Recreational Cannabis Legalization, Retail Sales, and Adolescent Substance Use Through 2021.

This cross-sectional study using survey datasets evaluates recreational cannabis legalization and retail sales policies and adolescent substance use through 2021.

Emerging Adult Mental Health During COVID: Exploring Relationships Between Discrete and Cumulative Individual and Contextual Stressors and Well-Being.

PURPOSE: Indicators of poor mental health increased during the COVID-19 pandemic among emerging adults aged 18-24 years, a group already at elevated risk. This study explores associations between contextual and personal stressors with symptoms of emerging adults' anxiety and depression, assessing both multidimensional and distinct measures of stress. METHODS: Using Census Household Pulse Surveys from emerging adults aged 18 to 24 years (N = 71,885) and administrative data from April 23, 2020 to March 29, 2021, we estimated logistic regression models adjusted for state and wave fixed effects. RESULTS: Rates of elevated anxiety and depressive symptoms rose dramatically among emerging adults during the first year of the COVID-19 pandemic. Results indicate that potential contextual stressors-state COVID-19 rates and state COVID-19 mitigation policies limiting social interactions (stay-at-home orders, restaurant closures, large gathering restrictions, and mask mandates)-were not significantly associated with symptoms. In contrast, personal economic stressors (nonemployment, household income loss, food insecurity, housing insecurity, lacking health insurance) and disruptions to education were associated significantly with elevated anxiety and depressive symptoms, with greater numbers of stressors associated with worse well-being. DISCUSSION: Emerging adults reported persistently high levels of elevated anxiety and depressive symptoms during the first year of the pandemic, outcomes associated not with COVID-19 rates or mitigation policies, but with economic inequities, and other personal stressors heightened by the pandemic. Providing targeted support for young adults, including ensuring access to mental health supports, health care, and economic relief, is critical.

COVID-19 vaccinations and mental health among U.S. adults: Individual and spillover effects.

RATIONALE: The COVID-19 pandemic led to dramatic increases not only in physical illness, but also in mental health symptoms and disorders among U.S. adults. Although the introduction of COVID-19 vaccines dramatically lowered rates of physical illness and death, little is known about the effects of vaccines on mental health. OBJECTIVES: We assessed both individual and spillover effects of COVID-19 vaccination on mental health disorders, and whether effects of individual vaccination varied based on contextual risks indicated by state infection rates and state vaccination rates. METHODS: Using data from the Household Pulse Survey, we assessed 448,900 adults surveyed within approximately the first six months of the U.S. vaccine rollout (February 3 - August 2, 2021). Coarsened exact matching balanced vaccinated and non-vaccinated participants on demographic and economic characteristics. RESULTS: Logistic regression analyses found 7% lowered odds of depression among vaccinated individuals, but no significant difference in anxiety. Reflecting potential spillover effects, state vaccination rates predicted lowered odds of anxiety and depression (1% decrease in odds for each additional 1% of the state population vaccinated). Although state COVID-19 infection rates did not moderate effects of individual vaccination on mental health outcomes, significant interactions indicated that effects of individual vaccination on mental health were stronger in contexts of lower state vaccination rates, and links between state vaccination rates and mental health problems were stronger among unvaccinated individuals. CONCLUSIONS: Results suggest that COVID-19 vaccinations improved the mental health of adults in the U.S., with lower rates of self-reported mental health disorders both among vaccinated individuals themselves and among other individuals living in the same state, particularly when those individuals were not themselves vaccinated. These direct and spillover effects on mental health expand our understanding of the benefits of COVID-19 vaccination for the wellbeing of adults in the U.S.

COVID-19-Related Stressors and Mental Health Disorders Among US Adults.

