Background: We investigated the percentage of insufficiently active adolescents who became young adults meeting moderate to vigorous physical activity (MVPA) guidelines. We also explored adolescent psychosocial and environmental factors that predicted MVPA guideline adherence in young adulthood. Methods: Participants included N = 1001 adolescents (mean age = 14.1 y) reporting < 7 hours per week of MVPA and followed (8 y later) into young adulthood through Project EAT. We examined mean weekly hours of MVPA, MVPA change between adolescence and young adulthood, and the proportion of participants meeting MVPA guidelines in young adulthood. With sex-stratified logistic regression, we tested 11 adolescent psychosocial and environmental factors predicting meeting MVPA guidelines in young adulthood. Results: Overall, 55% of insufficiently active adolescents became young adults meeting MVPA guidelines. On average, participants reported 3.0 hours per week of MVPA, which improved to 3.8 hours per week in young adulthood. Among female participants, higher MVPA in adolescence and stronger feelings of exercise compulsion predicted greater odds of meeting adult MVPA guidelines (odds ratioMVPA = 1.18; odds ratiocompulsion = 1.13). Among female and male participants, perceived friend support for activity in adolescence predicted greater odds of meeting adult MVPA guidelines (odds ratiofemale = 1.12; odds ratiomale = 1.26). Conclusions: Insufficiently active adolescents can later meet adult guidelines. Interventions that increase perceived friend support for activity may benefit individuals across development.

Introduction: Tobacco 21 (T21) policies have shown promise in reducing cigarette use among adolescents. This study examined whether local T21 policies affected adolescent use of a variety of tobacco products and whether results differed by grade level. Methods: We used repeated cross-sectional data from eighth, ninth, and eleventh-grade respondents to the 2016 (n = 107 981) and 2019 (n = 102 196) Minnesota Student Surveys. Generalized estimating equations modeled eight adolescent tobacco use outcomes in 2019 (past 30-day use of any tobacco, cigarettes, cigars, e-cigarettes, hookah, chewing tobacco, flavored tobacco, and multiple products) by T21 exposure, defined as respondents' attendance at a school within a jurisdiction with T21 policy implementation between the two surveys. Models controlled for demographic characteristics and product-specific baseline tobacco use at the school level in 2016 and were stratified by grade. Results: After adjusting for baseline tobacco use and other demographics, T21-exposed eighth and ninth-grade students had significantly lower odds of tobacco use than unexposed peers in five of eight models, i.e. any tobacco (aOR = 0.80, 95% CI: 0.74, 0.87), cigarettes (aOR = 0.81, 95% CI: 0.67, 0.99), e-cigarettes (aOR = 0.78, 95% CI: 0.71, 0.85), flavored tobacco (aOR = 0.79, CI: 0.70, 0.89), and dual/poly tobacco (aOR = 0.77, 95% CI: 0.65, 0.92). T21-exposed eleventh-grade students did not differ significantly in their odds of any tobacco use outcomes relative to their unexposed peers. Conclusions: T21 exposure is associated with lower odds of multiple forms of tobacco use, particularly among younger adolescent populations, supporting the implementation of T21 policies to reduce tobacco use in this population.

Weight stigma is prevalent among young people and harmful to health. The current study used a health equity lens to examine cross-sectional and longitudinal associations between experiencing weight teasing (a form of weight stigma) with a range of weight-related health behaviors and weight status in an ethnically/racially and socioeconomically diverse sample of young people. We also assessed whether ethnicity/race and adolescent socioeconomic status (SES) operated as effect modifiers in these relationships. Adolescents (n = 1568) were enrolled in EAT 2010–2018 (Eating and Activity over Time) and followed into young adulthood. Weight teasing; screen time; moderate-to-vigorous physical activity (MVPA); sleep duration; breakfast frequency; fruit, vegetable, sugar-sweetened beverage (SSB), and fast-food intake; and body mass index (BMI) were assessed at baseline (mean age = 14.4&nbsp;years) and eight-year follow-up (mean age = 22.2&nbsp;years). Multivariate linear regression estimated marginal means and 95% confidence intervals. All analyses adjusted for BMI and sociodemographic characteristics. Weight teasing was cross-sectionally associated with longer screen time, shorter sleep duration, and higher BMI during adolescence; and cross-sectionally associated with shorter sleep duration, lower breakfast frequency, higher fast-food intake, higher SSB intake, and higher BMI during young adulthood. In the longitudinal analyses, weight teasing was not associated with health behaviors but did predict higher BMI (teased: 28.2&nbsp;kg/m2, not teased: 26.4&nbsp;kg/m2, p &lt; 0.001). White and higher adolescent SES subgroups had higher MVPA, more frequent breakfast intake, lower fast-food intake, and lower BMI than their respective counterparts. The relationships between weight teasing and health behaviors and weight status were largely consistent across ethnic/racial and adolescent SES subgroups. Findings add to growing evidence that weight-based mistreatment poses a threat to weight-related health and that young people across ethnic/racial and SES subgroups are vulnerable to the negative effects of weight teasing. Limitations include attrition at follow-up and the self-reported nature of many measures. Results suggest a need for increased attention to existing recommendations to reduce weight stigma in young people from diverse ethnic/racial and socioeconomic backgrounds including training for healthcare providers to better equip them to address the harms of weight teasing and foster more compassionate care to promote health-supporting behaviors in young people.

