bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial and Ethnic Differences in Breastfeeding
Authors: McKinney Chelsea O. , Hahn-Holbrook Jennifer , Chase-Lansdale P. Lindsay , Ramey Sharon L. , Krohn Julie , Reed-Vance Maxine , Raju Tonse N.K. , Shalowitz Madeleine U. ,   on behalf of the Community Child Health Research Network
Published: November 2021

OBJECTIVES

Breastfeeding rates differ among racial/ethnic groups in the United States. Our aim was to test whether racial/ethnic disparities in demographic characteristics, hospital use of infant formula, and family history of breastfeeding mediated racial/ethnic gaps in breastfeeding outcomes.

METHODS

We analyzed data from the Community and Child Health Network study (N = 1636). Breastfeeding initiation, postnatal intent to breastfeed, and breastfeeding duration were assessed postpartum. Hierarchical linear modeling was used to estimate relative odds of breastfeeding initiation, postnatal intent, and duration among racial/ethnic groups and to test the candidate mediators of maternal age, income, household composition, employment, marital status, postpartum depression, preterm birth, smoking, belief that “breast is best, ” family history of breastfeeding, in-hospital formula introduction, and WIC participation.

RESULTS

Spanish-speaking Hispanic mothers were most likely to initiate (91%), intend (92%), and maintain (mean duration, 17.1 weeks) breastfeeding, followed by English-speaking Hispanic mothers (initiation 90%, intent 88%; mean duration, 10.4 weeks) and white mothers (initiation 78%, intent 77%; mean duration, 16.5 weeks); black mothers were least likely to initiate (61%), intend (57%), and maintain breastfeeding (mean duration, 6.4 weeks). Demographic variables fully mediated disparities between black and white mothers in intent and initiation, whereas demographic characteristics and in-hospital formula feeding fully mediated breastfeeding duration. Family breastfeeding history and demographic characteristics helped explain the higher breastfeeding rates of Hispanic mothers relative to white and black mothers.

CONCLUSIONS

Hospitals and policy makers should limit in-hospital formula feeding and consider family history of breastfeeding and demographic characteristics to reduce racial/ethnic breastfeeding disparities.
Bullying and Suicidal Ideation and Behaviors: A Meta-Analysis
Authors: Holt Melissa K. , Vivolo-Kantor Alana M. , Polanin Joshua R. , Holland Kristin M. , DeGue Sarah , Matjasko Jennifer L. , Wolfe Misty , Reid Gerald
Published: November 2021

BACKGROUND AND OBJECTIVES

Over the last decade there has been increased attention to the association between bullying involvement (as a victim, perpetrator, or bully-victim) and suicidal ideation/behaviors. We conducted a meta-analysis to estimate the association between bullying involvement and suicidal ideation and behaviors.

METHODS

We searched multiple online databases and reviewed reference sections of articles derived from searches to identify cross-sectional studies published through July 2013. Using search terms associated with bullying, suicide, and youth, 47 studies (38.3% from the United States, 61.7% in non-US samples) met inclusion criteria. Seven observers independently coded studies and met in pairs to reach consensus.

RESULTS

Six different meta-analyses were conducted by using 3 predictors (bullying victimization, bullying perpetration, and bully/victim status) and 2 outcomes (suicidal ideation and suicidal behaviors). A total of 280 effect sizes were extracted and multilevel, random effects meta-analyses were performed. Results indicated that each of the predictors were associated with risk for suicidal ideation and behavior (range, 2.12 [95% confidence interval (CI), 1.67–2.69] to 4.02 [95% CI, 2.39–6.76]). Significant heterogeneity remained across each analysis. The bullying perpetration and suicidal behavior effect sizes were moderated by the study’s country of origin; the bully/victim status and suicidal ideation results were moderated by bullying assessment method.

CONCLUSIONS

Findings demonstrated that involvement in bullying in any capacity is associated with suicidal ideation and behavior. Future research should address mental health implications of bullying involvement to prevent suicidal ideation/behavior.
Change of School Playground Environment on Bullying: A Randomized Controlled Trial
Authors: Farmer Victoria L. , Williams Sheila M. , Mann Jim I. , Schofield Grant , McPhee Julia C. , Taylor Rachael W.
Published: November 2021

OBJECTIVE

To investigate whether increasing risk and challenge in primary school playgrounds influences interactions between children.

METHODS

In a 2-year cluster-randomized controlled trial, 8 control schools were asked to not change their play environment, whereas 8 intervention schools increased opportunities for risk and challenge (eg, rough-and-tumble play), reduced rules, and added loose parts (eg, tires). Children (n = 840), parents (n = 635), and teachers (n = 90) completed bullying questionnaires at baseline, 1 (postintervention), and 2 (follow-up) years.

