Structure and trends of externalizing and internalizing psychiatric symptoms and gender differences among adolescents in the US from 1991 to 2018.

PURPOSE: We aimed to estimate the structure of internalizing and externalizing symptoms and potential time dynamics in their association. This is understudied among adolescents, despite increasing internalizing and decreasing externalizing symptoms in recent years. METHODS: We analyzed data from US Monitoring the Future cross-sectional surveys (1991-2018) representative of school-attending adolescents (N = 304,542). Exploratory factor analysis using maximum likelihood estimation method and promax rotation resulted in a two-factor solution (factor correlation r = 0.24) that differentiated eight internalizing and seven conduct-related externalizing symptoms. Time-varying effect modification linear regression models estimated the association between standardized internalizing and externalizing symptoms factor scores over time overall and by gender. RESULTS: In 2012, trends in average factor scores diverged for internalizing and externalizing factors. The average standardized internalizing factor score increased from - 0.03 in 2012 to 0.06 in 2013 and the average externalizing factor score decreased from - 0.06 in 2011 to - 0.13 in 2012. We found that for every one-unit increase in standardized internalizing factor score, standardized externalizing factor score increased by 0.224 units in 2010 (95% CI: 0.215, 0.233); the magnitude of this increase was 22.3% lower in 2018 (i.e., 0.174 units; 95% CI: 0.160, 0.188). Decoupling of internalizing and externalizing symptoms began earlier among boys (~ 1995) than among girls (~ 2010). CONCLUSION: The decoupling of internalizing and externalizing symptoms among adolescents suggests that changes in the prevalence of shared risk factors for adolescent psychiatric symptoms affect these dimensions in opposing directions, raising the importance of considering symptoms and their risk factors together in prevention and intervention efforts.

Association between county jail incarceration and cause-specific county mortality in the USA, 1987-2017: a retrospective, longitudinal study.

BACKGROUND: Mass incarceration has collateral consequences for community health, which are reflected in county-level health indicators, including county mortality rates. County jail incarceration rates are associated with all-cause mortality rates in the USA. We assessed the causes of death that drive the relationship between county-level jail incarceration and mortality. METHODS: In this retrospective, longitudinal study, we assessed the association between county-level jail incarceration rates and county-level cause-specific mortality using county jail incarceration data (1987-2017) for 1094 counties in the USA obtained from the Vera Institute of Justice and cause-specific mortality data for individuals younger than 75 years in the total county population (1988-2018) obtained from the US National Vital Statistics System. We fitted quasi-Poisson models for nine common causes of death (cerebrovascular disease, chronic lower respiratory disease, diabetes, heart disease, infectious disease, malignant neoplasm, substance use, suicide, and unintentional injury) with county fixed effects, controlling for all unmeasured stable county characteristics and measured time-varying confounders (county median age, county poverty rate, county percentage of Black residents, county crime rate, county unemployment rate, and state incarceration rate). We lagged county jail incarceration rates by 1 year to assess the short-term, by 5 years to assess the medium-term, and by 10 years to assess the long-term associations of jail incarceration with premature mortality. FINDINGS: A 1 per 1000 within-county increase in jail incarceration rate was associated with a 6·5% increase in mortality from infectious diseases (risk ratio 1·065, 95% CI 1·061-1·070), a 4·9% increase in mortality from chronic lower respiratory disease (1·049, 1·045-1·052), a 2·6% increase in mortality induced from substance use (1·026, 1·020-1·032), a 2·5% increase in suicide mortality (1·025, 1·020-1·029), and smaller increases in mortality from heart disease (1·021, 1·019-1·023), unintentional injury (1·015, 1·011-1·018), malignant neoplasm (1·014, 1·013-1·016), diabetes (1·013, 1·009-1·018), and cerebrovascular disease (1·010, 1·007-1·013) after 1 year. Associations between jail incarceration and cause-specific mortality rates weakened as time lags increased, but to a greater extent for causes of death with generally shorter latency periods (infectious disease and suicide) than for those with generally longer latency periods (heart disease, malignant neoplasm, and cerebrovascular disease). INTERPRETATION: Jail incarceration rates are potential drivers of many causes of death in US counties. Jail incarceration can be harmful not only to the health of individuals who are incarcerated, but also to public health more broadly. Our findings suggest important points of intervention, including disinvestment from carceral systems and investment in social and public health services, such as community-based treatment of substance-use disorders. FUNDING: US National Institute on Drug Abuse (National Institutes of Health).

Associations between digital technology and substance use among U.S. adolescents: Results from the 2018 Monitoring the Future survey.

