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BackgroundSome patterns of cannabis use may presage risk for long-term negative effects. We examined associations between a novel adolescent cannabis misuse scale and early-adult life course outcomes.MethodsWe performed a secondary data analysis of a cohort of Los Angeles, CA high school students from grade 9 through age 21. Participants reported baseline individual demographic and family characteristics at grade 9, adolescent cannabis misuse (8-items) and alcohol misuse (12-items) at grade 10, and outcomes at age 21. We used multivariable regression to model the associations of cannabis misuse scale score with problem substance use (defined as any of: 30-day illegal drug use, 30-day use of another's prescription to get high, hazardous drinking) and several secondary outcomes (behavioral, mental health, academic, social determinants of health), adjusting for covariates. Parallel analyses were conducted for alcohol misuse.ResultsThe 1,148 participants (86% retention) were 47% male, 90% Latinx, 87% US born, and 40% native English speakers. Approximately 11.4% and 15.9% of participants reported at least one item on the cannabis and alcohol misuse scales, respectively. At age 21, approximately 6.7% of participants reported problem substance use, which was associated with both Cannabis and Alcohol Misuse Scales (OR 1.31, 95%CI[1.16, 1.49] and OR 1.33, 95%CI[1.18, 1.49], respectively). Both scales were similarly associated with outcomes in all four categories.ConclusionsThe Adolescent Cannabis Misuse Scale is a promising tool for identifying early patterns of substance use that predict future negative outcomes and enabling early intervention at a critical period in youth development.

BackgroundAdolescent behaviors and academic outcomes are thought to be shaped by school climate. We sought to identify longitudinal associations between school climate measures and downstream health and academic outcomes.MethodsData from a longitudinal survey of public high school students in Los Angeles were analyzed. Eleventh-grade health and academic outcomes (dependent variables, eg, substance use, delinquency, risky sex, bullying, standardized exams, college matriculation), were modeled as a function of 10th-grade school climate measures (independent variables: institutional environment, student-teacher relationships, disciplinary style), controlling for baseline outcome measures and student/parental covariates.ResultsThe 1114 student respondents (87.8% retention), were 46% male, 90% Latinx, 87% born in the United States, and 40% native English speakers. Greater school order and teacher respect for students were associated with lower odds of multiple high risk behaviors including 30-day alcohol use (odds ratio [OR] 0.81; 95% confidence interval [CI] [0.72, 0.92] and OR 0.73; [0.62, 0.85]) and 30-day cannabis use (OR 0.74; [0.59, 0.91] and OR 0.76; [0.63, 0.92]). Neglectful disciplinary style was associated with multiple poor health and academic outcomes while permissive disciplinary style was associated with favorable academic outcomes.Implications for school health policy, practice, and equitySchool health practitioners may prospectively leverage school environment, teacher-student relationships, and disciplinary style to promote health and learning.ConclusionsOur findings identify specific modifiable aspects of the school environment with critical implications for life course health.

The success of personal non-pharmaceutical interventions as a public health strategy requires a high level of compliance from individuals in private social settings. Strategies to increase compliance in these hard-to-reach settings depend upon a comprehensive understanding of the patterns and predictors of protective social behavior. Social cognitive models of protective behavior emphasize the contribution of individual-level factors while social-ecological models emphasize the contribution of environmental factors. This study draws on 28 waves of survey data from the Understanding Coronavirus in America survey to measure patterns of adherence to two protective social behaviors-private social-distancing behavior and private masking behavior-during the COVID-19 pandemic and to assess the role individual and environmental factors play in predicting adherence. Results show that patterns of adherence fall into three categories marked by high, moderate, and low levels of adherence, with just under half of respondents exhibiting a high level of adherence. Health beliefs emerge as the single strongest predictor of adherence. All other environmental and individual-level predictors have relatively poor predictive power or primarily indirect effects.

Background: Adolescent behaviors and academic outcomes are thought to be shaped by school climate. We sought to identify longitudinal associations between school climate measures and downstream health and academic outcomes. Methods: Data from a longitudinal survey of public high school students in Los Angeles were analyzed. Eleventh-grade health and academic outcomes (dependent variables, eg, substance use, delinquency, risky sex, bullying, standardized exams, college matriculation), were modeled as a function of 10th-grade school climate measures (independent variables: institutional environment, student-teacher relationships, disciplinary style), controlling for baseline outcome measures and student/parental covariates. Results: The 1114 student respondents (87.8% retention), were 46% male, 90% Latinx, 87% born in the United States, and 40% native English speakers. Greater school order and teacher respect for students were associated with lower odds of multiple high risk behaviors including 30-day alcohol use (odds ratio [OR] 0.81; 95% confidence interval [CI] [0.72, 0.92] and OR 0.73; [0.62, 0.85]) and 30-day cannabis use (OR 0.74; [0.59, 0.91] and OR 0.76; [0.63, 0.92]). Neglectful disciplinary style was associated with multiple poor health and academic outcomes while permissive disciplinary style was associated with favorable academic outcomes. Implications for School Health Policy, Practice, and Equity: School health practitioners may prospectively leverage school environment, teacher-student relationships, and disciplinary style to promote health and learning. Conclusions: Our findings identify specific modifiable aspects of the school environment with critical implications for life course health.

