Prospective intergenerational mixed-methods investigation of the short- and long-term impact of COVID-19 on adolescent mental, social, and behavioral health

摘要 为了更好地了解COVID-19大流行对青年心理健康的短期和长期影响， 发展，我们将利用我们现有的随机对照试验，以学校为基础的健康关系， 程序. 2018年，我们在贫困社区随机抽取了24所德克萨斯州中学， （n=2865;平均年龄= 12.7; 50%女性; 36%黑人/非裔美国人，26%拉丁裔; 14%亚裔）接受了以下任一治疗 标准健康课程（n=12所对照学校）或第四R（n=12所干预学校）。参与者 完成基线和三次年度综合随访评估，抑郁症， 焦虑，敌意），社交（例如，生活状况、社会经济地位、学校气氛、压力）和行为 (e.g.,约会暴力，物质使用，性行为，（网络）欺凌，应对策略）健康。这 纵向数据，以及在COVID-19大流行之前制定的相关措施，以及由此产生的 家庭订单，提供了一个强有力的机会，了解这场全球危机对青年的长期影响 发展，心理健康，危险行为和学业成绩，并探讨风险和保护因素 缓和这种影响。因此，我们将：1）再进行四年的年度跟踪调查， 从12年级开始，跟踪学生，直到他们平均21岁; 2）招募和 评估参与者的父母; 3）用全面的数据来增加我们已经广泛的学生水平数据 流行病相关措施，以及学校，邻里和环境水平的因素， 对教育工作者（n=24）、学生（n=24）和家长进行定性访谈 （n=24）更深入地了解减轻或加剧COVID-19影响的因素， 导致学校、家庭、心理健康和发展受到干扰。具体目标是：（1）确定 COVID-19大流行对青少年心理、行为和社会健康的短期和长期影响， 以及他们的学习成绩和职业潜力; 2）检查家庭和 收入稳定性、亲子关系、父母心理健康、公平（受教育机会、数字鸿沟） 学习模式（面对面，在线，混合），学校中断，以及学校和社区气候对COVID- 19对青年的影响; 3）调查与流行病有关的压力因素（个人/家庭COVID 工作中断、食物获取、媒体消费和疫苗接种的影响）与短期和长期 长期健康行为和结果;以及4）评估Fourth R在减轻 COVID-19疫情的负面影响。鉴于干预的目标是心理健康，冲突 解决，应对和寻求帮助，我们假设，学生暴露于干预将证据 与对照学校的同龄人相比，他们的心理、社会和行为健康得到改善。我们的研究将 提供对COVID-19影响的严格和全面的了解-通过利用 数据来自正在进行的队列，并通过定性调查的背景。

Abstract To better understand the short- and long-term impact of the COVID-19 pandemic on youth mental health and development, we will leverage our existing randomized controlled trial of a school-based healthy relationships program. In 2018, we randomized 24 Texas middle schools in disadvantaged communities in which students (n=2865; Mean age = 12.7; 50% female; 36% Black/African American, 26% Latinx; 14% Asian) received either standard health curriculum (n=12 control schools) or Fourth R (n=12 intervention schools). Participants completed baseline and three annual comprehensive follow-up assessments of their mental (e.g., depression, anxiety, hostility), social (e.g., living situation, socio-economic status, school climate, stress), and behavioral (e.g., dating violence, substance use, sexual behavior, (cyber)bullying, coping strategies) health. This longitudinal data, with relevant measures established prior to the COVID-19 pandemic and resulting stay-at- home orders, provides a powerful opportunity to understand the long-term impact of this global crisis on youth development, mental health, risk behaviors, and academic achievement and explore risk and protective factors moderating this impact. Thus, we will 1) administer an additional four years of annual follow-up surveys, beginning in the 12th grade and follow students until they are, on average, 21 years of age; 2) recruit and assess parents of participants; 3) augment our already extensive student-level data with comprehensive pandemic-related measures, as well as school-, neighborhood-, and environmental-level factors that may moderate impact; and 4) conduct qualitative interviews of educators (n=24), students (n=24), and parents (n=24) to obtain a richer understanding of factors that mitigated or exacerbated the impact of COVID-19 and resulting disruptions to school, family, mental health, and development. Specific aims are to 1) Determine the short- and long-term impact of the COVID-19 pandemic on adolescents' mental, behavioral, and social health, as well as their academic performance and career potential; 2) Examine the moderating impact of family and income stability, parent-child relationships, parent mental health, equity (access to education, digital divide), learning model (in-person, online, hybrid), school disruptions, and school and neighborhood climate on COVID- 19 impacts for youth; 3) Investigate whether and how pandemic-related stressors (individual/family COVID impacts of job interruption, food access, media consumption, and vaccine uptake) are linked to short- and long- term health behaviors and outcomes; and 4) Evaluate the secondary benefits of Fourth R in mitigating the negative impact of the COVID-19 pandemic. Given that the intervention targets mental wellbeing, conflict resolution, coping, and help-seeking, we hypothesize that students exposed to the intervention will evidence improved mental, social, and behavioral health relative to their counterparts in control schools. Our study will provide a rigorous and comprehensive understanding of the impact of COVID-19 – quantitatively by leveraging data from an ongoing cohort and contextually through qualitative investigation.