OBJECTIVES: The COVID-19 pandemic has led to severe mental health repercussions. We examined rates of anxiety and depression in the United States during the pandemic by demographic characteristics, individual stressors, and COVID-19 infection rates and policy contexts. METHODS: We merged data from the April 2020-March 2021 US Household Pulse Survey with state-level data on COVID-19 rates and mitigation policies, including stay-at-home orders, face mask mandates, and restaurant closures. We estimated weighted logistic regression models to assess correlates of anxiety and depression. RESULTS: Rates of anxiety and depression peaked in late 2020 at 39% and 32%, respectively. Food insecurity and disrupted medical care were associated with more than twice the odds of anxiety and depression (food insecurity: odds ratio [OR] = 2.58 for anxiety and 2.61 for depression; disrupted medical care: OR = 2.40 and 2.27). Being not employed (OR = 1.32 for anxiety and 1.45 for depression), uninsured (OR = 1.30 and 1.38), housing insecure (OR = 1.41 and 1.34), and experiencing disruptions in education (OR = 1.28 and 1.25) were linked to 25% to 45% increased odds of anxiety and depression. Increases in state COVID-19 infection rates were associated with significantly heightened odds of anxiety and depression (OR = 1.01 for anxiety and depression), but state mitigation policies were not. CONCLUSIONS: Levels of anxiety and depression rose during the pandemic, particularly among economically vulnerable individuals and those experiencing economic and service disruptions. Future research should assess the effectiveness of policies targeting COVID-19 economic and service disruptions.

Prevalence of Adolescent Handgun Carriage: 2002-2019.

OBJECTIVES: This study explores the changing prevalence of adolescent handgun carriage, with attention to differences across sociodemographic groups. METHODS: Data were drawn from repeated cross-sectional, nationally representative surveys conducted annually from 2002 to 2019, the National Survey on Drug Use & Health. The study sample included adolescents aged 12 to 17 (N = 297 055). Logistic regression models estimated the prevalence of past year handgun carriage across cohort and sociodemographic subgroups. Interactions between 4-time cohorts and other variables explored sociodemographic variability in prevalence rates over time. RESULTS: Handgun carriage increased significantly, particularly among rural, White, and higher-income adolescents. Carriage increased by 41% over cohorts, with predicted prevalence rates increasing from 3.3% in 2002-2006 to 4.6% in 2015-2019. Across cohorts, rural (5.1%), American Indian/Alaskan Native (5.2%), lower-income (<$20 000; 3.9%), male (5.9%), and older (16-17 years old; 4.5%) adolescents were the most likely to report carriage. However, these patterns changed significantly over time, with White and higher-income adolescents (>$75 000) most likely to carry in the most recent cohorts. Predicted carriage rates increased from 3.1% to 5.3% among White adolescents, from 2.6% to 5.1% among higher-income adolescents, and from 4.3% to 6.9% among rural adolescents between the 2002-2006 and 2015-2019 cohorts. Carriage among Black, American Indian/Alaskan Native, and lower-income adolescents decreased. CONCLUSIONS: Adolescent handgun carriage is increasing, concentrated among particular subgroups of youth, and carriage patterns across sociodemographic groups have changed over time. Programs to address the risk of adolescent gun carriage should be tailored to the specific sociocultural and place-based concerns of diverse adolescents.

Examining Economic Risks in Adolescents' Families, Neighborhoods, and Schools: Implications for Mental and Behavioral Health in Early Adulthood.

PURPOSE: This study assessed long-term links among adolescent family, neighborhood, and school economic contexts and mental and behavioral health in early adulthood, irrespective of adult economic contexts. METHODS: Data were drawn from Add Health, following 10,180 participants from adolescence through early adulthood in the United States. Early adults self-reported on their depressive symptoms, perceived psychological stress, and alcohol use disorder. Income at family and school levels was drawn from youth and parent report; neighborhood income was derived from US Census Data. Multilevel models assessed associations between income in adolescence and early adult outcomes 13 years later while accounting for adolescent outcomes and income in early adulthood. Links with depressive symptoms and stress were assessed utilizing ordinary least squares regression; alcohol use disorder was assessed using ordered logistic regression. Nonlinearities in income effects were assessed with quadratic income variables in adolescence and early adulthood. RESULTS: Family income emerged as the most consistent predictor of depressive symptoms (p < .01) and stress (p < .01), showing negative curvilinear associations. In contrast, exposure to higher income schools (p < .01) and neighborhoods (p < .01) during adolescence was associated with heightened risks for alcohol use disorder in early adulthood. These links emerged over and above concurrent negative connections between early adult family and neighborhood economic contexts and depressive symptoms and stress. DISCUSSION: Findings call attention to persistent health-related risks across the income spectrum-not only at the lower end-and also highlight the long-term importance of broader economic contexts beyond the family context.

