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Background: Adolescence is a critical period of rapid physical and psychological change, yet it is also when many health and well-being problems first emerge, often setting limits on lifelong opportunities and achievements as youth transition into adulthood. The ground-breaking adverse childhood experiences (ACEs) study has significantly shaped the development of programs and policies aimed at fostering adolescent health. Nonetheless, there has been limited exploration into the heterogeneity among individuals experiencing a high number of ACEs, such as four or more. This study employs Latent Profile Analysis (LPA) to examine the diverse outcome profiles of adolescents who have been exposed to a substantial number of ACEs. Method: The data were from participants who experienced at least four ACEs by age 9 in the Future of Families and Child Wellbeing Study (N = 1427; 54% male; 59% Black; 15.3% Hispanic; 2.4% other). We applied LPA using the manual three-step method within Mplus 8 to establish profiles based on six developmental indicators at age 15. These indicators included optimism, perseverance, academic performance, internalizing and externalizing behavioral competence, and social skills. The full information maximum likelihood method was used to handle missing data. Results: The study identified three distinct profile groups according to model fit indices and interpretability: Multidimensional Competence Group (61.0%), Low Personality and Social Competence Group (23.8%), and Low Behavioral Competence Group (15.2%). Racial and ethnic backgrounds were significant predictors of membership in these different profile groups. Conclusions: In a research landscape often focused on the cumulative harm of ACEs, our study underscores the heterogeneity of trauma profiles among adolescents with substantial ACE exposure. Given that adolescence is a critical stage when health and well-being challenges emerge, tailored early interventions are important to supporting a successful transition into adulthood. We advocate for the importance of comprehensive screening for social-cognitive and behavioral health difficulties in trauma-affected youth, enabling practitioners to implement timely prevention strategies and tailored interventions that foster resilience and long-term well-being.

Research indicates complex associations between adverse childhood experiences (ACEs) and adolescent peer relationships. ACEs are related to lower peer status, yet the links between ACEs, peer characteristics, and peer relationship quality are inconclusive. The current literature has several further conceptual and methodological limitations, including a lack of attention to ACEs’ co-occurring nature, the developmental timing of ACEs during adolescence, and the multifaceted nature of peer relationships. In addition, much of the literature is cross-sectional. The current study addresses these limitations by examining the associations of early adolescents’ co-occurring ACEs at age 12 with three subsequent peer relationship aspects at age 16 (i.e., peer characteristics, peer status, and peer relationship quality) while controlling for demographics and early adversities. Participants included 883 youth from the Longitudinal Studies of Child Abuse and Neglect. Latent class analyses of the 10 ACEs, as examined in the original CDC-Kaiser ACE study, identified three distinct ACE classes at age 12 (threat, deprivation, and low ACEs) that were distinguished by gender, race, income, and early adversities. Further, the threat class was related to adverse outcomes in peer characteristics and status, while the deprivation class was associated with differences in peer relationship quality. These findings highlight the need for researchers and practitioners to consider ACEs’ co-occurring nature and tailor trauma-informed care accordingly. Findings also underscore the salience of studying ACEs that occur in the developmental period of early adolescence.

Adolescence and young adulthood is a critical stage when the economic foundations for life-long health are established. To date, there is little consensus as to whether marijuana use is associated with poor educational and occupational success in adulthood. We investigated associations between trajectories of marijuana use from ages 15 to 28 and multiple indicators of economic well-being in young adulthood including achievement levels (i.e., educational attainment and occupational prestige), work characteristics (i.e., full vs part-time employment, hours worked, annual income), financial strain (i.e., debt, trouble paying for necessities, delaying medical attention), and perceived workplace stress. Data were from the Victoria Healthy Youth Survey, a 10-year prospective study of a randomly recruited community sample of 662 youth (48% male; Mage = 15.5), followed biennially for six assessments. Models adjusted for baseline age, sex, SES, high school grades, heavy drinking, smoking, and internalizing and oppositional defiant disorder symptoms. Chronic users (our highest risk class) reported lower levels of educational attainment, lower occupational prestige, lower income, greater debt, and more difficulty paying for medical necessities in young adulthood compared to abstainers. Similarly, increasers also reported lower educational attainment, occupational prestige, and income. Decreasers, who had high early use but quit over time, showed resilience in economic well-being, performing similar to abstainers. Groups did not differ on employment status or perceived workplace stress. The findings indicate that early onset and persistent high or increasingly frequent use of marijuana in the transition from adolescent to young adulthood is associated with risks for achieving educational and occupational success, and subsequently health, in young adulthood.