RESULTS

Intervention children reported higher odds of being happy at school (at 2 years, odds ratio [OR]: 1.64; 95% confidence interval [CI]: 1.20–2.25) and playing with more children (at 1 year, OR: 1.66; 95% CI: 1.29–2.15) than control children. Although intervention children indicated they were pushed/shoved more (OR: 1.33; 95% CI: 1.03–1.71), they were less likely to tell a teacher (OR: 0.69; 95% CI: 0.52–0.92) at 2 years. No significant group differences were observed in parents reporting whether children had “ever” been bullied at school (1 year: P = .23; 2 years: P = .07). Intervention school teachers noticed more bullying in break time at 1 year (difference in scores: 0.20; 95% CI: 0.06–0.34; P = .009), with no corresponding increase in children reporting bullying to teachers (both time points, P ≥ .26).

CONCLUSIONS

Few negative outcomes were reported by children or parents, except for greater pushing/shoving in intervention schools. Whether this indicates increased resilience as indicated by lower reporting of bullying to teachers may be an unanticipated benefit.
LGBTQ Bullying: Translating Research to Action in Pediatrics
Authors: Earnshaw Valerie A. , Reisner Sari L. , Juvonen Jaana , Hatzenbuehler Mark L. , Perrotti Jeff , Schuster Mark A.
Published: November 2021

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth experience significant bullying that undermines their mental and physical health. National health organizations have called for the development of innovative strategies to address LGBTQ bullying. Pediatricians and other clinicians, medical and public health students, interdisciplinary researchers, government officials, school leaders, community members, parents, and youth from around the country came together at a national symposium entitled “LGBTQ Bullying: Translating Research to Action to Improve the Health of All Youth” in May 2016 to generate strategies to prevent LGBTQ bullying and meet the needs of LGBTQ youth experiencing bullying. This article describes key scientific findings on bullying, LGBTQ stigma, and LGBTQ bullying interventions that were shared at the symposium and provides recommendations for pediatricians to address LGBTQ bullying via clinical care, research, interventions, and policy. Symposium participants recommended that pediatricians engage in efforts to foster inclusive and affirming health care environments wherein LGBTQ youth feel comfortable discussing their identities and experiences, identify youth experiencing LGBTQ bullying, and prevent the negative health consequences of bullying among youth. Moreover, pediatricians can attend to how multiple identities (eg, sexual orientation, gender identity, race and/or ethnicity, disability, and others) shape youth experiences of bullying and expand intervention efforts to address LGBTQ bullying in health care settings. Pediatricians can further advocate for evidence-based, antibullying policies prohibiting bullying on the basis of sexual orientation and gender identity. Collaboration between pediatricians and diverse stakeholders can contribute to the development and implementation of lasting change in all forms of bullying, including LGBTQ bullying.
Peer Victimization, Depressive Symptoms, and Substance Use: A Longitudinal Analysis
Authors: Earnshaw Valerie A. , Elliott Marc N. , Reisner Sari L. , Mrug Sylvie , Windle Michael , Emery Susan Tortolero , Peskin Melissa F. , Schuster Mark A.
Published: November 2021

BACKGROUND

Peer victimization is common among youth and associated with substance use. Yet, few studies have examined these associations longitudinally or the psychological processes whereby peer victimization leads to substance use. The current study examined whether peer victimization in early adolescence is associated with alcohol, marijuana, and tobacco use in mid- to late adolescence, as well as the role of depressive symptoms in these associations.

METHODS

Longitudinal data were collected between 2004 and 2011 from 4297 youth in Birmingham, Alabama; Houston, Texas; and Los Angeles County, California. Data were analyzed by using structural equation modeling.

RESULTS

The hypothesized model fit the data well (Root Mean Square Error of Approximation [RMSEA] = 0.02; Comparative Fit Index [CFI] = 0.95). More frequent experiences of peer victimization in the fifth grade were associated with greater depressive symptoms in the seventh grade (B[SE] = 0.03[0.01]; P < .001), which, in turn, were associated with a greater likelihood of alcohol use (B[SE] = 0.03[0.01]; P = .003), marijuana use (B[SE] = 0.05[0.01]; P < .001), and tobacco use (B[SE] = 0.05[0.01]; P < .001) in the tenth grade. Moreover, fifth-grade peer victimization was indirectly associated with tenth-grade substance use via the mediator of seventh-grade depressive symptoms, including alcohol use (B[SE] = 0.01[0.01]; P = .006), marijuana use (B[SE] = 0.01[0.01]; P < .001), and tobacco use (B[SE] = 0.02[0.01]; P < .001).