Objective: Disordered eating behaviors (DEBs) have long-term, deleterious effects on health and are more prevalent among socially marginalized groups, likely as a result of systemic inequities across social determinants of health (SDoH). This exploratory study aimed to identify subgroups of emerging adults characterized by main and interactive associations between SDoH and two forms of DEB (binge eating, extreme unhealthy weight control behaviors). Method: Participants (n = 1568; age 22.2 ± 2.1 years) from the United States were drawn from the EAT 2010-2018 longitudinal study. Conditional inference tree (CIT) analyses derived main and intersecting SDoH related to DEB across 33 input variables collected during adolescence and emerging adulthood. Results: The binge eating CIT revealed five subgroups (prevalence: 6.3-23.2%) shaped by variables collected during emerging adulthood: appearance-based teasing (p < .001), financial difficulty (p = .003), gender (p < .001), and everyday discrimination (p = .008). The CIT results for extreme unhealthy weight control behaviors derived six subgroups (prevalence: 2.3-45.5%) shaped by weight teasing (p < .001) and gender (p < .001) during emerging adulthood and public assistance (p = .008) and neighborhood safety (p = .007) in adolescence. Discussion: This exploratory study revealed distinct subgroups of emerging adults with varying DEB prevalence, suggesting that variability in DEB prevalence may be partially explained by intersecting SDoH during adolescence and emerging adulthood. Hypothesis-driven research and replication studies are needed to further explore the associations between SDoH and DEB during emerging adulthood. Public Significance Statement: Disordered eating behaviors are common among young people in the United States and have long-term health consequences. This exploratory study identified subgroups of young people, characterized by combinations of social inequities (e.g., financial difficulties, teasing). Results highlight high-risk

Objective: Digital technology use and muscle-building behaviors reflect a wide range of behaviors with associated health risks. However, links between digital technology use and muscle-building behaviors remain unknown and this study aimed to address this gap. Method: Data were collected from a diverse sample of 1,483 young adults (mean age 22.2 ± 2.0 years) participating in the population-based Eating and Activity over Time 2018 study. Gender-stratified-modified Poisson regression models were used to determine cross-sectional associations between three types of digital technology use (screen time, social media, weight-related self-monitoring apps) and five types of muscle-building behaviors (changing eating, exercise, protein powders/shakes, pre-workout drinks, steroids/growth hormone/creatine/amino acids) in young adulthood, adjusted for sociodemographic characteristics and body mass index. Results: Screen time and social media were either not found to be associated with muscle-building behaviors or in a few instances, associated with less use of these behaviors (e.g., screen time and pre-workout drinks in men). In contrast, the use of weight-related self-monitoring apps was positively associated with all muscle-building behaviors, including steroids/growth hormone/creatine/amino acids in men (prevalence ratio [PR] = 1.83; 95% confidence interval [CI]: 1.13–2.97) and women (PR = 4.43; 95% CI: 1.68–11.68). Discussion: While most recreational screen time may represent sedentary behaviors not related to muscle-building behaviors, weight-related self-monitoring apps are highly associated with more muscle-building behaviors and could be a future target for interventions to discourage the use of steroids and other harmful muscle-building substances.

