School of Nursing (KR Choi and E Cardona), UCLA, Los Angeles, Calif; Department of Health Policy and Management (KR Choi, J La Charite, and LE Wisk), Fielding School of Public Health, Los Angeles, Calif.
National Clinician Scholars Program (L Bravo and T Elliott), Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, Calif.
Acad Pediatr. 2024 Nov-Dec;24(8):1236-1245. doi: 10.1016/j.acap.2024.07.006. Epub 2024 Jul 14.
This study aimed to investigate the relationships between four types of perceived discrimination (based on race and ethnicity, nationality/country of origin, gender identity, weight/body size), individually and cumulatively; positive childhood experiences (PCEs); and behavioral symptoms among pre-adolescent youth.
This study was a secondary analysis of data from the Adolescent Brain Cognitive Development (ABCD) Study, a US-based cohort study of pre-adolescent youth in the United States (N = 10,915). Our outcome was emotional/behavioral symptoms measured by the Child Behavior Checklist. Primary exposures were four types of discrimination, a count of 0-5 PCEs, and other adverse childhood experiences (ACEs). Multiple logistic regression models were used to estimate the relationship between perceived discrimination and clinical-range behavioral symptoms, including the role of PCEs and ACEs.
Weight discrimination was the most frequent exposure (n = 643, 5.9%). Race and weight perceived discrimination were associated with clinical-range externalizing and internalizing symptoms, respectively, but these associations were non significant once other ACEs were added to models. Cumulative discrimination was associated with clinical-range Child Behavior Checklist (CBCL) scores, even when accounting for other ACEs (aOR=1.47, 95% CI=1.2-1.8). PCEs slightly reduced the strength of this relationship and were independently associated with reduced symptoms (aOR=0.82, 95% CI=0.72-0.93).
Results of this national study suggest cumulative discrimination can exert emotional/behavioral health harm among youth. PCEs were independently associated with reduced behavioral symptoms. There is a need for further research on how to prevent discrimination and bolster PCEs by targeting upstream social inequities in communities.
本研究旨在探究四种感知歧视（基于种族和民族、国籍/原籍国、性别认同、体重/体型）、积极的童年经历（PCEs）和青春期前青少年的行为症状之间的个体和累积关系。
本研究是对美国青少年大脑认知发展（ABCD）研究数据的二次分析，该研究是一项针对美国青春期前青少年的美国队列研究（N=10915）。我们的结果是通过儿童行为检查表衡量的情绪/行为症状。主要暴露因素是四种歧视类型、0-5 种 PCEs 和其他不良童年经历（ACEs）。使用多逻辑回归模型来估计感知歧视与临床范围行为症状之间的关系，包括 PCEs 和 ACEs 的作用。
体重歧视是最常见的暴露（n=643，5.9%）。种族和体重感知歧视分别与临床范围的外显和内隐症状相关，但在加入其他 ACEs 后，这些关联不再显著。累积歧视与临床范围的儿童行为检查表（CBCL）评分相关，即使考虑到其他 ACEs 也是如此（aOR=1.47，95%CI=1.2-1.8）。PCEs 略微降低了这种关系的强度，并且与症状减轻独立相关（aOR=0.82，95%CI=0.72-0.93）。
这项全国性研究的结果表明，累积歧视可能会对青少年的情绪/行为健康造成伤害。PCEs 与减轻行为症状独立相关。需要进一步研究如何通过针对社区中上游社会不平等来预防歧视和增强 PCEs。