CONCLUSIONS

Youth who experienced more frequent peer victimization in the fifth grade were more likely to use substances in the tenth grade, showing that experiences of peer victimization in early adolescence may have a lasting impact by affecting substance use behaviors during mid- to late adolescence. Interventions are needed to reduce peer victimization among youth and to support youth who have experienced victimization.
Social Dominance, School Bullying, and Child Health: What Are Our Ethical Obligations to the Very Young?
Authors: Halpern Jodi , Jutte Douglas , Colby Jackie , Boyce W. Thomas
Published: November 2021

BACKGROUND

Recent research shows that by age 5, children form rigid social hierarchies, with some children consistently subordinated, and then later, bullied. Further, several studies suggest that enduring mental and physical harm follow. It is time to analyze the health burdens posed by early social dominance and to consider the ethical implications of ongoing socially caused harms.

METHODS

First, we reviewed research demonstrating the health impact of early childhood subordination. Second, we used philosophical conceptions of children’s rights and social justice to consider whether children have a right to protection and who has an obligation to protect them from social harms.

RESULTS

Collectively, recent studies show that early subordination is instantiated biologically, increasing lifetime physical and mental health problems. The pervasive, and enduring nature of these harms leads us to argue that children have a right to be protected. Further, society has a role responsibility to protect children because society conscripts children into schools. Society’s promise to parents that schools will be fiduciaries entails an obligation to safeguard each child’s right to a reasonably open future. Importantly, this role responsibility holds independently of bearing any causal responsibility for the harm. This new argument based on protecting from harm is much stronger than previous equality of opportunity arguments, and applies broadly to other social determinants of health.

CONCLUSIONS

Social institutions have a role responsibility to protect children that is not dependent on playing a causal role in the harm. Children’s rights to protection from social harms can be as strong as their rights to protection from direct bodily harms. Pediatrics 2015;135:S24–S30
Ten-Year Trends in Bullying and Related Attitudes Among 4th- to 12th-Graders
Authors: Waasdorp Tracy Evian , Pas Elise T. , Zablotsky Benjamin , Bradshaw Catherine P.
Published: November 2021

BACKGROUND AND OBJECTIVES

Bullying is a significant public health concern, and it has received considerable attention from the media and policymakers over the past decade, which has led some to believe that it is increasing. However, there are limited surveillance data on bullying to inform our understanding of such trends over the course of multiple years. The current study examined the prevalence of bullying and related behaviors between 2005 and 2014 and explored whether any such changes varied across schools or as a function of school-level covariates.

METHODS

Youth self-reports of 13 indicators of bullying and related behaviors were collected from 246 306 students in 109 Maryland schools across 10 years. The data were weighted to reflect the school populations and were analyzed by using longitudinal hierarchical linear modeling to examine changes over time.

RESULTS

The covariate-adjusted models indicated a significant improvement over bullying and related concerns in 10 out of 13 indicators (including a decrease in bullying and victimization) for in-person forms (ie, physical, verbal, relational) and cyberbullying. Results also showed an increase in the perceptions that adults do enough to stop bullying and students’ feelings of safety and belonging at school.

CONCLUSIONS

Prevalence of bullying and related behaviors generally decreased over this 10-year period with the most recent years showing the greatest improvements in school climate and reductions in bullying. Additional research is needed to identify factors that contributed to this declining trend.
Violence and Aggressive Behavior
Authors: Austerman Joseph
Published: November 2021

Education Gap

It is imperative to understand the etiology and risk factors that contribute to aggressive behaviors. Equally important is effectively assessing and using targeted management strategies to reduce pathologic aggression.

Objectives

After completing this article, readers should be able to:Recognize the biological and psychosocial determinants of aggression.Use effective interviewing and screening measures to assess aggressive behaviors.Coordinate psychosocial and biologic interventions to reduce aggression.
Pediatric Plastic and Reconstructive Surgery for Primary Care
Authors:   American Academy of Pediatrics
Published: November 2021

With contributions from the leading experts, Pediatric Plastic and Reconstructive Surgery for Primary Care provides primary care pediatricians and other professionals who care for children comprehensive coverage of both common and rare congenital and acquired pediatric conditions.

https://shop.aap.org/pediatric-plastic-and-reconstruction-surgery-for-primary-care-paperback/
Pediatric Collections: ADHD: Evaluation and Care
Authors:   American Academy of Pediatrics
Published: November 2021

This collection offers an evidence-based approach to evaluating children for ADHD.

https://shop.aap.org/pediatric-collections-adhd-evaluation-and-care-paperback/
Heading Home With Your Newborn
Authors: Jana Laura A.
Published: November 2021

This best-selling guide on newborns is now fully revised and updated with the essential information new parents need to navigate the first few days, weeks, and months with confidence. Available for purchase at https://shop.aap.org/heading-home-with-your-newborn-4th-edition-paperback/
Coding for Pediatrics 2021
Authors:   American Academy of Pediatrics Committee on Coding and Nomenclature (COCN)
Published: November 2021