Background and objectivesThe COVID-19 pandemic and related school closures may have disrupted school-related supports and services important to children's wellbeing. However, we lack national data about US children's wellbeing and family priorities for school-related services. We sought to determine 1) children's social-emotional wellbeing and 2) needs and priorities for school-based services in the 2021-2022 school year among a US sample of parents of school-aged children.MethodsIn June 2021, we surveyed 1504 parents of children enrolling in grades K-12 in the 2021-2022 school year participating in the Understanding America Study, a nationally representative probability-based Internet panel of families completing regular internet-based surveys (Response rate to this survey was 79.2%). Parents completed the Strengths and Difficulties Questionnaire and reported their needs for school-related services regarding "support getting healthcare", "mental wellness support", "food, housing, legal or transportation support", and "learning supports and enrichment." Weighted regressions examined associations among wellbeing, needs, and sociodemographic characteristics.ResultsApproximately one-quarter of children had deficits in hyperactivity (26.1%), one-third in peer problems (32.6%), and 40% in prosocial areas. Most parents (83.5%) reported a school-related need, with 77% reporting learning supports and enrichment needs and 57% reporting mental wellness needs. The highest priority needs were for tutoring, socialization, increased instructional time, coping with stress, and physical activity.ConclusionsUS school children have high social-emotional and school-related needs. Investments in schools are urgently needed, particularly for learning supports and mental wellness, to meet the high demand for services and parents' priorities to support child health and wellbeing.

ImportanceInterventions directly targeting social factors, such as education, may have the potential to greatly improve health.ObjectiveTo examine the association of attending a high-performing public charter high school with rates of substance use disorder and physical and mental health.Design, setting, and participantsThis cohort study used the random school admissions lottery system of high-performing public charter high schools in low-income neighborhoods of Los Angeles, California, to examine the health outcomes of students who applied to at least 1 of 5 of these high schools. Participants attended 147 different high schools and were randomly selected from those who won the admissions lottery (intervention group) and those who were placed on a waiting list (control group). Participants were surveyed at the end of grade 8 through transition into grade 9 and then from grade 10 through 3 years after high school completion (at age 21 years). Surveys were conducted from March 2013 through November 2021.InterventionAttendance at a high-performing public charter high school.Main outcomes and measuresSelf-reported alcohol use disorder and cannabis misuse, delinquent behaviors, physical and mental health, and body mass index.ResultsOf the 1270 participants at baseline (mean [SD] age, 14.2 [0.47] years; 668 female individuals [52.6%]). The control group included 576 individuals (45.4%), and 694 individuals (54.6%) were in the intervention group. Both groups were similar in almost all characteristics at baseline, and the median (IQR) follow-up was 6.4 (6.0-6.7) years. Participants attending a high-performing public charter high school had a 53.33% lower rate of hazardous or dependent alcohol use disorder compared with those in the control group (5.43% vs 11.64%; difference, -6.21% [95% CI, -11.87% to -0.55%]; P = .03). Among male participants, the intervention group had a 42.05% lower rate of self-reported fair or poor physical health (13.33% vs 23.01%; difference, -9.67% [95% CI, -18.30% to -1.05%]; P = .03) and a 32.94% lower rate of obesity or overweight (29.28% vs 43.67%; difference, -14.38% [95% CI, -25.74% to -3.02%]; P = .02) compared with the control group. Among female participants, attending a high-performing public charter high school was associated with worse physical health outcomes (30.29% vs 13.47% reporting fair or poor health; difference, 16.82% [95% CI, 0.36% to 33.28%]; P = .045) and higher rates of overweight or obesity (52.20% vs 32.91%; difference, 19.30% [95% CI, 3.37% to 35.22%]; P = .02) at age 21 years. Few differences in mental health outcomes were observed. Adjusting for educational outcomes did not significantly change these findings.Conclusions and relevanceResults of this study suggest that attending a high-performing public charter high school was associated with lower rates of substance use disorder independent of academic achievement. Physical health and obesity outcomes were also better but only for young men; the intervention group had worse physical health outcomes among young women for unclear reasons. Schools are a potent social determinant of health and an important target for future health interventions.

Adolescence is a critical transition period that sets the stage for adulthood and future health outcomes. Marked by key developmental milestones in brain maturation, increasing independence from parents, and greater connections to peers, adolescence is also a time of heightened risk for behavioral health problems, including substance use, violence, delinquency, and mental health issues. High school completion is a significant life course event and a powerful social determinant of health and health disparities. Jessor's Theory of Problem Behavior suggests that adolescent health behaviors and mental health problems are closely tied to poor educational outcomes and peer network formation in a reinforcing feedback loop, or vicious cycle, often leading to school failure, school disengagement, and drop-out. Schools are a novel platform through which vicious cycles can be disrupted and replaced with virtuous ones, simultaneously improving education and health. This article describes the potential for schools to transform health trajectories through interventions creating positive and supportive school climates. In addition, new models such as the Whole School Whole Community Whole Child Model promote whole child well-being, including cognitive, social, emotional, psychological, and physical development. Full-service community schools can serve as a hub coordinating and integrating all available resources to better respond to the needs of children and families. Present in every neighborhood, schools are a way to reach every school-age child and improve their health trajectories, providing an important platform for life course intervention research.