Developmental systems theories highlight the importance of understanding the bidirectional associations between parenting behaviors and children’s development. The current study examined the longitudinal and reciprocal links between two key parenting processes (i.e., maternal warmth and maternal harshness) and children’s self-regulation across early and middle childhood. Data were drawn from the Future of Families and Child Wellbeing Study when the children were ages 3, 5, and 9. Participants included 3,821 mother-child dyads from socioeconomic and racially/ethnically diverse backgrounds (50.45% African American, 26.21% Hispanic American, 20.09% White, and 3.25% other race/ethnicity). Latent Cross-Lagged Panel Models using the weighted least squares means and variance adjusted estimator were conducted across three waves. Results demonstrated significant bidirectional associations in middle childhood, such that maternal warmth at age 5 predicted children’s self-regulation at age 9, and children’s self-regulation at age 5 predicted maternal warmth at age 9. Child-driven effects were detected in early childhood, such that children’s lower levels of self-regulation at age 3 were associated with lower levels of maternal warmth and higher levels of maternal harsh parenting at age 5. The child-driven effect was also found in middle childhood for maternal harsh parenting. Findings support the transactional framework, suggesting a reciprocal association between parenting and child behaviors between early and middle childhood. Implications for holistic parental educational intervention programs are discussed. Highlights We examined the reciprocal associations between maternal warmth, maternal harsh parenting, and self-regulation among racially diverse and socioeconomic disadvantaged children. Lower levels of children’s self-regulation at age 3 were associated with lower levels of maternal warmth and higher levels of maternal harsh parenting at age 5. Bidirectional effects from ages 5 to 9 indicated that higher levels of maternal warmth were associated with higher levels of children’s self-regulation; similarly, higher levels of self-regulation elicited higher levels of maternal warmth.

Background and objectives: Machine learning approaches using random forest have been effectively used to provide decision support in health and medical informatics. This is especially true when predicting variables associated with Medicare reimbursements. However, more work is needed to analyze and predict data associated with reimbursements through Medicare and Medicaid services for physical therapy practices in the United States. The key objective of this study is to analyze different machine learning models to predict key variables associated with Medicare standardized payments for physical therapy practices in the United States. Materials and Methods: This study employs five methods, namely, multiple linear regression, decision tree regression, random forest regression, K-nearest neighbors, and linear generalized additive model, (GAM) to predict key variables associated with Medicare payments for physical therapy practices in the United States. Results: The study described in this article adds to the body of knowledge on the effective use of random forest regression and linear generalized additive model in predicting Medicare Standardized payment. It turns out that random forest regression may have any edge over other methods employed for this purpose. Conclusions: The study provides a useful insight into comparing the performance of the aforementioned methods, while identifying a few intricate details associated with predicting Medicare costs while also ascertaining that linear generalized additive model and random forest regression as the most suitable machine learning models for predicting key variables associated with standardized Medicare payments.

ObjectivesThe relationship between bully victimization and depression has been examined extensively with prior research showing long-term cascade of problems stemming from both exposure to victimization and depressive symptomology. However, prior research has failed to consider how protective factors may mitigate these long-term problems. Three theoretical models were tested: the interpersonal risk model, symptom driven model, and transactional model.MethodsThe present study employs a novel statistical technique to explore longitudinal reciprocal associations among bullying, depression, and school belonging in a sample of 2177 middle school students (ages 11 to 15) in a Midwestern state. We used a model building process to explore the overall association between bully victimization, depression, and school belonging as well as a multi-group model in which models were estimated for boys and girls, separately.ResultsIn our overall model, results indicated support for both symptom driven and interpersonal risk models. However, we did not find any significant buffering effect of school belonging. In our multi-group model, we found support for a buffering effect of school belonging for girls, but not boys. School belonging buffered long term problems associated with experiences of bully victimization via reductions in depression.ConclusionsOur findings point to the broader concept of school structure being differentially supportive and protective for various demographic groups and the need to consider the entire social ecology of a school when planning and implementing prevention interventions.