Purpose: Comprehensive sexuality education (CSE) has been shown to reduce sexual risk-taking behaviors and promote healthy sexual development, and studies have shown high support for this approach. However, the past decade has seen many changes in the political landscape and social controversies. The present study reports on an updated survey and analysis of changes in support from 2006 to 2021. Methods: Survey data were collected by telephone in 2006 (N = 1,605) and online and in-person in 2021 (N = 719) from separate samples of Minnesota parents of school-age children. Parents responded to items regarding preferences for CSE, support for teaching numerous specific sexuality education topics, and the grade level at which topics should be introduced. Chi-square tests and logistic regression (with weighted 2021 data) were used to detect differences in support between survey years and across demographic and personal characteristics. Results: At both time points, approximately 90% of parents thought that CSE should be taught in schools, with significant increases in support within several demographic categories. Support for including all specific topics was high, including for topics typically considered highly controversial (e.g., gender identity, 68.7%; abortion, 77.7% in 2021). Parents endorsed introducing most topics in elementary or middle school years. Discussion: Findings suggest that policy makers and educators in Minnesota can be confident of strong parental support for CSE covering a wide range of content to meet students’ needs. Advocacy and action to advance the use of national sexuality education standards are in keeping with the views of the overwhelming majority of parents of school-age children.

Prevalence of mental health problems among US youth has increased in recent years, and there is a dearth of epidemiological research at the state level that integrates risk and protective factors into population-based surveillance. We utilized the developmental assets framework to measure protective factors; we assessed (1) prevalence of depressive symptoms, high adverse childhood experiences (ACEs; ≥ 4 ACEs), and few developmental assets (≤ 2 assets) over time, and (2) associations among these three phenomena. Using 2016 and 2019 Minnesota Student Survey data, we utilized descriptive statistics, multivariable logistic regression, and post-estimation analyses (adjusting for school clustering and demographics). Using pooled data, we examined how high ACEs and few assets predicted depressive symptoms and we tested three-way interactions for high ACEs, few assets, and survey year. There were statistically significant increases in prevalence of depressive symptoms, high ACEs, and few assets between 2016 and 2019. High ACEs (AOR = 2.74; 95% CI = 2.61, 2.89) and few assets (AOR = 3.13; 95% CI = 3.00, 3.26) were positively related to depressive symptoms; interactions were statistically significant. Additive interactions showed that, compared to their counterparts, adolescents with high ACEs and few assets had the highest prevalence of depressive symptoms, and this group exhibited the largest increase in prevalence between 2016 and 2019. Depressive symptoms are highest among adolescents with high risk and few protective factors, and recent increases in the prevalence of depressive symptoms appear to have disproportionately occurred among these adolescents. We offer a potential roadmap for following the Centers for Disease Control and Prevention recommendations to integrate ACEs and protective factors into local public health efforts.

Hispanic/Latina students face difficulties engaging in physical activity, but schools can help by integrating activity into accrue the school day and offering sport and activity-based extracurricul...

Objectives. To describe the prevalence of sex trading by gender and by associations with mental health concerns and protective factors. Methods. We used data from 9th and 11th graders who completed the 2019 Minnesota Student Survey. The analytic sample (n = 67 806) included transgender and gender-diverse (TGD) youths and cisgender youths who reported trading sex. Data on 7 mental health measures and 4 school-related and health care-related protective factors were collected. Results. The prevalence of sex trading (5.9%) was 5 times higher among TGD students than cisgender students (1.2%). In addition, the prevalence of all mental health concerns was high among TGD students who traded sex (e.g., 75.9% reported a lifetime suicide attempt, as compared with 45.9% of cisgender students who traded sex). Fewer statistical differences were found across protective factors. When TGD students who traded sex were compared according to sex assigned at birth, no statistically significant differences were found. Conclusions. Our findings support strong calls for increased competence regarding gender and sex trading or exploitation in clinical and school-based settings to decrease health disparities among TGD youths. Public Health Implications. In this study, we have presented unique prevalence estimates of mental health disparities among TGD students in the United States who trade sex. Our results indicate that TGD students who trade sex are at risk for mental health symptoms and that sensitivity to both gender and sex trading or exploitation will be critical to meeting the needs of this group in clinical as well as school-based settings.