BackgroundSchools and school climate are thought to influence academic outcomes as well as child and adolescent development, health and well-being. We sought to examine the relationship between several aspects of the school climate with adolescent social-emotional health outcomes.MethodsWe analysed data from the Reducing Inequities through Social and Educational change Follow-up (RISE UP) Study, a longitudinal natural experimental study of Los Angeles high school students collected from 2013 to 2018. We analysed data on the portion of the sample that completed the baseline, 10th grade and 11th grade surveys (n=1114). Students reported their perceptions of school climate at 10th grade and social-emotional outcomes including grit, self-efficacy, depression, hopelessness, and stress at baseline (9th grade) and at 11th grade. Multivariable regressions adjusted for student and parental demographics and baseline social-emotional states tested associations between school climate and each outcome.ResultsStudents who reported being in authoritative school environments in 10th grade, one that is highly supportive and highly structured, had subsequently higher levels of self-efficacy (p

PurposeUnderstanding the full impact of COVID-19 on U.S. children, families, and communities is critical to (a) document the scope of the problem, (b) identify solutions to mitigate harm, and (c) build more resilient response systems. We sought to develop a research agenda to understand the short- and long-term mechanisms and impacts of the COVID-19 pandemic on children's healthy development, with the goal of devising and ultimately testing interventions to respond to urgent needs and prepare for future pandemics.DescriptionThe Life Course Intervention Research Network facilitated a series of virtual meetings that included members of 10 Maternal and Child Health (MCH) research programs, their research and implementation partners, as well as family and community representatives, to develop an MCH COVID-19 Research Agenda. Stakeholders from academia, clinical practice, nonprofit organizations, and family advocates participated in four meetings, with 30-35 participants at each meeting.AssessmentInvestigating the impacts of COVID-19 on children's mental health and ways to address them emerged as the highest research priority, followed by studying resilience at individual and community levels; identifying and mitigating the disparate negative effects of the pandemic on children and families of color, prioritizing community-based research partnerships, and strengthening local, state and national measurement systems to monitor children's well-being during a national crisis.ConclusionEnacting this research agenda will require engaging the community, especially youth, as equal partners in research co-design processes; centering anti-racist perspectives; adopting a "strengths-based" approach; and integrating young researchers who identify as Black, Indigenous, and People of Color (BIPOC). New collaborative funding models and investments in data infrastructure are also needed.

BackgroundDue to the COVID-19 pandemic, students and teachers have transitioned to online learning. The transition required changes in teaching practices to accommodate for an online learning environment. However, there are no studies characterizing physical educators' and school health experts' perspectives on physical education via distance learning or identifying best practices and their implications for student health.MethodsUsing purposive and snowball sampling, we conducted semi-structured interviews with 19 physical education teachers and school health experts across 21 California school districts on best practices for physical education via distance learning. Interviews were recorded, transcribed, and analyzed using a grounded theory approach.ResultsFour major themes emerged: (1) participants felt high quality physical education via distance learning was both critical and possible; (2) strategies for creating a successful distance learning environment included personalization, creativity, and inclusiveness; (3) resources necessary for success included professional development, administrative support, and equipment; and (4) lessons for the long-term.ConclusionsParticipants identified effective strategies, challenges, and recommendations for the future. Participants felt optimistic about their ability to provide quality physical education via distance learning, given the necessary supports, and perceived that they played a critical role in supporting student health during the COVID-19 pandemic.

ObjectiveChaos in the home is associated with worse childhood behaviors. We hypothesize chaos in the school environment might also be associated with teen risk behaviors.MethodsWe analyzed data from the Reducing Inequities through Social and Educational change Follow-Up study, a natural experiment designed to examine the impact of high-performing schools on adolescent outcomes. Students reported the amount of noise, order, and control in their school environment and whether they engaged in substance use, fighting, school absenteeism, and delinquent behaviors. We conducted cross-lagged panel structural equation modeling to examine the relationship between school chaos at 10th grade with risk behaviors at 11th grade while simultaneously examining the relationship between behaviors at 10th grade with chaos at 11th grade.ResultsAmong a sample of 1114 teens, 90% were Latinx and 40% were native English speakers. Students reporting more school chaos in 10th grade were more likely in 11th grade to report recent alcohol and cannabis use, physical fighting, school absenteeism, and delinquent behaviors in the last year. Cross-lagged structural equation model analyses indicate school chaos at 10th grade is linked to alcohol use and absenteeism at 11th grade, while fighting, absenteeism, and any delinquent behaviors at 10th grade are associated with more chaos at 11th grade. School engagement was not a mediating factor.ConclusionsAlthough causal relationships cannot be assumed, school chaos may be an important predictor of adolescent risk behaviors. Future studies should examine whether reducing school chaos leads to lower rates of adolescent risk behaviors.

ObjectiveUntreated vision problems are associated with poor school performance. Whether providing glasses alone improves performance, however, remains unknown. We sought to test whether receiving glasses was associated with improved school performance for low-income minority students in Los Angeles.MethodsFrom 2017 to 2018, we analyzed achievement marks in mathematics and language arts from 406 first to fifth grade students attending 24 public elementary schools who received glasses through a free school-based vision program between February and May 2014, and 23,393 of their nonparticipating same-school, same-grade peers. We calculated students' percentile rank during each grading period in 1 year before and 2 years since they received glasses. Multilevel linear regressions tested whether percentile rank differed from baseline at each subsequent grading period. Models accounted for clustering at the school level and controlled for gender, grade level, and baseline class rank. Interaction terms tested whether associations differed by gender and class rank.ResultsStudents increased 4.5 percentile points (P = .02) in language arts in the second year after receiving glasses. There was no change in math achievement overall; however, those with baseline performance in the bottom tercile had an immediate and sustained improvement of 10 to 24 percentile points from baseline (interaction term P < .001). Class rank for behavior marks decreased during the fourth grading period after receiving glasses but subsequently returned to baseline. There were no significant changes in work habits and no variation in results by gender.ConclusionsEnsuring access to vision care may be a simple, scalable strategy to improve language arts performance for low-income minority children.