Aggression among peers during adolescence is associated with deleterious developmental outcomes. Family violence has been strongly associated with many forms of aggression - such as verbal and physical aggression. Yet, associations between sibling and peer aggression at school and the protective role of school belonging remain understudied. Thus, the present study addresses this gap. Middle school students (N = 1611) completed self-report surveys four times across 2 years in a U.S. Midwest state. A multi-level within- and between-person longitudinal design was employed to examine associations among sibling aggression perpetration, witnessing intrafamilial violence, and verbal and physical peer aggression at school. Also, the moderating effect of school belonging between family violence and peer aggression was also investigated. Higher levels of sibling aggression were associated with higher verbal peer aggression at both within- and between-person levels. Family violence was associated with higher verbal and physical peer aggression, but only at the between-person level and not within-individuals. Higher school belonging was associated with less verbal and physical peer aggression overtime. School belonging moderated the relation between sibling aggression and verbal as well as physical aggression; higher within-person level sibling aggression was associated with lower verbal and physical aggression when students reported a strong sense of school belonging. Aggression prevention programs that focus on fostering school connectedness may mitigate the transmission of violence from home to school.

We differentiated marijuana-use trajectories in a large cohort of Canadian youth and compared the use of other substances, mental health symptoms, and behavioural problems for each of the identified trajectories at their baselines in adolescence (ages 12 to 18) and their endpoints (ages 22 to 29). Data came from the Victoria Healthy Youth Survey, a 10-year prospective study of a random community sample of 662 participants in Victoria, British Columbia, Canada (48% male; Mage = 15.5). Canadian youth were followed biennially for six assessments from 2003 to 2013. Five distinct marijuana-use classes were identified using latent-class growth-curve analyses: abstainers (29%), occasional users (27%), decreasers (14%), increasers (20%), and chronic users (11%). Lower use classes typically began use after age 15. Chronic users had more problem behaviours (e.g., attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and conduct problems) in both adolescence and young adulthood and more depressive symptoms in young adulthood than other classes. Decreasers reported more depressive symptoms in adolescence than chronic users and were less likely to co-use other substances in young adulthood. Increasers were similar to chronic users in young adulthood, but reported more illicit drug use and lower levels of depressive and oppositional-defiant disorder symptoms. Problematic marijuana use occurs in the context of mental health and problem behaviours as well as other substance-use concerns. Prevention and treatment approaches need to include anticipation and treatment of co-occurring problems to stem negative effects of marijuana during the transition from adolescence to young adulthood. Nous avons différencié les trajectoires en matière d'utilisation de cannabis d'une grande cohorte de jeunes Canadiens et comparé l'utilisation d'autres substances, de symptômes de santé mentale et de problèmes de comportement pour chacune des trajectoires identifiées à leurs lignes de base à l'âge de l'adolescence (entre 12 et 18 ans) et leurs résultats finaux (entre 22 et 29 ans). Les données proviennent de l'Enquête sur les jeunes en santé de Victoria, une étude prospective de 10 ans sur un échantillon de 662 participants sélectionnés au hasard de la collectivité de Victoria, Colombie-Britannique, Canada (48 % d'hommes; âge médian 15,5). Les jeunes Canadiens ont été suivis tous les deux ans au moyen de six évaluations s'échelonnant entre 2003 et 2013. Cinq catégories d'utilisation de cannabis distinctes ont été identifiées à partir d'une analyse de classe latente pour courbe de croissance : abstinents (29 %), utilisateurs occasionnels (27 %), utilisateurs dont la consommation est en baisse (14 %), utilisateurs dont la consommation est en hausse (20 %) et utilisateurs chroniques (11 %). Les catégories d'utilisation moindre ont généralement commencé l'utilisation après l'âge de 15 ans. Les utilisateurs chroniques présentaient davantage de problèmes de comportements (par ex., un trouble de déficit d'attention/hyperactivité, un trouble oppositionnel avec provocation ou un trouble comportemental) tant chez les adolescents que chez les jeunes adultes et davantage de symptômes de dépression chez les jeunes adultes que chez les autres catégories d'âge. Les utilisateurs dont la consommation est en baisse ont signalé plus de symptômes de dépression à l'adolescence que les utilisateurs chroniques et étaient moins susceptibles de co-utiliser d'autres substances au début de l'âge adulte. Les utilisateurs dont la consommation est en hausse ont signalé les mêmes symptômes que les utilisateurs chroniques au début de l'âge adulte, mais ont signalé une utilisation accrue de drogues illicites et des niveaux inférieurs de symptômes de dépression et de troubles oppositionnels avec provocation. L'utilisation problématique de cannabis se produit dans un contexte de santé mentale et de problèmes de comportement ainsi que d'autres préoccupations liées à la consommation de substances. Les approches de prévention et de traitement doivent inclure l'anticipation et la gestion de problèmes survenant en même temps pour contrecarrer les effets négatifs du cannabis lors du passage de l'adolescence au début de l'âge adulte. Public Significance Statement Early-onset and persistent high-frequency marijuana use is associated with negative outcomes for youth. Results show that patterns of marijuana use are firmly situated in contexts of polysubstance use and co-occurring mental health and behavioural problems during both adolescence and young adulthood. Acknowledging, assessing, and treating these co-occurring problems will be necessary to stem negative effects of marijuana-use patterns on developmental outcomes for youth.