between 15e17-years old had stopped gender-affirming medications compared with 10.6% of patients who started GnRHa between 9e14-years, though this difference did not reach statistical significance. Insurance sponsor's rank (family income), birth-assigned sex, and the presence of mood disorders were not associated with cessation rates. Within 2 years of starting GnRHa, 83.2% (95%CI: 70.2 e 94.4%) of patients had started gender-affirming hormones; within 8 years of starting GnRHa, this number increased to 91.6% (95%CI 81.6 e100%). Younger patients had a greater delay in starting gender-affirming hormones. Insurance sponsor's rank, birth-assigned sex, and the presence of mood disorders were not associated with initiation of gender-affirming hormones. Conclusions: Contrary to concerns, GnRHa use did not inevitably lead to use of gender-affirming hormones. One out of twelve TGD adolescents who started GnRHa to address gender dysphoria subsequently stopped treatment. Sources of Support: None. Purpose: StRONG was a multicenter randomized clinical trial of refeeding in hospitalized adolescents and young adults with malnutrition secondary to anorexia nervosa (AN) and atypical anorexia nervosa (AAN) (ClinicalTrials.gov #NCT02488109). At end-of-treatment, higher calorie refeeding (HCR) was more efficacious and less costly than lower calorie refeeding (LCR). Here we compare efficacy of HCR in AAN vs. AN. Methods: Participants were N¼120, 12-24 yr-olds with > 60% median Body Mass Index (%mBMI) and medical instability. AAN was defined as %mBMI >85% at baseline. Meal-based HCR began 2000 calories/day (kcal/d) and advanced 200 kcal/d; LCR began 1400 kcal/d and advanced 200 kcal every other day (no tube feeding). Efficacy was defined as time to restore a 6-point Medical Stability Index (MSI): heart rate (HR) 45 bpm; systolic blood pressure (SBP) 90 mmHg, temperature 35.6 C, orthostatic increase in HR 35 bpm and decrease SBP 20 mmHg, and 75% median BMI (%mBMI). Main outcome was days to restore MSI, compared between groups with unpaired t-test. Exploratory moderator analyses examined the interaction between refeeding treatment and diagnosis on key outcomes (time to recover heart rate and weight gain). Weight gain was defined as change in %mBMI. Results: Modified intention to treat analyses included N¼111. Mean age was 16.5 (2.5) yrs, 43% had AAN. Upon admission, %mBMI was 95.2 (9) in AAN vs. 76.5 (5.9) in AN, p<.001. Upon discharge, %mBMI was 98.3 (8.9) in AAN vs. 82.2 (5.3) in AN, p<.001. MSI was restored fastest in patients with AN refed by HCR [7.1 (5.4) days], whereas medical stability required three additional days to restore in patients with AAN [10.1 (5.3) days, p<0.01]. Diagnosis (AAN or AN) and treatment (HCR or LCR) interacted to weaken the effect of refeeding on HR recovery [B¼3.76 (.572,6.95), p¼0.021] and weight gain [B¼039 (.006,072), p¼0.021], which was 0.3% mBMI per day slower (p¼0.005) and 2.6% mBMI less overall (p¼0.009) in AAN than AN. Conclusions: While HCR is more efficacious than LCR for refeeding in AN, it may contribute to underfeeding in AAN. source) and four family variables (family functioning , parental connection, parental monitoring, and parental psychological control). The outcome, UWCB (e.g. fasting, vomiting, laxative use), was self-reported by young adults eight years later. Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) of UWCB for four weight stigma predictors and four family predictors. Models were adjusted for sociodemographic characteristics, baseline UWCB, and baseline BMI percentile, and predictors were modeled separately. Results: In analyses adjusted for sociodemographic characteristics, all weight stigma and family variables during adolescence longitudinally predicted significantly higher odds of UWCB eight years later. After additionally adjusting for baseline UWCB and baseline BMI percentile, two weight stigma variables (weight teasing from family [OR: 1.42, 95% CI: 1.08, 1.87] and hurtful weight-related comments from family [OR: 1.34, 95% CI: 1.06, 1.70]) and one family variable (poor family functioning [OR: 1.44, 95% CI: 1.14, 1.81]) remained significantly associated with subsequent UWCB. Conclusions: Findings indicate that there are long-term consequences , across major development periods, of weight teasing from family, hurtful weight-related comments from family, and low family 2022 SAHM Annual Meeting / Journal of Adolescent Health 70 (2022) S1eS32 S11

Surveillance data indicate youth have many sexual and gender identities that should be included in clinical forms and surveys to document and improve health equity.