Background: Due to the COVID-19 pandemic, students and teachers have transitioned to online learning. The transition required changes in teaching practices to accommodate for an online learning environment. However, there are no studies characterizing physical educators' and school health experts' perspectives on physical education via distance learning or identifying best practices and their implications for student health. Methods: Using purposive and snowball sampling, we conducted semi-structured interviews with 19 physical education teachers and school health experts across 21 California school districts on best practices for physical education via distance learning. Interviews were recorded, transcribed, and analyzed using a grounded theory approach. Results: Four major themes emerged--(1) participants felt high quality physical education via distance learning was both critical and possible; (2) strategies for creating a successful distance learning environment included personalization, creativity, and inclusiveness; (3) resources necessary for success included professional development, administrative support, and equipment; and (4) lessons for the long-term. Conclusions: Participants identified effective strategies, challenges, and recommendations for the future. Participants felt optimistic about their ability to provide quality physical education via distance learning, given the necessary supports, and perceived that they played a critical role in supporting student health during the COVID-19 pandemic.

ObjectivesSchools are thought to have an important impact on adolescent behaviors, but the mechanisms are not well understood. We hypothesize that there are measurable constructs of peer- and teacher-related extrinsic motivations for adolescent behaviors and sought to develop measures of school culture that would capture these constructs.MethodsWe developed several survey items to assess school behavioral culture and collected self-reported data from a sample of adolescents age 14-17 attending high school in low income neighborhoods of Los Angeles. We conducted exploratory and confirmatory factor analysis to inform the creation of simple-summated multi-item scales. We also conducted a cultural consensus analysis to identify the existence of shared pattern of responses to the items among respondents within the same school.ResultsFrom 1159 adolescents, six factors were identified: social culture regarding popular (Cronbach's alpha=0.84) and respected (alpha=0.83) behaviors, teacher support (alpha=0.86) and monitoring of school rules (alpha=0.85), valued student traits (alpha=0.67) and school order (alpha=0.68). Cultural consensus analysis identified a shared pattern of responses to the items among respondents at 8 of the 13 schools. School academic performance, which is based on standardized test results, is strongly correlated with social culture regarding popular behaviors (Pearson's correlation coefficient r=0.64), monitoring of school rules (r= 0.71), and school order (r= 0.83).ConclusionsThe exploratory and confirmatory factor analyses did not support a single, overall factor that measures school culture. However, the six identified sub-scales might be used individually to examine school influence on academic performance and health behaviors.

ImportanceAlthough school environments are thought to influence health behaviors, experimental data assessing causality are lacking, and which aspects of school environments may be most important for adolescent health are unknown.ObjectiveTo test whether exposure to high-performing schools is associated with risky adolescent health behaviors.Design, setting, and participantsThis natural experiment used admission lotteries, which mimic random assignment, to estimate the association of school environments and adolescent health. A survey of 1270 students who applied to at least 1 of 5 high-performing public charter schools in low-income minority communities in Los Angeles, California. Schools had an academic performance ranked in the top tertile of Los Angeles County public high schools, applicants outnumbered available seats by at least 50, and an admissions lottery was used. Participants included lottery winners (intervention group [n = 694]) and lottery losers (control group [n = 576]) from the end of 8th grade and beginning of 9th grade through the end of 11th grade. Intention-to-treat (ITT) and instrumental variable techniques estimated the association of winning the lottery and attending high-performing schools with health behaviors and whether the association varied by sex. Data were collected from March 11, 2013, through February 22, 2017, and analyzed from October 1, 2017, through July 1, 2018.ExposuresSchools were considered high performing if they placed in the top tercile of public high schools in LA County on 2012 state standardized tests. Most students attended that same school for 3 years (9th-11th grades).Main outcomes and measuresPrimary self-reported outcomes were 30-day and high-risk self-reported marijuana use. Additional health outcomes included 30-day alcohol use, alcohol misuse, ever being in a fight, ever having sex, and past-year delinquency. Potential intermediate factors (time studying, truancy, school mobility, school culture, school order, teacher support for college, and proportion of substance-using peers in students' social networks) were also examined.ResultsAmong the 1270 participating students (52.6% female; mean [SD] age at enrollment, 14.3 [0.5] years), ITT analysis showed that the intervention group reported less marijuana misuse than the control group (mean marijuana misuse score, 0.46 vs 0.71), as well as fewer substance-using peers (9.6% vs 12.7%), more time studying (mean, 2.63 vs 2.49 hours), less truancy (84.3% vs 77.3% with no truancy), greater teacher support for college (mean scores, 7.20 vs 7.02), more orderly schools (mean order score, 7.06 vs 6.83), and less school mobility (21.4% vs 28.4%) (all P