In the past two decades, there has been a significant amount of research on children’s relational aggression, which has been found to be associated with psychosocial problems. Longitudinal studies have examined changes in relational aggression during early adolescence in relation to individual characteristics; however, most studies compare individual differences between people with regard to rates of relational aggression. A shortcoming to the current literature is the lack of studies that use a multilevel approach to examine individual differences (between-person) as well as the extent to which individuals deviate from their own typical levels (within-person) over time. In this study, within- and between-person psychological and peer-related predictors of rates of relational aggression over time were examined. Participants included 1,655 students in 5th–8th grade (mean age: 13.01) from four public middle schools in the Midwest, which consisted 828 females and 827 males. In terms of race and ethnicity, 819 (49.5%) were African Americans, followed by 571 (34.5%) Whites, and 265 (16%) Others. Longitudinal data were collected over four waves across two years of middle school. The findings indicated that contrary to the hypothesis that relational aggression would increase over time, there was no significant growth across time. Age, gender, and race were not associated with relational aggression over time; however, consistent with the Social Cognitive Theory, changes in within-person impulsivity, anger, and peer delinquency were all positively related to increases in relational aggression. At the between-person level of analysis, depressive symptoms and peer delinquency were related to relational aggression. Findings suggest that school-based programs that address anger management, impulsivity, empathy, and victimization could help prevent relational aggression.

Adolescent delinquency and substance use are global problems. African American adolescents are especially susceptible to the life-changing consequences of these problem behaviors. Religiosity is a notable protective factor that has been shown to mitigate these behaviors. This study uses a person-centered approach to examine the extent to which religiosity is associated with lower rates of delinquency and substance use among urban African American adolescents in the United States. Latent Class Analysis was used to examine the heterogeneity in five religiosity items among a sample of adolescents ages 13–18. After identifying religiosity classes through a class enumeration process, we examined predictors of the classes using multinomial logistic regression. The classes were then used to predict several substance use and delinquency outcomes. Three religiosity classes were identified; “low religious beliefs and engagement,” (15.19%, n = 94), “religious with low active engagement,” (56.70%, n = 351), and “religious with high active engagement,” (28.11%, n = 174). Protective effects of religiosity on substance use (e.g., alcohol) and delinquency were found (e.g., assault). Implications for research and practice are discussed.