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PurposeSchool social capital incorporates the intangible prosocial resources from social networks, including expectations and social norms, found in a school environment. School social capital may influence health behaviors such as smoking. This study examined the association of school social capital with smoking behaviors from childhood into adolescence.MethodsWe used a cohort sampled from three U.S. cities for the Healthy Passages Longitudinal Study of Adolescent Health. The primary outcome was cigarette smoking at grade 10 (Wave 3). The primary predictor of interest was school social capital at grade 5 (Wave 1). We included potential covariates at the individual, school, and neighborhood levels at Wave 1. To account for simultaneous clustering in schools and neighborhoods, cross-classified multilevel models were used.ResultsAfter exclusions and imputations for missing variables, our final sample contained 3,968 students as constituents of 118 schools and 479 neighborhoods. With adjustment for the covariates, school social capital for grade 5 was negatively associated with cigarette smoking in grade 10. We estimated that a 1 standard deviation increase in the school average social capital for grade 5 is associated with an odds ratio of .86 (95% credible interval: .75-.98) for school-level smoking in grade 10.ConclusionsThis study suggests that school social capital in late elementary years is associated with reduced smoking behaviors among adolescents in the U.S. Influencing school social capital through enrichment of positive social norms and parent/teacher expectations may be a useful strategy to reduce adolescent smoking, with long-term implications for adult health.

PurposePrevious research has indicated that patients with anorexia nervosa (AN) or atypical AN with premorbid history of overweight/obesity have greater weight loss and longer illness duration than patients with no such history. However, little is known about the association of premorbid overweight/obesity and receiving inpatient medical care during treatment for an eating disorder.MethodsUsing logistic regression, we sought to determine if history of overweight/obesity was associated with receiving inpatient medical care in a sample of 522 patients (mean age 15.5 years, 88% female) with AN/atypical AN.ResultsBinary results demonstrated greater percent weight loss (27.4% vs. 16.2%) and higher percent median body mass index (%mBMI, 99.8% vs. 85.2%) at presentation in those with a history of overweight/obesity (p < .001) but no difference in duration of illness (p = .09). In models adjusted for demographics and percent weight loss, history of overweight/obesity was associated with lower odds of receiving inpatient medical care (odds ratio .60 [95% confidence interval: .45-.80]) at 1-year follow-up. However, these associations were no longer significant after adjusting for %mBMI. Mediation results suggest that %mBMI fully mediates the relationship between history of overweight/obesity and inpatient medical care, in that those with a history of overweight/obesity are less likely to receive care due to presenting at a higher weight.ConclusionsOur findings suggest that, despite greater degree of weight loss and no difference in duration of illness, participants with a history of overweight/obesity are less likely to receive inpatient medical care.

Background: Social capital in neighborhoods and workplaces positively affects health. Less is known about the influence of school social capital on student health outcomes, in particular weight status. We sought to examine the association between individual- and school-level social capital and student body mass index (BMI). Methods: Analyzing data from the National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents in grades 7-12 (N = 13,428), we used principal components analysis to define 3 school social capital factors: "connectedness" (feel part of/close to people/safe in school), "treatment" (get along with teachers/students, teachers treat students fairly), and "parental involvement" (school administrator reported percent family/parent self-reported participation in Parent Teacher Organization, average daily school attendance). We examined the associations between individual- and school-level social capital and individual BMI using multilevel modeling techniques. Results: In girls, both feeling connected to one's school (ß = -0.06, p < 0.05) and attending schools with overall high connectedness (b = -0.43, p < 0.01) were associated with lower BMIs. In boys only attending a school with high "treatment" was inversely associated with BMI (b = -0.61, p < 0.01), adjusting for individual and school demographics. Conclusions: Although further studies are needed, our findings suggest enhancing school social capital as a novel approach to addressing student obesity.

Objectives: To assess the occurrence rate, characteristics, and impact of eating disorders (EDs) in adolescents with epilepsy. Methods: In this observational study, adolescents with epilepsy seen in a single center between 2013 and 2022 who had comorbid EDs were compared to two control groups of adolescents with only epilepsy and only EDs. Patients with intellectual disability or autism spectrum disorder were excluded. Data retrieved included demographic and anthropometric details and clinical variables relating to seizure types, EDs, and psychiatric disorders and behaviors. Results: A total of 376 subjects were included in the study: 84 adolescents with both epilepsy and eating disorders, 135 with only epilepsy, and 157 with only EDs. The rate of EDs in adolescents with epilepsy was 7.0% (95% confidence interval [CI] 5.6%–8.5%) overall, 11.3% (95% CI 8.8%–14.3%) in females, and 3.1% (95% CI 1.9%–4.8%) in males. The median (interquartile range [IQR]) time difference between the onset of epilepsy to an ED was 1.6 (.5–3.6) years. Among adolescents with epilepsy, those with an ED were more likely to be female (p =.001) and have a lower body mass index z‐score (zBMI) percentile (p <.001). Epilepsy type, seizure frequency, or seizure duration were not specific for having or not having EDs. Among adolescents with EDs, those with epilepsy had a younger onset of their EDs (p <.001), included relatively more males (p =.007), and consisted of more cases of anorexia‐nervosa‐restrictive type (p <.001), and fewer cases of bulimia nervosa (p =.04) and binge eating disorder (p =.003). Adolescents with epilepsy and a comorbid ED were more likely to have psychiatric comorbidities such as depression, anxiety, and suicidality than adolescents with only epilepsy or EDs. Significance: EDs should be suspected and screened for in intellectually intact female and male adolescents with epilepsy, irrespective of their epilepsy type. If disturbed eating behaviors or EDs are identified, further evaluation should be directed at detecting other psychopathologies, including suicidality. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Recent studies have reported increasing eating disorder incidence and severity following the coronavirus disease 2019 (COVID-19) pandemic. In a diverse cohort of pediatric hospitals, we examined trends in the volume of emergency visits and inpatient admissions for eating disorders before and during the pandemic. METHODS: We examined monthly trends in volume of patients with eating disorders (identified by principal International Classification of Diseases, 10th Revision, diagnosis codes) across 38 hospitals in the Pediatric Health Information System pre-- (January 2018--March 2020) and post--COVID-19 onset (April 2020--June 2022). Using interrupted time series analysis, we examined the pre- and post monthly trends in eating disorder emergency and inpatient volume. RESULTS: Before the pandemic, eating disorder emergency visit volume was increasing by 1.50 visits per month (P5 .006), whereas in the first year postonset, visits increased by 12.9 per month (P < .001), followed by a 6.3 per month decrease in the second year postonset (P < .001). Pre--COVID-19, eating disorder inpatient volume was increasing by 1.70 admissions per month (P5 .01). In the first year postonset, inpatient volume increased by 11.9 per month (P < .001), followed by a 7.6 per month decrease in the second year postonset (P < .001). CONCLUSIONS: The volume of patients seeking emergency and inpatient eating disorder care at pediatric hospitals has increased dramatically since the pandemic onset and has not returned to prepandemic levels despite a decline in the second year postonset, with important implications for hospital capacity. [ABSTRACT FROM AUTHOR]