BACKGROUND AND OBJECTIVES: Early intervention services can improve outcomes for children with developmental delays. Health care providers, however, often struggle to ensure timely referrals and services. We tested the effectiveness of telephone-based early childhood developmental care coordination through 211 LA, a health and human services call center serving Los Angeles County, in increasing referral and enrollment in services. METHODS: In partnership with 4 clinic systems, we recruited and randomly assigned children aged 12 to 42 months with upcoming well-child visits and without a known developmental delay, to intervention versus usual care. All children received developmental screening and usual clinic care. Intervention children also received telephone connection to a 211 LA early childhood care coordinator who made referrals and conducted follow-up. Primary outcomes at a 6-month follow-up included parent-reported referral and enrollment in developmental services. Secondary outcomes included referral and enrollment in early care and education (ECE). Logistic regression models were used to estimate the odds of outcomes, adjusted for key covariates. RESULTS: Of 565 families (282 intervention, 283 control), 512 (90.6%) provided follow-up data. Among all participants, more intervention than control children were referred to (25% vs 16%, adjusted odds ratio [AOR] 2.25, P = .003) and enrolled in (15% vs 9%, AOR 2.35, P = .008) ≥1 service, and more intervention than control children were referred to (58% vs 15%, AOR 9.06, P < .001) and enrolled in (26% vs 10%, AOR 3.75, P < .001) ECE. CONCLUSIONS: Telephone-based care coordination through 211 LA is effective in connecting young children to developmental services and ECE, offering a potentially scalable solution for gaps and disparities. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by challenges in social communication and interaction and restricted or repetitive behavior, interests, or activities. Although ASD symptoms generally manifest in early childhood, many individuals experience delays accessing an autism diagnosis and related services. In this study, we identify the individual, social, and structural factors that influence parents' experiences of children's ASD diagnosis. METHODS:Parents of 25 children with autism participated in 60- to 90-minute semistructured in-person interviews. Interviews were recorded and transcribed verbatim. Transcripts were analyzed using the method of grounded theory. This inductive method allowed analysts to identify key themes related to participants' experiences of children's ASD diagnosis. RESULTS:The process of ASD diagnosis reflects an odyssey that includes 3 key phases: the prediagnosis phase, in which "Making Sense of Child Difference" is a primary characteristic of participants' experiences; the during-diagnosis phase, when "Navigating Diagnosis" suggests systematic barriers that influence the timing of ASD diagnosis; and the postdiagnosis phase, when participants' experiences of "Connecting to Services" point to the important role that personal efforts play in gaining access to care. CONCLUSIONS:In this study, we highlight individual, social, and structural factors that influence parent experiences before, during, and after their child's autism diagnosis. Our findings indicate the need for more consistent and continuous support for autistic individuals and their families during the diagnostic odyssey, as well as resources that better represent the diversity of experiences and symptoms associated with autism across the life course.

BackgroundWe examined whether standardized test scores and grades are related to risky behaviors among low-income minority adolescents and whether social networks and social-emotional factors explained those relationships.MethodsWe analyzed data from 929 high school students exposed by natural experiment to high- or low-performing academic environments in Los Angeles. We collected information on grade point average (GPA), substance use, sexual behaviors, participation in fights, and carrying a weapon from face-to-face interviews and obtained California math and English standardized test results. Logistic regression and mediation analyses were used to examine the relationship between achievement and risky behaviors.ResultsBetter GPA and California standardized test scores were strongly associated with lower rates of substance use, high-risk sexual behaviors, and fighting. The unadjusted relative odds of monthly binge drinking was 0.72 (95% confidence interval, 0.56-0.93) for 1 SD increase in standardized test scores and 0.46 (95% confidence interval, 0.29-0.74) for GPA of B- or higher compared with C+ or lower. Most associations disappeared after controlling for social-emotional and social network factors. Averaged across the risky behaviors, mediation analysis revealed social-emotional factors accounted for 33% of the relationship between test scores and risky behaviors and 43% of the relationship between GPA with risky behaviors. Social network characteristics accounted for 31% and 38% of the relationship between behaviors with test scores and GPA, respectively. Demographic factors, parenting, and school characteristics were less important explanatory factors.ConclusionsSocial-emotional factors and social network characteristics were the strongest explanatory factors of the achievement-risky behavior relationship and might be important to understanding the relationship between academic achievement and risky behaviors.

ObjectiveStudies suggest adolescent substance use aligns with academic and behavioral self-concept (whether teens think of themselves as good or bad students and as rule followers or rule breakers) as well as peer and adult social networks. Schools are an important context in which self-concept and social networks develop, but it remains unclear how school environments might be leveraged to promote healthy development and prevent substance use. We sought to describe how youth perceive the relationships among school environments, adolescent self-concept, social networks, and substance use.MethodsSemistructured interviews with 32 low-income minority youth (aged 17-22 years) who participated in a prior study, explored self-concept development, school environments, social networks, and substance use decisions. Recruitment was stratified by whether, during high school, they had healthy or unhealthy self-concept profiles and had engaged in or abstained from substance use.ResultsYouth described feeling labeled by peers and teachers and how these labels became incorporated into their self-concept. Teachers who made students feel noticed (eg, by learning students' names) and had high academic expectations reinforced healthy self-concepts. Academic tracking, extracurricular activities, and school norms determined potential friendship networks, grouping students either with well-behaving or misbehaving peers. Youth described peer groups, combined with their self-concept, shaping their substance use decisions. Affirming healthy aspects of their self-concept at key risk behavior decision points helped youth avoid substance use in the face of peer pressure.ConclusionsYouth narratives suggest school environments shape adolescent self-concept and adult and peer social networks, all of which impact substance use.