The 26th edition of the AAP cornerstone coding publication has been completely updated to include all pediatric changes in CPT® and ICD-10-CM codes for 2021—complete with expert guidance on their application.
Pediatric ICD-10-CM: A Manual for Provider Based Coding
Authors:   American Academy of Pediatrics Committee on Coding and Nomenclature (COCN)
Published: November 2021

This completely updated 6th edition includes all 2021 updates for pediatric ICD-10-CM codes as well as recently created COVID-19 coding guidance and a new chapter on codes for special purposes, such as vaping-related disorders.
Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers
Authors: Becerra-Culqui Tracy A. , Liu Yuan , Nash Rebecca , Cromwell Lee , Flanders W. Dana , Getahun Darios , Giammattei Shawn V. , Hunkeler Enid M. , Lash Timothy L. , Millman Andrea , Quinn Virginia P. , Robinson Brandi , Roblin Douglas , Sandberg David E. , Silverberg Michael J. , Tangpricha Vin , Goodman Michael
Published: November 2021

BACKGROUND

Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions.

METHODS

Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3–9 years old) and adolescents (10–17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/ or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date.

RESULTS

Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4–82) to 144 (95% CI 36–1248). The corresponding range for suicidal ideation was 25 (95% CI 14–45) to 54 (95% CI 18–218).

CONCLUSIONS

TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures.
Proposition 8 and Homophobic Bullying in California
Authors: Hatzenbuehler Mark L. , Shen Yishan , Vandewater Elizabeth A. , Russell Stephen T.
Published: November 2021

BACKGROUND

Bias-based bullying is associated with negative outcomes for youth, but its contextual predictors are largely unknown. Voter referenda that target lesbian, gay, bisexual, and transgender groups may be 1 contextual factor contributing to homophobic bullying.

METHODS

Data come from 14 consecutive waves (2001–2014) of cross-sectional surveys of students participating in the California Healthy Kids Survey (N = 4 977 557). Student responses were aggregated to the school level (n = 5121). Using a quasi-experimental design, we compared rates of homophobic bullying before and after Proposition 8, a voter referendum that restricted marriage to heterosexuals in November 2008.

RESULTS

Interrupted time series analyses confirmed that the academic year 2008–2009, during which Proposition 8 was passed, served as a turning point in homophobic bullying. The rate of homophobic bullying increased (blinear = 1.15; P , .001) and accelerated (bquadratic = 0.08; P , .001) in the period before Proposition 8. After Proposition 8, homophobic bullying gradually decreased (blinear = 20.28; P , .05). Specificity analyses showed that these trends were not observed among students who reported that they were bullied because of their race and/or ethnicity, religion, or gender but not because of their sexual orientation. Furthermore, the presence of a protective factor specific to school contexts among lesbian, gay, bisexual, and transgender youth (gay-straight alliances) was associated with a smaller increase in homophobic bullying pre–Proposition 8.

CONCLUSIONS

This research provides some of the first empirical evidence that public campaigns that promote stigma may confer risk for bias-based bullying among youth.
Mental Health, Drug, and Violence Interventions for Sexual/Gender Minorities: A Systematic Review
Authors: Coulter Robert W. S. , Egan James E. , Kinsky Suzanne , Friedman M. Reuel , Eckstrand Kristen L. , Frankeberger Jessica , Folb Barbara L. , Mair Christina , Markovic Nina , Silvestre Anthony , Stall Ron , Miller Elizabeth
Published: November 2021

CONTEXT

Compared with cisgender (nontransgender), heterosexual youth, sexual and gender minority youth (SGMY) experience great inequities in substance use, mental health problems, and violence victimization, thereby making them a priority population for interventions.

OBJECTIVE

To systematically review interventions and their effectiveness in preventing or reducing substance use, mental health problems, and violence victimization among SGMY.

DATA SOURCES

PubMed, PsycINFO, and Education Resources Information Center.

STUDY SELECTION

Selected studies were published from January 2000 to 2019, included randomized and nonrandomized designs with pretest and posttest data, and assessed substance use, mental health problems, or violence victimization outcomes among SGMY.

DATA EXTRACTION

Data extracted were intervention descriptions, sample details, measurements, results, and methodologic rigor.

RESULTS

With this review, we identified 9 interventions for mental health, 2 for substance use, and 1 for violence victimization. One SGMY-inclusive intervention examined coordinated mental health services. Five sexual minority–specific interventions included multiple state-level policy interventions, a therapist-administered family-based intervention, a computer-based intervention, and an online intervention. Three gender minority–specific interventions included transition-related gender-affirming care interventions. All interventions improved mental health outcomes, 2 reduced substance use, and 1 reduced bullying victimization. One study had strong methodologic quality, but the remaining studies’ results must be interpreted cautiously because of suboptimal methodologic quality.

