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

摘要 为了更好地了解新冠肺炎大流行对青少年心理健康和健康的短期和长期影响 发展，我们将利用我们现有的基于学校的健康关系的随机对照试验 程序。2018年，我们随机选择了24所德克萨斯州贫困社区的中学，这些学校的学生 (n=2865；平均年龄=12.7；50%女性；36%黑人/非洲裔美国人，26%拉丁裔美国人；14%亚洲人) 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全面的精神跟踪评估(例如，抑郁症， 焦虑、敌意)、社会(如生活状况、社会经济状况、学校氛围、压力)和行为 (例如，约会暴力、药物使用、性行为、(网络)欺凌、应对策略)健康。这 纵向数据，以及在新冠肺炎大流行之前建立的相关措施和由此产生的停留在 家庭订单，为了解这场全球危机对青年的长期影响提供了一个强有力的机会 发展、心理健康、危险行为和学业成就，并探索危险和保护因素 缓和这种影响。因此，我们将1)额外管理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 评估参与者的家长；3)通过全面的数据增强我们已经广泛的学生级别数据 与流行病有关的措施，以及学校、社区和环境层面的因素，可能 中等影响；4)对教育工作者(n=24)、学生(n=24)和家长进行定性访谈 (n=24)更丰富地了解缓解或加剧新冠肺炎影响的因素和 由此对学校、家庭、心理健康和发展造成干扰。具体目标是1)确定 新冠肺炎疫情对青少年心理、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、亲子关系、父母心理健康、公平(受教育机会、数字鸿沟)、 COVID上的学习模式(面对面、在线、混合)、学校中断以及学校和社区环境- 19对青年的影响；3)调查与流行病有关的压力源(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)评估第四R在减轻 新冠肺炎大流行的负面影响。鉴于干预的目标是精神健康，冲突 解决、应对和寻求帮助，我们假设暴露在干预下的学生将证明 与对照学校的同龄人相比，他们的心理、社交和行为健康状况有所改善。我们的研究将 严格而全面地了解新冠肺炎的影响-通过利用 来自持续队列的数据，以及通过定性调查得出的背景数据。

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.