Objective"What do you want to be when you grow up?" is a simple, commonly asked question that might provide insight into adolescent well-being. Career aspirations might reflect an adolescent's sense of identity, hope for the future, and self-efficacy, all of which are critical to identifying at-risk youth and intervening on risky behaviors. However, there are no studies on whether career aspirations are associated with adolescent emotional and health behavior outcomes.MethodsWe analyzed cross-sectional surveys of 929 ninth to 12th grade low-income minority adolescents in Los Angeles assessing career aspirations and its association with hopelessness, self-efficacy, substance use, violence, and risky sexual activity. We used Department of Labor statistics to categorize career aspirations according to amount of education required, income, and prestige. Generalized estimating equations accounted for sociodemographic characteristics, school type, academic performance, and clustering at the school level.ResultsGrades, standardized test scores, and health behaviors varied according to career type. Adolescents with higher career aspirations, measured according to career-related education, income, and prestige reported less hopelessness and more self-efficacy. After adjusting for confounders, aspirations requiring high levels of education were associated with decreased odds of alcohol use, at-school substance use, and risky sexual activity, and higher prestige scores were associated with decreased odds of other drug use.ConclusionsCareer aspirations might be a marker for adolescent health and well-being. Adults might consider asking a teen what they want to be when they grow up to gain insight into their levels of hopelessness and self-efficacy and provide context for counseling on healthy behavior change.

BackgroundPoor academic (eg, "I am a bad student") and behavioral (eg, "I am a troublemaker") self-concepts are strongly linked to adolescent substance use. Social networks likely influence self-concept. However, little is understood about the role teachers and athletic coaches play in shaping both academic and behavioral self-concepts.MethodsWe analyzed cross-sectional surveys of 929 9th-12th grade low-income minority adolescents in Los Angeles assessing self-concept, social networks, and 30-day use of alcohol, marijuana and other drugs. We performed generalized estimating equations, accounting for clustering at the school level and controlling for family and peer influences and contextual factors. We also tested whether self-concept-mediated associations between relationships with teachers or coaches and 30-day substance use.ResultsMore perceived teacher support was associated with lower odds of marijuana and other drug use and better academic and behavioral self-concepts. Behavioral self-concept mediated the associations between teacher support and substance use.ConclusionsBy facilitating relationships with adults and improving teachers' capacity to build supportive environments, schools may positively shape how adolescents see themselves, which might help reduce adolescent substance use.

Current recommendations emphasize developmental screening and surveillance to identify developmental delays (DDs) for referral to early intervention (EI) services. Many young children without DDs, however, are at high risk for poor developmental and behavioral outcomes by school entry but are ineligible for EI. We developed models for 2-year-olds without DD that predict, at kindergarten entry, poor academic performance and high problem behaviors. Data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), were used for this study. The analytic sample excluded children likely eligible for EI because of DDs or very low birth weight. Dependent variables included low academic scores and high problem behaviors at the kindergarten wave. Regression models were developed by using candidate predictors feasibly obtainable during typical 2-year well-child visits. Models were cross-validated internally on randomly selected subsamples. Approximately 24% of all 2-year-old children were ineligible for EI at 2 years of age but still had poor academic or behavioral outcomes at school entry. Prediction models each contain 9 variables, almost entirely parental, social, or economic. Four variables were associated with both academic and behavioral risk: parental education below bachelor's degree, little/no shared reading at home, food insecurity, and fair/poor parental health. Areas under the receiver-operating characteristic curve were 0.76 for academic risk and 0.71 for behavioral risk. Adding the mental scale score from the Bayley Short Form-Research Edition did not improve areas under the receiver-operating characteristic curve for either model. Among children ineligible for EI services, a small set of clinically available variables at age 2 years predicted academic and behavioral outcomes at school entry.

ObjectiveIndividual academic achievement is a well-known predictor of adult health, and addressing education inequities may be critical to reducing health disparities. Disparities in school quality are well documented. However, we lack nationally representative studies evaluating the impact of school quality on adult health. We aim to determine whether high school quality predicts adult health outcomes after controlling for baseline health, socio-demographics and individual academic achievement.MethodsWe analyzed data from 7037 adolescents who attended one of 77 high schools in the Unites States and were followed into adulthood from the National Longitudinal Study of Adolescent to Adult Health. Selected school-level quality measures-average daily attendance, school promotion rate, parental involvement, and teacher experience-were validated based on ability to predict high school graduation and college attendance. Individual adult health outcomes included self-rated health, diagnosis of depression, and having a measured BMI in the obese range.ResultsLogistic regressions controlling for socio-demographics, baseline health, health insurance, and individual academic performance demonstrated that school quality significantly predicted all health outcomes. As hypothesized, attending a school with lower average daily attendance predicted lower self-rated health (Adjusted Odds Ratio (AOR) 1.59, p = 0.003) and higher odds of depression diagnosis (AOR 1.35, p = 0.03); and attending a school with higher parent involvement predicted lower odds of obesity (AOR 0.69, p = 0.001). However, attending a school with higher promotion rate also predicted lower self-rated health (AOR1.20, p