LIMITATIONS

There exists a small collection of diverse interventions for reducing substance use, mental health problems, and violence victimization among SGMY.

CONCLUSIONS

The dearth of interventions identified in this review is likely insufficient to mitigate the substantial inequities in substance use, mental health problems, and violence among SGMY.
Pediatric Orthopaedics and Sports Injuries
Authors: Sarwark John F. , LaBella Cynthia R.
Published: November 2021

Fully revised and updated, the third edition delivers targeted guidance on the diagnosis, treatment, and management of orthopaedic problems and sports injuries. (This book features a full text reading experience. Click a chapter title to access content.) Available for purchase at https://shop.aap.org/pediatric-orthopaedics-and-sports-injuries-a-quick-reference-guide-3rd-edition-paperback/
Your Baby’s First Year
Authors: Altmann Tanya
Published: November 2021

Available ONLY to the lucky winners from NCE 2020!
Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults
Authors: Ryan Caitlin , Huebner David , Diaz Rafael M. , Sanchez Jorge
Published: November 2021

OBJECTIVE

We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults.

METHODS

On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys.

RESULTS

Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence.

CONCLUSIONS

This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.
Health and Care Utilization of Transgender and Gender Nonconforming Youth: A Population-Based Study
Authors: Rider G. Nicole , McMorris Barbara J. , Gower Amy L. , Coleman Eli , Eisenberg Marla E.
Published: November 2021

BACKGROUND

Transgender and gender nonconforming (TGNC) adolescents have difficulty accessing and receiving health care compared with cisgender youth, yet research is limited by a reliance on small and nonrepresentative samples. This study’s purpose was to examine mental and physical health characteristics and care utilization between youth who are TGNC and cisgender and across perceived gender expressions within the TGNC sample.

METHODS

Data came from the 2016 Minnesota Student Survey, which consisted of 80 929 students in ninth and 11th grade (n = 2168 TGNC, 2.7%). Students self-reported gender identity, perceived gender expression, 4 health status measures, and 3 care utilization measures. Chi-squares and multiple analysis of covariance tests (controlling for demographic covariates) were used to compare groups.

RESULTS

We found that students who are TGNC reported significantly poorer health, lower rates of preventive health checkups, and more nurse office visits than cisgender youth. For example, 62.1% of youth who are TGNC reported their general health as poor, fair, or good versus very good or excellent, compared with 33.1% of cisgender youth (χ2 = 763.7, P < .001). Among the TGNC sample, those whose gender presentation was perceived as very congruent with their birth-assigned sex were less likely to report poorer health and long-term mental health problems compared with those with other gender presentations.

CONCLUSIONS

Health care utilization differs between TGNC versus cisgender youth and across gender presentations within TGNC youth. With our results, we suggest that health care providers should screen for health risks and identify barriers to care for TGNC youth while promoting and bolstering wellness within this community.
Sexual Orientation and Suicide Attempt Disparities Among US Adolescents: 2009–2017
Authors: Raifman Julia , Charlton Brittany M. , Arrington-Sanders Renata , Chan Philip A. , Rusley Jack , Mayer Kenneth H. , Stein Michael D. , Austin S. Bryn , McConnell Margaret
Published: November 2021

BACKGROUND

Sexual minority adolescents face mental health disparities relative to heterosexual adolescents. We evaluated temporal changes in US adolescent reported sexual orientation and suicide attempts by sexual orientation.

METHODS

We used Youth Risk Behavioral Surveillance data from 6 states that collected data on sexual orientation identity and 4 states that collected data on sex of sexual contacts continuously between 2009 and 2017. We estimated odds ratios using logistic regression models to evaluate changes in reported sexual orientation identity, sex of consensual sexual contacts, and suicide attempts over time and calculated marginal effects (MEs).

RESULTS

The proportion of adolescents reporting minority sexual orientation identity nearly doubled, from 7.3% in 2009 to 14.3% in 2017 (ME: 0.8 percentage points [pp] per year; 95% confidence interval [CI]: 0.6 to 0.9 pp). The proportion of adolescents reporting any same-sex sexual contact increased by 70%, from 7.7% in 2009 to 13.1% in 2017 (ME: 0.6 pp per year; 95% CI: 0.4 to 0.8 pp). Although suicide attempts declined among students identifying as sexual minorities (ME: –0.8 pp per year; 95% CI: –1.4 to –0.2 pp), these students remained >3 times more likely to attempt suicide relative to heterosexual students in 2017. Sexual minority adolescents accounted for an increasing proportion of all adolescent suicide attempts.