Political to Personal: Shifts in Youths' Attitudes Following the 2016 U.S. Presidential Race and Election.

Sociopolitical events have been associated with shifts in youth mental health and attitudes. This study assessed six cohorts of American 12th graders (2012-2017) to examine trends in youths' attitudes about themselves, the future, and others surrounding the U.S. 2016 presidential race and election. Analyses assessed overall trends and variation by political affiliation. Results indicated a rise across cohorts in future pessimism and nihilism after 2015, driven by youth identified as Democrat rather than Republican. A rise in concern for others was similarly driven by Democrat youth, whereas a rise in value of diversity was shared across all political identities. In contrast, Republican youth cohorts reported increasing external locus of control relative to their Democratic peers. Implications are discussed.

Trends in mental health symptoms, service use, and unmet need for services among US adults through the first 8 months of the COVID-19 pandemic.

The COVID-19 pandemic has led to rising morbidity, mortality, and social and economic disruption, likely impairing mental health. The purpose of this study was to track trends in mental health symptoms, use of services, and unmet need for services among US adults, and to delineate variation across demographic strata. Data were drawn from the 2020 US Household Pulse Survey from repeated cross-sectional online surveys collected between April 23 and November 23, 2020 from 1,302,455 US adults, weighted to represent the US population. Survey respondents self-reported their symptoms of anxiety and depression, use of medication and counseling services, and unmet need for services. Reports of probable anxiety and depression rose significantly through the study period, to prevalence rates of 37% and 29%, respectively, by November, 2020, rates more than four times higher than early 2019 US norms. Use of prescription medication, counseling services, and unmet need for mental health services also rose significantly. Prevalence rates of probable mental health disorders were highest among young, less educated, single parent, female, Black and multi-racial respondents, with some vacillation in such disparities over cohorts. Young, female, and moderately educated respondents also reported higher unmet needs for services. Disparities in estimates of mental health disorders and mental health treatment indicate a striking disequilibrium between the potential need for and the use of mental health services during the COVID-19 pandemic. Rising mental health challenges are being borne largely by young, less advantaged people of color and women, with the potential for expanded interruptions to optimal functioning and societal recovery from COVID-19.

The myriad stressors imposed by the COVID-19 pandemic have impaired mental health and wellbeing. Although evidence from early in the pandemic revealed elevated rates of mental health conditions, research has not documented whether psychological disorders have continued to rise as the pandemic has persisted. In this research, we assess data from over 1.3 million US adults who participated in cross-sectional surveys between April and November, 2020 to track trends in mental health disorder symptoms and services. Our results show that reports of anxiety and depression rose significantly from April to November, 2020 to rates more than four-times higher than in 2019. We also found evidence of growing unmet need for mental health services. Rising mental health challenges are being borne largely by young, less advantaged people of color and women. Growing disparities in mental health disorders and treatment raise concerns for psychological, social, and economic recovery from COVID-19.

Trends in mental health symptoms, service use, and unmet need for services among U.S. adults through the first 9 months of the COVID-19 pandemic.

The COVID-19 pandemic has led to rising morbidity, mortality, and social and economic disruption, likely impairing mental health. The purpose of this study was to track trends in mental health symptoms, use of services, and unmet need for services among U.S. adults and to delineate variation across demographic strata. Data were drawn from the 2020 U.S. Household Pulse Survey from repeated cross-sectional online surveys collected between April 23 and November 23, 2020 from 1,483,378 US adults, weighted to represent the U.S. population. Survey respondents self-reported their symptoms of anxiety and depression, use of medication, counseling services, and unmet need for services. Reports of probable anxiety and depression rose significantly through the study period, to prevalence rates of 50% and 44%, respectively, by November 2020, rates six times higher than early 2019 U.S. norms. Use of prescription medication, counseling services, and unmet need for mental health services also rose significantly. Prevalence rates of probable mental health disorders were highest among young, less educated, single, female, Black and Hispanic respondents, with age and education disparities growing over cohorts. Young, female, and moderately educated respondents also reported higher unmet needs for services. Disparities in estimates of mental health disorders and mental health treatment indicate a striking disequilibrium between the potential need for and the use of mental health services during the COVID-19 pandemic. Rising mental health challenges are being borne largely by young, less advantaged people of color and women, with the potential for expanded interruptions to optimal functioning and societal recovery from COVID-19.