ObjectivesUp to 20 % of school-age children have a vision problem identifiable by screening, over 80 % of which can be corrected with glasses. While vision problems are associated with poor school performance, few studies describe whether and how corrective lenses affect academic achievement and health. Further, there are virtually no studies exploring how children with correctable visual deficits, their parents, and teachers perceive the connection between vision care and school function.MethodsWe conducted a qualitative evaluation of Vision to Learn (VTL), a school-based program providing free corrective lenses to low-income students in Los Angeles. Nine focus groups with students, parents, and teachers from three schools served by VTL explored the relationships between poor vision, receipt of corrective lenses, and school performance and health.ResultsTwenty parents, 25 teachers, and 21 students from three elementary schools participated. Participants described how uncorrected visual deficits reduced students' focus, perseverance, and class participation, affecting academic functioning and psychosocial stress; how receiving corrective lenses improved classroom attention, task persistence, and willingness to practice academic skills; and how serving students in school rather than in clinics increased both access to and use of corrective lenses.Conclusionsfor Practice Corrective lenses may positively impact families, teachers, and students coping with visual deficits by improving school function and psychosocial wellbeing. Practices that increase ownership and use of glasses, such as serving students in school, may significantly improve both child health and academic performance.

IntroductionStudies suggest students who are substantially older than the average age for their grade engage in risky health behaviors, including substance use. However, most studies do not account for the distinct reasons why students are old for their grade (ie, grade retention vs delayed school entry) or for their pubertal stage. Thus, whether the association between age for grade and substance use is confounded by these factors is unknown. We sought to determine whether age, grade, or pubertal stage were associated with early substance use.MethodsCross-sectional Healthy Passages Wave I survey data from 5,147 fifth graders and their caregivers in Alabama, California, and Texas from 2004 through 2006 were analyzed in 2014. Logistic regressions examined whether older age for grade, grade retention, delayed school entry, or pubertal stage were associated with use of any substance, cigarettes, alcohol, or other drugs.ResultsSeventeen percent of fifth graders reported trying at least 1 substance. Among boys, advanced pubertal stage was associated with increased odds of cigarette, alcohol, or other drug use, whereas delayed school entry was associated with lower odds of any substance, alcohol, or other drug use. Among girls, advanced pubertal stage was associated only with higher odds of alcohol use, and delayed school entry was not associated with substance use. Neither older age for grade or grade retention was independently associated with substance use after controlling for potential confounders.ConclusionAdvanced pubertal stage may be a more important risk factor for substance use than age for grade. Pediatricians should consider initiating substance use screening earlier for patients with advanced pubertal stage.

ObjectiveAt-school substance use is associated with increased rates of violence and delinquency. However, whether at-school substance use is a useful marker for other serious health risks and whether this association varies by gender or substance is still unclear.MethodsWe analyzed data from the national 2011 Youth Risk Behaviors Survey of 15,698 ninth to 12th grade students. We used multivariate regressions controlling for age and race and evaluated whether at-school marijuana and alcohol users were more likely than out-of-school users to exhibit 9 serious health risks (exposure to intoxicated driving, fighting, carrying a weapon at school, substance use with intercourse, experiencing intimate partner violence, being forced to have intercourse, experiencing depression, suicidal ideation, and attempting suicide). We included interaction terms to determine whether this association varied by gender or substance.ResultsAt-school alcohol and marijuana use were both associated with increased odds of all 9 serious health risks. The association between at-school substance use and fighting and being forced to have sex was greater for boys than for girls. Associations did not vary significantly by substance. Specificity of at-school substance use for serious health risks ranged from 0.93 to 0.96, and positive predictive values ranged from 0.23 to 0.69, well above the ranges for out-of-school use and nonuse.ConclusionsStudents found using alcohol or marijuana at school should be immediately and carefully screened for other serious health risks that pose significant present dangers; this might represent a critical opportunity to identify troubled youth.

ObjectivesWe examined whether exposure to high-performing schools reduces the rates of risky health behaviors among low-income minority adolescents and whether this is due to better academic performance, peer influence, or other factors.MethodsBy using a natural experimental study design, we used the random admissions lottery into high-performing public charter high schools in low-income Los Angeles neighborhoods to determine whether exposure to successful school environments leads to fewer risky (eg, alcohol, tobacco, drug use, unprotected sex) and very risky health behaviors (e.g., binge drinking, substance use at school, risky sex, gang participation). We surveyed 521 ninth- through twelfth-grade students who were offered admission through a random lottery (intervention group) and 409 students who were not offered admission (control group) about their health behaviors and obtained their state-standardized test scores.ResultsThe intervention and control groups had similar demographic characteristics and eighth-grade test scores. Being offered admission to a high-performing school (intervention effect) led to improved math (P < .001) and English (P = .04) standard test scores, greater school retention (91% vs. 76%; P < .001), and lower rates of engaging in ≥1 very risky behaviors (odds ratio = 0.73, P < .05) but no difference in risky behaviors, such as any recent use of alcohol, tobacco, or drugs. School retention and test scores explained 58.0% and 16.2% of the intervention effect on engagement in very risky behaviors, respectively.ConclusionsIncreasing performance of public schools in low-income communities may be a powerful mechanism to decrease very risky health behaviors among low-income adolescents and to decrease health disparities across the life span.