CONCLUSIONS

The proportion of adolescents reporting sexual minority identity and same-sex sexual contacts increased between 2009 and 2017. Disparities in suicide attempts persist. Developing and implementing approaches to reducing sexual minority youth suicide is critically important.
Teen Pregnancy Risk Factors Among Young Women of Diverse Sexual Orientations
Authors: Charlton Brittany M. , Roberts Andrea L. , Rosario Margaret , Katz-Wise Sabra L. , Calzo Jerel P. , Spiegelman Donna , Austin S. Bryn
Published: November 2021

OBJECTIVES

Young women who are sexual minorities (eg, bisexual and lesbian) are approximately twice as likely as those who are heterosexual to have a teen pregnancy. Therefore, we hypothesized that risk factors for teen pregnancy would vary across sexual orientation groups and that other potential risk factors exist that are unique to sexual minorities.

METHODS

We used multivariable log-binomial models gathered from 7120 young women in the longitudinal cohort known as the Growing Up Today Study to examine the following potential teen pregnancy risk factors: childhood maltreatment, bullying victimization and perpetration, and gender nonconformity. Among sexual minorities, we also examined the following: sexual minority developmental milestones, sexual orientation–related stress, sexual minority outness, and lesbian, gay, and bisexual social activity involvement.

RESULTS

Childhood maltreatment and bullying were significant teen pregnancy risk factors among all participants. After adjusting for childhood maltreatment and bullying, the sexual orientation–related teen pregnancy disparities were attenuated; these risk factors explained 45% of the disparity. Among sexual minorities, reaching sexual minority developmental milestones earlier was also associated with an increased teen pregnancy risk.

CONCLUSIONS

The higher teen pregnancy prevalence among sexual minorities compared with heterosexuals in this cohort was partially explained by childhood maltreatment and bullying, which may, in part, stem from sexual orientation–related discrimination. Teen pregnancy prevention efforts that are focused on risk factors more common among young women who are sexual minorities (eg, childhood maltreatment, bullying) can help to reduce the existing sexual orientation–related teen pregnancy disparity.
Transgender Adolescent Suicide Behavior
Authors: Toomey Russell B. , Syvertsen Amy K. , Shramko Maura
Published: November 2021

OBJECTIVES

Our primary objective was to examine prevalence rates of suicide behavior across 6 gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not exclusively male or female; and questioning. Our secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups.

METHODS

Data from the Profiles of Student Life: Attitudes and Behaviors survey (N = 120 617 adolescents; ages 11–19 years) were used to achieve our objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (ie, age, parents’ highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior.

RESULTS

Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts.

CONCLUSIONS

Suicide prevention efforts can be enhanced by attending to variability within transgender populations, particularly the heightened risk for female to male and nonbinary transgender adolescents.
Body Dissatisfaction and Mental Health Outcomes of Youth on Gender-Affirming Hormone Therapy
Authors: Kuper Laura E. , Stewart Sunita , Preston Stephanie , Lau May , Lopez Ximena
Published: November 2021

OBJECTIVES

Our first aim was to examine baseline differences in body dissatisfaction, depression, and anxiety symptoms by gender, age, and Tanner (ie, pubertal) stage. Our second aim was to test for changes in youth symptoms over the first year of receiving gender-affirming hormone therapy. Our third aim was to examine potential differences in change over time by demographic and treatment characteristics. Youth experiences of suicidal ideation, suicide attempt, and nonsuicidal self-injury (NSSI) are also reported.

METHODS

Participants (n = 148; ages 9–18 years; mean age 14.9 years) were receiving gender-affirming hormone therapy at a multidisciplinary program in Dallas, Texas (n = 25 puberty suppression only; n = 123 feminizing or masculinizing hormone therapy). Participants completed surveys assessing body dissatisfaction (Body Image Scale), depression (Quick Inventory of Depressive Symptoms), and anxiety (Screen for Child Anxiety Related Emotional Disorders) at initial presentation to the clinic and at follow-up. Clinicians completed the Quick Inventory of Depressive Symptoms and collected information on youth experiences of suicidal ideation, suicide attempt, and NSSI.

RESULTS

Affirmed males reported greater depression and anxiety at baseline, but these differences were small (P < .01). Youth reported large improvements in body dissatisfaction (P < .001), small to moderate improvements in self-report of depressive symptoms (P < .001), and small improvements in total anxiety symptoms (P < .01). No demographic or treatment-related characteristics were associated with change over time. Lifetime and follow-up rates were 81% and 39% for suicidal ideation, 16% and 4% for suicide attempt, and 52% and 18% for NSSI, respectively.