The myriad stressors imposed by the COVID-19 pandemic have impaired mental health and well-being. Although evidence from early in the pandemic revealed elevated rates of mental health conditions, research has not documented whether psychological disorders have continued to rise as the pandemic has persisted. In this research, we assess data from nearly 1.5 million U.S. adults who participated in cross-sectional surveys each week from April through November 2020 to track trends in mental health disorder symptoms and services. Our results show that reports of anxiety and depression rose significantly from April to November 2020 to rates six times higher than in 2019. We also found evidence of growing unmet need for mental health services. Rising mental health challenges are being borne largely by young, less advantaged people of color and women. Growing disparities in mental health disorders and treatment raise concerns for psychological, social, and economic recovery from COVID-19.

Recreational Marijuana Legalization and Adolescent Use of Marijuana, Tobacco, and Alcohol.

PURPOSE: Given the rapid expansion of recreational marijuana legalization (RML) polices, it is essential to assess whether such policies are associated with shifts in the use of marijuana and other substances, particularly for adolescents, who are uniquely susceptible to negative repercussions of marijuana use. This analysis seeks to provide greater generalizability, specificity, and methodological rigor than limited prior evidence. METHODS: Youth Risk Behavior Survey data from 47 states from 1999 to 2017 assessed marijuana, alcohol, cigarette, and e-cigarette use among adolescents (14-18+ years; N = 1,077,938). Associations between RML and adolescent past-month substance use were analyzed using quasi-experimental difference-in-differences zero-inflated negative binomial models. RESULTS: Controlling for other state substance policies, year and state fixed effects, and adolescent demographic characteristics, models found that RML was not associated with a significant shift in the likelihood of marijuana use but predicted a small significant decline in the level of marijuana use among users (incidence rate ratio = .844, 95% confidence interval [.720-.989]) and a small increase in the likelihood of any e-cigarette use (odds ratio of zero use = .647, 95% confidence interval [.515-.812]). Patterns did not vary over adolescent age or sex, with minimal differences across racial/ethnic groups. CONCLUSIONS: Results suggest minimal short-term effects of RML on adolescent substance use, with small declines in marijuana use and increase in the likelihood of any e-cigarette use. Given the delayed rollout of commercial marijuana sales in RML states and rapid expansion of RML policies, ongoing assessment of the consequences for adolescent substance use and related health and behavioral repercussions is essential.

Concentrated poverty in preschools and children's cognitive skills: The mediational role of peers and teachers.

Economic inequality and ensuing economic stratification in educational and community contexts are growing in the United States. Given these patterns, it is essential to understand the implications of economic stratification in early education settings. This paper delineates repercussions of the concentration of poor children in preschool programs using lagged structural equation models estimated in two longitudinal studies following 3396 4-year-old children in 486 primarily publicly-funded preschool classrooms through kindergarten entrance. Concentrated poverty in preschool classrooms was associated with lower language and reading skills in kindergarten in part through children's exposure to less cognitively-skilled peers, with teacher instructional quality not serving as a reliable mediator. These associations did not emerge in relation to children's math skills. Results expand conceptual models of peer effects and inform preschool policies which seek to increase quality and equity and enhance children's learning.

Secular Trends in Adolescent Depressive Symptoms: Growing Disparities between Advantaged and Disadvantaged Schools.

Growing economic inequality across the family and school contexts that adolescents inhabit may have significant consequences for their psychological well-being. Yet little research has assessed the mental health repercussions of economic inequities or whether such repercussions have shifted with rising inequality. This study assessed annual Monitoring the Future surveys with 8th (n = 124,468; age 13; 59 percent White, 41 percent students of color), 10th (n = 164,916; age 15; 65 percent white, 35 percent students of color), and 12th (n = 60,664; age 17; 66 percent white, 34 percent students of color) grade students from 1989-2017. Analyses tracked secular trends in adolescent depressive symptoms and assessed whether family and school socioeconomic status (SES) disparities in depressive symptoms have shifted over time. Depressive symptoms showed significant elevations in 2014-2017 among 8th, 10th, and 12th graders over 2010-2013 levels. Pervasive small SES gaps were found in adolescent depressive symptoms, with youth from lower SES families and lower SES schools reporting higher depressive symptoms than their more advantaged peers across all grades. Family SES gaps remained stable over recent decades, whereas school SES gaps rose significantly in recent years across all grades and genders, suggesting that the recent rise in depressive symptoms is driven by adolescents in low SES schools. The results suggest that repercussions of growing economic inequality may extend to psychological outcomes, and identify the need for greater preventive and intervention services targeting adolescent mental health.