Background: Poor academic (eg, "I am a bad student") and behavioral (eg, "I am a troublemaker") self-concepts are strongly linked to adolescent substance use. Social networks likely influence self-concept. However, little is understood about the role teachers and athletic coaches play in shaping both academic and behavioral self-concepts. Methods: We analyzed cross-sectional surveys of 929 9th-12th grade low-income minority adolescents in Los Angeles assessing self-concept, social networks, and 30-day use of alcohol, marijuana and other drugs. We performed generalized estimating equations, accounting for clustering at the school level and controlling for family and peer influences and contextual factors. We also tested whether self-concept-mediated associations between relationships with teachers or coaches and 30-day substance use. Results: More perceived teacher support was associated with lower odds of marijuana and other drug use and better academic and behavioral self-concepts. Behavioral self-concept mediated the associations between teacher support and substance use. Conclusions: By facilitating relationships with adults and improving teachers' capacity to build supportive environments, schools may positively shape how adolescents see themselves, which might help reduce adolescent substance use.

Background: Text messaging is an increasingly common mode of communication, especially among adolescents, and frequency of texting may be a measure of one's sociability. This study examined how text messaging ("texting") frequency and academic performance are associated with adolescent sexual behaviors. Methods: A cross-sectional survey was administered to students at a public charter high school in Los Angeles County, CA. Two hundred fifty-six high school students aged 14-20?years participated. Outcome measures were history of vaginal sex, condom use, and worries about pregnancy. The main predictors were text messaging frequency and self-reported academic performance. Results: In general, students with lower grades were more likely to have had vaginal sex. Greater texting frequency, however, was associated with vaginal sex only among students with higher grades. In addition, despite similar rates of condom use, sexually active students who both had good grades and texted frequently were more likely than others to have thought they or their partner might be pregnant. Conclusions: The association between texting and sexual behaviors may vary based on adolescent's academic performance. Adolescent sexual health interventions may benefit from using a combination of sociability measures (such as texting frequency) and academic performance as risk predictors.

BACKGROUND AND OBJECTIVES: Academic tracking is a widespread practice, separating students by prior academic performance. Clustering lower performing students together may unintentionally reinforce risky peer social networks, school disengagement, and risky behaviors. If so, mixing lower performing with high performing youth ("untracking") may be protective, leading to better adolescent health. METHODS: Advancement via Individual Determination (AVID), a nationally-disseminated college preparatory program, supports placingmiddle-performing students in rigorous collegepreparatory classes alongside high-performing peers.We conducted the first randomized, controlled trial of AVID in the United States, randomizing 270 students within 5 large public high schools to receive AVID (AVID group) versus usual school programming (control group). Participants completed surveys at the transition to high school (end of eighth grade/ beginning of ninth grade) and the end of ninth grade. Intent-to-treat analyses tested whether AVID resulted in healthier social networks (primary outcome), health behaviors, and psychosocial wellbeing. RESULTS: At follow-up, AVID students had lower odds of using any substance (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.48--0.89) and associating with a substance-using peer (OR 0.74, 95% CI 0.45--0.98), and higher odds of associating with a peer engaged in school (OR 1.73, 95% CI 1.11--2.70). Male AVID students had lower stress and higher self-efficacy, grit, and school engagement than control students (P < .05 for all). No adverse health effects among high-performing peers were observed. CONCLUSIONS: AVID positively impacts social networks, health behaviors, and psychosocial outcomes suggesting academic untrackingmay have substantial beneficial spillover effects on adolescent health. [ABSTRACT FROM AUTHOR]

COVID-19 highlighted the importance of schools for child health, as emerging data suggest that pandemic-related school closures may have led to worsening child health and exacerbated health disparities. This study examines school-aged children’s well-being, and characterizes changes in school-related needs, from 2021 to 2022. This is a secondary analysis of a longitudinal cohort study, where a nationally representative sample of parents of school-aged children were surveyed in June 2021 and 2022. The percentage of children with deficits in total difficulties, hyperactivity, and prosocial behavior decreased at follow-up, while a high percentage of children continued to experience peer problems. At least one school-related need remained for most parents. Highest priority needs were academic enrichment, socialization, physical activity, tutoring, and coping with stress. Academic support and social-emotional well-being remained major parental concerns, with social development showing significant deficit. Improvements in child well-being were experienced unequally across demographic groups. [ABSTRACT FROM AUTHOR]

Objectives: Although dental decay is preventable, it remains the most common pediatric chronic disease. We describe a public health approach to implementing a scalable and sustainable school-based oral health program for low-income urban children.Methods: The Los Angeles Trust for Children's Health, a nonprofit affiliated with the Los Angeles Unified School District, applied a public health model and developed a broad-based community-coalition to a) establish a District Oral Health Nurse position to coordinate oral health services, and b) implement a universal school-based oral health screening and fluoride varnishing program, with referral to a dental home. Key informant interviews and focus groups informed program development. Parent surveys assessed preventative oral health behaviors and access to oral health services. Results from screening exams, program costs and rates of reimbursement were recorded.Results: From 2012 to 2015, six elementary schools and three dental provider groups participated. Four hundred ninety-one parents received oral health education and 89 served as community oral health volunteers; 3,399 screenings and fluoride applications were performed on 2,776 children. Sixty-six percent of children had active dental disease, 27 percent had visible tooth decay, and 6 percent required emergent care. Of the 623 students who participated for two consecutive years, 56 percent had fewer or no visible caries at follow-up, while only 17 percent had additional disease. Annual program cost was $69.57 per child.Conclusions: Using a broad based, oral health coalition, a school-based universal screening and fluoride varnishing program can improve the oral health of children with a high burden of untreated dental diseases. [ABSTRACT FROM AUTHOR]