Purpose Grit, defined as “working strenuously toward challenges, maintaining effort and interest over years despite failure, adversity, and plateaus in progress,” is strongly associated with academic achievement and life success and may also be associated with health outcomes and behaviors. We examined predictors of grit, and the association between grit and health behaviors among at-risk Latino adolescents. Methods We analyzed baseline survey data collected in 2013-2014 from a sample of 1,270 9th graders in low-income neighborhoods of Los Angeles. We examined factors associated with grit and whether grit is associated with substance use and delinquent behaviors, controlling for adolescent and parent sociodemographic factors. Results In a sample of mostly Latino adolescents (89.5%), compared to those with low grit, those with high grit had significantly lower odds of alcohol use in the last 30 days (OR=0.30, p<0.001), marijuana use (OR=0.21, p<0.05), and fighting (OR=0.58, p<0.05). Involvement in delinquent behavior was also lower (β=-0.71, p<.001). Factors associated with more grit included authoritative parenting style, parental employment, and high self-efficacy scores. Conclusion Grit may be an important candidate protective factor against substance use and other risk behaviors among Latino adolescents.
BackgroundResearch has revealed that manifest Alzheimer’s disease (AD) dementia is preceded by preclinical and prodromal phases during which pathology is accumulating but function remains intact. This understanding and concern that disease-modifying interventions initiated at the dementia stage may come too late in the neurodegenerative process to be successful has led to a paradigm shift in AD clinical trials. AD trials now enroll patients with mild cognitive impairment (MCI) and persons with no cognitive symptoms. Trial designs are similar to those enrolling dementia participants. We set out to test the hypothesis that attitudes towards trial design features differ among different potential AD trial populations.MethodsWe sent a survey composed of 37 items assessing specific trial elements to 246 cognitively normal, MCI, and AD dementia participants at the University of California Los Angeles (UCLA) Alzheimer’s Disease Research Center (ADRC), from whom we received 91 responses (37 cognitively normal, 32 MCI, and 22 dementia). To quantify willingness to enroll, we created three composite scenarios by summing responses and fitting proportional odds models with a binary outcome variable for whether patients were highly willing to participate in low-, moderate-, or high-risk and burden trials.ResultsMCI participants less frequently correctly self-identified their diagnoses than those with dementia or normal cognition. Compared to dementia patients, the odds of participating in a low-risk, low-burden trial were 12% lower for MCI patients (odds ratio (OR) = 0.88, 95% confidence interval (CI) 0.23–3.29) and 70% lower (OR = 0.30, 95% CI 0.08–1.09) for cognitively normal participants. With increasing risk and burden, willingness to enroll decreased and the gap in relative willingness between diagnostic groups increased. In the medium-risk, medium-burden scenario, the estimated OR was 0.64 (95% CI 0.17–2.40) for MCI and 0.21 for the cognitively normal (95% CI 0.06–0.77). In the high-risk, high-burden scenario, the estimated OR indicated reduced willingness for MCI (OR = 0.27, 95% CI 0.06–1.15) and cognitively normal respondents (OR = 0.12, 95% CI 0.03–0.54).ConclusionsThese results suggest that AD trials enrolling predementia populations, especially those requiring frequent visits and implementing biomarker testing procedures, may encounter challenges to enrollment.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0311-5) contains supplementary material, which is available to authorized users.
Importance Although school environments are thought to influence health behaviors, experimental data assessing causality are lacking, and which aspects of school environments may be most important for adolescent health are unknown. Objective To test whether exposure to high-performing schools reduces risky adolescent health behaviors. Design We used admission lotteries—which mimic random assignment—to estimate the causal effect of school environments on adolescent health. We surveyed 1270 students who applied to high-performing public charter schools in low-income minority communities in Los Angeles. We followed lottery “winners” (Intervention) and “losers” (Control) from the end of 8th grade/beginning of 9th grade through the end of 11th grade. Intent-to-Treat (ITT) and Instrumental Variables (IV) techniques estimate the effects of “winning” the lottery and attending high-performing schools on health behaviors and whether effects varied by gender. Setting: Charter and non-charter public high schools in Los Angeles. Participants: Students applying to one of the 5 public charter schools in Los Angeles where the majority enrolled were economically disadvantaged, the school’s academic performance ranked in the top tertile of LA County public high schools, there were at least 50 more applicants than seats available, and they used an admissions lottery. Main Outcomes and Measures: Primary outcomes were 30-day marijuana use and high-risk marijuana use. Additional health outcomes included 30-day alcohol use, alcohol misuse, ever being in a fight, ever having sex and past year delinquency. We also examined potential intermediate factors (time studying, truancy, school mobility, school culture, school order, teacher support, and proportion of substance using peers in students’ social networks). Results Intent-to-treat analysis showed that lottery “winners” (n=694) reported less marijuana misuse than loterry “losers” (n=576), as well as fewer substance using peers, more time studying, less truancy, greater teacher support, more orderly schools, and less school mobility(all p<0.05). Stratified analyses suggest more consistent effects for boys with treatment effects noted as early as 9th grade. Conclusions and Relevance This natural experiment provides evidence that school environments can improve risky behaviors for low-income minority adolescents.
Background Schools and school climate are thought to influence academic outcomes as well as child and adolescent development, health and well-being. We sought to examine the relationship between several aspects of the school climate with adolescent social-emotional health outcomes. Methods We analysed data from the Reducing Inequities through Social and Educational change Follow-up (RISE UP) Study, a longitudinal natural experimental study of Los Angeles high school students collected from 2013 to 2018. We analysed data on the portion of the sample that completed the baseline, 10th grade and 11th grade surveys (n=1114). Students reported their perceptions of school climate at 10th grade and social-emotional outcomes including grit, self-efficacy, depression, hopelessness, and stress at baseline (9th grade) and at 11th grade. Multivariable regressions adjusted for student and parental demographics and baseline social-emotional states tested associations between school climate and each outcome. Results Students who reported being in authoritative school environments in 10th grade, one that is highly supportive and highly structured, had subsequently higher levels of self-efficacy (p< 0.001) and grit (p=0.01). They also had fewer depressive symptoms (p=0.008), and less hopelessness (p = 0.01), stress at school (p=0.002) and stress about the future (p=0.03) reported in 11th grade. Conclusions School climate, and particularly an authoritative school environment, is strongly associated with better social-emotional health among adolescents. Relationship with teachers and their disciplinary style may be a focus for future interventions to improve the social-emotional health of children.
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