Poverty and Academic Achievement Across the Urban to Rural Landscape: Associations with Community Resources and Stressors.

Poor children begin school with fewer academic skills than their nonpoor peers, and these disparities translate into lower achievement, educational attainment, and economic stability in adulthood. Child poverty research traditionally focuses on urban or rural poor, but a shifting spatial orientation of poverty necessitates a richer examination of how urbanicity intersects with economic disadvantage. Combining geospatial administrative data with longitudinal survey data on poor children from kindergarten through second grade (N ≈ 2,950), this project explored how differences in community-level resources and stressors across urbanicity explain variation in achievement. Resources and stressors increased in more urbanized communities and were associated with academic achievement. Both mediated differences in poor children's achievement. Mediation was both direct and indirect, operating through cognitive stimulation and parental warmth.

A quasi-experimental evaluation of marijuana policies and youth marijuana use.

BACKGROUND: Marijuana use carries risks for adolescents' well-being, making it essential to evaluate effects of recent marijuana policies. OBJECTIVES: This study sought to delineate associations between state-level shifts in decriminalization and medical marijuana laws (MML) and adolescent marijuana use. METHODS: Using data on 861,082 adolescents (14 to 18+ years; 51% female) drawn from 1999 to 2015 state Youth Risk Behavior Surveys (YRBS), difference-in-differences models assessed how decriminalization and MML policy enactment were associated with adolescent marijuana use, controlling for tobacco and alcohol policy shifts, adolescent characteristics, and state and year trends. RESULTS: MML enactment was associated with small significant reductions (OR = 0.911, 95% CI [0.850, 0.975]) of 1.1 percentage points in current marijuana use, with larger significant declines for male, Black, and Hispanic (2.7-3.9 percentage points) adolescents. Effects of MML increased significantly with each year of exposure (OR = 0.980, 95% CI [0.968, 0.992]). In contrast, decriminalization was not associated with significant shifts in use for the sample as a whole, but predicted significant declines in marijuana use among 14-year olds and those of Hispanic and other ancestry (1.7-4.4 percentage points), and significant increases among white adolescents (1.6 percentage points). Neither policy was significantly associated with heavy marijuana use or the frequency of use, suggesting that heavy users may be impervious to such policy signals. CONCLUSION: As the first study to concurrently assess unique effects of multiple marijuana policies, results assuage concerns over potential detrimental effects of more liberal marijuana policies on youth use.

Variations in links between educational success and health: Implications for enduring health disparities.

OBJECTIVES: Educational achievement and attainment have been posited to narrow health disparities seen across the socioeconomic spectrum and among racial and ethnic groups. Yet emerging evidence suggests that striving for educational success in contexts of marginalization may actually dysregulate physiological stress processes, thereby exacerbating rather than narrowing health disparities. Utilizing an allostatic load perspective and data drawn from a nationally representative sample, this study sought to clarify these links by attending to potential variation across the socioeconomic spectrum and among racial and ethnic groups. METHOD: Drawing on data from the National Longitudinal Study of Adolescent Health, multilevel regression analyses considered prospective associations between educational achievement and attainment and allostatic load among 12,672 young adults followed from ages 16 to 29 years. Interaction terms considered the potential for variation across the socioeconomic spectrum and among racial/ethnic groups. RESULTS: Findings revealed promotive links between educational attainment and physiological health but also suggested that benefits were not shared by all youth. Although links were consistent across the socioeconomic spectrum, non-Hispanic Black and Mexican American youth experienced reversed links-with educational attainment presaging higher rather than lower levels of allostatic load. CONCLUSION: These results extend this arena of work by highlighting the role that racial and ethnic-rather than socioeconomic-marginality plays in differential links between educational success and physiological health. Additional longitudinal research is necessary to discern the processes and contexts that may link educational success with differential later health among racial and ethnic groups. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Are the Benefits of Economic Resources for Socioemotional Functioning Shared across Racial/Ethnic Groups?

