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Background Understanding the temporal trend of the disease burden of stroke and its attributable risk factors in China, especially at provincial levels, is important for effective prevention strategies and improvement. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is to investigate the disease burden of stroke and its risk factors at national and provincial levels in China from 1990 to 2019. MethodsFollowing the methodology in the GBD 2019, the incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of stroke cases in the Chinese population were estimated by sex, age, year, stroke subtypes (ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage), and across 33 provincial administrative units in China from 1990 to 2019. Attributable mortality and DALYs of underlying risk factors were calculated by a comparative risk assessment. Findings In 2019, there were 3•94 million (95% uncertainty interval 3•43-4•58) new stroke cases in China. The incidence rate of stroke increased by 86•0% (73•2-99•0) from 1990, reaching 276•7 (241•3-322•0) per 100 000 population in 2019. The age-standardised incidence rate declined by 9•3% (3•3-15•5) from 1990 to 2019. Among 28•76 million (25•60-32•21) prevalent cases of stroke in 2019, 24•18 million (20•80-27•87) were ischaemic stroke, 4•36 million (3•69-5•05) were intracerebral haemorrhage, and 1•58 million (1•32-1•91) were subarachnoid haemorrhage. The prevalence rate increased by 106•0% (93•7-118•8) and age-standardised prevalence rate increased by 13•2% (7•7-19•1) from 1990 to 2019. In 2019, there were 2•19 million (1•89-2•51) deaths and 45•9 million (39•8-52•3) DALYs due to stroke. The mortality rate increased by 32•3% (8•6-59•0) from 1990 to 2019. Over the same period, the age-standardised mortality rate decreased by 39•8% (28•6-50•7) and the DALY rate decreased by 41•6% (30•7-50•9). High systolic blood pressure, ambient particulate matter pollution exposure, smoking, and diet high in sodium were four major risk factors for stroke burden in 2019. Moreover, we found marked differences of stroke burden and attributable risk factors across provinces in China from 1990 to 2019.Interpretation The disease burden of stroke is still severe in China, although the age-standardised incidence and mortality rates have decreased since 1990. The stroke burden in China might be reduced through blood pressure management, lifestyle interventions, and air pollution control. Moreover, because substantial heterogeneity of stroke burden existed in different provinces, improved health care is needed in provinces with heavy stroke burden.

Truancy has been a persistent problem in the United States for more than 100 years. Although truancy is commonly reported as a risk factor for substance use, delinquency, dropout, and a host of other negative outcomes for youth, there has been surprisingly little empirical investigation into understanding the causes and correlates of truancy using large, nationally representative samples. Using the adolescent sample (N = 17,482) of the 2009 National Survey on Drug Use and Health (NSDUH), this study presents the prevalence of truancy and examines individual, school engagement, parental, and behavioral correlates of truancy. Overall, 11% of adolescents between the ages of 12–17 reported skipping school in the past 30 days. Results from multinomial logistic regression models indicate skipping school was robustly associated with an increased probability of reporting externalizing behaviors, less parental involvement, and engagement and lower grades in school. Implications for theory, prevention, and policy are discussed.

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There has been considerable interest in the identification of putative subtypes of psychopathy over the past several years although none of this research has focused on juveniles who are high in psychopathic traits. Using a statewide sample of juvenile offenders, the present study sought to identify subtypes consistent with theoretical notions of primary and secondary psychopathy. Among those youths high in psychopathic traits ( n = 132), finite mixture modeling of various indicators of psychological distress resulted in a two-class solution. Consistent with theory, one subtype was characterized by higher levels of distress (e.g., anxiety, depression, suicidal ideation), whereas the other subgroup was lower on these dimensions and generally similar to nonpsychopathic control juveniles ( n = 135). Analyses of theoretically relevant external correlates (e.g., offense history, drug use, victimization) suggested that the two subtypes differed from each other on certain key variables as well as differed from the nonpsychopathic controls.

Despite research demonstrating that approximately 5% of study populations are composed of severely antisocial persons who account for a disproportionate share of problem behaviors, there have been no nationally representative studies assessing this phenomenon among adolescents. Using a large nationally representative sample (N ¼ 18,614), we identified a severe group (4.7% of respondents) characterized by involvement in varied and intensive externalizing behaviors, greater internalizing, lower academic achievement, and less parental involvement. The current study is the first nationally representative study of criminal careers/externalizing behaviors among adolescents in the United States, which is convergent with prior research and theory.

The purpose of this study was to explore prevalence and predictors of current and lifetime substance use, substance abuse disorder, and polysubstance use among older youth in foster care. Interviews were conducted with 406 17-year old youth (90% of those eligible) in one state's foster care system between December 2001 and June 2003. Forty-five percent of foster care youth reported using alcohol or illicit drugs within the last six months; 49% had tried drugs sometime during their lifetime and 35% met criteria for a substance use disorder. Having a diagnosis of Conduct Disorder and/or living in an independent living situation significantly increased the likelihood of current and lifetime substance use and disorder. A diagnosis of Post Traumatic Stress Disorder also predicted increased likelihood of polysubstance use and substance abuse disorder. In conclusion, older youth in the foster care system report similar levels of lifetime alcohol and illicit substance use when compared to the general adolescent population. However, rates of substance use disorder are high. Particularly at risk for both high rates of use and disorder are youth in independent living situations and youth with a diagnosis of Conduct Disorder or Post Traumatic Stress Disorder.

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