CONCLUSIONS

Results provide further evidence of the critical role of gender-affirming hormone therapy in reducing body dissatisfaction. Modest initial improvements in mental health were also evident.
Ethical Issues in Gender-Affirming Care for Youth
Authors: Kimberly Laura L. , Folkers Kelly McBride , Friesen Phoebe , Sultan Darren , Quinn Gwendolyn P. , Bateman-House Alison , Parent Brendan , Konnoth Craig , Janssen Aron , Shah Lesha D. , Bluebond-Langner Rachel , Salas-Humara Caroline
Published: November 2021

Transgender and gender-nonconforming (TGNC) youth who suffer from gender dysphoria are at a substantially elevated risk of numerous adverse physical and psychosocial outcomes compared with their cisgender peers. Innovative treatment options used to support and affirm an individual’s preferred gender identity can help resolve gender dysphoria and avoid many negative sequelae of nontreatment. Yet, despite advances in these relatively novel treatment options, which appear to be highly effective in addressing gender dysphoria and mitigating associated adverse outcomes, ethical challenges abound in ensuring that young patients receive appropriate, safe, affordable treatment and that access to this treatment is fair and equitable. Ethical considerations in gender-affirming care for TGNC youth span concerns about meeting the obligations to maximize treatment benefit to patients (beneficence), minimizing harm (nonmaleficence), supporting autonomy for pediatric patients during a time of rapid development, and addressing justice, including equitable access to care for TGNC youth. Moreover, although available data describing the use of gender-affirming treatment options are encouraging, and the risks of not treating TGNC youth with gender dysphoria are evident, little is known about the long-term effects of both hormonal and surgical interventions in this population. To support ethical decision-making about treatment options, we encourage the development of a comprehensive registry in the United States to track long-term patient outcomes. In the meantime, providers who work with TGNC youth and their families should endeavor to offer ethically sound, patient-centered, gender-affirming care based on the best currently available evidence.
Hormonal Treatment and Cardiovascular Risk Profile in Transgender Adolescents
Authors: Klaver Maartje , de Mutsert Renée , van der Loos Maria A.T.C. , Wiepjes Chantal M. , Twisk Jos W.R. , den Heijer Martin , Rotteveel Joost , Klink Daniel T.
Published: November 2021

BACKGROUND AND OBJECTIVES

The effects of endocrinological treatment on cardiovascular risk profile in transgender adolescents are unknown. In this retrospective cohort study, we aim to investigate these effects and assess obesity and dyslipidemia prevalence in transgender adolescents at 22 years compared with peers.

METHODS

Changes in BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, homeostatic model assessment for insulin resistance (HOMA-IR), and lipid values during treatment, along with the prevalence of obesity and dyslipidemia at 22 years, were recorded in 71 transwomen and 121 transmen who started gonadotropin-releasing hormone agonists in their adolescence (15 years), with a subsequent addition of sex hormones (17 years).

RESULTS

In transwomen, changes in BMI (+3.0; 95% confidence interval [CI] 1.6 to 4.4), SBP (–2 mmHg; 95% CI –7 to 3), DBP (+10 mmHg; 95% CI 7 to 14), glucose (0.0 mmol/L; 95% CI –0.2 to 0.2), HOMA-IR (+0.6; 95% CI –0.6 to 1.9), and lipid values were similar or more favorable compared with peers. The same was true for transmen regarding changes in BMI (+2.3; 95% CI 1.7 to 2.9), SBP (+7 mmHg; 95% CI 3 to 10), DBP (+7 mmHg; 95% CI 5 to 10), glucose (+0.1 mmol/L; 95% CI –0.1 to 0.3), HOMA-IR (–0.2; 95% CI –0.8 to 0.3), and lipid values. At age 22, obesity prevalence was 9.9% in transwomen, 6.6% in transmen, 2.2% in ciswomen, and 3.0% in cismen.

CONCLUSIONS

Generally, endocrinological treatment in transgender adolescents is safe regarding cardiovascular risk. Because obesity is more prevalent in transgender adolescents compared with peers, body weight management should be important during the medical trajectory.
Mental Health and Timing of Gender-Affirming Care
Authors: Sorbara Julia C. , Chiniara Lyne N. , Thompson Shelby , Palmert Mark R.
Published: November 2021

BACKGROUND

Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study.

METHODS

A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (<15 years of age at presentation) or older presenting youth (OPY) (≥15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex.

RESULTS

Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14–26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22–14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05–1.63]).

CONCLUSIONS

Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care.
STABLE Learner Manual 5E - Spanish
Authors: Karlsen Kristine A.
Published: November 2021

This Spanish version Learner Manual serves as a student handbook for either self-study of the S.T.A.B.L.E. CD-ROM or for instructor-led presentations. More than 220 pages of text, photos, and illustrations in full color. Coordinates well with CD-ROM and includes valuable appendices.
The Childhood Vaccination Schedule and the Lack of Association With Type 1 Diabetes
Authors: Glanz Jason M. , Clarke Christina L. , Daley Matthew F. , Shoup Jo Ann , Hambidge Simon J. , Williams Joshua T.B. , Groom Holly C. , Kharbanda Elyse O. , Klein Nicola P. , Jackson Lisa A. , Lewin Bruno J. , McClure David L. , Xu Stanley , DeStefano Frank
Published: November 2021

OBJECTIVES

Safety studies assessing the association between the entire recommended childhood immunization schedule and autoimmune diseases, such as type 1 diabetes mellitus (T1DM), are lacking. To examine the association between the recommended immunization schedule and T1DM, we conducted a retrospective cohort study of children born between 2004 and 2014 in 8 US health care organizations that participate in the Vaccine Safety Datalink.