Growth in economic disparities, economic segregation, and racial/ethnic diversity have occurred in tandem in the U.S., leading to essential questions concerning whether the benefits of economic resources are shared across diverse groups. Analyzing a sample of eighth grade early adolescents (age 14 years) drawn from the nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (N = 7625; 59% White, 12% Black, 19% Hispanic, 7% Asian, 2% Native American, and 2% multiracial; 47% female), lagged regression models assessed links between family, neighborhood, and school income and adolescent emotional and behavioral functioning. The results found that family income was associated with heightened emotional and behavioral functioning, and school income with improved behavioral functioning for White adolescents, whereas no benefits emerged for Black or Hispanic youth. In contrast, mixed associations emerged between income and early adolescent functioning for Asian and American Indian youth, with predominantly negative links appearing for multiracial youth. These patterns highlight diversity in the potential benefits and costs of economic resources, and suggest the need to better specify mechanisms through which economic disparities affect youth from varied backgrounds.

Locating Economic Risks for Adolescent Mental and Behavioral Health: Poverty and Affluence in Families, Neighborhoods, and Schools.

Research has identified risks of both poverty and affluence for adolescents. This study sought to clarify associations between income and youth mental and behavioral health by delineating economic risks derived from family, neighborhood, and school contexts within a nationally representative sample of high school students (N = 13,179, average age 16). Attending schools with more affluent schoolmates was associated with heightened likelihoods of intoxication, drug use, and property crime, but youth at poorer schools reported greater depressive and anxiety symptoms, engagement in violence, and for male adolescents, more frequent violence and intoxication. Neighborhood and family income were far less predictive. Results suggest that adolescent health risks derive from both ends of the economic spectrum, and may be largely driven by school contexts.

Environmental risks outweigh dopaminergic genetic risks for alcohol use and abuse from adolescence through early adulthood.

BACKGROUND: Alcohol use is a primary public health concern, particularly among adolescents and young adults. Based on the rapidly growing field of gene-environment models, this study assessed the combined role of environmental and dopamine-related genetic correlates of early alcohol use and abuse. METHODS: Multilevel growth models assessed trajectories of alcohol use and intoxication and ordered logistic regressions assessed alcohol use disorder among a sample of 12,437 youth from the nationally representative Add Health study who were followed from mid-adolescence through early adulthood. RESULTS: Endogenous and exogenous stressful life events and social norms supportive of alcohol use from parents and peers were significant predictors of alcohol use, intoxication, and alcohol use disorder, with consistent patterns across males and females. In contrast, a dopamine-system genetic risk score (GRS) was not associated with alcohol use trajectories nor alcohol use disorder in early adulthood, although weak connections emerged between the GRS and growth trajectories of intoxication, indicating that higher GRS predicted more frequent episodes of intoxication during the transition to adulthood but not during adolescence or later 20s. No evidence of gene-environment interactions emerged. CONCLUSIONS: Results extend a substantial body of prior research primarily assessing single genetic polymorphisms in the dopamine system, suggesting that dopaminergic GRSs may be associated with more problematic alcohol behaviors at some developmental periods, but further, that social norms and stressful life experiences are more consistent correlates of early and problematic alcohol use among youth. These environmental factors present potential targets for research manipulating contexts to identify causal pathways.

Early Maternal Employment and Children's Academic and Behavioral Skills in Australia and the United Kingdom.

This study assessed the links between early maternal employment and children's later academic and behavioral skills in Australia and the United Kingdom. Using representative samples of children born in each country from 2000 to 2004 (Australia N = 5,093, U.K. N = 18,497), OLS regression models weighted with propensity scores assessed links between maternal employment in the 2 years after childbearing and children's skills in first grade. There were neutral associations between maternal employment and children's first-grade skills in both countries. However, there was a slight indication that more time away from parenting was negatively linked to children's behavioral functioning in Australia and employment begun between 9 and 24 months was positively linked to cognitive skills for U.K. children of low-wage mothers.