Adolescent individual, school, and neighborhood influences on young adult hypertension risk.

Autor: Abdel Magid HS; Department of Epidemiology and Population Health, Stanford University, Stanford, California, United States of America.; Public Health Sciences Program, Santa Clara University, Santa Clara, California, United States of America., Milliren CE; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, United States of America., Rice K; Public Health Sciences Program, Santa Clara University, Santa Clara, California, United States of America., Molanphy N; Public Health Sciences Program, Santa Clara University, Santa Clara, California, United States of America., Ruiz K; Public Health Sciences Program, Santa Clara University, Santa Clara, California, United States of America., Gooding HC; Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America.; Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America., Richmond TK; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America., Odden MC; Department of Epidemiology and Population Health, Stanford University, Stanford, California, United States of America., Nagata JM; Division of Adolescent & Young Adult Medicine, University of California, San Francisco, San Francisco, California, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Apr 28; Vol. 17 (4), pp. e0266729. Date of Electronic Publication: 2022 Apr 28 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0266729
Abstrakt: Background: Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors. This study examines the association between individual, neighborhood, and school-level influences during adolescence on young adult blood pressure.
Methods: Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (1994-1995 aged 11-18 and 2007-2008 aged 24-32). We categorized hypertension as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Secondary outcomes included continuous systolic and diastolic blood pressure. We fit a series of cross-classified multilevel models to estimate the associations between young adulthood hypertension with individual-level, school-level, and neighborhood-level factors during adolescence (i.e., fixed effects) and variance attributable to each level (i.e., random effects). Models were fit using Bayesian estimation procedures. For linear models, intra-class correlations (ICC) are reported for random effects.
Results: The final sample included 13,911 participants in 128 schools and 1,917 neighborhoods. Approximately 51% (7,111) young adults were hypertensive. Individual-level characteristics-particularly older ages, Non-Hispanic Black race, Asian race, male sex, BMI, and current smoking-were associated with increased hypertension. Non-Hispanic Black (OR = 1.21; 95% CI: 1.03-1.42) and Asian (OR = 1.28; 95% CI: 1.02-1.62) students had higher odds of hypertension compared to non-Hispanic White students. At the school level, hypertension was associated with the percentage of non-Hispanic White students (OR for 10% higher = 1.06; 95% CI: 1.01-1.09). Adjusting for individual, school, and neighborhood predictors attenuated the ICC for both the school (from 1.4 null to 0.9 fully-adjusted) and neighborhood (from 0.4 to 0.3).
Conclusion: We find that adolescents' schools and individual-level factors influence young adult hypertension, more than neighborhoods. Unequal conditions in school environments for adolescents may increase the risk of hypertension later in life. Our findings merit further research to better understand the mechanisms through which adolescents' school environments contribute to adult hypertension and disparities in hypertension outcomes later in life.
Competing Interests: Potential Conflicts of Interest: Michelle Odden is a consultant for Cricket Health, Inc. The remaining authors have indicated no conflicts of interest to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje