significant racial/ethnic disparities in feeling angry and unsafe during witnessed police stops emerged, with multiracial, black, and Hispanic youth exhibiting the highest rates of these forms of emotional distress. In the case of Black and multiracial youth, officer intrusiveness and perceptions of procedural injustice collectively explain a large portion of disparities in emotional distress during witnessed stops., Conclusions: Youth of color are more likely to report emotional distress during witnessed police stops, largely due to the officer intrusiveness and perceived injustices that characterize these stops. Moving forward, scholars should consider whether racial/ethnic disparities in witnessing police violence and injustice may be a significant driver of mental health inequities among urban-born youth., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Adolescents are at risk for violating COVID-19 social distancing measures owing to salient developmental needs for autonomy and relatedness. This intensive longitudinal study investigated the initiation and sustainment of adolescents' daily social distancing behaviors., Methods: Focus group and daily-diary approaches were used to collect 6,216 assessments from a nationwide American adolescent sample (n = 444; M age  = 15.1; 40% male; 42% black/African American, 40% white/European American, 10% Latinx, 6% Asian American, 2% Native American) over the course of 14 days at the onset of the COVID-19 pandemic., Results: When adolescents were motivated by preventing others from getting sick, they were more likely to engage in social distancing (same day: B = .50, SE = .09, 95% confidence interval [CI] [.32, .68] p < .001; next day: B = .49, SE = .09, 95% CI [.31, .67] p < .001). Daily social support from friends (same day: B = .04, SE = .02, 95% CI [.01, .08] p < .05; next day: B = .08, SE = .02, 95% CI [.05, .12] p < .001), connectedness with friends via technology (same day: B = .23, SE = .04, 95% CI [.14, .32] p < .001; next day: B = .12, SE = .05, 95% CI [.03, .21] p < .001), and practical knowledge about ways to prevent contracting and transmitting COVID-19 (same day: B = .12, SE = .02, 95% CI [.08, .17] p < .001; next day: B = .05, SE = .02, 95% CI [.01, .10] p < .05) positively predicted adolescents' same- and next-day engagement in social distancing., Conclusions: Adolescents who were motivated by the desire to protect others were more likely to engage in social distancing. In addition, adolescents who learned about preventative health behaviors for mitigating COVID-19, received peer support, and remained virtually connected with friends were more likely to engage in daily social distancing at the onset of the pandemic., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Aims: Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation., Methods and Results: We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-to-event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24)., Conclusion: In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity., (© 2020 International Society on Thrombosis and Haemostasis.)

Rationale: Acute kidney injury (AKI) is associated with a poor outcome. Although pulmonary embolism (PE) may promote AKI through renal congestion and/or hemodynamic instability, its frequency and influence on outcome in patients with acute PE have been poorly studied., Methods: The frequency of AKI (defined according to the "Kidney Disease: Improving Global Outcomes" definition) at baseline and its influence on the 30-day mortality was evaluated in patients with acute PE from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. We used multivariate analysis to assess whether the presence of AKI influenced the risk for 30-day death., Results: The study included 21,131 patients, of whom 6222 (29.5%) had AKI at baseline: 4385 patients (21%) in stage 1, 1385 (6.5%) in stage 2 and 452 (2%) in stage 3. The proportion of patients with high-risk PE in those with no AKI, AKI stage 1, AKI stage 2 or AKI stage 3 was: 2.8%, 5.3%, 8.8% and 12%, respectively (p < 0.001). After 30 days, 1236 patients (5.9%) died. Overall mortality was 4% in patients with no AKI, 8.4% in AKI stage 1, 14% in AKI stage 2 and 17% in AKI stage 3 (all p < 0.001). AKI was independently associated with an increased risk of all-cause death at 30 days (odds ratio = 1.25; 95%CI: 1.02-1.54)., Conclusions: One in every 3-4 patients with acute PE had AKI at baseline. The presence of AKI independently predicted 30-day mortality. This study suggests that AKI may deserve to be evaluated as a prognostic factor in patients with acute PE., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Limited information exists about the epidemiology, management and outcomes of hemodynamically unstable patients with acute pulmonary embolism (PE). We aimed to evaluate the prevalence and outcomes of unstable PE, and to assess the acute management in routine clinical practice., Methods: This study included 34,380 patients from the RIETE registry with PE between 2001 and 2016. Primary outcomes included all-cause and PE-specific 30-day mortality. We used multivariable adjustments to calculate hazard ratios among unstable patients who did and did not receive reperfusion., Results: Overall, 1207 patients (3.5%) presented with hemodynamic instability. All-cause 30-day mortality was 14% and 5.4% in those with versus those without hemodynamic instability (P < 0.001). Two hundred and thirty eight (20%) unstable patients received reperfusion therapy. After multivariable adjustment, reperfusion therapy was associated with non-significantly reduced 30-day all-cause mortality (hazard ratio [HR] 0.71; 95% CI, 0.45 to 1.10; P = 0.12), and significantly reduced 30-day PE-related mortality (HR 0.56; 95% CI, 0.31 to 0.99; P = 0.04). When limiting the adjusted analyses to unstable patients with right ventricular dysfunction, the difference was significant for both all-cause (HR 0.65; 95% CI, 0.42 to 1.00; P = 0.05) and PE-related mortality (HR 0.52; 95% CI, 0.30 to 0.92; P = 0.02)., Conclusions: In a multinational registry of patients with PE, prevalence of hemodynamic instability was 3.5%, with high associated 30-day mortality rates. Although use of reperfusion was associated with lower mortality rates, particularly in patients with right ventricular dysfunction, it was used in only a fifth of patients., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Information on recurrent venous thromboembolic events (VTEs) and major bleeding risks during anticoagulant treatment in patients with cancer-associated VTEs and chronic kidney disease (CKD) is scarce, although it is of relevance in establishing better tailored management strategies in these patients., Objectives: We compared risks of recurrent VTEs and major bleeds in cancer-associated VTE patients with and without CKD., Methods: A total of 1684 patients diagnosed with a cancer-associated VTE between 2001 and 2011 were followed for 180 days after VTE diagnosis. Patients were treated mainly with low-molecular-weight heparin (LMWH) or vitamin-K antagonists (VKA). Primary outcomes were recurrent VTE and major bleeding. Secondary outcome was fatal bleeding., Results: Recurrent VTEs occurred in 15.9/100 patient years (py) in patients without CKD (eGFR > 60 mL min(-1) ), 19.5/100 py in those with CKD stage 3A (eGFR 45-60 mL min(-1) ), 14.9/100 py in those with CKD 3B (eGFR 30-45 mL min(-1) ), and 6.8/100 py in patients with CKD 4-5 (eGFR < 30 mL min(-1) ). Major bleeding occurred in 11.4/100 py in patients without CKD, 18.5/100 py in those with CKD stage 3A, 16.0/100 py in those with CKD 3B, and 40.8/100 py in patients with CKD 4-5. Fatal bleeding occurred in 1.1/100 py, 3.4/100 py, 6.3/100 py and 15.7/100 py, respectively. These increased bleeding risks in CKD patients were mainly observed in those on LMWH treatment, not VKA., Conclusions: The risk of major bleeding was increased in CKD patients with VTE and cancer, and was most prominent in those treated with LMWH and an eGFR < 30 mL min(-1) . These results indicate that LMWH should be used with caution in this specific population., (© 2013 International Society on Thrombosis and Haemostasis.)

Background: Traditionally, many patients with acute deep vein thrombosis (DVT) are treated not only by anticoagulation therapy but additionally by strict bed rest, which is aimed at reducing the risk of pulmonary embolism (PE) events. However, this risk has not been subjected to empirical verification., Patients and Methods: The Registro Informatizado de la Enfermedad TromboEmbólica is a Spanish registry of consecutively enrolled patients with objectively confirmed, symptomatic acute DVT or PE. In this analysis, the clinical characteristics, details of anticoagulant therapy, and clinical outcomes of enrolled patients with and without strict bed rest prescribed during the first 15 days were compared. Patients in whom ambulation was not possible were not included in this analysis., Results: A total of 2,650 patients entered the study (DVT, 2,038 patients; PE, 612 patients). Of these patients, 1,050 DVT patients (52%) and 385 PE patients (63%) were prescribed strict bed rest. New events of symptomatic, objectively confirmed PE developed during the 15-day study period in 11 patients with DVT (0.5%) and 4 patients with PE (0.7%). Five of these 15 patients (33%) died as a result of their PE. Age < 65 years (odds ratio [OR], 3.1; 95% confidence interval [CI], 0.98 to 11) and cancer (OR, 3.0; 95% CI, 0.98 to 9.1) were associated with an increased rate of new PEs. There were not significant differences between bedridden and ambulant patients in terms of new PE events, fatal PE, or bleeding complications., Conclusions: Our findings confirm those from previous reports suggesting that bed rest has no influence on the risk of developing PE among patients with acute DVT of the lower limbs. In addition, our findings show for the first time the lack of influence of bed rest even in patients presenting with acute submassive PE.

Objectives: To evaluate the efficacy and complications of noninvasive nasal mask bilevel continuous positive airway pressure ventilation in pediatric patients with hypoxemic respiratory insufficiency., Design: Retrospective chart review., Setting: Intensive care unit, university affiliated tertiary care children's hospital., Patients and Methods: The study reviewed all patients admitted to the pediatric ICU with acute hypoxemic respiratory insufficiency who received bilevel noninvasive continuous nasal mask positive airway pressure delivered by a bilevel positive airway pressure system (BiPAP; Respironics Inc; Murrysville, Pa)., Results: Bilevel nasal mask positive pressure ventilation was utilized in 28 patients. Median patient age was 8 years (range, 4 to 204 months). The most common primary diagnosis was pneumonia. Nine patients demonstrated severe underlying neurologic disease or immunocompromise. Median duration of nasal mask ventilation was 72 h (range, 20 to 840 h). Clinical and laboratory variables immediately prior to bilevel nasal mask positive airway pressure and approximately 1 h after institution were evaluated. Respiratory rate decreased significantly with nasal mask ventilation (45 +/- 18 breaths per minute to 33 +/- 11, mean +/- SD, p < 0.001). Arterial blood gas PaO2 (71 +/- 13 mm Hg to 115 +/- 55), PaCO2, pulse oximetry saturation, and pH all improved significantly (p < 0.01). Using standard estimates for inspired oxygen, calculated alveolar-arterial gradients (271 +/- 157 to 117 +/- 65, p = 0.001), and PaO2/FIo2 ratios (141 +/- 54 to 280 +/- 146, p < 0.001), both improved significantly with nasal mask ventilation. Only 3 of 28 patients required intubation or reintubation., Conclusions: We conclude that noninvasive nasal positive pressure mask ventilation can be safely and effectively used in pediatric patients to improve oxygenation in mild to moderate hypoxemic respiratory insufficiency. It may be particularly useful in patients whose underlying condition warrants avoidance of intubation.