OBJECTIVE: Social media and other digital technology use facilitate connection among adolescents, but also may reinforce norms and substance-related content from peers and advertisers. We use nationally representative data to examine the association between digital technology and past 30-day use of alcohol, cannabis, and vaping. METHODS: Data were drawn from the 2018 Monitoring the Future survey of US adolescents (N = 44,482). Poisson regressions estimated the association between hours/day of technology use and past 30-day use of alcohol, cannabis, and vaping adjusting for grade, sociodemographics, and other past-year drug use. RESULTS: Across grades, mean hours of social media/day was 3.06 (standard deviation = 2.90), past 30-day alcohol, cannabis, flavor vaping, cannabis vaping, and nicotine vaping were 15.7 %, 12.6 %, 10.6 %, 4.9 %, and 11.2 %, respectively. Digital technology use that required interaction with others was associated with increased risk of past 30-day drinking, cannabis use, and vaping. For example, social media 3+ hours/day was associated with past 30-day drinking (adjusted relative risk [aRR]: 1.99, 95 % CI: 1.65, 2.41). The magnitude of association was consistent across texting, phone calls, and video chatting, which were all more strongly associated with substance use than with activities that do not require interaction such as gaming and watching videos. CONCLUSION: Digital technology that facilitates interaction among adolescents, such as texting and social media, is associated with past substance use. Magnitudes of association are consistent across substances, supporting the hypothesis that networks of adolescents are social drivers of substance use, rather than the technology itself.

County Jail Incarceration Rates and County Mortality Rates in the United States, 1987-2016.

Objectives. To evaluate the relationship between changes in county jail incarceration rates and subsequent county mortality rates across the United States.Methods. We analyzed county jail incarceration rates from the Bureau of Justice Statistics from 1987 to 2016 for 1884 counties and mortality rates from the National Vital Statistics System. We fit 1-year-lagged quasi-Poisson 2-way fixed-effects models, controlling for unmeasured stable county characteristics, and measured time-varying confounders, including county poverty and crime rates.Results. A within-county increase in jail incarceration rates from the first to second quartile was associated with a 2.5% increase in mortality rates, adjusting for confounders (risk ratio [RR] = 1.03; 95% confidence interval [CI] = 1.02, 1.03). This association followed a dose-response relationship and was stronger for mortality among those aged 15 to 34 years (RR = 1.07; 95% CI = 1.06, 1.09).Conclusions. Within-county increases in jail incarceration rates are associated with increases in subsequent mortality rates after adjusting for important confounders.Public Health Implications. Our findings add to the growing body of empirical evidence of the harms of mass incarceration. The criminal justice reform and decarceration movements can use these findings as they develop strategies to end mass incarceration.

Gender and Weight among Thoroughbred Jockeys: Underrepresented Women and Underweight Men.

Discrimination can damage health by limiting an occupation to persons who are physically unsuited to it. In thoroughbred racing, male jockeys damage their health to reach racing weights, while women who could reach those weights more easily are excluded. The authors estimate the number of U.S. men and women who are light enough to work as jockeys and contrast them with the number of male and female jockeys. The authors contrast the distribution of body mass index in the general population and among top jockeys. Male jockeys outnumber female jockeys by 7 to 1, and by 50 to 1 in top races, and these numbers have not declined since the 1990s. Yet among adults who are light enough to work as jockeys, women outnumber men by at least 7 to 1, and women are half as likely to be underweight. Jockeys' health and performance might improve if barriers to women were lowered.

Social Environments, Genetics, and Black-White Disparities in Infant Mortality.

BACKGROUND: Genes and environments often interplay to produce population health. However, in some instances, the scientific literature has favoured one explanation, underplaying the other, even in the absence of rigorous support. We examine parental race disparity on the risk of infant mortality to see if such an analysis might provide clues to understanding the extent to which genes and environment may shape perinatal risks. METHODS: We assessed parental racial disparities in infant mortality among singletons by analysing the risk of infant mortality among racially consonant vs. dissonant couples over time between 1989-1997 and 1998-2006 in the state of Michigan (n = 1 428 199). We calculated the degree of modification of the relation between maternal race and infant mortality by paternal race dynamically across the two time periods. RESULTS: Infant mortality among interracial couples decreased with time relative to white-white couples, while infant mortality among black-black couples increased with time after adjusting for socio-economic, demographic, and prenatal care differences. The degree to which paternal black race strengthened the relation between maternal black race and higher infant mortality risk relative to white mothers increased with time throughout our study. CONCLUSIONS: Evidence from these data suggests that environmental factors likely play the greater role in explaining the parental race disparity and risk of infant mortality.