METHODS

Three measures of the immunization schedule were assessed: average days undervaccinated (ADU), cumulative antigen exposure, and cumulative aluminum exposure. T1DM incidence was identified by International Classification of Disease codes. Cox proportional hazards models were used to analyze associations between the 3 exposure measures and T1DM incidence. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated. Models were adjusted for sex, race and ethnicity, birth year, mother’s age, birth weight, gestational age, number of well-child visits, and study site.

RESULTS

In a cohort of 584 171 children, the mean ADU was 38 days, the mean cumulative antigen exposure was 263 antigens (SD = 54), and the mean cumulative aluminum exposure was 4.11 mg (SD = 0.73). There were 1132 incident cases of T1DM. ADU (aHR = 1.01; 95% CI, 0.99–1.02) and cumulative antigen exposure (aHR = 0.98; 95% CI, 0.97–1.00) were not associated with T1DM. Cumulative aluminum exposure >3.00 mg was inversely associated with T1DM (aHR = 0.77; 95% CI, 0.60–0.99).

CONCLUSIONS

The recommended schedule is not positively associated with the incidence of T1DM in children. These results support the safety of the recommended childhood immunization schedule.
Systematic treatment of morphological fruit types in plants of the class Liliopsida of the flora of Ukraine
Authors: Odintsova A. V. , Fishchuk O. S. , Scrypec K. I. , Danylyk I. M.
Published: November 2021

In this review, the scope of morphological diversity of fruits within the class Liliopsida belonging to the flora of Ukraine compared to the world flora diversity was analyzed. For the first time, the taxonomic diversity of monocot plants of the flora of Ukraine was analyzed, which includes 235 genera and about 1050 species, and the distribution of fruit types in the largest monocot families revealed. It was found that among monocot plants of the world flora, as also of the Ukrainian flora, more than 70% of generic and species diversity is taken up by the Orchidaceae, Poaceae, and Cyperaceae families having dry uniform fruits: inferior capsule (Orchidaceae) and one-seeded enveloped fruit (Poaceae and Cyperaceae). An annotated list of morphological fruit types was compiled for all 38 families of the natural and cultural flora of monocot plants of Ukraine. Among 12 families of the subclass Alismatidae, apocarpous polymerous or trimerous fruits, mostly with one-seeded fruitlets, occur in six families (Alismataceae, Butomaceae, Potamogetonaceae, Ruppiaceae, Scheuchzeriaceae, Zannichelliaceae). In 12 of 16 families of the subclass Liliidae, trimerous capsules are the most common (Agapanthaceae, Agavaceae, Alliaceae, Amaryllidaceae, Asphodelaceae, Colchicaceae, Hemerocallidacae, Hyacinthaceae, Iridaceae, Liliасеае, Melanthiaceae, Orchidaceae), while in six families berry-like fruit occurs in all members or in the single genus (Asparagaceae, Ruscaceae, Dioscoreaceae, Melanthiaceae (Paris), Liliасеае (Streptopus), Smilacaceae). Among 10 families of the subclass Commelinidae, in four families superior dry one-seeded fruits occur (Cyperaceae, Poaceae, Sparganiaceae, Typhaceae), while another four families have trimerous capsules (Cannaceae, Commelinaceae, Juncaceae, Pontederiaceae). In general, the most typical fruit on the familial taxonomical level is the capsule (17 families), berries occur in 10 families, aggregate fruits and one-seeded fruits are represented each in seven families, while the rarest fruit type is the schizocarp (Juncaginaceae). No monomerous follicles, poricide and operculate capsules, winged fruits and loments were found. The most controversial fruit types are found in two groups of families, for both of them the problem is the gynoecium type. These are families with one-seeded fruit (Аrасеае (Lemna), Cyperaceae, Hydrocharitaceae (Najas), Poaceae, Sparganiaceae, Typhaceae, Zosteraceae) and families with initial carpel fusion (Hydrocharitaceae (Stratiotes), Juncaginaceae, Melanthiaceae (Veratrum), Scheuchzeriaceae, Tofieldiaceae). As a result of our work, the key and the most relevant areas of carpological studies in Ukraine were defined, particularly, unifying the terminology, examination of the anatomical structure of the pericarp, revealing of the evolutionary and ecological aspects of fruit morphology.