This study aimed to identify patterns of change in muscle-building behaviors from adolescence to emerging adulthood and determine what adolescent factors predict new-onset muscle-building behavior in emerging adulthood. Prospective cohort data from a diverse sample of 1,535 participants followed from adolescence (baseline, Mage = 14.4 ± 2.0 years) to emerging adulthood (follow-up, Mage = 22.1 ± 2.0 years) from the population-based EAT 2010–2018 (Eating and Activity over Time) study were analyzed. Changes in muscle-building behavior were identified (starting, stopping, persistent use, or never use). Log-binomial regression models examined adolescent predictors of starting (i.e., new-onset) muscle-building behaviors in emerging adulthood. Prevalence of any use in adolescence (EAT 2010) and/or emerging adulthood (EAT 2018) was 55.1% (males) and 33.0% (females) for protein powder/shakes, 6.7% (males) and 5.4% (females) for steroids, and 19.4% (males) and 6.5% (females) for other muscle-building substances (e.g., creatine, amino acids). In particular, 22.6% (males) and 13.7% (females) started protein powder/shakes, 2.2% (males) and 1.0% (females) started steroid use, and 9.0% (males) and 2.0% (females) started other muscle-building substances during emerging adulthood. Adolescent protein powder/shake consumption was associated with starting steroids/other muscle-building substances use in emerging adulthood in males (adjusted risk ratio [ARR] 2.09, 95% confidence interval [CI] 1.29–3.39) and females (ARR 4.81, 95% CI 2.01–11.48). Adolescent use of protein powders/shakes may lead to a two- to five-fold higher risk of new use of steroids and other muscle-building products in emerging adulthood. Clinicians, parents, and coaches should assess for use of muscle-building behaviors in adolescents and emerging adults and discourage use of harmful products.

Objective: Sociocultural theories hold that family and peer weight-related teasing increases the risk for unhealthy weight control behaviors (UWCBs) by negatively impacting body image. Although much cross-sectional support exists for these pathways, longitudinal data are lacking. This study tested the longitudinal relationships among peer and family teasing (occurrence and perceived impact) in early adolescence, body satisfaction in late adolescence, and UWCBs in young adulthood among a racially/ethnically and socioeconomically diverse population. Method: Data were drawn from three waves of Project EAT over a 15-year period (Eating and Activity in Teens and Young Adults), and included responses from 1,902 young adults (57% female). Results: Among female participants, a mediated indirect pathway emerged with family weight-related teasing predicting increased engagement in UWCBs in early adulthood via poorer body image in late adolescence. In contrast, peer teasing did not predict body image or UWCBs. Among boys, the mediated indirect pathways were not significant. However, poor body image in late adolescent males predicted higher likelihood of engaging in UCWBs in early adulthood. Discussion: These findings support the long-term impact of family weight-related teasing on greater risk for UWCBs among girls and young women, and poor body image as a mechanism accounting for this relationship. Moreover, the results highlight the poor body image among adolescent boys as a factor for increased risk of engaging in UWCBs in early adulthood. Pending replication in current cohorts, health promotion and prevention involving family members of early adolescents that address family weight teasing and body image are needed.

Background: Self-weighing is widespread among young adults and is sometimes recommended by healthcare providers for weight management. The present study aims to deepen our understanding of who is frequently self-weighing among young adults, and to examine for whom self-weighing impacts mood based on weighing frequency and other eating and weight-related characteristics. Methods: Survey data were collected from a large population-based sample of young adults (31.1 ± 1.6y) participating in Project EAT-IV (n = 1719). Cross-sectional data were stratified across sex and analyzed with chi-square, t-tests, and linear and logistic regressions controlling for age, ethnicity/race, education level, and income. Results: Self-weighing frequency was higher among male and female young adults with a current eating disorder, those trying to lose weight or who endorsed any disordered eating behaviors or cognition, and females with higher BMI. Young adult females were significantly more likely than males to report that self-weighing impacted their mood (53% vs 27%, p < 0.05). Among both male and female young adults, there was a higher probability of participants reporting that self-weighing impacted their mood among those who were self-weighing more frequently, had higher BMI, were trying to lose weight, and endorsed disordered eating behaviors or cognitions. Conclusion: Findings suggest that for many young adults, particularly females and those with weight-related concerns, self-weighing is a behavior that comes with emotional valence. The emotional consequences of self-weighing should be considered when making public health and clinical recommendations regarding the usefulness of self-weighing.